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- Franzen-Röhl, Elisabeth, et al.
(författare)
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Increased cell-mediated immune responses in patients with recurrent herpes simplex virus type 2 meningitis.
- 2011
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Ingår i: Clinical and vaccine immunology : CVI. - 1556-679X. ; 18:4, s. 655-60
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Tidskriftsartikel (refereegranskat)abstract
- The clinical picture of herpes simplex virus type 2 (HSV-2) infection includes genital blisters and less frequently meningitis, and some individuals suffer from recurrent episodes of these manifestations. We hypothesized that adaptive and/or innate immune functional deficiencies may be a major contributing factor in susceptibility to recurrent HSV-2 meningitis. Ten patients with recurrent HSV-2 meningitis were studied during clinical remission. For comparison, 10 patients with recurrent genital HSV infections as well as 21 HSV-seropositive and 19 HSV-seronegative healthy blood donors were included. HSV-specific T cell blasting and cytokine secretion were evaluated in whole blood cultures. HSV-2-induced NK cell gamma interferon production, dendritic cell Toll-like receptor (TLR) expression, and TLR agonist-induced alpha interferon secretion were analyzed. Patients with recurrent HSV-2 meningitis had elevated T cell blasting and Th1 and Th2 cytokine production in response to HSV antigens compared to those of patients with recurrent genital infections. A somewhat increased NK cell response, increased dendritic cell expression of TLR3 and -9, and increased TLR-induced alpha interferon responses were also noted. Contrary to our expectation, recurrent HSV-2 meningitis patients have increased HSV-specific adaptive and innate immune responses, raising the possibility of immune-mediated pathology in the development of recurrent HSV2 meningitis.
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- Lagrelius, Anna-Maria
(författare)
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Doktorns dilemman : Att välja läkemedel med standarder som styrverktyg: effekter och konsekvenser
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I millennieskiftets Sverige blev oron för läkemedelskostnaderna och den allt snabbare kostnadsökningen ett allt mer akut styrproblem för Staten. Kostnaderna ökade belastningen på statskassan, samtidigt som Staten vare sig kunde kontrollera vad läkarna skrev ut eller hade legitimitet nog att beordra dem att skriva ut färre och billigare läkemedel. Med kostnadsökningarna och läkarnas autonomi stod Staten inför både kostnads- och styrdilemman. Gjordes ingenting skulle Staten komma att ses som svag och ekonomiskt oansvarig. Samtidigt skulle varje sparpaket kunna uppfattas som nedskärningar i välfärden och leda till impopularitet med bestraffning i nästkommande val. Med direkta styråtgärder för vad läkarna borde göra, i synnerhet av ekonomiska skäl, skulle Staten kunna förlora både anseende och legitimitet som huvudman för Hälso- och sjukvården. Med dessa utmaningar, scenarier och dilemman i vågskålarna, valde Staten att pröva ett nytt styrverktyg och lagstifta om standarder för lämpliga läkemedel för olika åkommor, som läkarna i respektive landsting borde följa. Standarder, organisatoriska handlingsregler som samtidigt är frivilliga att följa och tolka. Styrning genom frivillighet. Kan ett frivilligt styrverktyg som standarder leda till effekter på läkarnas val av läkemedel? Och om det är standarderna som bäst kan förklara den önskade förändringen - vilka mekanismer som specifikt har med standarderna att göra, kan förklara effekten? Den här studien visar att standarderna hade effekt, att ledningskontrollen ökade på bekostnad av läkarnas autonomi samt att den kanske främsta mekanismen bakom standardernas effekt var att standarderna aktiverade dilemman, dissonanser som läkarna på olika sätt försökte hantera och reducera.
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- Lagrelius, Maria
(författare)
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Contact allergy in Swedish adolescents : results from the BAMSE cohort study
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Contact allergy affects about 20-25% of adults in the general population, but it is not completely clear how common it is among children and adolescents. Contact allergy is caused by skin contact to sensitizing substances. Knowledge about the relation between skin exposures, related skin symptoms and contact allergy among children and adolescents is limited. Atopic dermatitis (AD) and filaggrin gene (FLG) mutations have been suggested as risk factors for contact allergy, though this needs to be further explored. Aims: To determine the prevalence of contact allergy at age 16 in a population-based cohort. To determine the prevalence of self-reported skin exposures and skin symptoms at age 16, and assess their association with contact allergy. To assess the association between AD at preschool age and contact allergy at age 16, and the association between FLG mutations and contact allergy, self-reported hand eczema and dry skin at 16 years. Methods: We used data from a Swedish population-based birth cohort (BAMSE), followed from birth to age 16. Adolescents answered questions about skin exposures and skin symptoms at age 16 years. Their parents completed questionnaires at baseline, when the child was 2 months old and then regarding AD at 1, 2, 4, 8, 12 and 16 years. Information about contact allergy was collected by patch test (n=2,285), and FLG mutation status was determined from blood samples at age 16. Results: Contact allergy prevalence was 15.3% among adolescents and higher among girls than boys (17.0% versus 13.4%, p=0.018). Nickel was the most frequent cause of contact allergy (7.5%), followed by fragrance mix I (FM I) (2.1%). Nickel allergy was more common among girls (9.8% versus 4.9%, p<0.001). Many adolescents reported piercing (55.4%) and hair dyeing (50.1%), and girls frequently reported related skin symptoms. Reports of piercing and itchy rash from metal items were associated with increased OR for nickel allergy (adjusted OR 1.77, 95% CI 1.04-3.03 and adjusted OR 2.25, 95% CI 1.57-3.23, respectively). Reported itchy rash from use of makeup or personal hygiene products was associated with increased OR for fragrance allergy (adjusted OR 2.11, 95% CI 1.02-4.35). AD at preschool age was associated with fragrance allergy (adjusted OR 3.10, 95%CI 1.66-5.80), but not with nickel allergy. This association was present among individuals with AD at preschool age with IgE sensitization, but not among individuals with AD at preschool age without. FLG mutations appeared unassociated with contact allergy and hand eczema, but were associated with dry skin at age 16 (adjusted OR 1.50, 95% CI 1.02-2.15). Conclusions: Contact allergy prevalence is high among adolescents in Sweden. Nickel allergy is the most common contact allergy, affecting more girls than boys. Piercing and hair dyeing were reported by the majority at 16 years. More girls than boys reported skin symptoms related to skin exposures. AD at preschool age may be associated with contact allergy to fragrance at 16 years. No association was observed between AD at preschool age and nickel allergy. FLG mutations were associated with dry skin, but not with contact allergy or hand eczema at age 16 years.
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- Vilela, Libe, et al.
(författare)
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Water, soap, and hand‐disinfectant exposure during the COVID‐19 pandemic and self‐reported hand eczema in frontline workers: A cross‐sectional study
- 2024
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Ingår i: Contact Dermatitis. - Stockholm : IVL Svenska Miljöinstitutet AB. - 0105-1873 .- 1600-0536.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDuring the COVID-19 pandemic, increased hand hygiene practices were implemented. Impaired skin health on the hands among healthcare workers has been reported previously. Knowledge of how worker in other occupations have been affected is scarce.ObjectivesTo investigate self-reported hand water-, and soap exposure and use of hand disinfectants, and hand eczema (HE) in frontline workers outside the hospital setting and in IT personnel during the COVID-19 pandemic.MethodsIn this cross-sectional study, a questionnaire was sent out between 1 March and 30 April in 2021, to 6060 randomly selected individuals representing six occupational groups.ResultsA significant increase in water exposure and hand disinfectant use was shown: Relative position (RP) 19; 95% confidence interval (CI) 0.17–0.21 and RP = 0.38: 95% CI 0.36–0.41, respectively. Newly debuted HE was reported by 7.4% of the population, more frequently among frontline workers (8.6%) compared to IT personnel (4.9%).ConclusionsWater and soap exposure and use of hand disinfectants increased during COVID-19 pandemic, which may increase the risk of hand eczema. This highlights the importance of communication and implementation of preventive measures to protect the skin barrier also in occupations other than healthcare workers.
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