| 1. |
- Bosi, A., et al.
(författare)
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Absolute and Relative Risks of Kidney Outcomes Associated With Lithium vs Valproate Use in Sweden
- 2023
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 6:7
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Tidskriftsartikel (refereegranskat)abstract
- Importance Among patients with bipolar disorder, discordant findings have been published on the nephrotoxic effects of lithium therapy. Objective To quantify absolute and relative risks of chronic kidney disease (CKD) progression and acute kidney injury (AKI) in people who initiated lithium compared with valproate therapy and to investigate the association between cumulative use and elevated lithium levels and kidney outcomes. Design, Setting, and Participants This cohort study had a new-user active-comparator design and used inverse probability of treatment weights to minimize confounding. Included patients initiated therapy with lithium or valproate from January 1, 2007, to December 31, 2018, and had a median follow-up of 4.5 years (IQR, 1.9-8.0 years). Data analysis began in September 2021, using routine health care data from the period 2006 to 2019 from the Stockholm Creatinine Measurements project, a recurrent health care use cohort of all adult residents in Stockholm, Sweden. Exposures New use of lithium vs new use of valproate and high (>1.0 mmol/L) vs low serum lithium levels. Main Outcomes and Measures Progression of CKD (composite of >30% decrease relative to baseline estimated glomerular filtration rate [eGFR] and kidney failure), AKI (by diagnosis or transient creatinine elevations), new albuminuria, and annual eGFR decrease. Outcomes by attained lithium levels were also compared in lithium users. Results The study included 10946 people (median [IQR] age, 45 [32-59] years; 6227 female [56.9%]), of whom 5308 initiated lithium therapy and 5638 valproate therapy. During follow-up, 421 CKD progression events and 770 AKI events were identified. Compared with patients who received valproate, those who received lithium did not have increased risk of CKD (hazard ratio [HR], 1.11 [95% CI, 0.86-1.45]) or AKI (HR, 0.88 [95% CI, 0.70-1.10]). Absolute 10-year CKD risks were low and similar: 8.4% in the lithium group and 8.2% in the valproate group. No difference in the risk of developing albuminuria or the annual rate of eGFR decrease was found between groups. Among more than 35000 routine lithium tests, only 3% of results were in the toxic range (>1.0 mmol/L). Lithium values greater than 1.0 mmol/L, compared with lithium values of 1.0 mmol/L or less, were associated with increased risk of CKD progression (HR, 2.86; 95% CI, 0.97-8.45) and AKI (HR, 3.51; 95% CI, 1.41-8.76). Conclusions and Relevance In this cohort study, compared with new use of valproate, new use of lithium was meaningfully associated with adverse kidney outcomes, with low absolute risks that did not differ between therapies. However, elevated serum lithium levels were associated with future kidney risks, particularly AKI, emphasizing the need for close monitoring and lithium dose adjustment.
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| 2. |
- Bosi, A., et al.
(författare)
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Quality of laboratory biomarker monitoring during treatment with lithium in patients with bipolar disorder
- 2023
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Ingår i: Bipolar Disorders. - : Wiley. - 1398-5647 .- 1399-5618. ; 25:6, s. 499-506
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundClinical guidelines recommend monitoring of creatinine and lithium throughout treatment with lithium. We here assessed the extent to which this occurs in healthcare in Sweden. MethodsThis is an observational study of all adults with bipolar disorder starting lithium therapy in Stockholm, Sweden, during 2007-2018. The main outcome was monitoring of blood lithium and creatinine at therapy initiation and/or once annually. The secondary outcome was monitoring of calcium and thyroid-stimulating hormone (TSH). Patients were followed up until therapy cessation, death, out-migration, or to the end of 2018. ResultsWe identified 4428 adults with bipolar disorder who started lithium therapy and were followed up for up to 11 years. Their median age was 39 years, and 63% were women. The median duration on lithium therapy was 4.3 (IQR: 1.9-7.45) years, and the majority who discontinued therapy started another mood stabilizer soon after. Overall, 21% started lithium therapy without assessing the serum/plasma concentration of creatinine. The proportion of people who did not have both lithium and creatinine measured increased from 21% in the first year to 33% in the eleventh year. The proportion with annual testing for TSH or calcium was slightly lower. As few as 16% of patients had both lithium and creatinine tested once annually during their complete time on lithium. ConclusionsIn a Swedish community sample, lithium and creatinine monitoring was inconsistent with guideline recommendations that call for measurement of annual biomarker levels.
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| 3. |
- Einarsson, Fredrik, 1968, et al.
(författare)
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Subscapularis muscle mechanics in children with obstetric brachial plexus palsy
- 2008
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Ingår i: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 33:4, s. 507-12
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the passive mechanical properties of the subscapularis muscle in children with a contracture as a result of obstetrical brachial plexus palsy. Muscle biopsies were harvested from nine children undergoing open surgery for shoulder contracture. Passive mechanical testing of single cells and muscle bundles was performed. Corresponding comparisons were made using muscle biopsies from seven healthy controls. Single muscle fibres from patients with obstetric brachial plexus palsy displayed a shorter slack sarcomere length, linear deformation of the fibre within a wider zone of sarcomere length and a greater relative increase in stiffness compared with muscle bundles. We conclude that secondary changes in muscle fibre properties will occur as a result of a longstanding lack of sufficient passive stretch, leading to compensatory changes in the extracellular matrix. These results suggest the presence of a dynamic feedback system constituting a muscle-to-extracellular matrix communication interface.
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| 4. |
- Hultgren, T., et al.
(författare)
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Structural characteristics of the subscapularis muscle in children with medial rotation contracture of the shoulder after obstetric brachial plexus injury
- 2010
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Ingår i: Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1532-2211 .- 1753-1934 .- 2043-6289. ; 35:1, s. 23-28
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to obtain a better understanding of the cause of the medial rotation contracture of the shoulder after obstetric brachial plexus lesions by studying the morphology of the shortened subscapularis muscle. Muscle biopsy specimens were harvested from 13 children with obstetric brachial plexus palsy who underwent corrective surgery for the rotation contracture. The majority of the subscapularis muscle biopsy samples had an essentially normal morphology and showed a predominance of type I myosin heavy chain isoform, while one biopsy showed signs of marked fibrosis and a predominance of type II myosin heavy chain isoform. The findings support the assumption that shortening of the subscapularis is caused primarily by the nerve injury, which weakens the antagonistic lateral rotators, but that direct injury to the muscle might be a contributory factor.
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| 5. |
- Larsson, Karin, 1955, et al.
(författare)
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Effects of Intervertebral Disc Cells on Neurite Outgrowth From Dorsal Root Ganglion Explants in Culture
- 2011
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Ingår i: Spine (Phila Pa 1976). - 0362-2436. ; 36:8, s. 600-6
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN.: An experimental study investigating the effect of disc cells on neurite outgrowth in a rat dorsal root ganglion (DRG) culture system. OBJECTIVE.: To examine the effects of the 2 nucleus pulposus (NP) cell populations, notochordal cells (NC) and chondrocyte-like cells (CC) on neurite outgrowth from DRGs. SUMMARY OF BACKGROUND DATA.: NP consists of at least 2 cell populations, NC and CC. The cells in NP have been shown to be responsible for negative effects on neurite outgrowth in vitro and on nerve tissue in vivo. It is unknown whether 1 cell type or combinations of the 2 cell types are responsible for the reported effects. METHODS.: A total of 939 DRGs from newborn Sprague Dawley rats were harvested and placed in culture dishes. After 24 hours, the neurite outgrowth was measured. NP was harvested from tail discs of adult rats and the NP cells were separated into 2 populations, NC and CC. The cell populations were applied to the DRG culture in different cell concentrations and combinations, and compared to medium. After 24 hours of exposure, the neurite outgrowth was reassessed and expressed as the ratio between the outgrowth at 48 and 24 hours culture. RESULTS.: NC in intermediate and high concentration and CC in high concentration induced a significant inhibition of the neurite outgrowth compared to culture medium. Further, one of the combinations (low NC and high CC concentration) resulted in a significant inhibition of the neurite outgrowth. CONCLUSION.: The present study demonstrated negative effects of NP cells on nerve tissue culture explants. The combination of low NC and high CC concentrations may mimic the situation in humans, where we have an increased proportion of chondrocyte-like cells with age. The results from this study may provide a biologic explanation for the large variation of symptoms in disc herniation patients despite similar mechanical influence on nerve tissue.
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| 6. |
- Larsson, Karin, 1955, et al.
(författare)
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Electron Microscopy Analysis of Neurites Extending from Dorsal Root Ganglia in vitro following Exposure to Intervertebral Disc Cells.
- 2012
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Ingår i: Cells, tissues, organs. - : S. Karger AG. - 1422-6421 .- 1422-6405. ; 196:1, s. 82-89
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Tidskriftsartikel (refereegranskat)abstract
- Nucleus pulposus cells from the intervertebral disc have been shown to have inhibiting effects on neurite outgrowth in vitro. The nucleus pulposus consists of at least 2 cell populations, notochordal cells and chondrocyte-like cells. The aim of this study was to analyze the morphology of the neurites, from rat dorsal root ganglia (DRG) in a culture system, after exposure of these 2 cell populations. DRG from perinatal rats was harvested and placed in culture dishes for 24 h. Nucleus pulposus cells from donor rats were separated into 2 populations and applied to the DRG and neurite culture for a further 24 h and compared to control cultures exposed to culture medium without cells. The DRG and neurites were thereafter prepared for scanning or transmission electron microscopy (SEM/TEM). Descriptive SEM and TEM analyses and calculations of the neurite diameter were performed. The visual appearance after SEM and TEM preparation was similar in the three different culture conditions. However, there was a statistically significant reduction of the neurite diameter for the cultures exposed to notochordal cells compared to the cultures exposed to medium and chondrocyte-like cells (TEM preparation). Prominent and frequent pathologic abnormalities in peripheral nerve diseases have been observed with changes in axonal caliber. This study may suggest that a preserved small amount of notochordal cells, as seen in human adults, may play a role in clinical situations where nerve tissue is exposed to disc material, i.e. in disc herniation or degeneration.
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| 7. |
- Larsson, Monica, et al.
(författare)
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Barn och unga migranters delaktighet
- 2015
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Ingår i: Kristofer Hansson & Eva Nordmark (Red.), Att arbeta med delaktighet inom habilitering. - Lund : Studentlitteratur. - 9789144107547 ; , s. 65-80
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Bokkapitel (refereegranskat)abstract
- Delaktighet har kommit att bli ett samlingsbegrepp för hur samhället ska kunna möta alla människors röster och perspektiv. Inte minst inom habiliteringens olika verksamheter är det idag ett centralt begrepp. Denna antologi tar sin utgångspunkt i ett mångfacetterat habiliteringsperspektiv och presenterar nya synsätt på hur delaktighet kan förstås, hur det praktiskt används, men också hur det kan problematiseras utifrån ett flervetenskapligt och tvärprofessionellt perspektiv.
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| 8. |
- Runesson, Björn
(författare)
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Consequences of kidney dysfunction in the community : health care-based epidemiological studies from the Stockholm creatinine measurements (scream) project
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic kidney disease (CKD) is affecting an increasing share of the world’s population, and presents a global health problem. The prevalence of CKD in society and its implication for various health outcomes have been difficult to assess due to unawareness and underuse of clinical diagnoses for CKD in clinical practice. The present work aims to inform the reader of the epidemic of CKD in Sweden through a newly created repository of health care data. Paper I describes the creation of the Stockholm CREAtinine Measurements (SCREAM) project, a health care extraction containing all creatinine values collected between 2006 and 2011 in the Stockholm region, together with a host of associated laboratory data, dispensed prescriptions, and diagnostic and demographic information. SCREAM has a good representation of the general population of Stockholm county, particularly of the elderly, with a coverage exceeding 90% among persons aged 65 or above. The coverage of people with diabetes was 98%, and that of ischemic heart disease was 97%. SCREAM captured 89% of deaths occurring in the region those years. Paper II investigates how causes of death correlate with estimated glomerular filtration rate (eGFR) in the last year of life. We observed a higher proportion of death from cardiovascular disease and infections with lower eGFR. Among cardiovascular causes, heart failure and arrhythmias became more common with lower eGFR. Diabetes complications were also more common in lower kidney function strata. Paper III evaluates the association between kidney function and the risk of incident fractures among people with CKD stages 3-5 (not on dialysis), and whether developing a fracture predicts subsequent risk of death or major cardiovascular adverse events (MACE). We found a gradual increase in the risk of fractures with lower eGFR in persons with CKD 3b-5 (HR 2.47 (1.94- 3.15) for hip fractures and 1.50 (1.25- 1.80) for non-hip fractures, in CKD 5 vs CKD 3a). In the aftermath of a fracture, mortality and MACE incidence were considerably increased, in both short (<90 days) and long term (>= 90 days) follow-up, as compared to non-fracture periods. Paper IV investigates the risk and severity of hypoglycaemia in relation to kidney function, among people with diabetes followed in outpatient care. We observed a significant, gradual rise in the multivariable-adjusted risk of hypoglycaemia with lower eGFR. Several other risk factors for hypoglycaemia were identified, among them type 1 diabetes, presence of diabetic complications, and liver diseases. The risk of fatal hypoglycaemia was also higher with lower eGFR
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| 9. |
- Runesson Kempe, Ulla, 1952-, et al.
(författare)
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Beyond the borders of the local : How “instructional products” from learning study can be shared and enhance student learning
- 2018
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Ingår i: International Journal for Lesson and Learning Studies. - : Emerald Group Publishing Limited. - 2046-8253 .- 2046-8261. ; 7:2, s. 111-123
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to present how experiences gained from a theory-informed lesson study – learning study (LrS) – in regard to a specific learning goal can be shared and used by other teachers in new contexts.Design/methodology/approach: A group of teachers worked together in a cyclic, iterative process of planning, evaluating and revising teaching. The aim was to provide possibilities for grade 2 and 3 students to become familiar with negative numbers. The teacher group came to the conclusion that the students needed to be able to differentiate some aspects of negative numbers. The conjecture was put to the test in a follow-up study (FS) with five new teachers and eight classes. One lesson was taught based on the empirical findings in the LrS.Findings: The results suggest that teachers’ collaborative work has possibilities to produce knowledge about critical aspects of learning that can be communicated and adopted in new contexts. The teachers in the FS were able to make sense of the results from LrS and incorporate the critical aspects in their teaching in a way that enhanced students’ learning.Originality/value: It is demonstrated that teacher collaboration in LrS can create knowledge that goes beyond the border of the local context.
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| 10. |
- Runesson Kempe, Ulla, et al.
(författare)
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Making distinctions – critical for the learning of the 'existence' of negative numbers? Exploring how 'instructional products' from a theory informed Lesson study can be shared and enhance student learning
- 2017
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Konferensbidrag (refereegranskat)abstract
- In this paper, we present how experiences gained from a theory informed Lesson study in regards to a specific learning goal can be shared and used by other teachers in new contexts. A group of teachers worked together in a cyclic, iterative process of planning, evaluating and revising teaching. The aim was to provide possibilities for grade 2 and 3 students to become familiar with negative numbers, thus to extend the number range from N to Z. Based on theoretical tenets about learning and empirical findings in the study the teacher group draw the conclusion that the pupils needed to be able to differentiate some aspects of negative numbers. The conjecture was put to the test in a follow-up study with five new teachers and eight classes. One lesson was taught based on the empirical finding in the Lesson study. When learning gains from pre- to post-test in these classes were compared to those in the Lesson study, similarities were found. It is suggested that accumulate evidence about ‘what must be learned’ across different classroom settings can be gained through a theory informed and goal oriented Lesson study.
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