| 1. |
- Söderström, Ulf, 1947-, et al.
(författare)
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Immigrant childrenwith type 1 diabetes have impaired metabolic control after three years oftreatment : a nation-wide cohort study in Sweden
- 2014
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To compare clinical status after three years of treatment and socio-demographic conditions at onset in children with diabetes born to immigrant parents with children to Swedish born parents. Design: Observational nationwide population based cohort-study on prospectively recorded registry data.Setting: All children with diabetes in Sweden and their parents between 2000 and 2010.Patients: 879 children with diabetes born to immigrant parents out of a total of 13 415 children, the immigrant cohort. To these we added 2627 children with diabetes of Swedish born parents, matched for gender, age and year of onset, the Swedish cohort.Main outcome: The immigrant children had a higher median HbA1c, 69 mmol/mol (8.5 %), compared to their Swedish peers 62 (7.8 %), p = 0.002, and the 75th percentile of 72 (8.8 %) vs 70 (8.5 %). There was however no difference in frequency of severe events of hypoglycemia or keto-acidosis between the two cohorts (p = 0.258). A linear regression model with HbA1c as dependent variable pointed out insulin units per kg BW as the main reason for inferior metabolic control, OR 11.410, CI 95% 7.418_15.402, p < 0.001.Conclusions: Children with diabetes born to immigrant parents have worse metabolic status three years after disease onset.
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| 2. |
- Söderström, Ulf, 1947-, et al.
(författare)
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Impaired metabolic control and socio-demographic status in immigrant children at onset of type 1 diabetes
- 2014
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Ingår i: Diabetic Medicine. - : Wiley-Blackwell. - 0742-3071 .- 1464-5491. ; 31:11, s. 1418-1423
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.Methods and design: This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type1 diabetes.Results: The proportion of low capillary pH (<7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P<0.001)]. HbA(1c) was also higher [95mmol/mol (10.8%) vs. 88mmol/mol (10.2%), respectively (P<0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA(1c) was 0.983 (95%CI 0.976-0.991) and for plasma glucose was 0.953 (95%CI 0.933-0.973).Conclusion: Children born to immigrant parents have lower capillary pH and higher HbA(1c) at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.
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| 3. |
- Söderström, Ulf, et al.
(författare)
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National Swedish study of immigrant children with type 1 diabetes showed impaired metabolic control after three years of treatment
- 2016
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Ingår i: Acta Paediatrica. - : WILEY-BLACKWELL. - 0803-5253 .- 1651-2227. ; 105:8, s. 935-939
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study examined the clinical status and socio-demographic conditions of children with type 1 diabetes at baseline and after three years of treatment, comparing those born to immigrant parents and Swedish parents. Methods: This observational nationwide population-based cohort study used prospectively collected registry data from Swediabkids, the National Quality Registry for Paediatric Diabetes in Sweden from 2000 to 2010. Of the 13 415 children with type 1 diabetes, there were 879 born to immigrant parents. We selected three children born to Swedish parents from the same registry for each immigrant child matching them by gender, age and year of diabetes onset (n = 2627; with 10 control children missing probably due to the matching procedure). Results: Immigrant children had a higher median glycated haemoglobin level (HbA1c) than their Swedish peers, but there was no difference in the frequency of hypoglycaemia or ketoacidosis between the two cohorts. A linear regression model with HbA1c as a dependent variable showed that insulin units per kilogram of body weight were the main reason for inferior metabolic control. Conclusion: Children with type 1 diabetes born to immigrant parents had inferior metabolic control three years after disease onset compared to children with Swedish born parents. Social family support and educational coping programmes are needed to improve treatment outcomes in immigrants with diabetes.
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| 4. |
- Söderström, Ulf, 1947-
(författare)
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Type 1 diabetes in children with non-Swedish background : epidemiology and clinical outcome
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sweden holds third place of diabetes incidence in young people after Finland and Sardinia. One fifth of the population is nowadays of foreign descent. We have a substantial number of immigrants from countries where the risk for T1D is considerably lower. Migration as a natural experiment is a concept to assess the risk for diabetes in offspring of immigrant parents and assess the interaction between genetics (genotype) and the impact of environment (phenotype).Aims: To study the risk of incurring diabetes for children of immigrant parents living in Sweden (I) and further study the risk if the child is born in Sweden or not (II); to specifically study and evaluate if children from East Africa have increased risk to develop T1D (III). To investigate if clinical and sociodemographic status at T1D onset differs between immigrant children compared to their Swedish indigenous peers (IV). Finally to study the clinical outcome and the impact of socio-demographic factors at diabetes onset after three years of treatment (V).Methods: All five studies are observational, nationwide and population based, on prospectively collected data. Statistics mainly by logistic and linear regressions.Results: Parental country of origin is a strong determinant for diabetes in the offspring. Children born to immigrant parents seem to keep their low risk compared to their Swedish peers (I). When adding the factor of being born in Sweden, the pattern changed; there was a significantly (p < 0.001) increased risk for T1D if the child was born in Sweden (II). East Africans have a substantial risk for T1D and especially if the children are born in Sweden (III). Immigrant children and adolescents have worse metabolic start at T1D onset compared to their indigenous Swedish peers (IV). After 3 years of treatment, the immigrant children had a sustained higher median HbA1c, compared to their Swedish peers (V).Conclusions: Genotype and influences during fetal life or early infancy have an important impact for the risk of T1D pointing towards epigenetics playing a substantial role. Children with an origin in East Africa have a high risk of incurring T1D. Immigrant children have worse metabolic start at T1D onset, which sustains after three years of treatment
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| 5. |
- Aili Fagerholm, Siri, 1980-
(författare)
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Insulin signaling in primary adipocytes in insulin sensitive and insulin resistant states
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Increasing numbers of people world-wide develops the disease type 2 diabetes. Development of type 2 diabetes is characterized by a shift from an insulin sensitive state to an insulin resistant state in peripheral insulin responding organs, which originates from the development of insulin resistance in the adipose tissue. Insulin resistance in combination with reduced pancreatic insulin secretion lead to overt type 2 diabetes.In this thesis, the insulin signaling network in primary adipocytes was analyzed. Key proteins and mechanisms were studied to gain deeper knowledge of signaling both in the insulin sensitive state and in the insulin resistant state produced by rapid weight gain as well as in type 2 diabetes.The surface of the adipocyte is dotted with invaginations in the cell membrane called caveolae that act as important metabolic and signaling platforms in adipocytes, and also harbor the insulin receptor. In paper I we show that insulin stimulation of primary adipocytes results in a rapid phosphorylation of the insulin receptor and caveolin-1, and that internalization of the proteins is mediated by endocytosis of caveolae.Weight gain due to overfeeding and obesity has been associated with the development of insulin resistance in insulin sensitive tissues such as the adipose tissue. In paper II we show that short-term overfeeding for one month of lean subjects results in an insulin resistant state. At the end of the study, the subjects had developed a mild systemic insulin resistance. Moreover, in isolated subcutaneous adipocytes we found several alterations of the insulin signaling pathway that mimicked alterations found in isolated subcutaneous adipocytes from subjects with type 2 diabetes.In paper III we present a first dynamic mathematical model of the insulin signaling network in human adipocytes that are based on experimental data acquired in a consistent fashion. The model takes account of insulin signaling in both the healthy, insulin sensitive state and in the insulin resistant state of type 2 diabetes. We show that attenuated mTORC1-mediated positive feedback to control of phosphorylation of IRS1 at Ser307 is an essential component of the insulin resistant state of type 2 diabetes. A future application of the model is the identification and evaluation of drug targets for the treatment of insulin resistance and type 2 diabetes.In paper IV we examine the protein kinase that catalyzes the insulin stimulated mTORC1- mediated feedback to IRS1. We find that the phosphorylation of IRS1 at Ser307 is not likely to be catalyzed by the kinases S6K1, mTOR or PKB. However, a catalyzing protein kinase for the in vitro phosphorylation of IRS1 at Ser307 was found to be associated with the complex mTORC1.In conclusion, this thesis provide new insights and characterize mechanisms of the intrinsically complex insulin signaling network of primary adipocytes, both in insulin sensitive and insulin resistant states.
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| 6. |
- Andersson, Mona, 1948-
(författare)
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Botvids väg till rätt vård : Planering av ett interorganisatoriskt vårdkedjeprojekt
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The patient Botvid´s way to right care. The planning process of an inter-organizational care pathway project.A general problem in an elderly patient’s care – and rehabilitation process, which involves different care providers, is that there is no one single staff that is responsible for the whole “production process” i.e. from diagnosis to completed treatment. All too often care providers focus on their own part of the process with insufficient communication with other providers, resulting in low quality of care. Poor co-operation also leads to increased demand for check-ups, unproductive waiting time, duplication of work and other inefficiencies. A solution to these co-ordination problems can be to introduce process orientation (integrated care pathways). A process view requires the concerned staff to look at their own work with other eyes. The process view implies that they need to change focus to what is best from the patient’s point of view.Experiences from earlier reforms, that were centrally initiated and managed, show that the concerned staff (doctors, nurses etc.) had too little influence during the planning and implementation phases. Several official reports therefore call attention to the need for broad participation from all of the different staff categories in organizational development.In this thesis a qualitative case study of the planning process of an inter-organizational project between primary care, hospital treatment and municipality care is presented. The aim of the project was to develop an organization that could support a process view among the care providers. The focus of the thesis is on how the project management acted to shape the necessary conditions for a process view to enable the professional staff to participate, and on the role that the change strategy played in this connection.The results show that the professional staff had an active role in the management of the project. The initiator was a doctor, who managed the project team of 50 care staff together with a project leader. This team had a series of meetings and conferences during ten months. By exchanging ideas and experiences they found solutions to the operative problems that were the starting points for the project. They developed an action plan in consensus, with prioritized activities, which is now to be implemented.
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| 7. |
- Andersson, Per, 1961-, et al.
(författare)
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Virtuell utbildning på distans : erfarenheter från ledarskaps- och coachingprogrammet
- 2006
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Pedagogik betraktas som en nyckelfaktor för hur kommunikation utvecklas i online utbildning. Det är emellertid inte bara pedagogik som är av betydelse för interaktions- och kommunikationsmönster. IT-systemen, t.ex. lärplattformar, strukturerar informationen på olika sätt (se t.ex. Kear 2001; Lövheim, 2002) och flera kommunikationskanaler kan också upprätthålla och öka kommunikationen bland studenter (Haythornthwaite et al., 2000). Utgångspunkt för pedagogiska institutionens utveckling av IT-stöd i utbildning bygger på en kombination av ett pedagogiskt förhållningssätt och nya moderna tekniska lösningar. Utifrån den utgångspunkten utvecklas modeller för IT-stöd, som kombinerar och pedagogiska och tekniska aspekter, i både campus- och distansutbildning.Institutionens senaste projekt är ledarskaps- och coachingprogrammet som är en 80-poängs distansutbildning under 3,5 år. Programmet sker i samarbete med flera idrottsförbund. En av ambitionerna med programmet är att försöka utveckla former för IKT-stödd undervisning mot idrottsområdet. T.ex. inom områden som av tradition starkt varit knutna till campus som t.ex. metodikundervisning. En viktig del i projektet är att skapa modeller och riktlinjer för utveckling av flexibla studentanpassade IKT-baserade lärmiljöer, där t.ex teknik som streaming, podcasting, synkrona möten, nätbaserad examination mm. byggs in som, naturliga kursverktyg. Utgångspunkten för den IT-pedagogiska basen i programmet bygger vidare på resultat från tidigare projekt inom pedagogiska institutionen. Dessa projekt är videoanvändning inom VFU för reflektion och diskussion (se t.ex. Söderström et al, 2004) och United Network for Educational Technology (UniNet). I samband med att utbildningen genomförs pågår ett forskningsprojekt om det IT-stödda lärandet inom ledarskaps- och coachingprogrammet.Utgångspunkten för ledarskaps och coachingprogrammet har handlat om att (se t.ex. Davies, 2002; Tolmie & Boyle, 2000):• Ge stöd och support (guider, webbaserade instruktioner mm)• Skapa meningsfulla och stimulerande uppgifter• Som lärare vara synlig• Stimulera samarbete och kollaborationUtbildningens virtuella lärmiljö (Open Source plattform) underlättar för att praktiskt, reflektivt och i interaktion med lärare och andra studenter förena teori och praktik. Miljön stödjer olika typer av digitalt material. T.ex. via synkrona (direkta) möten streamade föreläsningar, ljudfiler, forum för återkoppling och diskussion. Lärmiljön som används bygger på forskning runt lärgemenskaper där ljud och video har stor betydelse och textkommunikationen medvetet tonats ner. Utbildningen är åtkomlig via olika teknologier som mobiltelefoni (wap) och via www och stödjer ljud, bild och text. Programmets ca 60 studenter är för närvarande inne på sitt tredje moment. Vi kan konstatera att vi haft minimala teknikproblem vilket borgar för att vi kan fokusera resurserna mot pedagogiska och innehållsliga frågor. De data som samlats in inom ramen för forskningen om gemenskaper kommer att analyseras under 2006.
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| 8. |
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| 9. |
- Axelsson, Karin, 1968-, et al.
(författare)
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Analyzing best practice and critical success factors in a health information system case : Are there any shortcuts to successful IT implementation?
- 2011
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Ingår i: Proceedings of the 19th European Conference on Information Systems - ECIS 2011. - : European Conference on Information Systems (ECIS) and Association for Information Systems AIS Electronic Library (AISeL). - 9789526035741 ; , s. 2157-2168
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This paper discusses critical success factors (CSF) and best practice in relation to IT implementation in the health sector. We have studied a University Hospital’s implementation of a health information system (HIS) and particularly one clinic which implementation process was described as very successful compared to other units at this hospital. The purpose of the paper is to gain further understanding of if and how well CSFs and best practice solutions can explain this successful case. We do this in order to explore if CSFs and best practice offer any shortcuts to successful IT implementation. By understanding the reasons behind this case’s success we can identify if CSFs and best practice potentially can explain the success, or if there are other explanations in this case. Based on our findings we discuss and question the sometimes overestimated belief in CSFs and best practice as shortcuts to success performance. An important contribution from this study is that situational and contextual factors are very critical to understand and acknowledge during HIS implementations.
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| 10. |
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