| 1. |
- Brorsen Smidt, Thomas, et al.
(författare)
-
Expanding gendered sites of resistance in the neoliberal academy
- 2018
-
Ingår i: European Journal of Higher Education. - : Informa UK Limited. - 2156-8235 .- 2156-8243. ; 10, s. 115-129
-
Tidskriftsartikel (refereegranskat)abstract
- Neoliberalism has long found its way into higher education and made life hard for academics in a number of different ways. The literature that maps out resistance to this development focuses on the gendered aspects of labour-economic issues. However, this study argues that the zeitgeist of neoliberalism has gendered consequences far beyond market-based categories. Thirty-two in-depth interviews with current and former academics at the University of Iceland are analysed. They demonstrate that the conceptualization of gendered sites of resistance is in need of expansion. Academics still resist traditional neoliberal derivatives by (1) exiting the institution (2) complaining through official channels (3) refusing to take part in certain activities or (4) by directly confronting their superiors. However, these resistance strategies harbour new gendered sites of resistance related to tokenism, bullying and gendered harassment.
|
|
| 2. |
- Einarsdottir, Margret
(författare)
-
Glucocorticoid-induced adrenal insufficiency
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Glucocorticoids (GCs) are effective in treating many diseases and are widely used. However, glucocorticoid treatment can down-regulate the hypothalamic-pituitary-adrenal axis and lead to glucocorticoid-induced adrenal insufficiency. This thesis aimed to investigate the prevalence of oral GC prescriptions, related mortality, and the prevalence of GC-induced adrenal insufficiency during topical GC treatment and during intermittent high-dose GC therapy. Methods: Individuals, living in Västra Götaland county, with prescriptions of prednisolone ≥5 mg/day (or equivalent dose of other GCs) for ≥21 days during 2007–2014 were identified in The Swedish Prescribed Drug Register. By using a personal identification number, patients were cross-linked with four other Swedish registries to collect information on indication for GC treatment, comorbidities, and cause-of death. To study if death was related to GC-induced adrenal insufficiency, medical records from 300 patients who died from sepsis were investigated. Twenty-seven patients with oral lichen planus receiving topical GC were studied and in a prospective study 10 adults with lymphoma receiving intermittent, high-dose GC were included. Results: During 2007–2014, 14.1% of inhabitants (n=223 211) in Western Sweden received prescriptions for oral GCs at doses associated with risk of developing GC-induced adrenal insufficiency. GC users had a 2-fold overall risk of dying compared to controls (adjusted hazard ratio 2.1, 95% confidence interval 2.0–2.1). Under- and undiagnosed GC-induced adrenal insufficiency possibly contributed to the death in 47 of 300 (16%) patients considered to have died from sepsis. Approximately 20% of patients receiving chronic topical GCs in the oral cavity had GC-induced adrenal insufficiency. None of the patients receiving intermittent high-dose GC therapy had GC-induced adrenal insufficiency. Conclusion: Oral GC treatment is common and can lead to GC-induced adrenal insufficiency and increased mortality. GC-induced adrenal insufficiency is underdiagnosed and awareness is essential for the diagnosis and treatment.
|
|
| 3. |
- Einarsdottir, Margret, et al.
(författare)
-
High Mortality Rate in Oral Glucocorticoid Users: A Population-Based Matched Cohort Study
- 2022
-
Ingår i: Frontiers in Endocrinology. - : Frontiers Media SA. - 1664-2392. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- ObjectiveThe aim of the study was to investigate all-cause and disease-specific mortality in a large population-based cohort of oral glucocorticoid (GC) users. MethodsThis was a retrospective, matched cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. The cause of death was obtained from the Swedish Cause-of-Death Registry. Patients receiving prednisolone >= 5 mg/day (or equivalent dose of other GC) for >= 21 days between 2007-2014 were included. For each patient, one control subject matched for age and sex was included. The study period was divided into 3-month periods and patients were divided into groups according to a defined daily dose (DDD) of GC used per day. The groups were: Non-users (0 DDD per day), low-dose users (>0 but <0.5 DDD per day), medium-dose users (0.5-1.5 DDD per day) and high-dose users (>1.5 DDD per day). Hazard ratios (HRs), unadjusted and adjusted for age, sex and comorbidities, were calculated using a time-dependent Cox proportional hazard model. ResultsCases (n=223 211) had significantly higher all-cause mortality compared to controls (HR adjusted for age, sex and comorbidities 2.08, 95% confidence interval 2.04 to 2.13). After dividing the cases into subgroups, adjusted HR was 1.31 (1.28 to 1.34) in non-users, 3.64 (3.51 to 3.77) in low-dose users, 5.43 (5.27 to 5.60) in medium-dose users and, 5.12 (4.84 to 5.42) in high-dose users. The highest adjusted hazard ratio was observed in high-dose users for deaths from sepsis 6.71 (5.12 to 8.81) and pulmonary embolism 7.83 (5.71 to 10.74). ConclusionOral GC users have an increased mortality rate compared to the background population, even after adjustment for comorbidities. High-dose users have an increased risk of dying from sepsis, and pulmonary embolism compared to controls. Whether the relationship between GC exposure and the excess mortality is causal remains to be elucidated.
|
|
| 4. |
- Einarsdottir, Margret, et al.
(författare)
-
High prescription rate of oral glucocorticoids in children and adults: a retrospective cohort study from Western Sweden.
- 2020
-
Ingår i: Clinical endocrinology. - : Wiley. - 1365-2265 .- 0300-0664. ; 92:1, s. 21-28
-
Tidskriftsartikel (refereegranskat)abstract
- Glucocorticoids (GCs) are a cornerstone in treating various common and uncommon diseases. The aim of this study was to estimate the prevalence of GC use in terms of doses associated with risk of tertiary adrenal insufficiency in adults and children, and treatment indications.This was a retrospective cohort study. Information on dispensed prescriptions was obtained from the Swedish Prescribed Drug Register. Patients with prescriptions of prednisolone (or equivalent dose of other GCs) ≥5 mg daily for ≥21 days between 2007-2014 were included. Information on concurrent diseases was obtained from the Swedish National Patient Register and the Västra Götaland Regional Healthcare Database.Of 1,585,335 inhabitants in Västra Götaland County, 223,211 were included in the study (women 55.6%). Mean age was 48 ± 24 years. Period prevalence of oral GC use during the 8-year study period was 14.1%. The highest prevalence (27.4%) was in men aged 80-89 years and lowest (7.5%) in men 10-19 years of age. The period prevalence in children 0-9 years of age was 10.6%. COPD and asthma were the most common indications for treatment (17.2%) followed by allergy (12.5%), and malignant neoplasms (11.5%). Allergy was the most frequent indication (20.5%) in children and adolescents.Between 2007-2014, every seventh inhabitant in western Sweden received a GC prescription at doses associated with risk of developing tertiary adrenal insufficiency. These findings illustrate the importance of awareness of the potential development of tertiary adrenal insufficiency in both pediatric and adult patients.
|
|
| 5. |
- Einarsdottir, Margret, et al.
(författare)
-
Impact of chronic oral glucocorticoid treatment on mortality in patients with COVID-19: analysis of a population-based cohort.
- 2024
-
Ingår i: BMJ open. - 2044-6055. ; 14:3
-
Tidskriftsartikel (refereegranskat)abstract
- While glucocorticoid (GC) treatment initiated for COVID-19 reduces mortality, it is unclear whether GC treatment prior to COVID-19 affects mortality. Long-term GC use raises infection and thromboembolic risks. We investigated if patients with oral GC use prior to COVID-19 had increased mortality overall and by selected causes.Population-based observational cohort study.Population-based register data in Sweden.All patients infected with COVID-19 in Sweden from January 2020 to November 2021 (n=1 200 153).Any prior oral GC use was defined as ≥1GC prescription during 12 months before index. High exposure was defined as ≥2GC prescriptions with a cumulative prednisolone dose ≥750mg or equivalent during 6 months before index. GC users were compared with COVID-19 patients who had not received GCs within 12 months before index. We used Cox proportional hazard models and 1:2 propensity score matching to estimate HRs and 95% CIs, controlling for the same confounders in all analyses.3378 deaths occurred in subjects with any prior GC exposure (n=48806; 6.9%) and 14850 among non-exposed (n=1 151 347; 1.3%). Both high (HR 1.98, 95% CI 1.87 to 2.09) and any exposure (1.58, 1.52 to 1.65) to GCs were associated with overall death. Deaths from pulmonary embolism, sepsis and COVID-19 were associated with high GC exposure and, similarly but weaker, with any exposure. High exposure to GCs was associated with increased deaths caused by stroke and myocardial infarction.Patients on oral GC treatment prior to COVID-19 have increased mortality, particularly from pulmonary embolism, sepsis and COVID-19.
|
|
| 6. |
- Einarsdottir, Margret Jona, et al.
(författare)
-
Intermittent high-dose glucocorticoid treatment does not cause adrenal insufficiency in patients with diffuse large B-cell lymphoma - a prospective study.
- 2023
-
Ingår i: Acta haematologica. - 1421-9662.
-
Tidskriftsartikel (refereegranskat)abstract
- Glucocorticoid (GC) treatment suppresses the hypothalamic-pituitary-adrenal axis and can cause GC-induced adrenal insufficiency. In this study we investigated the incidence of GC-induced adrenal insufficiency in patients receiving intermittent short-term high-dose oral GC treatment for newly diagnosed diffuse large B-cell lymphoma. Cosyntropin stimulation test was used to assess adrenal function at study entry (baseline), at 2 months (before the 5th cycle), and 6 months from baseline (3 months after the last cycle). Ten patients were included (40% women). Mean age was 61 years. The mean (range) plasma morning cortisol was 407 (320-530) nmol/L at baseline, 373 (260-610) nmol/L at 2 months, and 372 (230-520) nmol/L 6 months from baseline. All patients had normal response to cosyntropin stimulation at baseline as well as 2 and 6 months from baseline. Thus, none of the patients developed biochemically verified adrenal insufficiency. Therefore, short-term high-dose GC therapy, a commonly used adjuvant treatment in patients with malignant hematological diseases, does not seem to down-regulate the hypothalamic-pituitary-adrenal axis.
|
|
| 7. |
- Einarsdottir, Margret, et al.
(författare)
-
Topical clobetasol treatment for oral lichen planus can cause adrenal insufficiency.
- 2024
-
Ingår i: Oral diseases. - 1601-0825. ; 30:3, s. 1304-1312
-
Tidskriftsartikel (refereegranskat)abstract
- Glucocorticoids suppress the hypothalamic-pituitary-adrenal axis, which may lead to glucocorticoid-induced adrenal insufficiency. The study aimed to investigate the prevalence of this state in patients with oral lichen planus treated with topical clobetasol propionate.In this cross-sectional study, 30 patients with oral lichen planus receiving long-term (>6weeks) clobetasol propionate gel 0.025% were invited to participate. Adrenal function was assessed by measuring morning plasma cortisol after a 48-h withdrawal of clobetasol treatment. In patients with plasma cortisol <280nmol/L, a cosyntropin stimulation test was performed.Twenty-seven patients were included. Twenty-one (78%) patients presented with plasma cortisol ≥280nmol/L (range 280-570nmol/L), and six (22%) <280nmol/L (range 13-260nmol/L). Five of these six patients underwent cosyntropin stimulation that revealed severe adrenal insufficiency in two patients (cortisol peak 150nmol/L and 210nmol/L) and mild adrenal insufficiency in three patients (cortisol peak 350-388nmol/L).In this study, approximately 20% of patients receiving intermittent topical glucocorticoid treatment for oral lichen planus had glucocorticoid-induced adrenal insufficiency. It is essential for clinicians to be aware of this risk and to inform patients about the potential need for glucocorticoid stress doses during intercurrent illness.
|
|
| 8. |
- Einarsdottir, Margret, et al.
(författare)
-
Undiagnosed adrenal insufficiency as a cause of premature death in glucocorticoid users.
- 2024
-
Ingår i: Endocrine connections. - 2049-3614. ; 13:4
-
Tidskriftsartikel (refereegranskat)abstract
- It is unknown whether glucocorticoid (GC)-induced adrenal insufficiency may cause premature mortality in GC users. We conducted a retrospective cohort study to investigate if undiagnosed and undertreated GC-induced adrenal insufficiency is a contributor to premature death in GC users.Information on dispensed prescriptions in West Sweden from 2007 to 2014 was obtained from the Swedish Prescribed Drug Register. Cause of death was collected from the Swedish Cause of Death Register. Of 223,211 patients who received oral GC prescriptions, 665 died from sepsis within 6 months of their last prescription. Three hundred of these patients who had died in hospital were randomly selected for further investigation. Medical records were initially reviewed by one investigator. Furthermore, two additional investigators reviewed the medical records of patients whose deaths were suspected to be caused by GC-induced adrenal insufficiency.Of 300 patients (121 females, 40%), 212 (75%) were prescribed GC treatment at admission. The mean age was 76 ± 11 years (range 30-99). Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a probable contributor to death by at least two investigators in 11 (3.7%) patients. In five of these 11 cases, long-term GC therapy was abruptly discontinued during hospitalization. Undiagnosed or undertreated GC-induced adrenal insufficiency was considered a possible contributing factor to death in a further 36 (12%) patients.GC-induced adrenal insufficiency is an important contributor to premature death in GC users. Awareness of the disorder during intercurrent illness and following cessation of GC treatment is essential.
|
|
| 9. |
- Johansson, Ann, et al.
(författare)
-
Interstitial photodynamic therapy for primary prostate cancer incorporating realtime treatment dosimetry
- 2007
-
Ingår i: Progress in Biomedical Optics and Imaging - Proceedings of SPIE. - : SPIE. - 1605-7422 .- 1042-4687. ; 6427, s. 4270-4270
-
Konferensbidrag (refereegranskat)abstract
- Photodynamic therapy (PDT) for the treatment of prostate cancer has been demonstrated to be a safe treatment option capable of inducing tissue necrosis and decrease in prostate specific antigen (PSA). Research groups report on large variations in treatment response, possibly due to biological variations in tissue composition and shortterm response to the therapeutic irradiation. Within our group, an instrument for interstitial PDT on prostate tissue that incorporates realtime treatment feedback is being developed. The treatment protocol consists of two parts. The first part incorporates the pre-treatment plan with ultrasound investigations, providing the geometry for the prostate gland and surrounding risk organs, an iterative random-search algorithm to determine near-optimal fiber positions within the reconstructed geometry and a Block-Cimmino optimization algorithm for predicting individual fiber irradiation times. During the second part, the therapeutic light delivery is combined with measurements of the light transmission signals between the optical fibers, thus monitoring the tissue effective attenuation coefficient by means of spatially resolved spectroscopy. These data are then used as input for repeated runs of the Block-Cimmino optimization algorithm. Thus, the irradiation times for individual fibers are updated throughout the treatment in order to compensate for the influence of changes in tissue composition on the light distribution at the therapeutic wavelength.
|
|
| 10. |
- Rasmusson, Elisabeth, et al.
(författare)
-
Low-dose rate brachytherapy with I-125 seeds has an excellent 5-year outcome with few side effects in patients with low-risk prostate cancer
- 2016
-
Ingår i: Acta Oncologica. - Oxon : Taylor & Francis. - 0284-186X .- 1651-226X. ; 55:8, s. 1016-1021
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Low-dose rate brachytherapy (LDR-BT) has been used in Sweden for more than a decade for treatment of low-risk prostate cancer. This study presents the outcome for patients treated with LDR-BT at a single institution with focus on the association between dose and biochemical failure-free survival (BFFS).Methods: In total 195 patients were treated with LDR-BT between 2004 and 2008. The patients were followed systematically for side effects for at least one year. PSA levels were followed regularly from three months and for at least five years. Outcome was analyzed in relation to clinical variables at baseline and to radiotherapy data.Results: Kaplan-Meier estimated BFFS at five years was 95.7%. Dose to the prostate in terms of D-90% was significantly associated with BFFS [HR 0.90 (95%CI 0.83-0.96), p=0.002].Conclusion: Out data confirmed that absorbed dose is a predictive factor for BFFS for low-risk patients without androgen deprivation therapy. With our treatment routines and dosimetry, a D-90% in the range of 170-180Gy gives excellent outcomes with acceptable toxicity for patients with low-risk prostate cancer.
|
|
