| 1. |
- Bridel, Claire, et al.
(författare)
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Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology : A Systematic Review and Meta-analysis
- 2019
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Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149 .- 2168-6157. ; 76:9, s. 1035-1048
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Forskningsöversikt (refereegranskat)abstract
- Importance Neurofilament light protein (NfL) is elevated in cerebrospinal fluid (CSF) of a number of neurological conditions compared with healthy controls (HC) and is a candidate biomarker for neuroaxonal damage. The influence of age and sex is largely unknown, and levels across neurological disorders have not been compared systematically to date.Objectives To assess the associations of age, sex, and diagnosis with NfL in CSF (cNfL) and to evaluate its potential in discriminating clinically similar conditions.Data Sources PubMed was searched for studies published between January 1, 2006, and January 1, 2016, reporting cNfL levels (using the search terms neurofilament light and cerebrospinal fluid) in neurological or psychiatric conditions and/or in HC.Study Selection Studies reporting NfL levels measured in lumbar CSF using a commercially available immunoassay, as well as age and sex.Data Extraction and Synthesis Individual-level data were requested from study authors. Generalized linear mixed-effects models were used to estimate the fixed effects of age, sex, and diagnosis on log-transformed NfL levels, with cohort of origin modeled as a random intercept.Main Outcome and Measure The cNfL levels adjusted for age and sex across diagnoses.Results Data were collected for 10 059 individuals (mean [SD] age, 59.7 [18.8] years; 54.1% female). Thirty-five diagnoses were identified, including inflammatory diseases of the central nervous system (n = 2795), dementias and predementia stages (n = 4284), parkinsonian disorders (n = 984), and HC (n = 1332). The cNfL was elevated compared with HC in a majority of neurological conditions studied. Highest levels were observed in cognitively impaired HIV-positive individuals (iHIV), amyotrophic lateral sclerosis, frontotemporal dementia (FTD), and Huntington disease. In 33.3% of diagnoses, including HC, multiple sclerosis, Alzheimer disease (AD), and Parkinson disease (PD), cNfL was higher in men than women. The cNfL increased with age in HC and a majority of neurological conditions, although the association was strongest in HC. The cNfL overlapped in most clinically similar diagnoses except for FTD and iHIV, which segregated from other dementias, and PD, which segregated from atypical parkinsonian syndromes.Conclusions and Relevance These data support the use of cNfL as a biomarker of neuroaxonal damage and indicate that age-specific and sex-specific (and in some cases disease-specific) reference values may be needed. The cNfL has potential to assist the differentiation of FTD from AD and PD from atypical parkinsonian syndromes.
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| 2. |
- Sharrack, Basil, et al.
(författare)
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Autologous haematopoietic stem cell transplantation and other cellular therapy in multiple sclerosis and immune-mediated neurological diseases : updated guidelines and recommendations from the EBMT Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of EBMT and ISCT (JACIE)
- 2020
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Ingår i: Bone Marrow Transplantation. - : Springer Nature. - 0268-3369 .- 1476-5365. ; 55:2, s. 283-306
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Tidskriftsartikel (refereegranskat)abstract
- These updated EBMT guidelines review the clinical evidence, registry activity and mechanisms of action of haematopoietic stem cell transplantation (HSCT) in multiple sclerosis (MS) and other immune-mediated neurological diseases and provide recommendations for patient selection, transplant technique, follow-up and future development. The major focus is on autologous HSCT (aHSCT), used in MS for over two decades and currently the fastest growing indication for this treatment in Europe, with increasing evidence to support its use in highly active relapsing remitting MS failing to respond to disease modifying therapies. aHSCT may have a potential role in the treatment of the progressive forms of MS with a significant inflammatory component and other immune-mediated neurological diseases, including chronic inflammatory demyelinating polyneuropathy, neuromyelitis optica, myasthenia gravis and stiff person syndrome. Allogeneic HSCT should only be considered where potential risks are justified. Compared with other immunomodulatory treatments, HSCT is associated with greater short-term risks and requires close interspeciality collaboration between transplant physicians and neurologists with a special interest in these neurological conditions before, during and after treatment in accredited HSCT centres. Other experimental cell therapies are developmental for these diseases and patients should only be treated on clinical trials.
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| 3. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: Clinical Endocrinology. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 4. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: CLINICAL ENDOCRINOLOGY. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 5. |
- Bergström, Sven, et al.
(författare)
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Molecular characterization of Borrelia burgdorferi isolated from Ixodes ricinus in northern Sweden.
- 1992
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 24:2, s. 181-188
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Tidskriftsartikel (refereegranskat)abstract
- Ixodes ricinus ticks, harbouring Borrelia burgdorferi, were found in an area in northern Sweden, not thought to be endemic for Lyme borreliosis. This investigation took place at Norrbyskär, an island situated in the Bothnian Gulf, 63 degrees 33'N/19 degrees 52'E. One of 42 nymphal and 8/43 adult I. ricinus ticks collected carried spirochetes as seen by phase contrast microscopy. Pure bacterial cultures were obtained from 2 of the ticks. Western blot analysis using species-specific monoclonal antibodies showed that the isolated spirochetes were B. burgdorferi. The identity of the isolated spirochetes was confirmed by DNA amplification using B. burgdorferi OspA and flagellin gene specific oligonucleotides as well as partial DNA sequencing of the respective OspA and flagellin genes. The 2 isolated spirochaete populations were different as shown by their protein profiles in sodium dodecyl sulphate polyacrylamide gels. Moreover, the demonstration of Lyme borreliosis in a patient from the island of Norrbyskär indicates the need for clinical consideration of this disease in northern Sweden.
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| 6. |
- Brage, Christina, 1950-, et al.
(författare)
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PEER OBSERVATION OF TEACHING IN A LIBRARY SETTING : A PILOT STUDY
- 2016
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Ingår i: ICERI2016 Proceedings 9th annual International Conference of Education, Research and Innovation, Seville, Spain. 14-16 November, 2016. - : IATED. - 9788461758951 ; , s. 6827-6832
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Konferensbidrag (refereegranskat)abstract
- This paper explores participant perceptions of the impact of a Peer Observation of Teaching scheme offered to teaching librarians at Linköping University library.Information literacy sessions or support are offered to almost all students in all courses at Linköping University. Instructional duties have become a common expectation for librarians working in academic libraries. As a teaching librarian you normally divide your time between reference services, collection development and information literacy instruction. But without little formal training in the teaching role you can become very insecure. It’s not uncommon that you feel left alone especially in the support of continuing professional development. Therefore it’s necessary for academic librarians to talk and reflect about their teaching. Peer observation through critical friends is one way to demonstrate that we are reflecting on the quality of our teaching, learning and assessment practices. The relationship between critical friends is one that encourages and cultivates constructive critique. But it’s important that the main conditions exists, besides the obvious trust and commitment, namely to have knowledge of the context of the teaching environment. The librarians at Linköping University teach the “same” students and face the same challenges.In preparation for the introduction of a peer observation of teaching scheme, a seminar was offered to staff. Our hope was that the librarians involved could see that this initiative could lead to professional development that improves both teaching practices and hopefully also student performance. Many senior librarians are themselves, experienced, effective teachers and therefore, they were likely to be competent observers of various aspects of the teaching conducted at the library. The librarian requesting observation met the observing librarian to discuss the objectives of the observation. A limited number of focused objectives was chosen that could address specific items on which the librarian desired feedback. The observing librarian attended the library session and took notes on the session with the objectives in mind.We assessed the effort by using two types of data collection tools, a questionnaire and semi-structured interviews. The latter were used to add depth and quality of the data collected in the questionnaire. Information was collected from all participants. The questionnaire consisted of closed questions to gain relevant factual data. A pilot questionnaire was answered and assessed by two critical friends ensuring that the questions were clear and valid. The preliminary results indicated that most of the participants were satisfied with the possibility to be able to self-reflect on how this process positively can impact their teaching skills. The peer observation process seemed to provide both the observee and the observer with the opportunity to mutually enhance the quality of their teaching practice. It also provided an opportunity to disseminate good practice amongst colleagues by sharing thoughts on teaching practice and supporting each other’s development of teaching skills.This process was not about getting everyone to teach in the same way, it was about helping individuals to reflect on and evaluate their own approach to teaching. It was expected that both parties in the observation would benefit from the discussions arising.
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| 7. |
- Brandén, Jennie, et al.
(författare)
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Utsatthet för sexuellt våld bland samiska kvinnor i Sverige : den Samiska HLV studien 2021
- 2023
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Ingår i: Tidsskrift for kjønnsforskning. - Oslo. - 0809-6341 .- 1891-1781. ; 47:2-3, s. 113-129
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Tidskriftsartikel (refereegranskat)abstract
- Frågan om sexuellt våld har under de senaste åren fått ett allt större utrymme i Sápmi. I denna artikel, som baseras påden populationsbaserade studien «Samisk hälsa på lika villkor» (Samisk HLV) 2021, undersöks utsatthet för sexuelltvåld bland samiska kvinnor och män i Sverige jämfört med kvinnor och män i Sveriges befolkning. Analysen visaratt sexuellt våld mot kvinnor utgör ett mycket omfattande samhällsproblem i det samiska samhället, i minst sammaomfattning som i övriga Sverige. Samiska kvinnor rapporterar en signifikant högre utsatthet för flera former av sexuelltvåld jämfört med kvinnor i Sverige, däribland utsatthet för våldtäkt och våldtäktsförsök. Analysen visar även attsamiska kvinnor är mer benägna att söka vård samt polisanmäla efter övergreppet, vilket nyanserar bilden av en tystnadkring sexuellt våld i Sápmi. Utifrån ett urfolksfeministiskt perspektiv belyser artikeln hur könade och kolonialamaktrelationer samspelar vad gäller utsatthet för sexuellt våld i Sverige och att positionen som både kvinna och sameökar utsattheten för sexuellt våld, medan att vara man och same inte gör det. Sammantaget pekar artikeln på att bådekön och samisk tillhörighet har betydelse för utsatthet för sexuellt våld och därmed på vikten av att inkludera samiskaperspektiv i framtida forskning om, och politiska insatser mot, sexuellt våld.
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| 8. |
- Brandén, Jennie, 1984-, et al.
(författare)
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Våld mot samiska kvinnor
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I den här rapporten presenterar vi resultat från forskningsprojektet ”Våld mot samiska kvinnor” som 2021-2024 genomförts av forskargruppen Lávvuo vid Umeå Universitet, på uppdrag av Sámediggi (Sametinget i Sverige).Rapporten består av en kvantitativ och en kvalitativ del, samt fem åtgärdsförslag riktade till Sveriges regering.De kvantitativa resultaten i korthetDen kvantitativa delen av rapporten baseras på enkätundersökningen Samisk hälsa på lika villkor som genomfördes 2021. Resultaten har jämförts med Sveriges befolkning genom den nationella enkäten Sexuell och reproduktiv hälsa genomförd 2017. Det övergripande mönstret är att kvinnor är betydligt mer utsatta för våld än män, samt att samiska kvinnor 2021 uppger en högre våldsutsatthet än kvinnor i Sverige 2017, för de flesta typer av våld.Över hälften av de samiska kvinnorna har utsatts för sexuellt våld (55,5 procent), sju av tio har utsatts för psykiskt våld (68,5 procent) och nästan var tredje för fysiskt våld (27,9 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för de grövsta formerna av sexuellt våld, såsom våldtäktsförsök (14,1 jämfört med 10,6 procent) och våldtäkt (10,3 jämfört med 7,0 procent).En större andel samiska kvinnor än kvinnor i Sverige i stort uppger utsatthet för psykiskt våld, både sammantaget (68,5 jämfört med 50,9 procent) och vad gäller alla de former av psykiskt våld som undersöktes.Även när det gällde fysiskt våld rapporterade samiska kvinnor (27,9 procent) en högre utsatthet jämfört med kvinnor i Sverige (22,0 procent).Samiska kvinnors utsatthet för våld varierar med både ålder och geografi. Överlag var utsattheten högst bland kvinnor yngre än 45 år. Geografiskt var utsattheten för sexuellt och fysiskt våld högre bland samiska kvinnor i mellersta och södra Sverige, med undantag av Stockholmsområdet. För psykiskt våld hade samiska kvinnor i Jämtland Härjedalen en högre utsatthet.Det finns flera starka samband mellan olika typer av våldsutsatthet och psykisk och fysisk ohälsa. Upprepad våldsutsatthet (fler än en gång) är förenat med ännu högre risk för ohälsa, särskilt psykisk ohälsa. Starkast är detta samband när det gäller stress och självmordstankar.När det gäller diskriminering och rasism uppger en betydande andel av samer i Sverige att de utsatts någon gång i livet. Liksom för andra former av våld i denna undersökning visar analysen att en högre andel samiska kvinnor (44,5 procent) utsatts jämfört med samiska män (37,0 procent).HBTQ-samer är mer våldsutsatta än andra samer. Detta gäller sexuellt våld (64,6 jämfört med 30,9 procent), psykiskt våld (81,7 jämfört med 58,4 procent) och fysiskt våld (43,8 jämfört med 25,5 procent).De kvalitativa resultaten i korthetDen kvalitativa delen baseras på intervjuer med professionella som arbetar inom samhällets stödstrukturer för våldsutsatta i olika delar av den svenska delen av Sápmi.Intervjustudien visar att våld mot samiska kvinnor är en fråga som behöver förstås i relation till den bredare politiska och historiska, koloniala, och könade kontext som våldet utspelar sig i.Frågan om våld mot samiska kvinnor osynliggörs och beskrivs som svår att adressera – både i det samiska samhället och i majoritetssamhället.Kunskapen om det samiska samhället är låg inom samhällets stödstrukturer. Deltagare beskrev att samiska perspektiv saknas i styrdokument kring mäns våld mot kvinnor och i befintlig terminologi. Detta gör att förhållanden i det samiska samhället som kan påverka den våldsutsattas situation negligeras i mötet med samiska klienter, patienter och brukare som utsätts för våld.Frågan om våld mot samiska kvinnor beskrevs som ”känslig” och ”laddad”. Sammantaget framträder ett stigma kring frågan och en oro för att ”göra fel” eller bidra till fördomar och rasism mot samer, både i det samiska samhället och majoritetssamhället.Problemet med våld mot samiska kvinnor beskrevs som svår att adressera inom en redan marginaliserad samisk kontext, där värnandet av samiska kollektiva rättigheter har prioriterats.Det finns en rad särskilda förhållanden knutna till det samiska samhället som är viktiga att ha kunskap om och vara lyhörd för i mötet med våldsutsatta samiska personer och i arbetet för att motverka våld mot samiska kvinnor.Närheten och lokalkännedomen i mindre samhällen beskrevs som styrkor, men samtidigt lyftes utmaningar såsom bristande anonymitet, resurser, kompetens och insatser. Svårigheten att vara anonym och långa geografiska avstånd till samhällets stöd beskrevs som extra påtagligt i det samiska samhället. Stark samhörighet i det samiska samhället beskrevs som positivt men också potentiellt problematiskt när det gäller den utsattas situation.Bristande tillit till myndigheter bland samer är en potentiell barriär för att nå och stötta våldsutsatta samiska kvinnor. Den bristande tilliten relaterades till både historiska och samtida erfarenheter av okunskap, förtryck, rasism och diskriminering.Deltagare beskrev ojämställdhet och tystnad kring våld mot kvinnor i det samiska samhället, och att våld mot kvinnor ofta hanteras internt. Tystnaden knöts till en lojalitet med samiska män, ett ideal att samiska kvinnor ska vara starka och klara sig själva, samt en vilja att skydda familjen och det samiska kollektivet.Ett centralt hinder för utsatta kvinnor att lämna en våldsam relation beskrevs vara rädslan för att uppbrottet skulle innebära förlust av deras samiska sammanhang. Ens samiska identitet beskrevs till exempel som nära knuten till platsen och markerna och därmed som svår att upprätthålla vid flytt till en annan ort för att söka skydd.Åtgärdsförslag till Sveriges regeringBaserat på de utvecklingsbehov som identifierats genom detta forskningsprojekt utmynnar rapporten i fem åtgärdsförslag riktade till den svenska regeringen.Uppdra åt Sametinget att följa upp och samordna arbetet för att motverka våld mot samiska kvinnor.Utforma en nationell policy för att motverka våld mot samiska kvinnor.Utveckla stödstrukturer för våldsutsatta samiska kvinnor och flickor.Genomför kortsiktiga utbildningsinsatser.Säkra långsiktig kunskapsproduktion och kompetenshöjning.
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| 9. |
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| 10. |
- Burman, Maria, et al.
(författare)
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Body Mass Index, Mini Nutritional Assessment, and their Association with Five-Year Mortality in Very Old People
- 2015
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Ingår i: The Journal of Nutrition, Health & Aging. - Paris : Springer. - 1279-7707 .- 1760-4788. ; 19:4, s. 461-467
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: to investigate the prevalence of malnutrition and the association between Body Mass Index (BMI), Mini Nutritional Assessment (MNA) and five-year mortality in a representative population of very old (>85 years) people.DESIGN: A prospective cohort study.SETTING: A population-based study of very old people in northern Sweden and western Finland, living in institutional care or in the community.PARTICIPANTS: Out of 1195 potential participants, 832 were included (mean age 90.2±4.6 years).MEASUREMENTS: Nutritional status was assessed using BMI and MNA and the association of those two variables with five-year mortality was analyzed.RESULTS: The mean BMI value for the whole population was 25.1±4.5 kg/m2, with no difference between genders (P=0.938). The mean MNA score was 22.5±4.6 for the whole sample, and it was lower for women than for men (P<0.001). Thirteen percent were malnourished (MNA<17) and 40.3% at risk of malnutrition (MNA 17-23.5) according to MNA. Also, 34.8% of those with a MNA score <17 still had a BMI value ≥22.2 kg/m2. A BMI value <22.2 kg/m2 and a MNA score<17 were associated with lower survival. The association with mortality seemed to be J-shaped for BMI, and linear for MNA.CONCLUSIONS: Malnutrition according to MNA was common, but a substantial portion of those with a low MNA score still had a high BMI value, and vice versa. The association with mortality appeared to be J-shaped for BMI, and linear for MNA. The MNA seems to be a good measurement of malnutrition in very old people, and BMI might be misleading and could underestimate the prevalence of malnutrition, especially in women.
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