| 1. |
- Bengtsson, Björn, et al.
(författare)
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High occurrence of mecC-MRSA in wild hedgehogs (Erinaceus europaeus) in Sweden
- 2017
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Ingår i: Veterinary Microbiology. - : Elsevier. - 0378-1135 .- 1873-2542. ; 207, s. 103-107
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the occurrence of mecC-MRSA in wild hedgehogs (Erinaceus europaeus) in Sweden and characterized the obtained isolates. Samples from 55 hedgehogs from five counties of Sweden were cultivated selectively for MRSA and putative isolates were confirmed by real-time PCR detecting mecA, mecC, nuc and PVL genes. mecC-MRSA was confirmed in 35 (64%) animals from three geographically separated counties. Confirmed isolates were spa-typed and tested for antimicrobial susceptibility by broth microdilution. Eight different spa-types were identified (t843, t978, t3391, t9111, t10751, t10893, t11015, t15312) of which t843 (49%) was the most common. The spa-types t843, t3391 and t978 were found in isolates from two counties. The study shows that mecC-MRSA is common in wild hedgehogs in two counties of Sweden but occurs in hedgehogs also in other parts of the country. Our findings suggest that hedgehogs could be a reservoir for mecC-MRSA. In addition, similar spa-types of isolates from hedgehogs and isolates previously described in domesticated animals and in humans indicates transfer between these populations.
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| 2. |
- Buckley, Sarah, et al.
(författare)
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Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum : a systematic review with implications for the function of the oxytocinergic system
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding.AIM: To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems.METHODS: Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables.RESULTS: Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus.CONCLUSIONS: Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.
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| 3. |
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| 4. |
- Ekström, Eva-Charlotte, et al.
(författare)
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Effects of prenatal micronutrient and early food supplementation on metabolic status of the offspring at 4.5 years of age. The MINIMat randomized trial in rural Bangladesh.
- 2016
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 45:5, s. 1656-1667
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fetal nutritional insults may alter the later metabolic phenotype. We hypothesized that early timing of prenatal food supplementation and multiple micronutrient supplementation (MMS) would favourably influence childhood metabolic phenotype.METHODS: Pregnant women recruited 1 January to 31 December 2002 in Matlab, Bangladesh, were randomized into supplementation with capsules of either 30 mg of iron and 400 μg of folic acid, 60 mg of iron and 400 μg of folic acid, or MMS containing a daily allowance of 15 micronutrients, and randomized to food supplementation (608 kcal) either with early invitation (9 weeks' gestation) or usual invitation (at 20 weeks). Their children (n = 1667) were followed up at 4.5 years with assessment of biomarkers of lipid and glucose metabolism, inflammation and oxidative stress.RESULTS: Children in the group with early timing of food supplementation had lower cholesterol (difference -0.079 mmol/l, 95% confidence interval (CI) -0.156; -0.003), low-density lipoprotein (LDL) (difference -0.068 mmol/l, 95% CI -0.126; -0.011) and ApoB levels (difference -0.017 g/l, 95% CL -0.033; -0.001). MMS supplementation resulted in lower high-density lipoprotein (HDL) (difference -0.028 mmol/l, 95% CL -0.053; -0.002), lower glucose (difference -0.099 mmol/l, 95% CL -0.179; -0.019) and lower insulin-like growth factor 1 (IGF-1) (difference on log scale -0.141 µg/l, 95% CL -0.254; -0.028) than 60 mg iron and 400 μg folic acid. There were no effects on markers of inflammation or oxidative stress.CONCLUSIONS: Findings suggest that in a population where malnutrition is prevalent, nutrition interventions during pregnancy may modify the metabolic phenotype in the young child that could have consequences for later chronic disease risks.
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| 5. |
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| 6. |
- Ekström, Magnus, et al.
(författare)
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A nationwide structure for valid Long-Term oxygen therapy : 29-Year prospective data in Sweden
- 2017
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Ingår i: International Journal of COPD. - 1176-9106. ; 12, s. 3159-3169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term oxygen therapy (LTOT) improves prognosis in COPD with severe hypoxemia. However, adherence to criteria for eligibility and quality of LTOT is often insufficient and varies between countries. The aim of this study was to evaluate a national structure for prescription and management of LTOT over three decades in Sweden. Methods: The study was a prospective, population-based study of 23,909 patients on LTOT from 1987 to 2015 in the Swedish National Register of Respiratory Failure (Swedevox). We assessed the prevalence, incidence, and structure of LTOT; completeness of registration in Swedevox; and validity of prescription and management of LTOT in Sweden according to seven published quality indicators. Results: LTOT was prescribed by 48 respiratory or medicine units and managed mainly by specialized oxygen nurses. Swedevox had a stable completeness of 85% of patients starting LTOT since 1987. The national incidence of LTOT increased from 3.9 to 14.7/100,000 inhabitants over the time period. In 2015, 2,596 patients had ongoing therapeutic LTOT in the registry, a national prevalence of 31.6/100,000. Adherence to prescription recommendations and fulfillment of quality criteria was stable or improved over time. Of patients starting LTOT in 2015, 88% had severe hypoxemia (partial pressure of arterial oxygen [PaO2] < 7.4 kPa) and 97% had any degree of hypoxemia (PaO2 < 8.0 kPa); 98% were prescribed oxygen ≥15 hours/day or more; 76% had both stationary and mobile oxygen equipment; 75% had a mean PaO2> 8.0 kPa breathing oxygen; and 98% were non-smokers. Conclusion: We present a structure for prescription, management, and follow-up of LTOT. The national registry effectively monitored adherence to prescription recommendations and most likely contributed to improved quality of care.
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| 7. |
- Ekström, Magnus, et al.
(författare)
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Comorbidity and Sex-Related Differences in Mortality in Oxygen-Dependent Chronic Obstructive Pulmonary Disease
- 2012
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is not known why survival differs between men and women in oxygen-dependent chronic obstructive pulmonary disease (COPD). The present study evaluates differences in comorbidity between men and women, and tests the hypothesis that comorbidity contributes to sex-related differences in mortality in oxygen-dependent COPD. Methods: National prospective study of patients aged 50 years or older, starting long-term oxygen therapy (LTOT) for COPD in Sweden between 1992 and 2008. Comorbidities were obtained from the Swedish Hospital Discharge Register. Sex-related differences in comorbidity were estimated using logistic regression, adjusting for age, smoking status and year of inclusion. The effect of comorbidity on overall mortality and the interaction between comorbidity and sex were evaluated using Cox regression, adjusting for age, sex, Pa-O2 breathing air, FEV1, smoking history and year of inclusion. Results: In total, 8,712 patients (55% women) were included and 6,729 patients died during the study period. No patient was lost to follow-up. Compared with women, men had significantly more arrhythmia, cancer, ischemic heart disease and renal failure, and less hypertension, mental disorders, osteoporosis and rheumatoid arthritis (P<0.05 for all odds ratios). Comorbidity was an independent predictor of mortality, and the effect was similar for the sexes. Women had lower mortality, which remained unchanged even after adjusting for comorbidity; hazard ratio 0.73 (95% confidence interval, 0.68-0.77; P<0.001). Conclusions: Comorbidity is different in men and women, but does not explain the sex-related difference in mortality in oxygen-dependent COPD.
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| 8. |
- Ekström, Magnus, et al.
(författare)
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Effects of Cardiovascular Drugs on Mortality in Severe Chronic Obstructive Pulmonary Disease : A Time-Dependent Analysis
- 2013
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Ingår i: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 187:7, s. 715-720
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Tidskriftsartikel (refereegranskat)abstract
- Rationale: Cardiovascular drugs may improve survival in chronic obstructive pulmonary disease (COPD). However, previous studies did not account for major sources of bias, and drug effects have not been evaluated in severe COPD.Objectives: To estimate the time-dependent effects of cardiovascular drugs on survival in oxygen-dependent COPD, accounting for immortal and immeasurable time bias.Methods: Prospective national study of patients starting long-term oxygen therapy for COPD in Sweden between 1 October 2005 and 30 June 2009. Effects on mortality were estimated using extended Cox regression adjusted for age, sex, PaO2, PaCO2, World Health Organization performance status, body mass index, comorbidity, and concomitant medications. Immortal and immeasurable time bias was addressed by analyzing all medications as time-dependent variables and accounting for hospitalized time, respectively.Measurements and Main Results: Time-dependent effects of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, antiplatelet drugs, β-blockers, and statins on all-cause mortality were measured. Of the 2,249 included patients, 1,129 (50%) died under observation. No patient was lost to follow-up. The adjusted time-dependent model was compatible with reduced mortality for antiplatelet drugs (hazard ratio [HR], 0.86; 95% CI, 0.75–0.99; P = 0.030) and trends for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 0.90; 95% CI, 0.79–1.04; P = 0.166) and statins (HR, 0.86; 95% CI, 0.72–1.03; P = 0.105), whereas β-blockers increased mortality (HR, 1.19; 95% CI, 1.04–1.37; P = 0.010).Conclusions: This study supports that antiplatelet drugs improve survival and β-blockers decrease survival in oxygen-dependent COPD.
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| 9. |
- Ekström, Magnus, et al.
(författare)
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Increased relative mortality in women with severe oxygen-dependent COPD
- 2010
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Ingår i: Chest. - : American College of Chest Physicians. - 0012-3692 .- 1931-3543. ; 137:1, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although the incidence of COPD is rapidly increasing in women, knowledge is lacking concerning differences in relative mortality and causes of death in women compared with men. We aimed to analyze differences in relative mortality and cause-specific mortality between men and women on long-term oxygen therapy (LTOT) for COPD. Methods: Patients starting LTOT for COPD in Sweden between January 1, 1987, and December 31, 2004, were prospectively followed until termination of LTOT or through December 31, 2004. Causes of death according to the Swedish National Causes of Death Register were compared between the study group and the general Swedish population matched for age and sex, with the relative mortality expressed as standardized mortality rates (SMRs). Results: A total of 7,646 patients, 4,033 women and 3,613 men, were followed for a median of 1.7 years (range 0-18.0). No patient was lost to follow-up. A total of 5,448 patients, 2,745 women and 2,703 men, died. Women had a higher SMR than men: overall mortality, SMR 12.0 (95%, 11.6-12.5) vs 7.4 (95% CI, 7.1-7.6); for respiratory disease, SMR 127.9 (95% CI, 122.4-133.6) vs 66.0 (95% CI, 63.1-69.0); cancer, SMR 3.5 (95% CI, 3.0-3.9) vs 2.2 (95% CI, 1.9-2.5); and cardiovascular disease, SMR 3.7 (95% CI, 3.3-4.1) vs 2.5 (95% CI, 2.3-2.7), respectively. Conclusions: In severe COPD treated with long-term oxygen, women have higher relative mortality than men both overall and for respiratory disease, as well as for cardiovascular disease and cancer.
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| 10. |
- Fogde, Marinette, 1977-
(författare)
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The work of job seeking : studies on career advice for white-collar workers
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In contemporary working life, training and guidance on how to write a curriculum vitae (CV) or succeed at an interview are fundamental features of job seeking. This kind of training and guidance, which emphasizes communicative skills and performance, entails ideals and norms in the process of becoming employed. This study focuses in particular on guidance by a Swedish white-collar union and how students at universities negotiate career advice. Central questions are: What kind of characteristics, values and moral obligations are constructed as ideals for job seekers? How is the governing of job seekers linked to the social and political context? How is governing and self-governing constructed in the interaction between career coaches and students? How is the subject position as a job seeker negotiated? These questions are explored in four separate but interrelated articles. The empirical material includes analyses of texts, fieldwork data and interviews. The theoretical framework is inspired by the Foucauldian concept of governmentality and the concept of discursive positioning.Findings indicate that job seeking is constructed in terms of self-marketing of individuals and the moral qualities are being active and ambitious in terms of job searching as well as taking responsibility in working on and displaying one’s personality. The study also points to ambiguities in career advice and obstacles to working on the self to become “sellable”. The career discourse is interspersed with other discourses (as national identity and gender) and other subject positions in these discourses. The technology of self-esteem is a technology for mobilizing the students in this context. In terms of “self-work”, this study shows how the students and future white-collar workers negotiate and work on their self to become employable. In addition, it is argued that career advice must be understood in relation to ideals of employability, flexibility and self-help discourses.
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