| 1. |
|
|
| 2. |
- Bäckström, Torbjörn, et al.
(författare)
-
Paradoxical effects of GABA-A modulators may explain sex steroid induced negative mood symptoms in some persons
- 2011
-
Ingår i: Neuroscience. - Oxford : Elsevier BV. - 0306-4522 .- 1873-7544. ; 191:Special issue, s. 46-54
-
Forskningsöversikt (refereegranskat)abstract
- Some women have negative mood symptoms, caused by progestagens in hormonal contraceptives or sequential hormone therapy or by progesterone in the luteal phase of the menstrual cycle, which may be attributed to metabolites acting on the GABA-A receptor. The GABA system is the major inhibitory system in the adult CNS and most positive modulators of the GABA-A receptor (benzodiazepines, barbiturates, alcohol, GABA steroids), induce inhibitory (e.g. anesthetic, sedative, anticonvulsant, anxiolytic) effects. However, some individuals have adverse effects (seizures, increased pain, anxiety, irritability, aggression) upon exposure. Positive GABA-A receptor modulators induce strong paradoxical effects including negative mood in 3%-8% of those exposed, while up to 25% have moderate symptoms. The effect is biphasic: low concentrations induce an adverse anxiogenic effect while higher concentrations decrease this effect and show inhibitory, calming properties. The prevalence of premenstrual dysphoric disorder (PMDD) is also 3%-8% among women in fertile ages, and up to 25% have more moderate symptoms of premenstrual syndrome (PMS). Patients with PMDD have severe luteal phase-related symptoms and show changes in GABA-A receptor sensitivity and GABA concentrations. Findings suggest that negative mood symptoms in women with PMDD are caused by the paradoxical effect of allopregnanolone mediated via the GABA-A receptor, which may be explained by one or more of three hypotheses regarding the paradoxical effect of GABA steroids on behavior: (1) under certain conditions, such as puberty, the relative fraction of certain GABA-A receptor subtypes may be altered, and at those subtypes the GABA steroids may act as negative modulators in contrast to their usual role as positive modulators; (2) in certain brain areas of vulnerable women the transmembrane C1(-) gradient may be altered by factors such as estrogens that favor excitability; (3) inhibition of inhibitory neurons may promote disinhibition, and hence excitability. This article is part of a Special Issue entitled: Neuroactive Steroids: Focus on Human Brain. (C) 2011 Published by Elsevier Ltd on behalf of IBRO.
|
|
| 3. |
|
|
| 4. |
- Köhler, Birgitta, 1943, et al.
(författare)
-
Mutans Streptococci and Caries Prevalence in Children after Early Maternal Caries Prevention: A Follow-Up at 19 Years of Age
- 2012
-
Ingår i: Caries Research. - : S. Karger AG. - 0008-6568 .- 1421-976X. ; 46:5, s. 474-480
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The efficacy of early maternal caries prevention was evaluated. Furthermore, the difference between children colonised with mutans streptococci (MS) at an early or late stage with regard to the prevalence of carious lesions was determined. Methods: The children of first-time mothers selected on the basis of high salivary levels of MS for participation in a caries prevention programme were recalled at the age of 19 years. They were examined for salivary MS, lesion prevalence (decayed and filled surfaces, DFS) and MS in plaque from 12 selected proximal surfaces. Results: The recall rate was 70% for the children of both the high-control and interventional groups. All high-control children and 67% of the interventional children were colonised by MS. All the children with non-detectable MS in saliva were also negative in all plaque samples. No statistically significant difference was found between the groups in terms of DFS, although more interventional children were caries free than in the control group. Early-colonised children, irrespective of group iden-tity, had higher salivary MS levels and DES than later MS-colonised children. Conclusion: The results indicate that it is possible to remain negative for MS into adulthood if non-colonised at an early age and this affects the development of carious lesions. Strategies for the prevention of dental caries in early childhood should, therefore, include measures to prevent or delay early colonisation by cariogenic bacteria. Copyright (C) 2012 S. Karger AG, Basel
|
|
| 5. |
- Köhler, Birgitta, 1943, et al.
(författare)
-
Mutans streptococci and caries prevalence in children after early maternal caries prevention: a follow-up at eleven and fifteen years of age.
- 2010
-
Ingår i: Caries research. - : S. Karger AG. - 1421-976X .- 0008-6568. ; 44:5, s. 453-8
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The efficacy of early maternal caries prevention on children was evaluated. Material: First-time mothers selected on the basis of a high level of salivary mutans streptococci (MS) and mothers excluded at screening due to a low level of MS (“low”) were recalled when their children were 11 yrs old. The salivary MS was determined in the mothers. Their children were examined for salivary MS and lesion prevalence (DFS) at age 11 and 15 yrs. Results: More high control mothers displayed > 106 MS than the high interventional and “low” control mothers and, vice versa, more interventional and “low” control mothers had MS counts of < 3x105 than control mothers. More of “interventional” and “low” children had < 105 MS/ml as compared with control children. All the “high control” children had detectable MS. MS were undetected in 5 “interventional” and 5 “low children” at 15 yrs. Significantly fewer “high control” than “interventional” and “low children” were caries free at 11 and 15 yrs of age. Non-MS-colonised children at 3 yrs of age, irrespective of group identity, displayed statistically lower MS counts and DFS at 15 yrs than those colonised at 3 yrs of age. Children with clinical caries/fillings at 15 yrs had had a significantly higher level of MS at 11 yrs of age than those without clinical caries/fillings. Conclusion: The clinical trial focusing on the mothers resulted in long-term benefits for their children. Children colonised by MS at an early stage developed more caries than those colonised at a later stage.
|
|
| 6. |
- Øvretveit, John, et al.
(författare)
-
Implementing organization and management innovations in Swedish healthcare : Lessons from a comparison of 12 cases
- 2012
-
Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 26:2, s. 237-257
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to compare the implementation of twelve different "organization and management innovations" (OMIs) in Swedish healthcare, to discover the generic and specific factors important for successful healthcare improvement change in a public health system.Design/methodology/approach: Longitudinal cross-case comparison of twelve case studies was employed, where each case study used a common framework for collecting data about the process of change, the content of change, the context and the intermediate and final outcomes.Findings: Clinical leaders played a more important part in the development of these successful service innovations than managers. Strategies for and patterns of change implementation were found to differ according to the type of innovation. Internal organisational context factors played a significant role in the development of nearly all, but external factors did not. "Developmental evolution" better described the change process than "implementation".Research limitations/implications: The 12 cases were all of relatively successful change processes: some unsuccessful examples would have provided additional testing of of the hypotheses about what would predict successful innovation which were used in the case comparison. The cross-case comparative hypothesis testing method allows systematic comparison if the case data are collected using similar frameworks, but this approach to management research requires considerable resources and coordination.Practical implications: Management innovations that improve patient care can be carried out successfully by senior clinicians, under certain circumstances. A systematic approach is important both for developing and adapting an innovation to a changing situation. A significant amount of time was required for all involved, which could be reduced by "fast-tracking" approval for some type of change.Originality/value: This is the first empirical report comparing longitudinal and contextualised findings from a number of case studies of different organisational and management healthcare innovations. The findings made possible explanations for success factors and useful practical recommendations for conditions needed to nurture such innovation in public healthcare.
|
|
