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- Austeng, Dordi, et al.
(författare)
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Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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- Holmstrom, Gerd, et al.
(författare)
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Treatment for retinopathy of prematurity in Sweden 2008-2021: Reduced gestational age of treated infants and remaining differences in treatment type and recurrence rates between hospitals
- 2024
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Ingår i: ACTA OPHTHALMOLOGICA. - : John Wiley & Sons. - 1755-375X .- 1755-3768. ; 102:4, s. 401-408
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThis study aimed to investigate various aspects of treatment for retinopathy of prematurity (ROP) in Sweden over the past 14 years, nationally and at a hospital level.MethodsData on screening and treatment for ROP in infants born in Sweden from 2008 to 2021 were extracted from the national ROP register, SWEDROP. During this period, Swedish screening guidelines were reduced from gestational age (GA) < 32 weeks to <31 weeks in 2012 and to <30 weeks in 2020.ResultsAltogether, 10 959 infants were screened and 600 infants treated for ROP during the study period. Parallel to changed guidelines, the number of screened infants decreased (p < 0.000) and the incidence of ROP and frequency of treatment increased (p < 0.001), while both remained similar in infants with a GA below 30 weeks. Among treated infants, GA and BW were reduced over the years (p < 0.001). Laser treatment (85.2% of primary treatments) became less common and anti-VEGF injections (13.6%) became more common over time (p < 0.001). Altogether 16 eyes were treated with the encircling band and 13 with vitrectomy. The total frequency of retreatment (32.7% of treated eyes) remained similar over time but was more common after primary anti-VEGF injection (67.7%) than laser treatment (27.2%). There were differences between the seven university hospitals regarding type of treatment and number of retreatments (p < 0.001).ConclusionThe frequency of treatment and retreatment for ROP remained similar over time, but the type of treatment changed and anti-VEGF injections became more common. Differences between treating hospitals emphasize the importance of centralizing the most severe cases.
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- Andersson, Kristina, et al.
(författare)
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Challenges and opportunities with the EU Taxonomy Regulation– with focus on chemical safety and usage in complex products
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The use of Policy Lab processes has been growing in Sweden and other countries to accelerate the adaptation of regulations to emerging technologies. Policy Lab facilitates active collaboration between relevant authorities, companies, and stakeholders through interactive and iterative methods based on Design Thinking principles. This approach bridges the gap between the legislative domain responsible for developing regulatory frameworks and the innovative companies that create solutions for emerging markets using new technologies and opportunities. In our study, we applied Policy Lab processes to the EU Taxonomy Regulation to identify challenges and opportunities related to chemical safety and usage for manufacturers of complex products. The EU Taxonomy Regulation, along with its delegated acts, represent a serious effort to establish standardized sustainability reporting within EU. However, it is still in its early stages and lacks maturity. Moreover, certain ambiguities within the regulation currently prevent a comprehensive comparison of companies due to the development of other legislations. Addressing these gaps depends on the future development of, for example, REACH. Our conclusion is that the EU Taxonomy Regulation is part of a larger “movement” that reflects the policymakers’ intentions. This intention also includes increased data sharing at a significantly different level compared to current practices. In the long run, the shift will enable authorities to access the data and develop new legislations. Our specific focus was on the objective of pollution prevention and control regarding the use and presence of hazardous substances listed in Appendix C of the EU Taxonomy Regulation. According to Appendix C, activities must not lead to the manufacture, placing on the market or use of listed substances, whether on their own, in mixture or in articles. Regarding listed substances, reference is made to existing EU legislation that regulates hazardous substances within the EU. The most challenging aspect in Appendix C is point (g), which aims to identify substances, whether alone, in mixtures, or in articles, that meet the criteria set out in Article 57 of REACH but are not yet included in the Candidate list. Our workshops, interviews, and literature review confirmed that the main challenge in meeting the criteria of Appendix C, specifically point (g) is the need to enhance transparency and traceability throughout supply chains. Overcoming these challenges requires addressing barriers, such as the lack of a harmonized regulatory framework across the value chain, the need for faster identification and restriction of hazardous substances, and the reinforcement of stronger enforcement measures. The enabling of full declaration of the hazardous properties and functions of the substances, while considering the balance between information disclosure and protecting trade secrets, would reduce the need for extensive tracking of substance of very high concern along the value chain. To improve communication along the value chain and identify data gaps while protecting trade secrets, workshop participants have proposed the use of a user-friendly interface based on traffic light scenario. This interface would serve as a filter mechanism, allowing product manufacturers to establish specific criteria for material suppliers to respond to. The objective is to enhance communication, establish criteria, and effectively identify data gaps. While the SCIP database ensures accessibility of information on articles containing substances from the Candidate List above 0.1 w/w%, it is limited to hazardous substances on that list. This means that hazardous substances not listed in the Candidate List may not be covered by the database. The EU Commission has proposed the implementation of a digital product passport to enhance information sharing about products and their supply chain, including substances of concern. Our study is conducted under the Mistra SafeChem program, where screening tools for hazard and exposure assessment of substances are currently being developed. These tools aim to provide screening data for direct decision-making based on the Defined Approach (DA). These screening tools have the potential to contribute to filling data gaps during the early design phases of complex products, particularly when screening for multiple material alternatives.
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- Andriollo, Tito, et al.
(författare)
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Uncovering the local inelastic interactions during manufacture of ductile cast iron : How the substructure of the graphite particles can induce residual stress concentrations in the matrix
- 2018
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Ingår i: Journal of the mechanics and physics of solids. - : Elsevier. - 0022-5096 .- 1873-4782. ; 111, s. 333-357
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Tidskriftsartikel (refereegranskat)abstract
- Recent X-ray diffraction (XRD) measurements have revealed that plastic deformation and a residual elastic strain field can be present around the graphite particles in ductile cast iron after manufacturing, probably due to some local mismatch in thermal contraction. However, as only one component of the elastic strain tensor could be obtained from the XRD data, the shape and magnitude of the associated residual stress field have remained unknown. To compensate for this and to provide theoretical insight into this unexplored topic, a combined experimental-numerical approach is presented in this paper. First, a material equivalent to the ductile cast iron matrix is manufactured and subjected to dilatometric and high-temperature tensile tests. Subsequently, a two-scale hierarchical top-down model is devised, calibrated on the basis of the collected data and used to simulate the interaction between the graphite particles and the matrix during manufacturing of the industrial part considered in the XRD study. The model indicates that, besides the viscoplastic deformation of the matrix, the effect of the inelastic deformation of the graphite has to be considered to explain the magnitude of the XRD strain. Moreover, the model shows that the large elastic strain perturbations recorded with XRD close to the graphite–matrix interface are not artifacts due to e.g. sharp gradients in chemical composition, but correspond to residual stress concentrations induced by the conical sectors forming the internal structure of the graphite particles. In contrast to common belief, these results thus suggest that ductile cast iron parts cannot be considered, in general, as stress-free at the microstructural scale.
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| 7. |
- Ask, Samuel, et al.
(författare)
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The effect of psychosocial interventions for sexual health in patients with pelvic cancer : a systematic review and meta-analysis
- 2024
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Ingår i: Acta Oncologica. - : Medical Journals Sweden AB. - 0284-186X .- 1651-226X. ; 63:1, s. 230-239
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Forskningsöversikt (refereegranskat)abstract
- Aim: The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer.Methods: Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers.Results: Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01).Discussion: There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.
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| 8. |
- Austeng, Dordi, et al.
(författare)
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Natural history of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
- 2010
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Ingår i: Archives of ophthalmology (1960). - : American Medical Association. - 0003-9950. ; 128:10, s. 1289-1294
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the natural history of retinopathy of prematurity (ROP) in 506 extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. Methods: A national population–based study was performed in Sweden from April 1, 2004, to March 31, 2007. According to the study protocol, initial eye examinations were to be performed at postnatal week 5, and examinations were repeated until the retina was completely vascularized or until criteria for treatment were met. The examinations were to be performed weekly, enabling study of the course and severity of ROP. In infants without ROP or with mild ROP without progression during the latest examinations, further examinations were performed weekly or every other week from postmenstrual age 35 weeks. Results: During the study, 368 infants (72.7%) developed ROP. Postmenstrual age at onset of ROP was significantly related to severity of ROP, even when controlling for gestational age (ie, the earlier the onset of ROP, the higher the risk of developing severe ROP). Site of onset of ROP was significantly related to gestational age at birth. The risk of nasal onset was almost doubled for every week of decrease in gestational age at birth. Nasal onset was associated with severe ROP, even after adjusting for gestational age at birth. Conclusion: This population-based study confirms results of the Cryotherapy for Retinopathy of Prematurity study and shows new correlations regarding time and site of onset of ROP, both of which are associated with disease severity.
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| 9. |
- Austeng, Dordi, et al.
(författare)
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Regional differences in screening for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden : the EXPRESS study
- 2014
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Ingår i: Acta Ophthalmologica. - : Wiley-Blackwell. - 1755-375X .- 1755-3768. ; 92:4, s. 311-315
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary aim was to analyse regional incidences of retinopathy of prematurity (ROP) and frequencies of treatment and their relation to perinatal risk factors during a 3-year period. A secondary aim was to study adherence to the study screening protocol in the different regions.Methods: A population-based study of neonatal morbidity in extremely preterm infants in Sweden (EXPRESS) was performed during 2004-2007. Screening for ROP was to start at postnatal age 5weeks and to continue weekly until the retina was completely vascularized or until regression of ROP. Logistic regression analyses were used for evaluation of differences in incidence of Any ROP, ROP 3 or more and ROP Type 1 between the seven regions of the country.Results: The regional incidence of ROP varied between 54% and 92% for Any ROP, between 25% and 43% for ROP stage 3 or more and between 8% and 23% of infants with ROP Type 1, all of whom were treated. There was no significant difference between the regions regarding ROP Type 1, even when adjusting for known risk factors for ROP.Conclusion: The heterogeneity between the regions regarding the incidence of ROP was reduced with increasing severity of ROP, and there was no heterogeneity regarding frequency of treatment for ROP, which is the most important issue for the children. We cannot exclude observer bias regarding mild ROP and ROP stage 3 in this study.
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