| 1. |
- Hellström, Ann, 1959, et al.
(författare)
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Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort
- 2022
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 12:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment. Setting Eye and paediatric clinics in Sweden. Participants Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007-2018. Cases were excluded if ophthalmological follow-up records could not be traced. Primary and secondary outcome measures Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records. Results The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI. Conclusions Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
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| 2. |
- Hellström, William, et al.
(författare)
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Low fraction of fetal haemoglobin is associated with retinopathy of prematurity in the very preterm infant
- 2022
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Ingår i: British Journal of Ophthalmology. - : BMJ. - 0007-1161 .- 1468-2079. ; 106, s. 970-974
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Tidskriftsartikel (refereegranskat)abstract
- Background: Blood loss and adult blood transfusions are common during the neonatal period in preterm infants. The objective of the study was to clarify if degree of loss of fetal haemoglobin (HbF) was associated with later retinopathy of prematurity (ROP). Methods: Retrospective observational cohort study. In total, 452 infants born <30 gestational weeks at a tertiary level neonatal intensive care unit in Sweden in 2009-2015 were included, 385 of whom had final ROP outcome. Mean fractions of HbF (%) during the first postnatal week were calculated from 11 861 arterial blood gas analyses. The relationship between fractions of HbF (%) and ROP was evaluated. Results: The mean (SD) gestational age (GA) at birth was 26.4 (1.8) weeks. In total, 104 (27 %) infants developed ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP, OR by a 10% increase 0.83 (95% CI: 0.71 to 0.97; p=0.019), following adjustment for GA at birth, small for GA and sex. Infants with HbF (%) in the lowest quartile had OR of 22.0 (95% CI: 8.1 to 59.2; p<0.001) for ROP development compared with those in the highest quartile. The predictive ability (area under the curve) of HbF (%) in the full model during the first week was 0.849 for ROP. Conclusions: Early low fraction of HbF is independently associated with abnormal retinal neurovascular development in the very preterm infant. The potential benefit of minimising blood loss on development of ROP will be investigated in a multicenter randomised trial (NCT04239690). © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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| 3. |
- Anderson, Lotta, et al.
(författare)
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Universitetsutbildares upplevda kompetens för att undervisa studenter i behov av pedagogiska anpassningar i sin studiesituation
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- I konventionen om rättigheter för personer med funktionsnedsättning (2008/09:8) fastslås att personer med funktionsnedsättning ges nödvändigt stöd inom det allmänna utbildningssystemet för att underlätta deras ändamålsenliga utbildning. Även i Malmö högskolas policy dokument (2016-2018) inkluderas ett förhållningssätt som ska byggas på mångfald. I studenters rättigheter och skyldigheter (Mah, 2011) eftersträvas en arbetsmiljö som stödjer studenters lärande och främjar deras fysiska och psykiska hälsa. I studenthälsans undersökning ”Hur mår våra studenter” (Mah, 2015) pekar resultaten på att en eller flera funktionsnedsättningar skulle kunna vara en riskfaktor i vissa avseenden. Vidare att funktionsnedsättning minskar sannolikheten för att uppleva sig klara av sina studier och ökar sannolikheten för att uppleva sig trakasserad och diskriminerad. Larsdotter Frid och Krantz (2012) visar att det är problematiskt att tillgängliggöra den konkreta undervisningssituationen för studenter med funktionsnedsättning. Syfte: Med detta som bakgrund finns det ett behov av att kartlägga och identifiera universitetsutbildares upplevda och uttryckta behov av kompetens avseende t.ex pedagogiska anpassningar av studenters studiesituation. Metod: En webenkät skickades ut till 2 fakulteter vid ett lärosäte (A) och en vid en fakultet vid ett annat lärosäte (B). Totalt svarade 131 (svarsfrekvens). Pågående analyser kvalitativa såväl som kvantitativa (SPSS). Resultat: Det finns tendenser som uppvisar en skillnad i upplevd kompetens mellan lärosäten där en större andel anställda vid lärosäte B uppger både högre och lägre kompetens jämfört med anställda vid lärosäte A. Anställda vid lärosäte A tenderar att uppge ett större kompetensutvecklingsbehov när det gäller studenter i behov av anpassningar av studiesituationen. När den egna kompetensen skattas högt tenderar behovet av kompetensutveckling också skattas högt (73%) bland anställda vid lärosäte A medan anställda vid lärosäte B skattar lågt kompetensutvecklingsbehov (39 %). Anställda vid båda lärosätena uppger god kännedom om styrdokumenten. När det gäller kompetens om olika funktionsnedsättningar skattar anställda vid lärosäte B högre kompetens än anställda vid lärosäte A oavsett funktionsnedsättning. Störst skillnader ses i kompetens gällande neuropsykiatriska funktionsnedsättningar samt hörsel-, och synnedsättningar. Diskussion/implikationer: Tolkning av materialet pågår.
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| 4. |
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| 5. |
- Bergquist, Henrik, et al.
(författare)
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Structured Diagnostic and Treatment Approach Versus the Usual Primary Care Approach in Patients With Gastroesophageal Reflux Disease : A Cluster-randomized Multicenter Study
- 2013
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Ingår i: Journal of Clinical Gastroenterology. - 0192-0790 .- 1539-2031. ; 47:7, s. E65-E73
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Tidskriftsartikel (refereegranskat)abstract
- Goals: To compare the clinical outcomes of gastroesophageal reflux disease (GERD) patients treated with an implemented new structured pathway (NSP) or according to existing local clinical practices [old clinical pathway (OCP)]. Background: GERD is a major challenge at the primary care level. Study: Primary care centers (n=24) were cluster randomized to handle patients suffering from symptoms suggestive of GERD according to the NSP (n=97) or the OCP (n=134). In the NSP, the GerdQ questionnaire score was used both for diagnosis and management including treatment. We used validated questionnaires to evaluate disease symptoms, quality of life, and costs at inclusion and at follow-up 2 to 6 months later. Results: On the basis of the Reflux Disease Questionnaire, 56% of the patients treated with the NSP reported total symptom relief at the follow-up compared with 33% in the OCP group (P=0.0013). The reflux symptoms after treatment affected daily activities to a lesser extent in the patients in the NSP group compared with the OCP group (10% vs. 13%, respectively, P=0.01). The utility score of the EuroQoL-5D questionnaire improved more in the NSP group than in the OCP group (0.05 vs. 0.02, respectively, P<0.001). The patients in the NSP group had an approximately 50% lower average total cost for GERD-related health care resources compared with the OCP group [301 Swedish Kronor (SEK) vs. 588 SEK, respectively, NS]. Conclusions: The management of GERD patients in primary care centers using a structured clinical pathway and the results of the GerdQ improves the clinical outcome compared with prevailing local routines (NCT00842387).
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| 6. |
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| 7. |
- Dellve, Lotta, 1965, et al.
(författare)
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Del 2. Tystnad om problem på arbetsplatsen
- 2024
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Ingår i: Tystnadskultur? Två studier av Göteborgs stads organisation. Rapport 167. ISSN 1401-7199. - Göteborg : Göteborgs universitet.
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Studien visar att det inte finns ett slags tystnad, men att tystnad förekommer i olika grad och på olika sätt inom Göteborgs stads förvaltningar. Genom intervjuer med fokusgrupper och enskilda framträder brister vad gäller återkoppling och förändring av de problem som påpekas, vilket i sin tur tenderar leda till att medarbetare i lägre grad artikulerar och rapporterar problem, risker och missförhållanden. Ett annat problem som framkommer i intervjuerna är skönmåleri, det vill säga att ledningen bitvis söker förmedla en mer positiv och problemfri bild av verksamheten än vad medarbetare upplever är fallet. Lotta Dellve och Gustaf Kastberg Weichselberger (red.)
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| 8. |
- Fernstål, Lotta, et al.
(författare)
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Inledning : Om Sverige i tiden
- 2015
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Ingår i: Sverige i tiden. - Stockholm : Historiska museets förlag. - 9789189176591 ; , s. 9-15
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Healy, Katie, et al.
(författare)
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Salivary IgG to SARS-CoV-2 indicates seroconversion and correlates to serum neutralization in mRNA-vaccinated immunocompromised individuals
- 2022
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Ingår i: Med. - : Cell Press. - 2666-6359 .- 2666-6340. ; 3:2, s. 137-153.e3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immunocompromised individuals are highly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Whether vaccine-induced immunity in these individuals involves oral cavity, a primary site of infection, is presently unknown.Methods: Immunocompromised patients (n = 404) and healthy controls (n = 82) participated in a prospective clinical trial (NCT04780659) encompassing two doses of the mRNA BNT162b2 vaccine. Primary immunodeficiency (PID), secondary immunodeficiencies caused by human immunodeficiency virus (HIV) infection, allogeneic hematopoietic stem cell transplantation (HSCT)/chimeric antigen receptor T cell therapy (CAR-T), solid organ transplantation (SOT), and chronic lymphocytic leukemia (CLL) patients were included. Salivary and serum immunoglobulin G (IgG) reactivities to SARS-CoV-2 spike were measured by multiplex bead-based assays and Elecsys anti-SARS-CoV-2 S assay.Findings: IgG responses to SARS-CoV-2 spike antigens in saliva in HIV and HSCT/CAR-T groups were comparable to those of healthy controls after vaccination. The PID, SOT, and CLL patients had weaker responses, influenced mainly by disease parameters or immunosuppressants. Salivary responses correlated remarkably well with specific IgG titers and the neutralizing capacity in serum. Receiver operating characteristic curve analysis for the predictive power of salivary IgG yielded area under the curve (AUC) = 0.95 and positive predictive value (PPV) = 90.7% for the entire cohort after vaccination.Conclusions: Saliva conveys vaccine responses induced by mRNA BNT162b2. The predictive power of salivary spike IgG makes it highly suitable for screening vulnerable groups for revaccination.
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| 10. |
- Hellström, Ann, 1959, et al.
(författare)
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Association of Docosahexaenoic Acid and Arachidonic Acid Serum Levels With Retinopathy of Prematurity in Preterm Infants
- 2021
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Ingår i: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 4:10
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Supplementing preterm infants with long-chain polyunsaturated fatty acids (LC-PUFA) has been inconsistent in reducing the severity and incidence of retinopathy of prematurity (ROP). Furthermore, few studies have measured the long-term serum lipid levels after supplementation. OBJECTIVE To assess whether ROP severity is associated with serum levels of LC-PUFA, especially docosahexaenoic acid (DHA) and arachidonic acid (AA), during the first 28 postnatal days. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed the Mega Donna Mega study, a randomized clinical trial that provided enteral fatty acid supplementation at 3 neonatal intensive care units in Sweden. Infants included in this cohort study were born at a gestational age of less than 28 weeks between December 20, 2016, and August 6, 2019. MAIN OUTCOMES AND MEASURES Severity of ROP was classified as no ROP, mild or moderate ROP (stage 1-2), or severe ROP (stage 3 and type 1). Serum phospholipid fatty acids were measured through gas chromatography-mass spectrometry. Ordinal logistic regression, with a description of unadjusted odds ratio (OR) as well as gestational age- and birth weight-adjusted ORs and 95% CIs, was used. Areas under the curve were used to calculate mean daily levels of fatty acids during postnatal days 1 to 28. Blood samples were obtained at the postnatal ages of 1, 3, 7, 14, and 28 days. RESULTS A total of 175 infants were included in analysis. Of these infants, 99 were boys (56.6%); the median (IQR) gestational age was 25 weeks 5 days (24 weeks 3 days to 26 weeks 6 days), and the median (IQR) birth weight was 785 (650-945) grams. A higher DHA proportion was seen in infants with no ROP compared with those with mild or moderate ROP or severe ROP (OR per 0.5-molar percentage increase, 0.49 [95% CI, 0.36-0.68]; gestational age- and birth weight-adjusted OR, 0.66 [95% CI, 0.46-0.93]). The corresponding adjusted OR for AA levels per 1-molar percentage increase was 0.83 (95% CI, 0.66-1.05). The association between DHA levels and ROP severity appeared only in infants with sufficient AA levels, suggesting that a mean daily minimum level of 7.8 to 8.3 molar percentage of AA was necessary for a detectable association between DHA level and less severe ROP. CONCLUSIONS AND RELEVANCE This cohort study found that higher mean daily serum levels of DHA during the first 28 postnatal days were associated with less severe ROP even after adjustment for known risk factors, but only in infants with sufficiently high AA levels. Further studies are needed to identify LC-PUFA supplementation strategies that may prevent ROP and other morbidities.
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