| 1. |
- Berggren, Kristina, et al.
(författare)
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Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals
- 2022
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Ingår i: Clinical and Experimental Dental Research. - : Wiley-Blackwell. - 2057-4347. ; 8:1, s. 84-95
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Obstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA. Methods A qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi-structured face-to-face interviews were performed followed by qualitative content analysis. Results Interviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers. Conclusions Dental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.
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| 2. |
- Broström, Eva Berggren
(författare)
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Bronchopulmonary dysplasia from newborn disease to long-term sequelae
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Bronchopulmonary Dysplasia (BPD) is a complication of premature birth that is associated with increased mortality and morbidity in infancy and impaired lung function and obstructive lung disease from childhood to adulthood. The pathogenesis of BPD is multifactorial, and may involve one or more of the following: a deficiency in surfactant production in the immature lung, chronic inflammatory processes before and after birth, oxidative stress, and trauma due to mechanical ventilation. Surfactant replacement therapy, which reduces acute lung injury in the preterm infant, could be one way to prevent later development of BPD. So far, surfactant therapy requires invasive intubation that may itself be traumatic. In this thesis, we evaluated an alternative, non-invasive way to deliver surfactant. This trial of surfactant inhalation via nasal CPAP in spontaneously breathing infants unfortunately did not prove beneficial. Pre- and postnatal inflammatory processes may initiate and aggravate the course of BPD. Some of the underlying inflammatory processes e.g. activation of the neutrophil and macrophage systems, have been well described but other processes, such as the role of eosinophils and other inflammatory markers in the pathology of BPD, have not yet been well characterised. This thesis shows that levels of activated eosinophils in the circulation are elevated in infants with BPD, a sign of chronic, systemic inflammation. We also found that the degree of eosinophil activation was positively associated with the severity of BPD (as determined by the duration of supplementary O2 treatment). Future studies may establish whether a causal relationship exists between states of eosinophil activation in preterm infants and BPD. Moderate and severe BPD is associated with an increased risk for airway obstruction and low forced expiratory volume in childhood. As shown herein, respiratory mechanics is also altered in children with mild BPD. This finding is important because it emphasizes the need for careful clinical follow up of all BPD children, regardless of the severity of the disease, in order to minimize further deterioration in lung function. BPD not only affects lung function but general development as well; thoseffected may develop cognitive and motor performance deficits and exhibit behavioural difficulties. This thesis also sheds new light on public health consequences of very preterm birth. We know little about the possible long-term consequences of premature birth for lung function in old age. In a unique birth cohort born in 1925-49 in Sweden, we found that moderate to-very preterm birth is associated with obstructive lung disease in old age, the severity of which required frequent hospitalisation. The results from this historic cohort cannot be directly extrapolated to preterm infants born today. However, the much higher survival rate in the modern era of neonatal intensive care suggests that infants born preterm nowadays could be at even higher risk of developing obstructive airways disease in adult life than were previous generations. This finding emphasizes the importance of extending follow up programs into adult life. Preterm birth is a global and serious health issue. A better understanding of its potential adverse impact in infancy and childhood may lead to better intervention and treatment strategies and improved long-term outcome.
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| 3. |
- Henckel, Ewa, et al.
(författare)
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A novel association between ykl-40, a marker of structural lung disease, and short telomere length in 10-year-old children with bronchopulmonary dysplasia
- 2021
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Ingår i: Children. - : MDPI. - 2227-9067. ; 8:2
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Tidskriftsartikel (refereegranskat)abstract
- Extremely preterm infants are born with immature lungs and are exposed to an inflammatory environment as a result of oxidative stress. This may lead to airway remodeling, cellular aging and the development of bronchopulmonary dysplasia (BPD). Reliable markers that predict the long-term consequences of BPD in infancy are still lacking. We analyzed two biomarkers of cellular aging and lung function, telomere length and YKL-40, respectively, at 10 years of age in children born preterm with a history of BPD (n = 29). For comparison, these markers were also evaluated in sex-and-age-matched children born at term with childhood asthma (n = 28). Relative telomere length (RTL) was measured in whole blood with qPCR and serum YKL-40 with ELISA, and both were studied in relation to gas exchange and the regional ventilation/perfusion ratio using three-dimensional V/Q-scintigraphy (single photon emission computer tomography, SPECT) in children with BPD. Higher levels of YKL-40 were associated with shorter leukocyte RTL (Pearson’s correlation: −0.55, p = 0.002), but were not associated with a lower degree of matching between ventilation and perfusion within the lung. Serum YKL-40 levels were significantly higher in children with BPD compared to children with asthma (17.7 vs. 13.2 ng/mL, p < 0.01). High levels of YKL-40 and short RTLs were associated to the need for ventilatory support more than 1 month in the neonatal period (p < 0.01). The link between enhanced telomere shortening in childhood and structural remodeling of the lung, as observed in children with former BPD but not in children with asthma at the age of 10 years, suggests altered lung development related to prematurity and early life inflammatory exposure. In conclusion, relative telomere length and YKL-40 may serve as biomarkers of altered lung development as a result of early-life inflammation in children with a history of prematurity.
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| 4. |
- Mörelius, Evalotte, 1965-, et al.
(författare)
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The Stockholm Neonatal Family-Centered Care Study : Effects on Salivary Cortisol in Infants and their Mothers
- 2011
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Konferensbidrag (refereegranskat)abstract
- BACKGROUND: Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants.AIMS:To evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers’ and the preterm infants’ salivary cortisol levels.METHODS:This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 hours/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge.RESULTS:No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants’ and their mothers’ baseline and response cortisol in the FC group: r=0.31 (p=0.001) and r=0.24 (p=0.01), respectively. Such correlation was not observed in the SC group: r=0.14 (p=0.14) and r=0.18 (p=0.07), respectively.CONCLUSIONS: Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants’ and their mothers’ salivary cortisol levels.
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| 5. |
- Mörelius, Evalotte, et al.
(författare)
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The Stockholm Neonatal Family-Centered Care Study : Effects on salivary cortisol in infants and their mothers
- 2012
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Ingår i: Early Human Development. - : Elsevier. - 0378-3782 .- 1872-6232. ; 88:7, s. 575-581
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Tidskriftsartikel (refereegranskat)abstract
- Background: Parental involvement in the care of preterm infants in neonatal intensive care units (NICUs) is common, but little is known about the effect on stress responses in mothers and infants. Aims: The aim of this study is to evaluate the effect of family-centered care on salivary cortisol reactivity in mothers and preterm infants and the correlation between the mothers and the preterm infants salivary cortisol levels. Methods: This study is part of a randomized controlled trial conducted at two level-II NICUs, including Family Care (FC), where parents were able to stay 24 h/day from admission to discharge, and Standard Care (SC). To investigate the cortisol response, saliva was collected from 289 preterm infants and their mothers before and after a diaper change at the time of discharge. Results: No significant differences were found between the two groups in salivary cortisol reactivity, either in mothers or in infants. The results revealed a correlation between preterm infants and their mothers baseline and response cortisol in the FC group: r = 0.31 (p = 0.001) and r = 0.24 (p = 0.01), respectively. Such correlation was not observed in the SC group: r = 0.14 (p = 0.14) and r = 0.18 (p = 0.07), respectively. Conclusions: Family-centered care had no effect on salivary cortisol reactivity during diaper change. However, sharing the same environment may increase the concordance between preterm infants and their mothers salivary cortisol levels.
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| 6. |
- Um-Bergström, Petra, et al.
(författare)
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Lung function development after preterm birth in relation to severity of Bronchopulmonary dysplasia
- 2017
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Ingår i: BMC Pulmonary Medicine. - : BIOMED CENTRAL LTD. - 1471-2466. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bronchopulmonary dysplasia (BPD) is a strong risk factor for respiratory morbidity in children born preterm. Our aims were to evaluate lung function in adolescents born preterm with and without a history of BPD, and to assess lung function change over time from school age.Methods: Fifty-one individuals born in Stockholm, Sweden between gestational ages 24 to 31 weeks (23 neonatally diagnosed with respiratory distress syndrome (RDS) but not BPD, and 28 graded as mild (n = 17), moderate (n = 7) or severe (n = 4) BPD) were examined in adolescence (13-17 years of age) using spirometry, impulse oscillometry (IOS), plethysmography, and ergospirometry. Comparison with lung function data from school age (6-8 years of age) was also performed.Results: Adolescents with a history of BPD had lower forced expiratory volume in 1 s (FEV1) compared to those without BPD (-0.61 vs.-0.02 z-scores, P < 0.05), with lower FEV1 values significantly associated with BPD severity (P for trend 0.002). Subjects with severe BPD had higher frequency dependence of resistance, R5-20, (P < 0.001 vs. non-BPD subjects) which is an IOS indicator of peripheral airway involvement. Between school age and adolescence, FEV1/FVC z-scores decreased in all groups and particularly in the severe BPD group (from -1.68 z-scores at 6-8 years to -2.74 z-scores at 13-17 years, p < 0.05 compared to the non-BPD group).Conclusions: Our results of spirometry and IOS measures in the BPD groups compared to the non-BPD group suggest airway obstruction including involvement of peripheral airways. The longitudinal result of a decrease in FEV1/FVC in the group with severe BPD might implicate a route towards chronic airway obstruction in adulthood.
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