| 1. |
- Haghighi, Mona, et al.
(författare)
-
A Comparison of Rule-based Analysis with Regression Methods in Understanding the Risk Factors for Study Withdrawal in a Pediatric Study
- 2016
-
Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
-
Tidskriftsartikel (refereegranskat)abstract
- Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions.
|
|
| 2. |
- Bäck, Jennie, 1981-
(författare)
-
The Plasma Contact System : New Functional Insights from a Hemostatic and Thrombotic Perspective
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The physiological role of the plasma contact system still remains a partial enigma. The aim of the presented work was to expand our understanding of the plasma contact system, focusing on its physiological activation and function, principally from a hemostatic perspective. It also explored contact system activation under pathological conditions. We found that when human platelets become activated in blood, plasma proteins of the contact system bind to platelets and initiate contact activation. The platelet-triggered contact activation contributed to clot formation by shortening the clotting time and enhancing clot stability. We demonstrated that the regulation of contact activation elicited by activated platelets differed from the previously described contact activation elicited by negatively charged material surfaces. Platelet-triggered contact activation and activation propelled by clotting blood were found to be regulated by antithrombin, whereas material-induced activation was regulated by C1 inhibitor. We also showed that the fibrin fibers that are formed during the clot process further enhance and propagate the contact activation initially induced by activated platelets. Fibrin not only activated factor XII but also seemed to increase the affinity of antithrombin for the proteases of the contact system, leading to the generation of contact enzyme-antithrombin complexes during clot formation. To determine whether the contact system might be involved in the inflammation and vascular disease associated with systemic lupus erythematosus (SLE), we analyzed plasma samples from SLE patients. These patients were found to have altered levels of contact enzyme-serpin complexes, supporting the concept that the contact system may be involved in the pathophysiology of SLE. The contact enzyme-antithrombin complexes were clearly linked to platelet activation in vivo. Altered levels of both FXIIa-antithrombin and FXIIa-C1 inhibitor were found to be correlated with previous vascular disease and may therefore be potential biomarkers for assessing the risk of thrombotic events in SLE patients. These findings add to our knowledge of how the plasma contact system is activated and functions in vivo and will help us to understand the role of the contact system, not only in hemostasis but also in vascular disease and thrombotic conditions.
|
|
| 3. |
- Frennesson, Christina, et al.
(författare)
-
Significant improvements in near vision, reading speed, central visual field and related quality of life after ranibizumab treatment of wet age-related macular degeneration
- 2010
-
Ingår i: ACTA OPHTHALMOLOGICA. - : Blackwell Publishing Ltd. - 1755-375X .- 1755-3768. ; 88:4, s. 420-425
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). Methods: The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69-95 years). In addition to a full ophthalmological examination - including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography - near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. Results: Mean BCVA increased from 62 +/- 11 to 66 +/- 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 +/- 5 to 6 +/- 3 points (33%; p = 0.0006) and reading speed increased from 59 +/- 40 to 85 +/- 50 words/min (44%; p andlt; 0.0001). The mean deviation from normal of the visual field improved from -9 +/- 7 to -6 +/- 5 dB (33%; p andlt; 0.0001). Quality of life improved for distance activities from 54 +/- 28 to 63 +/- 28 points (17%; p andlt; 0.0001) but significantly (p = 0.024) more for near activities, from 49 +/- 26 to 63 +/- 26 points (29%; p andlt; 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. Conclusion: The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously.
|
|
| 4. |
- Kristensen, Ingrid, et al.
(författare)
-
Assessment of volume segmentation in radiotherapy of adolescents; a treatment planning study by the Swedish Workgroup for Paediatric Radiotherapy
- 2014
-
Ingår i: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 53:1, s. 126-133
-
Tidskriftsartikel (refereegranskat)abstract
- Background and purpose. The variability in target delineation for similar cases between centres treating paediatric and adolescent patients, and the apparent differences in interpretation of radiotherapy guidelines in the treatment protocols encouraged us to perform a dummy-run study as a part of our quality assurance work. The aim was to identify and quantify differences in the segmentation of target volumes and organs at risk (OARs) and to analyse the treatment plans and dose distributions. Materials and methods. Four patient cases were selected: Wilms tumour, Hodgkins disease, rhabdomyosarcoma of the prostate and chordoma of the skull base. The five participating centres received the same patient-related material. They introduced the cases in their treatment planning system, delineated target volumes and OARs and created treatment plans. Dose-volume histograms were retrieved for relevant structures and volumes and dose metrics were derived and compared, e. g. target volumes and their concordance, dose homogeneity index (HI), treated and irradiated volumes, remaining volume at risk and relevant V x and D x values. Results. We found significant differences in target segmentation in the majority of the cases. The planning target volumes (PTVs) varied two-to four-fold and conformity indices were in the range of 0.3-0.6. This resulted in large variations in dose distributions to OARs as well as in treated and irradiated volumes even though the treatment plans showed good conformity to the PTVs. Potential reasons for the differences in target delineation were analysed. Conclusion. Considerations of the growing child and difficulties in interpretation of the radiotherapy information in the treatment protocols were identified as reasons for the variation. As a result, clarified translated detailed radiotherapy guidelines for paediatric/adolescent patients have been recognised as a way to reduce this variation.
|
|
| 5. |
- Ljungberg, Ulla K, et al.
(författare)
-
The interaction between different domains of staphylococcal protein A and human polyclonal IgG, IgA, IgM and F(ab')2: separation of affinity from specificity
- 1993
-
Ingår i: Molecular Immunology. - 1872-9142. ; 30:14, s. 1279-1285
-
Tidskriftsartikel (refereegranskat)abstract
- Binding properties of staphylococcal protein A (SpA) to different human immunoglobulins have been investigated. In this analysis, intact SpA as well as SpA-derived fragments containing one to five IgG-binding domains of different compositions, were used. The affinity binding constants of the different proteins to human polyclonal IgG, IgA, IgM and F(ab')2-fragments as well as their binding capacity to the immunoglobulin molecules were determined. The results show that although all the proteins bound to IgG, regardless of size or composition, the binding strength differed significantly. Proteins containing five domains have a stronger affinity for IgG than those containing one or two. There were no marked differences in binding strength between different domains. However, the binding ability to IgA and IgM showed a marked difference between the various SpA-derived proteins of different compositions. This discrepancy was correlated to differences in their relative binding properties to isolated F(ab')2-fragments of IgG. Hence, we conclude that the binding affinity is mainly affected by the number of domains, whereas the binding specificity is to a large extent determined by which domains are selected.
|
|
| 6. |
- Nilsson, Ulla L, et al.
(författare)
-
Patients with AMD and a large absolute central scotoma can be trained successfully to use eccentric viewing, as demonstrated in a scanning laser ophthalmoscope
- 2003
-
Ingår i: Vision Research. - 0042-6989 .- 1878-5646. ; 43:16, s. 1777-1787
-
Tidskriftsartikel (refereegranskat)abstract
- Twenty patients with age-related macular degeneration, an absolute central scotoma and a mean visual acuity of 0.04 (20/475) were studied. A scanning laser ophthalmoscope (SLO) was used for microperimetry and determination of preferred retinal locus, often located to the left of the retinal lesion (corresponding to a location to the left of the visual field scotoma), which is considered unfavorable for reading. All 20 patients were trained to use a new and more favorable retinal locus for reading, above (or occasionally below) the retinal lesion (corresponding to a location below or above the visual field scotoma), first by reading scrolled text under simultaneous fixation monitoring and instruction in the SLO and then by reading printed text, using high magnification (mean 14.3╫). For the 18 patients who learned to use eccentric viewing, reading speed with adequate magnification prior to training was 9.0▒5.8 words/min. With training (mean 5.2 hours), it increased significantly (p<0.001) to 68.3▒19.4 words per min. Training of eccentric reading has thus proved to be very successful.
|
|
| 7. |
- Olsson, Marie, et al.
(författare)
-
Utveckling av näringsladdad broccolisoppa
- 2020
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Hälsosamma livsmedel är idag något som många konsumenter prioriterar när de väljer mat till måltider, och intresset är också stort för färdiga rätter. Detta projekt initierades för att öka intresset för konsumtion av broccoli, en produkt med bra hälsovärde beaktat innehåll av näringsämnen och andra nyttiga ämnen, och att möta konsumenters efterfrågan på hälsosamma färdiga rätter. Broccolisorten ’Beneforte’ valdes eftersom denna sort har en dokumenterad högre halt av glukorafanin*. Det pågår kliniska studier i Europa om hälsoeffekter av broccolisorter med hög halt av detta ämne och dessa skulle kunna leda till att ett hälsopåstående blir godkänt av EFSA, den europeiska livssäkerhetsmyndigheten. Produkter baserade på denna broccolisort skulle då kunna marknadsföras med hälsopåståendet.
|
|
| 8. |
- Orwelius, Lotti, et al.
(författare)
-
The Swedish RAND-36 Health Survey - reliability and responsiveness assessed in patient populations using Svensson's method for paired ordinal data.
- 2018
-
Ingår i: Journal of Patient-Reported Outcomes. - : Springer Publishing Company. - 2509-8020. ; 2:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The Short Form 36-Item Survey is one of the most commonly used instruments for assessing health-related quality of life. Two identical versions of the original instrument are currently available: the public domain, license free RAND-36 and the commercial SF-36.RAND-36 is not available in Swedish. The purpose of this study was threefold: to translate and culturally adapt the RAND-36 into Swedish; to evaluate its reliability and responsiveness using Svensson's method for paired ordered categorical data; and to assess the usability of an electronic version of the questionnaire.The translation process included forward and backward translations and reconciliation. Test-retest reliability was examined during a period of two-weeks in 84 patients undergoing dialysis for chronic kidney disease. Responsiveness was examined in 97 patients before and 2 months after a cardiac rehabilitation program. Usability tests and cognitive debriefing of the electronic questionnaire were carried out with 18 patients.Results: The Swedish translation of the RAND-36 was conceptually equivalent to the English version. Test-retest reliability was supported by non-significant relative position (RP) values among dialysis patients for all RAND-36 subscales (range - 0.02 to 0.10; all confidence intervals (CI) included zero). Responsiveness was demonstrated by significant improvements in RP values among cardiac rehabilitation patients for all subscales (range 0.22-0.36; lower limits of all CI > 0.1) except two subscales (General health, RP -0.02; CI -0.13 to 0.10; and Role functioning/emotional, RP 0.03; CI -0.09 to 0.16). In cardiac rehabilitation patients, sizable individual variation (RV > 0.2) was also shown for the Pain, Energy/fatigue and Social functioning subscales.The electronic version of RAND-36 was found easy and intuitive to use.Conclusions: Our results provide evidence supporting the reliability and responsiveness of the newly translated Swedish RAND-36 and the user-friendliness of the electronic version. Svensson's method for paired ordinal data was able to characterize not only the direction and size of differences among the patients' responses at different time points but also variations in response patterns within groups. The method is therefore, besides being suitable for ordinal data, also an important and novel tool for gaining insights into patients' response patterns to treatment or interventions, thus informing individualized care.
|
|
| 9. |
- Ahlström, Monica, et al.
(författare)
-
Ett praktiskt försök : nationell prioriteringsmodell tillämpad i Landstinget i Kalmar Län
- 2008
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Idag finns en nationell modell för hur öppna vertikala prioriteringar kan genomföras. Den är resultatet av de samlade erfarenheterna av att omsätta riksdagens riktlinjer för prioriteringar i praktiskt prioriteringsarbete. Modellen är framtagen av Socialstyrelsen, PrioriteringsCentrum samt flera vårdförbund och landsting gemensamt. Också FSA och LSR har ställt sig bakom den. Fram tills nu har det dock saknats praktisk erfarenhet av att tillämpa modellen inom arbetsterapi och sjukgymnastik. Men sedan drygt två år tillbaka har de båda rehabiliteringsenheterna Samrehab och Rehab Söder i Landstinget i Kalmar län med stöd av PrioriteringsCentrum bedrivit ett prioriteringsarbete i enlighet med modellen. Det är deras erfarenheter denna rapport handlar om.Prioriteringsarbetet har med nära stöd av verksamhetsledningarna letts av en projektgrupp bestående av arbetsterapeuter och sjukgymnaster från de båda enheterna som fungerat som handledare, ansvarat för metodutveckling och utbildning samt kontinuerligt utvärderat arbetet. Själva tillämpningen av den nationella modellen har ett antal utvecklingsgrupper inom olika specialistområden stått för. De har valt ut och rangordnat tillstånd och olika åtgärder som de ansett angelägna att ta fram prioriteringar för.Ett av syftena med prioriteringsarbetet i Samrehab och Rehab Söder var att få till stånd länsövergripande prioriteringar inom vissa verksamheter och/eller för vissa sjukdomstillstånd för en mer likvärdig vård. Idag finns elva sådana prioriteringsordningar presenterade på landstingets intranät och ytterligare ett tiotal är under bearbetning. Utöver vinsterna med det förbättrade samarbetet mellan länsdelarna har alltså den interna öppenheten i prioriteringarna ökat. Alla anställda kan lätt få fram prioriteringsordningarna via basenheternas hemsidor när man behöver det. Andra vinster av prioriteringsarbetet är att kännedomen och kunskapen om riksdagens riktlinjer för prioriteringar har ökat, att en större del av basenheternas verksamhet idag är faktabaserad än innan prioriteringsarbetet startade samt att den kliniska erfarenheten har tillvaratagits och dokumenterats på ett mer systematiskt sätt än tidigare. Det har dessutom skett en utveckling av den nationella modellen som har blivit mer konkret vad det gäller svårighetsgrad och nytta. En majoritet av deltagarna i utvecklingsgrupperna har haft en positiv inställning till att arbeta med prioriteringar utifrån modellen och upplever också att de erhållit ett språk som gör det möjligt att kommunicera prioriteringar med politiker och landstingsledning.I rapporten presenteras också de frågor kring modellens olika steg som dykt upp under arbetets gång. Tre frågor har dominerat; syftet med prioriteringsarbetet, tolkningen av modellen samt dokumentationen av prioriteringsarbetet. Syftet har inte alltid upplevts som helt klart och sambandet mellan prioriteringsarbetet och annat kvalitetsarbete som t ex framtagande av behandlingsriktlinjer har varit otydligt. När det gäller tolkningen av modellen har t ex graderingen av svårighetsgrad och patientnytta gett upphov till frustration. Också den skriftliga presentationen av prioriteringsordningarna har stundtals upplevts som krånglig och svår att förmedla till övriga medarbetare på ett användbart sätt.Alla de åtgärder som projektgruppen vidtagit för att underlätta de svårigheter som dykt upp delar de här med sig av i rapporten. Likaså pekar de ut viktiga förutsättningar för ett prioriteringsarbete (som t ex tid, kompetens, kontinuitet och legitima deltagare). Syftet med att pröva om den nationella modellen för öppna vertikala prioriteringar är användbar i Samrehabs och Rehab Söders prioriteringsarbete är uppnådd och det har inte framkommit något som ger anledning att ifrågasätta modellens grundstruktur. Förslag har dock givits bl a avseende bedömning av svårighetsgrad och patientnytta för att ytterligare underlätta tillämpningen.Nu planerar enheterna att gå vidare med sitt prioriteringsarbete, dels genom att fortsätta att ta fram behandlingsriktlinjer som kombineras med prioriteringar men också genom att ytterligare utveckla prioriteringsstödet för de enskilda medarbetarna i deras dagliga patientarbete. Om andra verksamheter i Sverige följer efter detta exempel från Kalmar län med att öppet redovisa hur de hanterar prioriteringar i sin verksamhet kommer ytterligare nya erfarenheter att hjälpa metodutvecklingen på traven.
|
|
| 10. |
- Alfvén, Gösta, et al.
(författare)
-
Smärta hos barn och ungdomar ett eftersatt område
- 2012
-
Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 109:19, s. 966-967
-
Tidskriftsartikel (refereegranskat)abstract
- En enkät om organisationen av omhändertagandet av akut och återkommande smärta hos barn har besvarats av 26 av landets 34 barnkliniker. Drygt en tredjedel av dessa har organiserad verksamhet för akut och/eller långvarig smärta. En femtedel av barnklinikerna har en verksamhet som är specifikt organiserad för barn. Flertalet av dessa mottagningar är bemannade med deltidsarbetande personal. Endast två läkare och fyra sjuksköterskor arbetar heltid med dessa frågor, och antalet psykologer och sjukgymnaster är begränsat.
|
|
