| 1. |
- Andrén, Oliver C. J., et al.
(författare)
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Antibiotic-Free Cationic Dendritic Hydrogels as Surgical-Site-Infection-Inhibiting Coatings
- 2019
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Ingår i: Advanced Healthcare Materials. - : Wiley. - 2192-2640 .- 2192-2659.
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Tidskriftsartikel (refereegranskat)abstract
- A non-toxic hydrolytically fast-degradable antibacterial hydrogel is herein presented to preemptively treat surgical site infections during the first crucial 24 h period without relying on conventional antibiotics. The approach capitalizes on a two-component system that form antibacterial hydrogels within 1 min and consist of i) an amine functional linear-dendritic hybrid based on linear poly(ethylene glycol) and dendritic 2,2-bis(hydroxymethyl)propionic acid, and ii) a di-N-hydroxysuccinimide functional poly(ethylene glycol) cross-linker. Broad spectrum antibacterial effect is achieved by multivalent representation of catatonically charged β-alanine on the dendritic periphery of the linear dendritic component. The hydrogels can be applied readily in an in vivo setting using a two-component syringe delivery system and the mechanical properties can accurately be tuned in the range equivalent to fat tissue and cartilage (G' = 0.5-8 kPa). The antibacterial effect is demonstrated both in vitro toward a range of relevant bacterial strains and in an in vivo mouse model of surgical site infection.
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| 2. |
- Blom, Kristina, 1967
(författare)
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Development of novel molecular methods for Campylobacter species and for Helicobacter pylori
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and Aim: Different Campylobacter species and Helicobacter pylori are common causes of gastrointestinal infections that may result in diarrhea and chronic gastritis, respectively. The overall aim of this thesis was to develop novel methods for identification, differentiation and characterization of these bacteria. This included comparison of expression of mRNA encoding virulence associated antigens by H. pylori grown in vitro and in vivo and to study the expression of these antigens on the bacterial surfaces. Results: A specific, PCR-based DNA probe hybridization assay was developed for identification of Campylobacter fetus, a bacterium that has caused several outbreaks of human disease during the last decades. The specificity of the probe was evaluated by DNA sequence homology analyses and highly specific identification of C. fetus could be accomplished using the probe labelled with either 32P or digoxigenin. A highly specific PCR-RFLP method was established that allowed rapid identification of different Campylobacter species and also discrimination between Campylobacter spp. and members of the closely related genera Arcobacter, Wolinella and Helicobacter.A QCRT-PCR method was established that allowed quantification of mRNA in H. pylori grown in vivo and in vitro and also very sensitive enumeration of bacterial cells. By this method mRNA that encodes two putative virulence factors in H. pylori, i.e. urease and the neutrophil activating protein (NAP), was studied in a mouse adapted H. pylori strain (SS1) after 1, 2, 3, 4, 7 and 11 days of growth in broth and after 3 days and 2, 6, 12 and 18 weeks of growth in C57/Bl6 mice. Both ureA and nap mRNA were increased in bacteria grown in vivo as compared to in vitro, suggesting that H. pylori is capable of modulating gene expression in response to environmental stimuli. To enable studies of possible surface expression of different antigens on H. pylori a flow cytometric (FCM) assay was established. By using highly specific monoclonal antibodies (MAbs) it was shown that 100% and 30-70% of in vitro grown H. pylori expressed the LPS and N-acetyl-neuraminyllactose binding hemagglutinin (HpaA), respectively on the bacterial surface during different growth phases. In contrast, NAP was surface-expressed only on few cells at late stage of growth and urease was not expressed at all on the bacterial cell surface at any time point during 11 days of culture. The gene expression and surface localization of HpaA was also analyzed in different reference strains and fresh clinical isolates. Although all strains transcribed the hpa gene, as shown by Northern blotting, and all bacterial colonies of the different strains expressed HpaA in dot blot analyses, the surface expression of this antigen on individual bacteria varied considerably, both between strains and during different growth phases.Conclusion: Novel PCR-based methods have been developed that allow highly specific identification and differentiation of different species of Campylobacter. By using QCRT-PCR H. pylori could be quantified with high sensitivity and the expression of mRNA in H. pylori grown in vivo and in vitro could be compared. A method allowing demonstration of surface localization of putative virulence factors was also developed. The different methods may be useful tools in clinical diagnostics, in epidemiological studies and in efforts to further characterize virulence factors in common enteropathogenic bacteria.
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| 3. |
- Blom, Kerstin, et al.
(författare)
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Internet Treatment Addressing either Insomnia or Depression, for Patients with both Diagnoses : A Randomized Trial
- 2015
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Ingår i: Sleep. - : Oxford University Press (OUP). - 0161-8105 .- 1550-9109. ; 38:2, s. 267-277
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Tidskriftsartikel (refereegranskat)abstract
- Study Objectives: To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression. Design: A 9-w randomized controlled trial with 6- and 12-mo follow-up. Setting: Internet Psychiatry Clinic, Stockholm, Sweden. Participants: Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists. Interventions: Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression. Measurements and Results: Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Asberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups. Conclusions: In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment.
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| 4. |
- C:son Silander, H, et al.
(författare)
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Surgical treatment for epilepsy: a retrospective Swedish multicenter study.
- 1997
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Ingår i: Acta neurologica Scandinavica. - 0001-6314. ; 95:6, s. 321-30
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Tidskriftsartikel (refereegranskat)abstract
- The characteristics of patients suffering from drug resistant epilepsy, including the results of the preoperative evaluation and epilepsy surgery were retrospectively analyzed in a Swedish multicenter 10-year cohort of children and adults. Altogether 152 patients (65 children and 87 adults) treated during the period 1980-1990 in three epilepsy centers were included and followed-up 2 years after surgery. Median age at onset of seizures was 4 years for the children and 12 years for the adults. A localization related epilepsy was present in 85% of the children and in 95% of the adults. The mean number of seizure types in the children was 1.7 (range 1-4) and in the adults 1.8 (range 1-4). The median monthly seizure frequency was 52 and 15 for children and adults respectively. Resective surgery was performed in 143 cases (94 temporal, 31 extratemporal, 9 multilobar and 9 major resection procedures) and palliative procedures in 16 cases (13 callosotomies and 3 stereotactic amygdalotomies). Postoperative neurological deficits were detected in 9% of the patients after temporal lobe resections and in 15% of the patients after extratemporal and multilobar resection procedures. Two years after resective surgery 53% of the children and 49% of the adults were seizure free. Another 25% of the patients had a more than 50% reduction of seizure frequency. In the postoperative non seizure free group of patients there was a negative correlation between decrease in weighted seizure severity and decrease in seizure frequency. This finding stresses the need for including other parameters than seizure frequency when evaluating the outcome of epilepsy surgery.
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| 5. |
- Carlsson, Ing-Marie, 1961-, et al.
(författare)
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Maintaining power : women's experiences from labour onset before admittance to maternity ward
- 2012
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Ingår i: Midwifery. - Oxon, United Kingdom : Elsevier. - 0266-6138 .- 1532-3099. ; 28:1, s. 86-92
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Tidskriftsartikel (refereegranskat)abstract
- Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward.Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used.Findings: ‘Maintaining power’ was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: ‘to share the experience with another’, ‘to listen to the rhythm of the body’, ‘to distract oneself’ and ‘to be encased in a glass vessel’, explained how the women coped and thereby maintained power.Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process.
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| 6. |
- Ek, Kristina
(författare)
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Att leva med mycket svår kronisk obstruktiv lungsjukdom : ett liv i slowmotion
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe how people with very severe obstructive pulmonary disease (COPD) experienced their every day lives and created meaning, with focus on end-of-life. A second aim was to describe how death and dying can be viewed from the perspective of relatives to people with COPD. In study I, eight patients were interviewed about how COPD affected their everyday lives. A phenomenological method was used. In study II, four people with COPD who lived alone were interviewed over time, to illuminate how the illness influenced their everyday life and their existential thoughts about life and death. In study III, four couples of whom one partner in each couple had COPD were interviewed several times to illuminate the affect the illness had on the spousal relationship, their self-expressed needs, and their existential thoughts, from the perspective of two people living together. A phenomenological-hermeneutic method was used for the analyses in studies IIand III. Study IV aimed at studying patients’ last six months of life with focuson dying and death, and in this study content analysis was used.The studies (I-IV) revealed that suffering from very severe COPD can be a daily struggle to survive as well as to maintain the self-image. The studies also explicate experiences of a shrinking life space, and questions of meaning were being challenged (I). Study II showed that living alone provided feelings of independency. However the bodily losses reminded the patients’ about death and raised fears about death of being painful, as they did not want to face death alone. For the couples in study III living with COPD meant living in a changed pace with uncertainty, changed intimate relationship and finding new ways of living together. Study IV outlined the trajectory of illness to be irregular and characterized by periods of sudden deterioration, making it difficult to plan for the future. Death was experienced as an unexpected experience and was described by all as peaceful. The results in this thesis have outlined important insight into the existential challenges of living with COPD as experienced by the ill persons themselves and their next of relatives.
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| 7. |
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| 8. |
- Ek, Kristina, et al.
(författare)
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Shifting life rhythms : couples' stories about living together when one spouse has advanced chronic obstructive pulmonary disease
- 2011
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Ingår i: Journal of Palliative Care. - : Centre de Recherche * Institut Universitaire de Geriatrie de Montreal. - 0825-8597 .- 2369-5293. ; 27:3, s. 189-197
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study examines couples' experiences of living together when one partner has advanced chronic obstructive pulmonary disease (COPD).Method: Repeated qulitative interviews with four couples over eight-month period, where one spouse in each couple suffered from advanced COPD. The final dataset comprised 19 interviews. A phenomenological-hermeneutical method was used to interpret the interview text.Findings: One main theme, "living with the disease and one's spouse in a new and changeable life rhythm", emerged from three subthemes: "living with uncertainty", "living in a changed intimate relationship" and "finding new ways of living together". A mutual sense of comanionship between the spouses facilitated their changes of reshaping their relationship and adapting it to the new life rhythm required by everyday life with the disease.Conclusion: The healthy spouse had major responsibility for the health of their sick spouse. Awareness of the couple's own conceptions and knowledge of health and illness is central to person-focused care, as is awareness of what values are important to them when restructing their everyday life.
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| 9. |
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| 10. |
- Ek, Kristina, et al.
(författare)
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Struggling to retain living space : patients' stories about living with advanced chronic obstructive pulmonary disease
- 2011
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 67:7, s. 1480-1490
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This paper is a report of a study of the experience of living with advanced chronic obstructive pulmonary disease and long-term oxygen therapy when living alone.Background: Chronic obstructive pulmonary disease affects an increasing number of people. Breathlessness, fatigue and dejection are common symptoms during the last years of life.Method: Repeated qualitative interviews with four participants were conducted over an 8-month period in 2008. The data comprised 17 interviews, 15 telephone conversations and various field notes. A phenomenological hermeneutical method was used to interpret the text.Findings: The analysis resulted in two main themes and five sub-themes. The first main theme, Being subordinated to the sick body, implies that the body, assistive devices and entrusting oneself to the hands of others can both extend and restrict the living space. The second main theme, Protecting significant values of identity, encompasses both the struggle to maintain self-image and the awareness of one's own death.Conclusion: Living alone with advanced chronic obstructive pulmonary disease is a challenging and complex phenomenon. The everyday life was characterized by a struggle to keep autonomy during a time of increasing dependency and need for help. A person-centred nursing care, built upon peoples' own experiences, may be one way to promote identity and dignity in patients even when they are close to death.
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