| 61. |
- Ahlsson, Fredrik, 1967-
(författare)
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Being Born Large for Gestational Age : Metabolic and Epidemiological Studies
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.
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| 62. |
- Ahlström, Gerd, et al.
(författare)
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Enjoying work or Burdened by it? : How personal Assistants Experience and Handle Stress at Work
- 2012
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Ingår i: Journal of Social Work in Disability & Rehabilitation. - : Routledge. - 1536-710X .- 1536-7118. ; 11:2, s. 112-127
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Tidskriftsartikel (refereegranskat)abstract
- A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of “difficulties of being in a subordinate position,” and those regarding management strategies could be brought together under the theme of “coming to terms with the work situation.” There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching.
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| 63. |
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| 64. |
- Ahlzen, Rolf
(författare)
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Illness as unhomelike being-in-the-world? : Phenomenology and medical practice
- 2011
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Ingår i: Medicine, Health care and Philosophy. - : Springer. - 1386-7423 .- 1572-8633. ; 14:3, s. 323-331
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Tidskriftsartikel (refereegranskat)abstract
- Scientific medicine has been successful by ways of an ever more detailed understanding and mastering of bodily functions and dysfunctions. Biomedical research promises new triumphs, but discontent with medical practice is all around. Since several decades this has been acknowledged and discussed. The philosophical traditions of phenomenology and hermeneutics have been proposed as promising ways to approach medical practice, by ways of a richer understanding of the meaning structures of health and illness. In 2000, Swedish philosopher Fredrik Svenaeus published a book where he proposes that the phenomenological hermeneutics of Martin Heidegger and also the reflections on health and illness of Hans-Georg Gadamer offer important ways to approach the nature of medicine. In particular, Svenaeus argues that the goal of medicine is to promote and restore health, and that health ought to be seen as "homelike being-in-the-world". Unhealth, illness, consequently should be understood as a situation where a person's "being-in-the-world" in characterized by that lack of the rhythm, balance and "tune" of everyday living that characterizes not "being at home". In this article, Svenaeus' position is briefly outlined. Questions are raised whether "unhomelikeness" is to be seen as a metaphor, and, if so, if it is a fruitful such. Furthermore, I discuss whether or not a discourse on health and illness in these terms may be misleading in a situation where the ontological presuppositions of Heidegger are lost out of sight and the popular understanding of health psychology predominates. I also approach the question whether Svenaeus' assumptions may inadvertently lead us to an unjustifiably broad understanding of the tasks of medicine. It is finally concluded that Svenaeus phenomenological and hermeneutical approach is both interesting and promising. There are, however, several questions that ought to be pursued further, and the step from philosophical analysis to everyday clinical discourse may be unexpectedly long and risky.
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| 65. |
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| 66. |
- Ahlzén, Rolf, 1950-
(författare)
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Why should physicians read? : Understanding clinical judgement and its relation to literary experience
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Is literary experience of any practical relevance to the clinician? This is the overall question addressed by this investigation, which starts by tracing the historical roots of scientific medicine. These are found to be intimately linked to a form of rationality associated with the scientific revolution of the 17th century and with “modernity”. Medical practice, however, is dependent also on another form of rationality associated with what Stephen Toulmin calls “the epistemology of the biographical”. The very core of clinical medicine is shown to be the clinical encounter, an interpretive meeting where the illness experience is at the centre of attention. The physician can reach the goals of medicine only by developing clinical judgement. Clinical judgement is subjected to close analysis and is assumed to be intimately connected to the form of knowledge Aristotle called phronesis. In order to explore how literature – drama, novels, poetry – may be related to clinical judgement, a view of literature is presented that emphasizes literature as an invitation to the reader, to be met responsibly and responsively. Literature carries a potential for a widened experience, for a more nuanced perception of reality – and this potential is suggested to be ethically relevant to the practice of medicine. The “narrative rationality” of a literary text constitutes a complement to the rationality pervading scientific medicine. The final step in my analysis is a closer exploration of the potential of the literary text to contribute to the growth of clinical judgement, in relation to the challenges of everyday clinical work. Some of the conditions that may facilitate such growth are outlined, but it is also shown that full empirical evidence for the beneficial effects of reading on the clinician reader is beyond reach.
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| 67. |
- Ahmad, I., et al.
(författare)
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Validity of diagnoses, treatment dates, and rating scales in the Swedish national quality register for electroconvulsive therapy
- 2022
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 76:2, s. 96-103
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Tidskriftsartikel (refereegranskat)abstract
- Background The Swedish national quality register for electroconvulsive therapy (Q-ECT) contains data on patients receiving treatment with electroconvulsive therapy (ECT) in Sweden. Aim This study determined the validity of diagnoses, treatment dates, and rating scales in the Q-ECT by investigating the degree of accordance between data from the Q-ECT and patient records. Materials and methods From January 2016 to December 2017, 200 treatment series were randomly selected from the Q-ECT. The corresponding patient records were requested from the treating hospitals. Data on the indicative diagnosis, dates for the first and the last ECT session, and rating scales were compared between the Q-ECT and patient records using (i) a strict and (ii) a liberal method of assessment. Using the liberal method, each variable was assessed as accordant if it belonged to the same diagnosis group, or if the dates differed by less than 1 week, or ratings differed by only 1 point on the Clinical Global Impression Scale (CGI- S), or no more than 3 points on the Montgomery angstrom sberg Depression Rating Scale between the Q-ECT and the patient record. Results A total of 179 patient records were received. The strict method of assessment showed an accordance of 89% or higher for all studied variables. The liberal method showed an accordance of 95% or higher. Conclusions We conclude that data on the studied variables in the Q-ECT have high validity. However, limited use of some rating scales makes the results uncertain. Measures can be taken to further improve the data quality.
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| 68. |
- Ahmadi, Zainab, et al.
(författare)
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Smoking and home oxygen therapy : a review and consensus statement from a multidisciplinary Swedish taskforce
- 2024
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Ingår i: European Respiratory Review. - : European Respiratory Society. - 0905-9180 .- 1600-0617. ; 33:171
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Forskningsöversikt (refereegranskat)abstract
- Background: Home oxygen therapy (HOT) improves survival in patients with hypoxaemic chronic respiratory disease. Most patients evaluated for HOT are former or active smokers. Oxygen accelerates combustion and smoking may increase the risk of burn injuries and fire hazards; therefore, it is considered a contraindication for HOT in many countries. However, there is variability in the practices and policies regarding this matter. This multidisciplinary Swedish taskforce aimed to review the potential benefits and risks of smoking in relation to HOT, including medical, practical, legal and ethical considerations.Methods: The taskforce of the Swedish Respiratory Society comprises 15 members across respiratory medicine, nursing, medical law and ethics. HOT effectiveness and adverse risks related to smoking, as well as practical, legal and ethical considerations, were reviewed, resulting in five general questions and four PICO (population–intervention–comparator–outcome) questions. The strength of each recommendation was rated according to the GRADE (grading of recommendation assessment, development and evaluation) methodology.Results: General questions about the practical, legal and ethical aspects of HOT were discussed and summarised in the document. The PICO questions resulted in recommendations about assessment, management and follow-up of smoking when considering HOT, if HOT should be offered to people that meet the eligibility criteria but who continue to smoke, if a specific length of time of smoking cessation should be considered before assessing eligibility for HOT, and identification of areas for further research.Conclusions: Multiple factors need to be considered in the benefit/risk evaluation of HOT in active smokers. A systematic approach is suggested to guide healthcare professionals in evaluating HOT in relation to smoking.
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| 69. |
- Ahuja, Satpal, et al.
(författare)
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Epilogue
- 2011
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Ingår i: Usher Syndrome: Pathogenesis, Diagnosis and Therapy. - 9781612092270 ; , s. 429-434
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 70. |
- Ahuja, Satpal, et al.
(författare)
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MicroRNAs in Retinal Pathophysiology and Therapeutics
- 2011
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Ingår i: Usher Syndrome: Pathogenesis, Diagnosis and Therapy. - 9781612092270 ; , s. 199-211
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Bokkapitel (refereegranskat)abstract
- Following identification of tRNA and rRNA, the non-protein coding RNAs (ncRNAs) have been demonstrated to possess catalytic ribozyme functions (Cech et al., 1981; Guerrier-Takada et al., 1983). In recognition of the latter work, T.R. Cech and S. Altman were awarded the 1989 Noble Prize in Chemistry. Fire, et al. (1998) discovered that small double stranded RNA (ds RNA) silences the gene expression. For this observation Andre Fire and C.C. Mello earned the 2006 Nobel Prize in Physiology or Medicine. Two years later, V.R. Ambros, D.C. Baucombe, and G.B. Ruvkun were honored with the Albert Lasker Basic Medical Research Award (2008) for their contributions in the field of small RNA dependent gene regulation in plants and animals. All these findings have revolutionized the fields of gene regulation, RNA biology and brought out the possibilities of its exploitation for understanding the living processes and for use as therapeutic agents.
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