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- Andersson, Maria L.E., et al.
(författare)
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Autoantibodies to Disease-Related Proteins in Joints as Novel Biomarkers for the Diagnosis of Rheumatoid Arthritis
- 2023
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Ingår i: Arthritis & Rheumatology. - : Wiley. - 2326-5191 .- 2326-5205. ; 75:7, s. 1110-1119
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Tidskriftsartikel (refereegranskat)abstract
- Objective. This study was undertaken to develop and characterize a multiplex immunoassay for detection of autoantibodies against peptides derived from proteins known to play a role in development of arthritis and that are also expressed in joints.Methods. We selected peptides from the human counterpart of proteins expressed in the joints, based on mouse models that showed these to be targeted by pathogenic or regulatory antibodies in vivo. Using bead-based flow immunoassays measuring IgG antibodies, we selected triple helical or cyclic peptides, containing the epitopes, to avoid collinear reactivity. We characterized the analytical performance of the immunoassay and then validated it in 3 independent rheumatoid arthritis (RA) cohorts (n = 2,110), Swedish age- and sex-matched healthy controls, and patients with osteoarthritis (OA), patients with psoriatic arthritis (PsA), and patients with systemic lupus erythematosus (SLE).Results. Screening assays showed 5 peptide antigens that discriminated RA patients from healthy controls with 99% specificity (95% confidence interval [CI] 98-100%). In our validation studies, we reproduced the discriminatory capacity of the autoantibodies in 2 other RA cohorts, showing that the autoantibodies had high discriminatory capacity for RA versus OA, PsA, and SLE. The novel biomarkers identified 22.5% (95% CI 19-26%) of early RA patients seronegative for anti-cyclic citrullinated peptide and rheumatoid factor. The usefulness of the biomarkers in identifying seronegative RA patients was confirmed in validation studies using 2 independent cohorts of RA patients and cohorts of patients with OA, PsA, and SLE.Conclusion. A multiplex immunoassay with peptides from disease-related proteins in joints was found to be useful for detection of specific autoantibodies in RA serum. Of note, this immunoassay had high discriminatory capacity for early seronegative RA.
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- Avby, Gunilla, 1965-, et al.
(författare)
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Samarbete bygger en stark primärvård
- 2017
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Ingår i: Dagens Nyheter 2017-08-17. - Stockholm : Dagens Nyheter. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)
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- Haghighi, Mona, et al.
(författare)
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A Comparison of Rule-based Analysis with Regression Methods in Understanding the Risk Factors for Study Withdrawal in a Pediatric Study
- 2016
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions.
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- Höög, Elisabet, et al.
(författare)
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Developing an organizational change facilitating agency’s approach to system-wide development in health and social care
- 2013
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Konferensbidrag (refereegranskat)abstract
- PurposeThe important role of change agents as facilitators of organizational development processes is well recognized. Change interventions can address several levels: individuals, group/units or organizational systems. To facilitate system wide changes in complex health and social service organizations multiple facilitation approaches are needed. The purpose of this study was to examine an organizational change facilitating agency (OCFA) acquiring a new system wide facilitation approach.Design/MethodologyThe case study focuses on a regional support unit in Swedish health and social care, centered on care of the elderly and functionally impaired. Interviews, surveys, process diaries and observations of meetings provided data for qualitative content analyses.ResultsRespondents described a rocky journey and a learning loop providing insights on how to support development and learning for actors on multiple organizational levels. The OCFA learning process included meta levels of reflection and parallel work with organizational pilot cases. Respondents reported enhanced analytical and problem solving skills and the previously vague OCFA role was clarified and expanded. During the studied period the OCFA group clarified and enlarged their mission and organizational role in communication with stakeholders.LimitationsTo fully understand the potential of OCFA and system wide facilitation approaches further investigations are needed.Research/Practical ImplicationsOrganizational development requires adequate change process support. How to attain such support is less known. The provided description of a support function acquiring a system-wide facilitation approach can aid future development of the OCFA function.Originality/ValueThis study contributes to the knowledge on how to develop the approaches used by an OCFA to facilitate system-wide organizational development.
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| 9. |
- Kjellström, Sofia, 1970-, et al.
(författare)
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Leadership as a driver for work motivation : a study of well-functioning primary healthcare centers in Sweden
- 2017
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Konferensbidrag (refereegranskat)abstract
- Introduction: Little is known about how, why, or under which circumstances work motivation is formed and linked to reforms and interventions.Aim: The aim of this study is to explore work motivation among professionals at well-functioning primary healthcare centers subject to a national healthcare reform which include financial incentives.Material & method: Five primary healthcare centers in Sweden were purposively selected for being well-operated and representing public/private and small/large units. Forty-three interviews were completed with different medical professions and qualitative deductive content analysis was conducted.Results: Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of nonhierarchical collaboration, and systematic quality improvement work. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. The units expressed a collective capacity to produce direction, alignment and commitment.Conclusions: The design of the reforms and leadership are essential preconditions for work motivation. Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection and quality improvement work. The values of the study consist of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms, and how professionals collectively produce leadership.
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| 10. |
- Kjellström, Sofia, 1970-, et al.
(författare)
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Work motivation among healthcare professionals: A study of well-functioning primary healthcare centers in Sweden.
- 2017
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Ingår i: Journal of Health Organization and Management [1477-7266]. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 31:4, s. 487-502
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Purpose – The purpose of this paper is to explore work motivation among professionals at well-functioningprimary healthcare centers subject to a national healthcare reform which include financial incentives. Design/methodology/approach – Five primary healthcare centers in Sweden were purposively selectedfor being well-operated and representing public/private and small/large units. In total, 43 interviews werecompleted with different medical professions and qualitative deductive content analysis was conducted. Findings – Work motivation exists for professionals when their individual goals are aligned with the organizational goals and the design of the reform. The centers’ positive management was due to a unique combination of factors, such as clear direction of goals, a culture of non-hierarchical collaboration, and systematicquality improvement work. The financial incentives need to be translated in terms of quality patient care to provide clear direction for the professionals. Social processes where professionals work together as cohesive groups, and provided space for quality improvement work is pivotal in addressing how alignment is created. Practical implications – Leaders need to consistently translate and integrate reforms with the professionals’ drives and values. This is done by encouraging participation through teamwork, time for structured reflection, and quality improvement work. Social implications – The design of the reforms and leadership are essential preconditions for work motivation. Originality/value – The study offers a more complete picture of how reforms are managed at primary healthcare centers, as different medical professionals are included. The value also consists of showing how a range of aspects combine for primary healthcare professionals to successfully manage external reforms.
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