| 1. |
- Ambrosi, Aurelie, et al.
(författare)
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Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern
- 2012
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group. - 0003-4967 .- 1468-2060. ; 71:3, s. 334-340
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Tidskriftsartikel (refereegranskat)abstract
- Objective Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10-20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. less thanbrgreater than less thanbrgreater thanMethods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies. less thanbrgreater than less thanbrgreater thanResults There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (pandlt;0.05). Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18-24 occurring during January-March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (pandlt;0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. less thanbrgreater than less thanbrgreater thanConclusion This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.
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| 2. |
- Andersson, Sten-Ove, et al.
(författare)
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Doctors’ and Nurses’ Perceptions of Military Pre-hospital Emergency Care
- 2014
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to identify physicians’ and nurses’ perceptions of military prehospital emergency care before and after an international mission. A qualitative empirical study with a phenomenographic approach was used. The aim is to identify the area of knowledge, pre-hospital care in a military environment, in terms of expressions from doctors and nurses focussing on the variation in how learning of pre-hospital care is perceived. The result of the study is a set of descriptive categories on a collective level, showing the variation in how doctors and nurses perceived the phenomenon of military pre-hospital emergency care. The results after predeployment training can be categorized as (1) to learn military medicine, (2) to take care of the casualty and (3) to have safety awareness. The results after an international mission can be categorized as (1) to collaborate with others, (2) to deliver general health care, and (3) to improve competence in military medicine. Possible implications of the results from the present study are the following; (I) better conditions for doctors and nurses to provide appropriate military medical care by clarification and better understanding of professions in the mission area (doctors, nurses, officers), since they may have different goals for their actions, (II) to pay attention to all aspects of military health care during predeployment training, including general health care in the mission area, (III) to implement new knowledge in military medicine in the predeployment training, and (IV) to train for the reality all doctors and nurses are about to meet. These results indicate that the training should be developed in order to optimize the prepare physicians and nurses for international assignments. This may result in increased safety for the provider of care, while at the same time minimizing suffering and enhancing the possibility of survival of the injured.
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| 3. |
- Andersson, Sten-Ove, et al.
(författare)
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Interaction, Action, and Reflection : How Medics Learn Medical Care in the Swedish Armed Forces
- 2013
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Ingår i: Military medicine. - : Association of Military Surgeons of the U S. - 0026-4075 .- 1930-613X. ; 178:8, s. 861-866
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how learning is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. interaction during the period of education is important for learning. action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.
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| 4. |
- 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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| 5. |
- Jansson, Linda, et al.
(författare)
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Repeated electroconvulsive seizures increase the number of vessel-associated macrophages in rat hippocampus.
- 2012
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Ingår i: Journal of ECT. - 1533-4112. ; 28:3, s. 174-179
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We have previously reported that electroconvulsive seizure (ECS)-an animal model of the antidepressant treatment electroconvulsive therapy-causes glial cell activation in hippocampus and other limbic areas. In the current study, we have investigated whether the cellular response to ECS includes recruitment and infiltration of nonresident macrophages into the hippocampal brain parenchyma. METHODS: Adult rats received 1 ECS daily for 10 consecutive days and were then killed at different time points after the last ECS treatment. Brain sections were immunostained for laminin, a matrix protein expressed in the basal membrane of blood vessels, in combination with anti-CD163, which identifies mature blood-borne macrophages. The number of CD163 cells in the hippocampus was quantified. We also investigated the number of vessel-associated cells expressing CD4 and major histocompatibility complex class II (MHC II). CD4 is mainly expressed by CD4 T cells, but can also be found on macrophages, monocytes, and activated microglia, whereas MHC II is expressed by macrophages, activated microglia, dendritic cells, and B cells. RESULTS: Our results demonstrate increased numbers of CD163 and CD4 cells following ECS. Most CD4 cells within the vasculature had a similar morphology to the CD163 macrophages. No CD163 cells were detected outside the vessels but a subpopulation of CD4 cells was seen in the brain parenchyma, here with a morphology resembling microglia. There was a transient increase in the number of blood vessel-associated MHC II cells following ECS. CONCLUSIONS: Our observations showed that the cellular response to ECS involves recruitment of blood-derived macrophages, but we could not see any infiltration into the brain parenchyma of these cells.
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| 6. |
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| 7. |
- Johansson, Veronica, et al.
(författare)
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Beyond Blind Optimism and Unfounded Fears : Deep Brain Stimulation for Treatment Resistant Depression
- 2013
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Ingår i: Neuroethics. - : Springer Science and Business Media LLC. - 1874-5504 .- 1874-5490. ; 6:3, s. 457-471
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Tidskriftsartikel (refereegranskat)abstract
- The introduction of new medical treatments based on invasive technologies has often been surrounded by both hopes and fears. Hope, since a new intervention can create new opportunities either in terms of providing a cure for the disease or impairment at hand; or as alleviation of symptoms. Fear, since an invasive treatment involving implanting a medical device can result in unknown complications such as hardware failure and undesirable medical consequences. However, hopes and fears may also arise due to the cultural embeddedness of technology, where a therapy due to ethical, social, political and religious concerns could be perceived as either a blessing or a threat. While Deep Brain Stimulation (DBS) for treatment resistant depression (TRD) is still in its cradle, it is important to be proactive and try to scrutinize both surfacing hopes and fears. Patients will not benefit if a promising treatment is banned or avoided due to unfounded fears, nor will they benefit if DBS is used without scrutinizing the arguments which call for caution. Hence blind optimism is equally troublesome. We suggest that specificity, both in terms of a detailed account of relevant scientific concerns as well as ethical considerations, could be a way to analyse expressed concerns regarding DBS for TRD. This approach is particularly fruitful when applied to hopes and fears evoked by DBS for TRD, since it can reveal if our comprehension of DBS for TRD suffer from various biases which may remain unnoticed at first glance. We suggest that such biases exist, albeit a further analysis is needed to explore this issue in full.
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| 8. |
- Nordgren, Max, et al.
(författare)
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Orchestrated Regulation of Nogo Receptors, Lotus, AMPA Receptors and BDNF in an ECT Model Suggests Opening and Closure of a Window of Synaptic Plasticity
- 2013
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- Electroconvulsive therapy (ECT) is an efficient and relatively fast acting treatment for depression. However, one severe side effect of the treatment is retrograde amnesia, which in certain cases can be long-term. The mechanisms behind the antidepressant effect and the amnesia are not well understood. We hypothesized that ECT causes transient downregulation of key molecules needed to stabilize synaptic structure and to prevent Ca2+ influx, and a simultaneous increase in neurotrophic factors, thus providing a short time window of increased structural synaptic plasticity. Here we followed regulation of NgR1, NgR3, LOTUS, BDNF, and AMPA subunits GluR1 and GluR2 flip and flop mRNA levels in hippocampus at 2, 4, 12, 24, and 72 hours after a single episode of induced electroconvulsive seizures (ECS) in rats. NgR1 and LOTUS mRNA levels were transiently downregulated in the dentate gyrus 2, 4, 12 and 4, 12, 24 h after ECS treatment, respectively. GluR2 flip, flop and GluR1 flop were downregulated at 4 h. GluR2 flip remained downregulated at 12 h. In contrast, BDNF, NgR3 and GluR1 flip mRNA levels were upregulated. Thus, ECS treatment induces a transient regulation of factors important for neuronal plasticity. Our data provide correlations between ECS treatment and molecular events compatible with the hypothesis that both effects and side effects of ECT may be caused by structural synaptic rearrangements.
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| 9. |
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