| 1. |
- Anderl, Ines, 1973-
(författare)
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Activation of the Cellular Immune Response in Drosophila melanogaster Larvae
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the last 40 years, Drosophila melanogaster has become an invaluable tool in understanding innate immunity. The innate immune system of Drosophila consists of a humoral and a cellular component. While many details are known about the humoral immune system, our knowledge about the cellular immune system is comparatively small. Blood cells or hemocytes constitute the cellular immune system. Three blood types have been described for Drosophila larvae. Plasmatocytes are phagocytes with a plethora of functions. Crystal cells mediate melanization and contribute to wound healing. Plasmatocytes and crystal cells constitute the blood cell repertoire of a healthy larva, whereas lamellocytes are induced in a demand-adapted manner after infection with parasitoid wasp eggs. They are involved in the melanotic encapsulation response against parasites and form melanotic nodules that are also referred to as tumors.In my thesis, I focused on unraveling the mechanisms of how the immune system orchestrates the cellular immune response. In particular, I was interested in the hematopoiesis of lamellocytes.In Article I, we were able to show that ectopic expression of key components of a number of signaling pathways in blood cells induced the development of lamellocytes, led to a proliferative response of plasmatocytes, or to a combination of lamellocyte activation and plasmatocyte proliferation.In Article II, I combined newly developed fluorescent enhancer-reporter constructs specific for plasmatocytes and lamellocytes and developed a “dual reporter system” that was used in live microscopy of fly larvae. In addition, we established flow cytometry as a tool to count total blood cell numbers and to distinguish between different blood cell types. The “dual reporter system” enabled us to differentiate between six blood cell types and established proliferation as a central feature of the cellular immune response. The combination flow cytometry and live imaging increased our understanding of the tempo-spatial events leading to the cellular immune reaction.In Article III, I developed a genetic modifier screen to find genes involved in the hematopoiesis of lamellocytes. I took advantage of the gain-of-function phenotype of the Tl10b mutation characterized by an activated cellular immune system, which induced the formation blood cell tumors. We screened the right arm of chromosome 3 for enhancers and suppressors of this mutation and uncovered ird1.Finally in Article IV, we showed that the activity of the Toll signaling pathway in the fat body, the homolog of the liver, is necessary to activate the cellular immune system and induce lamellocyte hematopoiesis.
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| 2. |
- Avican, Kemal, 1980-
(författare)
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Persistent infection by Yersinia pseudotuberculosis
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Enteropathogenic Yersinia species can infect many mammalian organs such as the small intestine, cecum, Peyer’s patches, liver, spleen, and lung and cause diseases that resemble a typhoid-like syndrome, as seen for other enteropathogens. We found that sublethal infection doses of Y. pseudotuberculosis gave rise to asymptomatic persistent infection in mice and identified the cecal lymphoid follicles as the primary site for colonization during persistence. Persistent Y. pseudotuberculosis is localized in the dome area, often in inflammatory lesions, as foci or as single cells, and also in neutrophil exudates in the cecal lumen. This new mouse model for bacterial persistence in cecum has potential as an investigative tool for deeper understanding of bacterial adaptation and host immune defense mechanisms during persistent infection. Here, we investigated the nature of the persistent infection established by Y. pseudotuberculosis in mouse cecal tissue using in vivo RNA-seq of bacteria during early and persistent stages of infection. Comparative analysis of the bacterial transcriptomes revealed that Y. pseudotuberculosis undergoes transcriptional reprogramming with drastic down-regulation of T3SS virulence genes during persistence in the cecum. At the persistent stage, the expression pattern in many respects resembles the pattern seen in vitro at 26°C. Genes that are up-regulated during persistence are genes involved in anaerobiosis, chemotaxis, and protection against oxidative and acidic stress, which indicates the influence of different environmental cues. We found that the Crp/CsrA/RovA regulatory cascades influence the pattern of bacterial gene expression during persistence. Furthermore, we show that ArcA, Fnr, FrdA, WrbA, RovA, and RfaH play critical roles in persistence. An extended investigation of the transcriptional regulator rfaH employing mouse infection studies, phenotypic characterizations, and RNA-seq transcriptomics analyses indicated that this gene product contributes to establishment of infection and confirmed that it regulates O-antigen biosynthesis genes in Y. pseudotuberculosis. The RNA-seq results also suggest that rfaH has a relatively global effect. Furthermore, we also found that the dynamics of the cecal tissue organization and microbial composition shows changes during different stages of the infection. Taken together, based on our findings, we speculate that this enteropathogen initiates infection by using its virulence factors in meeting the innate immune response in the cecal tissue. Later on, these factors lead to dysbiosis in the local microbiota and altered tissue organization. At later stages of the infection, the pathogen adapts to the environment in the cecum by reprogramming its transcriptome from a highly virulent mode to a more environmentally adaptable mode for survival and shedding. The in vivo transcriptomic analyses for essential genes during infections present strong candidates for novel targets for antimicrobials.
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| 3. |
- Beckman Rehnman, Jeannette, 1969-
(författare)
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New methods to evaluate the effect of conventional and modified crosslinking treatment for keratoconus
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Today corneal crosslinking with ultraviolet-A photoactivation of riboflavin is an established method to halt the progression of keratoconus. In some cases, when the refractive errors are large and the visual acuity is low, conventional corneal crosslinking may not be sufficient. In these cases it would be desirable with a treatment that both halts the progression and also reduces the refractive errors and improves the quality of vision.Aims: The aims of this thesis were to determine whether mechanical compression of the cornea during corneal crosslinking for keratoconus using a sutured rigid contact lens could improve the optical and visual outcomes of the treatment, and also to find methods to evaluate the effect of different corneal crosslinking treatment regimens.Methods: In a prospective, open, randomized case-control study, 60 eyes of 43 patients with progressive keratoconus, aged 18-28 years, planned for routine corneal crosslinking, and a corresponding age- and sex-matched control group was included. The patients were randomized to conventional corneal crosslinking (CXL; n=30) or corneal crosslinking with mechanical compression of the cornea during the treatment (CRXL; n=30).Biomicroscopy, autorefractometry, best spectacle corrected visual acuity, axial length measurement, Pentacam® HR Scheimpflug photography, pachymetry, intraocular pressure measurements and corneal biomechanical assessments were performed before treatment (baseline) and at 1 month and 6 months after the treatment.One of the articles evaluated and compared the optical and visual outcomes between CXL and CRXL, while the other three articles focused on methods to evaluate treatment effects. In Paper I, the corneal light scattering was manually quantified from Scheimpflug images throughout the corneal thickness at 8 measurements points, 0.0 to 3.0 mm from the corneal centre, in patients treated with CXL. In Paper IV the corneal densitometry (light scattering) was measured with the Pentacam® HR software, in 4 circular zones around the corneal apex and at 3 different depths of the corneal stroma, in both CXL and CRXL treated corneas. Paper III quantified the biomechanical effects of CXL in vivo.Results: Corneal light scattering after CXL showed distinctive spatial and temporal profiles and Applanation Resonance Tonometry (ART) -technology demonstrated an increased corneal hysteresis 1 and 6 months after CXL. When comparing the refractive and structural results after CXL and CRXL, CRXL failed to flatten the cornea, and the treatment did not show any benefits to conventional CXL treatment, some variables even indicated an inferior effect. Accordingly, the increase in corneal densitometry was also less pronounced after CRXL.Conclusions: Analysis of corneal light scattering/densitometry shows tissue changes at the expected treatment location, and may be a relevant variable in evaluating the crosslinking effect. ART -technology is an in vivo method with the potential to assess the increased corneal hysteresis after CXL treatment. By refining the method, ARTmay become a useful tool in the future. Unfortunately, CRXL does not improve the optical and visual outcomes after corneal crosslinking. Possibly, stronger crosslinking would be necessary to stabilize the cornea in a flattened position.
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| 4. |
- Blom, Helena, 1970-
(författare)
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Violence exposure among Swedish youth
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundViolence is a global public health problem and violence among youth is a matter of high priority. Adolescence and young adulthood are important periods for the foundation of future health. Youth victimization may have serious health consequences, making it important to address the occurrence and socio-medical context for possible interventions against violence.AimsTo analyze prevalence, risk patterns and gender differences in emotional, physical, sexual, and multiple-violence victimizations and the associations between violence victimization and sexual ill health, sexual risk behaviors and mental health in Swedish youth.MethodsA cross sectional study using two samples, a national sample from nine youth health centers in Sweden and a population-based sample from a middle-sized Swedish city. The questionnaire included standardized instruments addressing violence exposure (NorAQ), socio-demographics, mental and sexual ill-health and sexual risk behaviors, alcohol and substance use. Proportions and crude and adjusted odds ratios with a 95% CI were calculated.ResultsA total of 2,250 young women and 920 men, aged 15-23, answered the questionnaire at the youth health centers. In upper secondary school, 1,658 women and 1,589 men, aged 15-22, answered the questionnaire.High prevalence rates with gendered differences both in rates and in co-occurrence of different types of violence were found. Women were more often exposed to emotional violence and sexual violence than men, while men were more often physically victimized. For both women and men, violence victimization before the age of 15 was strongly associated with all types of violence victimizations during the past year.Strong associations were found between multiple-violence victimization and poor mental health in both genders. Among the sexually experienced students, consistent associations between lifetime multiple-violence victimization and various sexual ill-health and sexual risk behaviors were found in both genders, except for non-contraceptive use.ConclusionsHigh prevalence of violence victimization in youth and strong associations between victimization, especially multiple victimization, and poor mental and sexual health were found. This needs to be recognized and addressed in social and medical settings.
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| 5. |
- Bonde, Mari, 1982-
(författare)
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Structure and Function of the Borrelia burgdorferi Porins, P13 and P66
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Borrelia burgdorferi is an elongated and helically shaped bacterium that is the causal agent of the tick-borne illness Lyme disease. The disease manifests with initial flu-like symptoms and, in many cases, the appearance of a skin rash called erythema migrans at the site of the tick bite. If left untreated the disease might cause impairment of various organs such as the skin, heart, joints and the nervous system. The bacteria have a parasitic lifestyle and are always present within a host. Hosts are usually ticks or different animals and birds that serve as reservoirs for infection. B. burgdorferi are unable to synthesize building blocks for many vital cellular processes and are therefore highly dependent on their surroundings to obtain nutrients. Because of this, porins situated in the outer membrane, involved in nutrient uptake, are believed to be very important for B. burgdorferi. Except for a role in nutrient acquisition, porins can also have a function in binding extracellular matrix proteins, such as integrins, and have also been implicated in bacterial adaptation to new environments with variations in osmotic pressure.P13 and P66 are two integral outer membrane proteins in B. burgdorferi previously shown to have porin activities. In addition to its porin function, P66 also has integrin binding activity. In this thesis, oligomeric structures formed by the P13 and P66 protein complexes were studied using the Black lipid bilayer technique in combination with nonelectrolytes. Initial attempts were also made to study the structure of P13 in Nanodiscs, whereby membrane proteins can insert into artificial lipid bilayers in their native state and the structure can be analyzed by electron microscopy. In addition, the role of P13 and P66 in B. burgdorferi osmotic stress adaptation was examined and also the importance and role of the integrin-binding activity of P66 in B. burgdorferi infections in mice.Using Black lipid bilayer studies, the pore forming activity of P13 was shown to be much smaller than previously thought, exhibiting activity at 0.6 nS. The complex formed by P13 was approximately 300 kDa and solely composed of P13 monomers. The channel size was calculated to be roughly 1.4 nm. Initial Nanodisc experiments showed a pore size of 1.3 nm, confirming the pore size determined by Black lipid bilayer experiments. P66 form pores with a single channel conductance of 11 nS and a channel size of 1.9 nm. The porin assembles in the outer membrane into a large protein complex of 420 kDa, containing exclusively P66 monomers. The integrin-binding function of P66 was found to be important for efficient bacterial dissemination in the murine host but was not essential for B. burgdorferi infectivity. Neither P13 nor P66 had an active role in osmotic stress adaptation. Instead, two p13 paralogs were up-regulated at the transcript level in B. burgdorferi cultured under glycerol-induced osmotic stress.
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| 6. |
- Buckland, Robert, 1976-
(författare)
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DNA precursor asymmetries, Mismatch Repair and their effect on mutation specificity
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In order to build any structure, a good supply of materials, accurate workers and quality control are needed. This is even the case when constructing DNA, the so-called “Code of Life.” For a species to continue to exist, this DNA code must be copied with incredibly high accuracy when each and every cell replicates. In fact, just one mistake in the 12 million bases that comprise the genome of budding yeast, Saccharomyces cerevisiae, can be fatal. DNA is composed of a double strand helix made up of just four different bases repeated millions of times. The building blocks of DNA are the deoxyribonucleotides (dNTPs); dCTP, dTTP, dATP and dGTP. Their production and balance are carefully controlled within each cell, largely by the key enzyme Ribonucleotide Reductase (RNR). Here, we studied how the enzymes that copy DNA, the replicative polymerases α, δ and ε, cope with the effects of an altered dNTP pool balance. An introduced mutation in the allosteric specificity site of RNR in a strain of S. cerevisiae, rnr1-Y285A, leads to elevated dCTP and dTTP levels and has been shown to have a 14-fold increase in mutation rate compared to wild type. To ascertain the full effects of the dNTP pool imbalance upon the replicative polymerases, we disabled one of the major quality control systems in a cell that corrects replication errors, the post-replicative Mismatch Repair system. Using both the CAN1 reporter assay and whole genome sequencing, we found that, despite inherent differences between the polymerases, their replication fidelity was affected very similarly by this dNTP pool imbalance. Hence, the high dCTP and dTTP forced Pol ε and Pol α/δ to make the same mistakes. In addition, the mismatch repair machinery was found to correct replication errors driven by this dNTP pool imbalance with highly variable efficiencies. Another mechanism to protect cells from DNA damage during replication is a checkpoint that can be activated to delay the cell cycle and activate repair mechanisms. In yeast, Mec1 and Rad53 (human ATR and Chk1/Chk2) are two key S-phase checkpoint proteins. They are essential as they are also required for normal DNA replication and dNTP pool regulation. However the reason why they are essential is not well understood. We investigated this by mutating RAD53 and analyzing dNTP pools and gene interactions. We show that Rad53 is essential in S-phase due to its role in regulating basal dNTP levels by action in the Dun1 pathway that regulates RNR and Rad53’s compensatory kinase function if dNTP levels are perturbed.In conclusion we present further evidence of the importance of dNTP pools in the maintenance of genome integrity and shed more light on the complex regulation of dNTP levels.
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| 7. |
- Carlsson, Magnus
(författare)
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Physiological demands of competitive elite cross-country skiing
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Researchers have, for decades, contributed to an increased collective understanding of the physiological demands in cross-country skiing; however, almost all of these studies have used either non-elite subjects and/or performances that emulate cross-country skiing. To establish the physiological demands of cross-country skiing, it is important to relate the investigated physiological variables to the competitive performance of elite skiers. The overall aim of this doctoral thesis was, therefore, to investigate the external validity of physiological test variables to determine the physiological demands in competitive elite cross-country skiing.Methods The subjects in Study I – IV were elite male (I – III) and female (III – IV) cross-country skiers. In all studies, the relationship between test variables (general and ski-specific) and competitive performances (i.e. the results from competitions or the overall ski-ranking points of the International Ski Federation (FIS) for sprint (FISsprint) and distance (FISdist) races) were analysed. Test variables reflecting the subject’s general strength, upper-body and whole-body oxygen uptake, oxygen uptake and work intensity at the lactate threshold, mean upper-body power, lean mass, and maximal double-poling speed were investigated.Results The ability to maintain a high work rate without accumulating lactate is an indicator of distance performance, independent of sex (I, IV). Independent of sex, high oxygen uptake in whole-body and upper-body exercise was important for both sprint (II, IV) and distance (I, IV) performance. The maximal double-poling speed and 60-s double-poling mean power output were indicators of sprint (IV) and distance performance (I), respectively. Lean mass was correlated with distance performance for women (III), whereas correlations were found between lean mass and sprint performance among both male and female skiers (III). Moreover, no correlations between distance performance and test variables were derived from tests of knee-extension peak torque, vertical jumps, or double poling on a ski-ergometer with 20-s and 360-s durations (I), whereas gross efficiency while treadmill roller skiing showed no correlation with either distance or sprint performance in cross-country skiing (IV).Conclusion The results in this thesis show that, depending on discipline and sex, maximal and peak oxygen uptake, work intensity at the lactate threshold, lean mass, double-poling mean power output, and double-poling maximal speed are all externally valid physiological test variables for evaluation of performance capability among elite cross-country skiers; however, to optimally indicate performance capability different test-variable expressions should be used; in general, the absolute expression appears to be a better indicator of competitive sprint performance whereas the influence of body mass should be considered when evaluating competitive distance performance capability of elite cross-country skiers.
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| 8. |
- Carlsson, Tomas
(författare)
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The importance of body-mass exponent optimization for evaluation of performance capability in cross-country skiing
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Performance in cross-country skiing is influenced by the skier’s ability to continuously produce propelling forces and force magnitude in relation to the net external forces. A surrogate indicator of the “power supply” in cross-country skiing would be a physiological variable that reflects an important performance-related capability, whereas the body mass itself is an indicator of the “power demand” experienced by the skier. To adequately evaluate an elite skier’s performance capability, it is essential to establish the optimal ratio between the physiological variable and body mass. The overall aim of this doctoral thesis was to investigate the importance of body-mass exponent optimization for the evaluation of performance capability in cross-country skiing.Methods In total, 83 elite cross-country skiers (56 men and 27 women) volunteered to participate in the four studies. The physiological variables of maximal oxygen uptake (V̇O2max) and oxygen uptake corresponding to a blood-lactate concentration of 4 mmol∙l-1 (V̇O2obla) were determined while treadmill roller skiing using the diagonal-stride technique; mean oxygen uptake (V̇O2dp) and upper-body power output (Ẇ) were determined during double-poling tests using a ski-ergometer. Competitive performance data for elite male skiers were collected from two 15-km classical-technique skiing competitions and a 1.25-km sprint prologue; additionally, a 2-km double-poling roller-skiing time trial using the double-poling technique was used as an indicator of upper-body performance capability among elite male and female junior skiers. Power-function modelling was used to explain the race and time-trial speeds based on the physiological variables and body mass.Results The optimal V̇O2max-to-mass ratios to explain 15-km race speed were V̇O2max divided by body mass raised to the 0.48 and 0.53 power, and these models explained 68% and 69% of the variance in mean skiing speed, respectively; moreover, the 95% confidence intervals (CI) for the body-mass exponents did not include either 0 or 1. For the modelling of race speed in the sprint prologue, body mass failed to contribute to the models based on V̇O2max, V̇O2obla, and V̇O2dp. The upper-body power output-to-body mass ratio that optimally explained time-trial speed was Ẇ ∙ m-0.57 and the model explained 63% of the variance in speed.Conclusions The results in this thesis suggest that V̇O2max divided by the square root of body mass should be used as an indicator of performance in 15-km classical-technique races among elite male skiers rather than the absolute or simple ratio-standard scaled expression. To optimally explain an elite male skier’s performance capability in sprint prologues, power-function models based on oxygen-uptake variables expressed absolutely are recommended. Moreover, to evaluate elite junior skiers’ performance capabilities in 2-km double-poling roller-skiing time trials, it is recommended that Ẇ divided by the square root of body mass should be used rather than absolute or simple ratio-standard scaled expression of power output.
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| 9. |
- Chand, Damini, 1986-
(författare)
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Mechanistic Implications and Characterization of Anaplastic Lymphoma Kinase (ALK) mutations in Neuroblastoma
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase that was first reported as a fusion partner of nucleophosmin in Anaplastic large cell lymphoma in 1994. ALK is involved in myriad of cancers including neuroblastoma which is the most common extracranial solid tumor affecting young children. It arises in the neural crest cells of sympathetic nervous system origin and is responsible for 12% of all childhood cancer deaths. Several point mutations in ALK have been described in both familial and sporadic neuroblastoma.With the aim to understand the role of ALK in neuroblastoma further, we investigated the point mutations in ALK reported in patients. Using cell culture based methods and Drosophila as a model organism; we first characterized these mutations under three broad categories: 1) Ligand independent mutations that were constitutively active, 2) Kinase dead mutation and 3) Ligand dependent mutations that behaved as inducible wild type. Further, to understand the activation mechanism of ALK, we constructed mutations that could potentially alter ALK’s conformation based on the available crystal structure. From the data generated, we were able to provide a new perspective to the activation of full length ALK receptor. This was more in line with activation mechanism of insulin receptor and different from that suggested for ALK fusion protein. From a clinical point of view, all the mutations in the study were blocked to different degrees using the ALK inhibitor, crizotinib. Lastly, we identified potential downstream targets of ALK using phosphoproteomics. From the various targets identified, we focused on STAT3 and confirmed its role as a mediator in ALK initiated MYCN transcription. We showed that STAT3 inhibition led to reduction of MYCN levels and thereby identifying it as a potential therapeutic target in neuroblastoma. Overall, our study highlights clinical relevance of ALK mutations in neuroblastoma and from a basic biology viewpoint; it reveals important mechanistic insight into receptor activation.
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| 10. |
- Edvardsson, Berit, 1953-
(författare)
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"Det är inte mig det är fel på, det är huset" : en studie av prognosfaktorer och bemötande med fokus på sjuka hus-syndromet
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Sick Building Syndrome, SBS, är fortfarande 2015 ett tillstånd som vållar mycket diskussion. Symtomen kan grupperas i slemhinnesymtom, hudsymtom och allmänna symtom. I definitionen ingår att personen/ personerna som fått symtom har exponerats för dålig inomhusluft i en speciell byggnad. När personen inte är i byggnaden så förbättras eller försvinner symtomen. Många olika faktorer kan orsaka eller medverka till uppkomst eller försämringar av SBS-symtom, som t.ex. luftens innehåll av olika ämnen, luftflöden, temperatur, buller, fukt och mögel. Utbredd enighet finns om att fukt och mögel i byggnaderna påverkar eller ger upphov till symtom hos vissa personer som exponeras där. Psykosociala faktorer som arbetets organisation och krav och individuella faktorer som kön och personlighet påverkar också.Syfte: Hypotesen är att faktorer som tidigare hälsa, åtgärder på arbetet, tid, behandling, personlighet och copingresurser alla kan påverka prognosen för SBS-patienterna. Syftet med avhandlingen är att undersöka hur symtomen påverkar arbetsförmågan och om patienterna återhämtar sig från SBS-symtomen. Ett annat syfte är att undersöka bemötande och de erfarenheter som SBS-symtomen gett en grupp av informanter med SBS. För att förstå om personlighet mätt med självbild och coping hade någon betydelse för progressionen av SBS-symtom och arbetsförmåga gjordes jämförelser av personlighet mellan en patientgrupp med SBS, en patientgrupp med handeksem, en patientgrupp med elkänslighet och en normalpopulation.Metod: En uppföljningsenkät skickades till 239 patienter med SBS-symtom som under åren 1986–1998 blivit undersökta och bedömda på Universitets-sjukhuset i Umeå, Sverige. Frågorna innehöll social och medicinsk status, nuvarande symtom, behandlingar, åtgärder på arbetsplatsen, coping och självbild och svarsfrekvensen var 79,1%. Prognos och riskfaktorer för prognos beräknades för SBS-patienterna. Mätningar av personlighetsfaktorer gjordes med instrumentet Structural analysis of Social Behaviour, SASB, och coping mättes med Coping Resources Inventory, CRI. Likadana uppföljningsenkäter skickades till en grupp patienter med handeksem och patienter med upplevd elkänslighet. Svarsfrekvensen var 68% respektive 73% och enkätsvaren har sedan analyserats och jämförts genom beräknngar av prognos med fokus på självbild och coping för SBS-patienterna och handeksempatienterna. Jämförelser gjordes också mellan de tre olika grupperna och en kontrollgrupp vad gäller självbild och coping. För att undersöka erfarenheterna av SBS-symtomen och bemötandet genomfördes kvalitativa intervjuer med 10 informanter som hade eller hade haft SBS-symtom. Fem av dem hade diagnostiserats en längre tid tillbaka medan de andra fem hade haft SBS-symtomen en kortare period. Semi-strukturerade intervjuformulär användes vid intervjuerna och anlyserades med kvalitativ innehållsanalys.Resultat: Graden och svårigheten av SBS-symtomen minskade över tid trots att nästan hälften av SBS-patienterna beskrev att symtomen var mer eller mindre oförändrade efter 7 år eller mer. Risken att ha symtom vid uppföljningen var större för de patienter som remitterats sent efter symtomdebut men även för de som hade kort uppföljningstid. Risken att inte ha någon arbetsförmåga vid uppföljningen var signifikant ökad om det var mer än ett års skillnad mellan symtomdebut och första läkarbesöket p.g.a. SBS-symtomen eller om patienten vid första undersökningen hade fler än 5 SBS-symtom. Dagliga aktiviteter som t.ex. bussåkning förvärrade också symtomen för patienterna. Informanternas upplevelser av SBS-symtomen från början visar en influensaliknande bild med rinnande näsa och ögon, heshet, hosta och huvudvärk. Informanterna agerar för att klara av situationen när symtomen förvärras. Genom hela processen upplever de en brist på bekräftelse och stöd från arbetsgivare, primärvård, företagshälsovård och fastighetsförvaltare.Alla tre patientgrupperna hade högre värden i spontan och positiv självbild i jämförelse med en kontrollgrupp. De hade också alla lägre värden i kontroll medan patienterna med handeksem och de med elkänslighet hade högre värden i sin negativa självbild. När det gäller coping skilde sig inte patientgrupperna från kontrollgruppen utom i CRI kognitiv där SBS-patienterna hade hög poäng i motsats till handeksempatienterna som hade låg poäng i samma domän. De elkänsliga patienterna hade i stället höga poäng i domänen andlig/filosofisk. Självbild eller copingförmåga var inte associerade med SBS-symtom eller symtom av handeksem vid uppföljningen och deras personlighet påverkade inte arbetsförmågan. Tidigare atopisk dermatit var en signifikant risk för kvarvarande symtom men inte för arbetsförmågan hos handeksempatienterna.Slutsats: En grupp av patienter som tidigare diagnostiserats för symtom från inomhusmiljön har kroniska symtom och påverkan på sitt sociala liv. Över tid minskar symtomen. Resultaten pekar på att ett tidigt omhändertagande är av vikt. SBS-symtomen är från början svåra att upptäcka för alla inblandade och kunskap om hur symtomen kan uppstå i dagligt liv kan bidra till bredare förståelse. Erfarenheterna från personer med SBS visar på avsaknad av bekräftelse och stöd från vården, företagshälsan, arbetsgivare och fastighetsförvaltare. Sambandet mellan symtom och inomhusmiljö får inte glömmas bort. Stöd och bekräftelse innebär också kunskap om skyldigheter för arbetsgivare och fastighetsförvaltare.Skillnad i självbild i jämförelse med en kontrollgrupp ses hos patientgrupperna med symtom som är delvis oförklarade men också hos handeksempatienter med ett väletablerat tillstånd. Det kan innebära att patienter med kroniska tillstånd överlag kan avvika från den allmänna populationen. Patienterna visar som grupp en hög positiv och hög spontan självbild som kan leda till svårigheter att sätta gränser. Detta kan leda till en mental stress och i förlängningen också ge en ökad känslighet/sårbarhet för miljöfaktorer.
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