| 1. |
- Bergman, Ebba, et al.
(author)
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Pharmacokinetics of gefitinib in humans : the influence of gastrointestinal factors
- 2007
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In: International Journal of Pharmaceutics. - : Elsevier BV. - 0378-5173 .- 1873-3476. ; 341:1-2, s. 134-142
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Journal article (peer-reviewed)abstract
- Purpose To investigate whether differences in plasma pharmacokinetic profiles of gefitinib between healthy subjects having normal (N; t1/2 > 20 h) and altered (A; t1/2 < 20 h) pharmacokinetic (PK) profiles might be explained by inter-individual variability in gastric emptying and/or precipitation/dissolution of gefitinib in the proximal small intestine. Methods One hundred healthy male subjects were screened to enable identification of subjects with the two PK profiles. Twenty five subjects from the screening were subsequently enrolled in an intubation study where a 250 mg gefitinib dispersion preparation (IRESSA®, AstraZeneca) was administered directly into the stomach. Intestinal fluid samples were withdrawn continuously for 180 min post-dose using the Loc-I-Gut catheter positioned in the jejunum. The crystalline form of gefitinib was determined using Raman microscopy. Results There were no differences between normal and altered subjects with regard to gastric emptying or the precipitation/dissolution of gefitinib in jejunal fluid. Due to difficulties in crystalline identification in the jejunal fluid samples, only the same crystalline form as the dosed form was identified. Conclusions There was no pronounced difference in gastric emptying, precipitation and re-dissolution of gefitinib in proximal human jejunum between normal and altered subjects. Other mechanism(s) are also likely to be important in explaining the inter-individual differences in plasma exposure to gefitinib, such as polymorphism in various metabolic enzymes and/or transport proteins. However, the difference between altered and normal subjects cannot be easily explained and it is likely a multifactorial explanation including low jejunal pH, increased expression of enzymatic and transporter activity and rapid small intestine transit.
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| 2. |
- de Brun, Maryam, 1991-, et al.
(author)
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Changing diagnostic criteria for gestational diabetes (CDC4G) in Sweden : A stepped wedge cluster randomised trial
- 2024
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In: PLoS Medicine. - : Public Library of Science (PLoS). - 1549-1277 .- 1549-1676. ; 21:7
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Journal article (peer-reviewed)abstract
- BACKGROUND: The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes.METHODS AND FINDINGS: A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations.CONCLUSIONS: In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term.TRIAL REGISTRATION: The trial is registered with ISRCTN (41918550).
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| 3. |
- Jung, Christian, et al.
(author)
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A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
- 2019
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In: Journal of critical care. - : W B SAUNDERS CO-ELSEVIER INC. - 0883-9441 .- 1557-8615. ; 52, s. 141-148
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Journal article (peer-reviewed)abstract
- Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.Methods: In total, 5063 VIPs were induded in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 +/- 5 vs 7 +/- 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.
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| 4. |
- Lundesjö Kvart, Susanne, 1969-
(author)
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Konsten att undervisa ryttare : En studie om ridlärares pedagogiska praktik
- 2020
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Doctoral thesis (other academic/artistic)abstract
- This thesis concerns how riding teachers’ reflect upon their teaching and how they teach. The overall aim of the thesis is to contribute with knowledge about how riding lessons are organized, regarding both the accomplishment of lessons as activity systems and the interactional organization of instructional work. Horseback riding can be understood as an embodied and practical knowledge, and includes communication and collaboration between horse and rider, sometimes referred to as equestrian feel (Dashper, 2016). Two different theoretical perspectives were applied to explore how such knowledge is taught. Activity theory (Engeström, 1987) was used to analyze interviews with and observations of ten riding teachers about their understanding and implementation of their pedagogical practice. Teachers’ and students’ interactions during riding lessons were examined using an ethnomethodological and conversation analytic approach (Goodwin, 2000; Schegloff, 1996). The analyses were based on video-recordings of ten group lessons and 40 one-on-one riding lessons.The results show that riding lessons can be conceptualized as activity systems where the focus of teaching constantly changes; from horse to student to routine. Traditions and safety regulations are shown to generate contradictions that may hinder the teachers from developing their teaching. However, the teachers express a wish to use more student collaborative methods, and display an intention to communicate with students about equestrian feel. Another result unveils how the teacher and the individual students, within the mobile context of riding lessons, make instructional sequences possible by co-creating instructional spaces. A third result illuminates the participants’ collaborative work to make equestrian feel available for instruction. The teacher molds equestrian feel through online instructions, i.e., instructions produced during the students’ active riding. These instructions shift focus between the students’ seat and influence, the horse’s actions and the student’s embodied feel. Moreover, the teachers are shown to use visual, verbal and embodied resources as they interpret equestrian feel for the student. In sum, the studies shed light on the complex art of teaching practical and embodied knowledge of riding.
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| 5. |
- Persson Osowski, Christine, et al.
(author)
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Agreement between child and parent reports of 10- to 12-year-old children’s meal pattern and intake of snack foods
- 2012
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In: Journal of human nutrition and dietetics (Print). - 0952-3871 .- 1365-277X. ; 25:1, s. 50-58
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Journal article (peer-reviewed)abstract
- Background: Dietary assessment in children is associated with misreporting, which is a problem with both child and parent reports. Therefore, it is of interest to study how children and parents report children's eating, respectively, although comparative studies are rare. The aim of the present article was to study the meal patterns and intake of certain snack foods of 10- to 12-year-old children as reported by the children and their parents, respectively, and to determine whether there was agreement between the child and parent reports. An additional aim was to study what factors might influence rater agreement. Methods: School children aged 10-12 years and their parents were given parallel questionnaires regarding the children's meal pattern. Matched pairs (n = 147) were analysed for agreement. Descriptive statistics were used to study all variables. Rater agreement and whether agreement depends on the age and the sex of the child, the sex of the parent and household type were analysed using ordinal regression models. Correlations between the child and parent assessments were estimated as polychoric correlations. Results: There was a general agreement between child and parent reports, except with respect to sweets and chocolate, where children reported less frequent consumption than the parents did (P = 0.0001). The sex of the child was a significant factor regarding consumption of in-between meals (P = 0.0001) and soft drinks (P = 0.01). Most children had breakfast, school lunch and dinner every day, whereas it was less common to report daily consumption of in-between meals. Conclusions: There was a general agreement between children's and parents' reports, and most children were reported to have a regular meal pattern.
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| 6. |
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| 7. |
- Persson Osowski, Christine, et al.
(author)
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Children's understanding of food and meals in the foodscape at school
- 2012
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In: International Journal of Consumer Studies. - : Wiley. - 1470-6423 .- 1470-6431. ; 36:1, s. 54-60
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Journal article (peer-reviewed)abstract
- Children come into contact with food in different places and contexts, i.e. ‘foodscapes’. The aim of the paper was to study what knowledge children construct regarding food and meals in the foodscape at school and how they do so, focusing on the school meal context. Observations, interviews and focus group interviews were used. The children appropriated ideas and understandings from the adult world and society as a whole and used it among their peers in the school meal situation. This included the adoption of institutional commensality, the telling of stories about food, and the classification of foods in dichotomies.
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| 8. |
- Persson Osowski, Christine, et al.
(author)
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Perceptions and memories of the free school meal in Sweden
- 2010
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In: Food, Culture, and Society. - 1552-8014 .- 1751-7443. ; 13:4, s. 555-572
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Journal article (peer-reviewed)abstract
- The aim of the present article was to gain a deeper understanding of the free school meal as an embedded phenomenon in the Swedish culture. This was achieved by studying perceptions and memories of the Swedish school meal. One hundred and ninety-two informants took part in the study by responding to an ethnological questionnaire. The results showed that the school meal was seen as a second-class meal with regard to the staff, environment and to some extent the food. The school meal was also seen as part of the Swedish welfare state, as it represents universal and equal social benefits for everyone. One interpretation of this is that the informants liked the idea of having a free public school meal, but that the meal does not live up to their expectations, that is, a meal with the same values as one served at home.
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| 9. |
- Persson Osowski, Christine, et al.
(author)
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Teachers' interaction with children in the school meal situation : The example of pedagogic meals in Sweden
- 2013
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In: Journal of nutrition education and behavior. - : Elsevier BV. - 1499-4046 .- 1878-2620. ; 45:5, s. 420-427
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Journal article (peer-reviewed)abstract
- Objective: School meals are also a teaching occasion in which children learn about food and meals, which is referred to as "pedagogic meals" in Sweden. The aim of the present article was to study how the pedagogic meal is practiced in preschool and school settings, with focus on how teachers acted when interacting with the children. Design: Observations, interviews, and focus group interviews. Setting: School canteens. Participants: Three schools. Phenomenon of Interest: Teaching in the school meal situation. Analysis: Social constructionism, new social studies of childhood. Results: The teachers took on 3 different roles. The sociable teacher role entailed turning the school lunch into a social occasion, the educating teacher role involved educating the children, and the evasive teacher role was not associated with the definition of a pedagogic meal. The teacher roles, which ranged from adult-oriented to child-oriented, and which varied in the level of interaction with the children, were summarized in a framework named the Adult-to Child-oriented Teacher Role Framework for School Meals (ACTS). Conclusions and Implications: To realize the potential of pedagogic meals, teachers must be educated and become aware of the effects of their behaviors. In this situation, the ACTS framework can constitute a useful tool.
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