| 1. |
- Alexandersson, Bjarki T., et al.
(författare)
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Diverticulosis is not associated with altered gut microbiota nor is it predictive of future diverticulitis : a population-based colonoscopy study
- 2023
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 58:10, s. 1131-1138
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Tidskriftsartikel (refereegranskat)abstract
- Background: The etiopathogenesis of diverticular disease is unknown.Objective: To compare the fecal and mucosa-associated microbiota between participants with and without diverticulosis and participants who later developed diverticulitis versus those that did not from a population-based study.Methods: The PopCol study, conducted in Stockholm, Sweden, invited a random sample of 3556 adults to participate, of which 745 underwent colonoscopy. Overall, 130 participants (17.5%) had diverticulosis. 16S rRNA gene sequencing was conducted on available sigmoid biopsy samples from 529 and fecal samples from 251 individuals. We identified individuals who subsequently developed acute diverticulitis up to 13 years after sample collection. In a case-control design matching for gender, age (+/−5 years), smoking and antibiotic exposure, we compared taxonomic composition, richness and diversity of the microbiota between participants with or without diverticulosis, and between participants who later developed acute diverticulitis versus those who did not.Results: No differences in microbiota richness or diversity were observed between participants with or without diverticulosis, nor for those who developed diverticulitis compared with those who did not. No bacterial taxa were significantly different between participants with diverticulosis compared with those without diverticulosis. Individuals who later developed acute diverticulitis (2.8%) had a higher abundance of genus Comamonas than those who did not (p = .027).Conclusions: In a population-based cohort study the only significant difference was that those who later develop diverticulitis had more abundance of genus Comamonas. The significance of Comamonas is unclear, suggesting a limited role for the gut microbiota in the etiopathogenesis of diverticular disease.
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| 2. |
- Alexandersson, Bjarki T., et al.
(författare)
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Inflammatory Bowel Disease Is not Linked to a Higher Rate of Adverse Events in Colonoscopy : a Nationwide Population-based Study in Sweden
- 2023
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Ingår i: Journal of Crohn's & Colitis. - 1873-9946 .- 1876-4479. ; 17:12, s. 1962-1967
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Tidskriftsartikel (refereegranskat)abstract
- Background and Aims: Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study.Methods: Data from 969 532 colonoscopies, including 164 012 [17%] on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding [T810] and perforation [T812] within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation.Results: Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding [odds ratio 0.66, p <0.001] and perforation [odds ratio 0.79, p <0.033] were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation.Conclusions: Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.
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| 3. |
- Hedin, Katarina, et al.
(författare)
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Initial symptoms and three months follow-up after acute COVID-19 in outpatients : An international prospective cohort study
- 2023
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Ingår i: European Journal of General Practice. - : Informa UK Limited. - 1381-4788 .- 1751-1402. ; 29:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with COVID-19. Objectives: To assess long-COVID and post-COVID (WHO definition: symptomatic at least 12 weeks), describe lingering symptoms, their impact on daily activities, and general practice visits and explore risk factors for symptom duration in outpatients. Methods: A prospective study of adult outpatients with confirmed SARS-CoV-2 infection and symptoms consistent with COVID-19 in 11 European countries, recruited during 2020 and 2021 from primary care and the community. Structured follow-up by phone interviews (symptom rating, symptom impact on daily activities and general practice visits) was performed at weeks 2, 4, 8, and 12 by study personnel. Data was analysed descriptively by using correlation matrixes and Cox regression. Results: Of 270 enrolled patients, 52% developed long-COVID and 32% post-COVID-syndrome. When only considering the presence of moderate or (very) severe symptoms at weeks 8 and 12, these percentages were 28% and 18%, respectively. Fatigue was the most often reported symptom during follow-up. The impact of lingering symptoms was most evident in sports and household activities. About half (53%) had at least one general practice contact during follow-up. Obese patients took twice as long to return to usual health (HR: 0.5, 95%CI: 0.3–0.8); no other risk profile could predict lingering symptoms. Conclusion: Long-COVID and post-COVID are also common in outpatients. In 32%, it takes more than 12 weeks to return to usual health.
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| 4. |
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| 5. |
- Kokkinou, Efthymia, et al.
(författare)
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CD45RA(+)CD62L(-) ILCs in human tissues represent a quiescent local reservoir for the generation of differentiated ILCs
- 2022
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Ingår i: Science immunology. - : AMER ASSOC ADVANCEMENT SCIENCE. - 2470-9468. ; 7:70
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Tidskriftsartikel (refereegranskat)abstract
- Innate lymphoid cells (ILCs) are highly plastic and predominantly mucosal tissue-resident cells that contribute to both homeostasis and inflammation depending on the microenvironment. The discovery of naive-like ILCs suggests an ILC differentiation process that is akin to naive T cell differentiation. Delineating the mechanisms that underlie ILC differentiation in tissues is crucial for understanding ILC biology in health and disease. Here, we showed that tonsillar ILCs expressing CD45RA lacked proliferative activity, indicative of cellular quiescence. CD62L distinguished two subsets of CD45RA(+) ILCs. CD45RA(+)CD62L(+) ILCs (CD62L(+) ILCs) resembled circulating naive ILCs because they lacked the transcriptional, metabolic, epigenetic, and cytokine production signatures of differentiated ILCs. CD45RA(+)CD62L(-) ILCs (CD62L(-) ILCs) were epigenetically similar to CD62L(+) ILCs but showed a transcriptional, metabolic, and cytokine production signature that was more akin to differentiated ILCs. CD62L(+) and CD62L(-) ILCs contained uni- and multipotent precursors of ILC1s/NK cells and ILC3s. Differentiation of CD62L(+) and CD62L(-) ILCs led to metabolic reprogramming including up-regulation of genes associated with glycolysis, which was needed for their effector functions after differentiation. CD62L(-) ILCs with preferential differentiation capacity toward IL-22-producing ILC3s accumulated in the inflamed mucosa of patients with inflammatory bowel disease. These data suggested distinct differentiation potential of CD62L(+) and CD62L(-) ILCs between tissue microenvironments and identified that manipulation of these cells is a possible approach to restore tissue-immune homeostasis.
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| 6. |
- Leijon, Anna, et al.
(författare)
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Content validity and feasibility of the BABITT questionnaire : assisted infant toilet training and bowel and bladder function in children
- 2024
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Functional bowel and bladder disorders are prevalent among children. The impact of assisted infant toilet training on the prevalence of childhood bowel and bladder disorders has not previously been investigated. As self-reported bowel and bladder symptoms can be unreliable, robust tools are essential to evaluate interventions. The ROME Foundation offers diagnostic criteria for functional gastrointestinal disorders, while the International Children's Continence Society (ICCS) provides definitions for functional bladder disorders. Our research group has launched the BABITT study, a two-armed intervention study to investigate whether assisted infant toilet training reduces the prevalence of functional bowel and bladder disorders.Aim: To construct a questionnaire, assessing bowel and bladder function in children introduced to infant toilet training and to evaluate content validity as well as feasibility.Methods: In three consecutive steps, a web-based questionnaire was developed. In Step 1, the questionnaire was outlined based on literature review and consensus panel discussions. In Step 2, the questionnaire was validated regarding relevance and simplicity by the content validity index (CVI) method. In Step 3, a pilot phase allowed for assessment of feasibility in the clinical study setting.Results: In Step 1, the Rome criteria and ICCS frameworks were selected for primary outcomes. After the final assessment round in Step 2, the i-CVI ranged from 0.88-1.00 in most items, in all domains, for both relevance and simplicity. Generally lower scores on simplicity emphasized revisions of this aspect of the items. In the pilot phase Step 3, respondent burden was analysed and feasibility assessed. The response rate at the 2-months questionnaire was 95% and acceptability of the intervention was satisfactory.Conclusion: A web- based questionnaire for assessment of parent-reported bladder and bowel function in children who are introduced to infant toilet training was developed. The questionnaire emerged as valid and feasible in its context.
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| 7. |
- Nilsson, Terese, 1982-, et al.
(författare)
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Bowel and bladder function in infant toilet training (BABITT) - protocol for a randomized, two-armed intervention study
- 2022
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the last decades, the average age for toilet training has increased in the western world. It is suggested that the postponed initiation of toilet training is a contributing factor to problems related to bowel and bladder control. Functional gastrointestinal and urinary tract disorders are prevalent in childhood, causing suffering in affected children and for their families, and consuming healthcare resources. To evaluate whether assisted infant toilet training can prevent functional gastrointestinal and urinary tract disorders in young children, we are conducting a randomized intervention study with a 4-year follow-up. Methods: This randomized two-armed intervention study will include 268 Swedish infants recruited at six child healthcare centers in Region Dalarna located in the central part of Sweden. The intervention entails parents being instructed and practicing assisted infant toilet training with their child. Children are randomized to start assisted infant toilet training at 0-2 months or at 9-11 months of age. The primary objective is to determine the efficacy of assisted infant toilet training initiated at 0-2 months on the prevalence of functional gastrointestinal disorders (defined as infant colic, infant dyschezia and/or functional constipation) up to the age of 9 months. Secondary objectives are to evaluate whether assisted toilet training initiated during the first year of life reduce the prevalence of functional gastrointestinal disorders (defined as functional constipation, gastrointestinal symptoms and/or stool toileting refusal) and urinary tract disorders (defined as bladder dysfunction and/or urinary tract infections) up to the age of 4 years. Furthermore, infant-to-mother attachment, parental stress, the toilet training process and overall parental experiences will be evaluated/explored. Discussion: This protocol article presents the rationale and design of a randomized two-armed intervention study that will determine the efficacy of assisted infant toilet training on functional gastrointestinal disorders up to the age of 9 months. Furthermore, the study will evaluate whether assisted infant toilet training during the first year of life can prevent functional gastrointestinal and urinary tract disorders in children up to 4 years of age. If effective, assisted infant toilet training could be recommended in child healthcare settings and new evidence-based guidelines on infant toilet training could be implemented.
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| 8. |
- Arntsberg, Louise, et al.
(författare)
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Management and documentation of pneumonia–a comparison of patients consulting primary care and emergency care
- 2024
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Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
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Tidskriftsartikel (refereegranskat)abstract
- Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia. Objective: To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. Design: Medical record review of vital signs, examination findings and severity of pneumonia. Setting: Primary and emergency care. Subjects: Two hundred and forty patients diagnosed with pneumonia. Main outcome measures: Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. Results: Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. Conclusions: Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.
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| 9. |
- Berglund, Anders, 1974-, et al.
(författare)
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THE PEDAGOGICAL DEVELOPERS INITIATIVE : SYSTEMATIC SHIFTS, SERENDIPITIES, AND SETBACKS
- 2017
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Ingår i: 13th International CDIO Conference in Calgary, Canada, June 18-22, 2017.
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Konferensbidrag (refereegranskat)abstract
- Pedagogical projects have often, at KTH Royal Institute of Technology, as well as elsewhere, been initiated and managed by individual enthusiasts rather than dedicated teams. This generally decreases the possibility of successful implementation of more ambitious ideas, e.g., changing educational programs, implementing the CDIO syllabus, or strengthening the pedagogical development of larger parts of the faculty. To enable wider and more effective change, KTH top management therefore launched a universityencompassing three-year project in 2014, in which a group of highly motivated teachers from all schools at KTH were appointed part-time pedagogical developers (PDs). The PDs were given the task of promoting pedagogical development and facilitate cooperation and knowledge exchange among faculty members, as described in two previous papers at CDIO conferences. From 2017, the outcomes of this project are supposed to be integrated parts of the KTH line organization. The project has led to numerous actions, which would have been difficult to set in motion unless given the freedom in time to explore and to develop into a collective effort rather than a myriad of individual “stand-alone” examples. By addressing key areas for pedagogical development, our group of dedicated faculty have tried to surpass the suboptimal "lock-in" of strict individual reasoning and to deal with surfaced questions and relevant issues in a broader collective manner. A major insight confirmed by the project and its many sub-projects has indeed been the fundamental importance of collegial discussions and the creation of processes that facilitate and support teacher cooperation. We have also, through discussions with faculty at KTH, confirmed the need for clearly defined, tangible incentives for teachers, motivating them to participate in pedagogical development activities, even if this means less time left for the traditional pathway to rewards within academia, i.e. research. In this paper, we chart changes that have occurred in the educational practices at KTH by describing and discussing the project’s focus on pedagogical development of faculty, actual execution of changes in the engineering educations, lessons learned along the way, and visions yet to be realised.
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| 10. |
- Berglund, Anders, et al.
(författare)
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The Pedagogical Developers Initiative – Changing Educational Practices and Strengthening CDIO skills
- 2015
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Ingår i: <em>Proceedings of the 11th International CDIO Conference, Chengdu, China, June 8-11 2015</em>.
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Konferensbidrag (refereegranskat)abstract
- This paper put emphasis on change agents within the universities and how local initiatives can be systematically approached and ramped up. Rooted in the challenges and constraints that have been addressed in past educational program initiatives, the case consists of specific focus areas to leverage impact. Universities continuously strives to provide the best conditions for an inspiring and prosperous learning environment, and to provide educational programs with teaching of excellent educational quality. KTH is no exception and therefore the university management has initiated a pedagogical program starting in 2014. One of the first thing initiated within the framework of this pedagogical program is the creation of a group of 24 pedagogical developers.The focus for the pedagogical developers is to facilitate the opportunities for KTHs faculty to work together and create consensus on educational development in different teaching teams. This paper presents the University's pedagogical developers' initiative as a whole and how this has been outlined in detail to reach specific redesign targets. The School of Industrial Engineering and Management pedagogical group consists of five practicing teachers that besides this new role also engage heavily in various courses of the School's departments. Since the pedagogical initiative is aligned with several important CDIO aspects, e.g. the learning environment, formats of formative feedback, assessment and examination there is also importance to reassure this in the existing Master level programs.At KTH the five-year comprehensive Master of Science in Engineering programs concern distinct vocational educations in which the CDIO aspects are very important. At the same time the programs has been divided in a basic level (B.Sc. in Engineering) of three years and a advanced level (M.Sc.) of two years. This has for instance made it harder to align the progression between first cycle level and second cycle level regarding for instance the CDIO efforts (e.g. oral and written communication, teamwork). This paper will therefore discuss and enhance how the pedagogical programme, we as pedagogical developers, can support and strengthen the initiation and implementation of the CDIO aspects in the education.
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