| 1. |
- Aronsson, Annette
(författare)
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Misoprostol : pharmacokinetics and effects on uterine contractility and cervical ripening in early pregnancy
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Misoprostol is an orally active synthetic PGE1 analogue which has become an important drug in obstetric and gynaecological practice because of its uterotonic and cervical priming actions. It is safe, cheap, widely available and stable at room temperature. Misoprostol has been found to be useful for medical abortion, cervical priming prior to surgical abortion, evacuation of the uterus in cases of incomplete abortion, missed abortion and intrauterine foetal death, induction of labour and treatment and prevention of post-partum haemorrhage. It was discovered in clinical studies that the misoprostol tablets licensed for oral use could be administered by other routes and that this could influence efficacy. A better understanding of the impact of the route of administration would thus help to further improve misoprostol regimens for several indications. The aims of this thesis were therefore to evaluate the effect of different administration routes and doses of conventional misoprostol and a new slow release (SR) formulation of misoprostol, focusing on its effects on uterine contractility and the pharmacokinetic profile of misoprostol free acid (MPA). In addition, the effect of misoprostol on inflammatory mediators in the cervix was investigated. Healthy women with a normal intrauterine pregnancy in the first trimester who requested vacuum aspiration for termination of pregnancy were recruited for the studies. Uterine contractility was studied after treatment with oral (400 μg), vaginal (400 μg) or sublingual misoprostol (200 or 400 μg). Regardless of the dose and route of administration, the first effect of misoprostol to be observed was a rise in tonus which was more pronounced after oral or sublingual administration. Following sublingual and vaginal administration, regular uterine contractions developed, while oral treatment had only a minor effect on uterine contractions. The response to oral treatment with 400 and 800 μg SR misoprostol was also compared to the response to 400 μg conventional oral misoprostol. SR misoprostol was found to have less effect on uterine tonus, although it was more potent in terms of inducing uterine contractions. The pharmacokinetic profile of MPA following administration of SR misoprostol compared to conventional vaginal and sublingual misoprostol revealed lower peak plasma levels but a longer lasting elevation of these plasma levels. The effect of 400 μg oral or vaginal misoprostol on inflammatory mediators in the cervical tissue was compared with an untreated control group. Immunohistochemical analysis was performed on cervical biopsies. Treatment with misoprostol was associated with higher levels of leukocytes (CD45), and monocytes (CD68) in the cervix compared to untreated controls. A greater staining of MMP 8 and MMP 9 was found following treatment, while TIMP 1 and 2 expression did not differ between the treatment and control groups. Taken together, the results indicate that the peak MPA serum levels seem to correlate with uterine tonus, while the duration of elevated serum levels seems to correlate with the effect on uterine contractility. A certain threshold level of MPA is needed, but once this is reached; the duration of elevated MPA over this critical threshold seems to be the most important parameter in terms of inducing contractions. The findings relating to the pharmacokinetic properties and the effect on uterine contractility of different routes of administration will enable clinicians to design optimal regimens for various clinical applications.
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| 2. |
- Forsberg, Lucas, 1977-
(författare)
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Involved Parenthood : Everyday Lives of Swedish Middle-Class Families
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The dissertation studies how 16 Swedish middle-class parents understand and form their parenthood in everyday life. The focus is set on how they involve themselves in their children’s care and education, and how parental identities are negotiated in relation to cultural norms on parenthood. The analysis is based on qualitative methods, in particular interviews and participant observation with video camera in eight families. The study, which is inspired by poststructuralist perspectives on identity formation, shows that the informants position themselves in relation to a norm on involved parenthood, which is negotiated differently depending on social context and gender. The dissertation includes four empirical studies. The first focuses on the subjectivities and dilemmas that are created by parents’ strategies to manage time and childcare. The strategies render everyday life more effective, but the parents also want to be child-centered, which forces them to balance between positions as involved and uninvolved parents. The second study examines how the fathers negotiate their involvement in household work, childcare and time with children. To great extent, they follow the discourse on gender-equal and involved fatherhood, but they at times resist it through drawing on notions of child-centeredness, kinship, and a gendered division of labor. The third study focuses on how parents and teachers negotiate children’s education and rearing. Study four shows how the parents position themselves as involved parents in relation to their children’s homework. In conclusion, the dissertation shows that the parents idealize time spent with the children, but that in everyday life it is hard to get this time. Instead, much time is spent for the child, that is, doing household work and childcare. In both cases, time is child-centered, but time with the child is by the parents seen as “more” involved time.
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| 3. |
- 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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| 4. |
- Hård af Segerstad, Elin M., et al.
(författare)
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Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk
- 2023
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Ingår i: American Journal of Clinical Nutrition. - 0002-9165. ; 118:6, s. 1099-1105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Higher gluten intake in childhood is associated with increased incidence of celiac disease autoimmunity (CDA) and celiac disease. It remains to be studied whether different dietary patterns independent of gluten intake contribute to the incidence. Objectives: This study aimed to explore associations of dietary patterns by age 2 y with risk of CDA and celiac disease in genetically susceptible children. Methods: Data was used from 6726 participants at genetic risk of type 1 diabetes and celiac disease enrolled in the observational cohort, The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children were annually screened for tissue transglutaminase autoantibodies (tTGAs) from age 2 y. Principal component analysis extracted dietary patterns, based on intake of 27 food groups assessed by 3-d food records at age 9 to 24 mo. The primary outcome was CDA (i.e., persistently tTGA-positive in at least 2 consecutive samples), and the secondary outcome was celiac disease. During follow-up to mean age 11.0 (standard deviation 3.6) y, 1296 (19.3%) children developed CDA, and 529 (7.9%) were diagnosed with celiac disease. Associations of adherence to dietary patterns (per 5-unit increase) with the study outcomes were estimated by Cox regression models adjusted for risk factors including gluten intake. Results: At age 9 mo, a dietary pattern higher in the food groups vegetable fats and milk was associated with reduced risk of CDA (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79, 0.98; P = 0.02). At 24 mo, a dietary pattern higher in the food groups wheat, vegetable fats, and juices, and lower in milk, meat, and oats at age 24 mo was associated with increased risk of CDA (HR: 1.18; 95% CI: 1.05, 1.33; P < 0.001) and celiac disease (HR: 1.24; 95% CI: 1.03, 1.50; P = 0.03). Conclusions: Dietary patterns in early childhood are associated with risk of CDA and celiac disease in genetically predisposed children, independent of gluten intake.
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| 5. |
- Lundgren, Markus, et al.
(författare)
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Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity
- 2017
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.
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| 6. |
- Niinistö, Sari, et al.
(författare)
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Children's erythrocyte fatty acids are associated with the risk of islet autoimmunity
- 2021
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to investigate the associations between erythrocyte fatty acids and the risk of islet autoimmunity in children. The Environmental Determinants of Diabetes in the Young Study (TEDDY) is a longitudinal cohort study of children at high genetic risk for type 1 diabetes (n = 8676) born between 2004 and 2010 in the U.S., Finland, Sweden, and Germany. A nested case-control design comprised 398 cases with islet autoimmunity and 1178 sero-negative controls matched for clinical site, family history, and gender. Fatty acids composition was measured in erythrocytes collected at the age of 3, 6, and 12 months and then annually up to 6 years of age. Conditional logistic regression models were adjusted for HLA risk genotype, ancestry, and weight z-score. Higher eicosapentaenoic and docosapentaenoic acid (n - 3 polyunsaturated fatty acids) levels during infancy and conjugated linoleic acid after infancy were associated with a lower risk of islet autoimmunity. Furthermore, higher levels of some even-chain saturated (SFA) and monounsaturated fatty acids (MUFA) were associated with increased risk. Fatty acid status in early life may signal the risk for islet autoimmunity, especially n - 3 fatty acids may be protective, while increased levels of some SFAs and MUFAs may precede islet autoimmunity.
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| 7. |
- Thakur, Harshad, et al.
(författare)
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Knowledge, Practices, and Restrictions Related to Menstruation among Young Women from Low Socioeconomic Community in Mumbai, India.
- 2014
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Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 2:Jul 3
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Tidskriftsartikel (refereegranskat)abstract
- The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30-40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls.
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