| 1. |
- Lindahl, Göran, et al.
(författare)
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Bergslagen : Arbetsplatser och bostäder under hundra år
- 1983
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Rapport (populärvet., debatt m.m.)abstract
- Denna skrift utgör resultatet av Arkitekturskolans studier läsåret 1978-79. Att redigera manuskripten visade sig arbetskrävande och har också dragit ut på tiden. Att vissa av de uppgifter som lämnas inte är helt aktuella spelar ändå inte så stor roll - tyngdpunkten i framställningen ligger på det historiska materialet och de långa tidsperspektiven.Arbetet inleds med en demografisk översikt över ett brett bälte tvärs över Mellansverige från Värmland till Upplandskusten. Där antyds utvecklingens huvudriktning både i Bergslagens gamla kärnområden och i yttre zoner av delvis annan karaktär. Därefter följer åtta från varandra fristående kapitel som dock alla har ett gemensamt mål, att granska och analysera bebyggelseu.tvecklingen inom ett tydligt avgränsat område. Konkretion och åskådlighet har eftersträvats - därför har också stor möda nedlagts på bildmaterialet i form av kartor, ritningar och foton. Valet av undersökningsobjekt har gjorts av författarna själva, som också utformat sina avsnitt självständigt.
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| 2. |
- Wennerholm, Ulla-Britt, 1948, et al.
(författare)
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Timing of umbilical cord clamping for neonatal and maternal outcomes
- 2012
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Ingår i: Health Technology Assessment, HTA center Region Västra Götaland. ; :48, s. 1-51
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Forskningsöversikt (refereegranskat)abstract
- Method and patient group Late versus early clamping of the umbilical cord- maternal and infant effects Question at issue Is early umbilical cord clamping not different from or better than late umbilical cord clamping regarding postpartum infant iron deficiency and iron deficiency anaemia variables, long-term cognitive function, loss of stem cells, maternal postpartum haemorrhage, manual removal of retained placenta and correct sampling for blood gas analysis? Studied risks and benefits for patients of the new health technology Level of evidence: The literature search identified four studies that fulfilled the selection criteria; a systematic review (SR) and three subsequently published randomised controlled trials (RCTs). The definition of early cord clamping varied from within 10 to < 60 sec between studies. The SR was methodologically of high quality but included mainly studies with high risk of bias. One of the RCTs was of high and the others of low quality. Infant outcomes O1 No studies evaluated cognitive function or loss of stem cells. Conclusions: There is some support for an increased risk of immediate anaemia (6.3% vs 1.2%) (GRADE ⊕⊕) and support for lower immediate Hb (mean difference 18g/l) and haematocrit (GRADE ⊕⊕⊕) with early as compared with late clamping. There is support for little or no difference regarding these outcomes at long-term (at 2 to 6 months of age) (GRADE ⊕⊕⊕). There is some support for an increased risk of long-term iron deficiency (5.7% vs. 0.6%) (GRADE ⊕⊕) and support for lower long-term ferritin levels (GRADE ⊕⊕⊕). There is some support for little or no difference regarding jaundice requiring phototherapy and a low Apgar score (<7 at 5 min) (GRADE⊕⊕) and insufficient support for an effect on the need for admittance to special baby care nursery or neonatal intensive care unit (GRADE ⊕) ). Maternal outcomes O2 There is some support for little or no difference regarding severe postpartum bleeding (GRADE ⊕⊕) and insufficient support for an effect on the need for manual removal of placenta (GRADE ⊕ ).. Methodological outcome O3 There is insufficient scientific documentation to evaluate the rate of correct sampling for cord blood acid-base and gas analysis after early versus late clamping. Ethical questions Is early cord clamping of the healthy term neonate ethically acceptable in view of unknown long-term infant risks regarding cognitive function? Presently, late cord clamping does not allow cord blood collection. Future research may identify optimal timing of cord clamping, to resolve these ethical issues. Economical aspects There are no reasons to believe that initial costs are different.
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| 3. |
- Bergh, Christina, 1953, et al.
(författare)
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Regionalt HTA-arbete kan ge bra genomslag i vården. Goda exempel från Västra Götaland : [Regional HTA work can have a good impact on health care. Good examples form Vastra Gotaland].
- 2010
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Ingår i: Läkartidningen. - 0023-7205. ; 107:29-31, s. 1780-1783
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Tidskriftsartikel (refereegranskat)abstract
- HTA (health technology assessment) innebär en systematisk granskning av det vetenskapliga underlaget för en viss teknik. Ett väl definierat PICO (patients, intervention, comparison, outcome) är en grundförutsättning för att få fram den dokumentation som ska granskas. En fokuserad fråga är central i HTA-processen. En teknik granskas med avseende på effektivitet och risker, etiska och organisatoriska aspekter samt kostnader. I en systematisk litteraturöversikt granskas vetenskapliga artiklar med avseende på kvalitet och relevans. Slutsatserna evidensgraderas enligt GRADE. I Västra Götalandsregionen har inrättats ett HTA-centrum som arbetar med regional medicinsk utvärdering. Regionalt HTA-arbete har flera fördelar; en är att den praktiska omsättningen av de nyvunna kunskaperna troligen kan ske snabbare.
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| 4. |
- Blomqvist, Fredrik Lennart Rune, 1947, et al.
(författare)
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Platelet aggregation in healthy women during normal pregnancy - a longitudinal study.
- 2019
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Ingår i: Platelets. - : Informa UK Limited. - 1369-1635 .- 0953-7104. ; 30:4, s. 438-444
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Tidskriftsartikel (refereegranskat)abstract
- Increased platelet activation is involved in obstetric complications such as preeclampsia and intrauterine growth retardation. It is of interest to study platelet aggregation during pregnancy, since increased aggregation theoretically could be a mechanism associated with placenta-mediated complications, which possibly could be prevented by drugs inhibiting platelet aggregation. There are, however, few robust studies describing platelet aggregation during normal pregnancy. The present longitudinal study was performed in order to study platelet aggregation during normal pregnancy resulting in a healthy child, during the puerperium and in nonpregnant, fertile women. Healthy, nonsmoking, pregnant women (n=104), aged under 39years and with BMI <35, were followed during pregnancy and postpartum. Twenty-seven nonpregnant, non-puerperal, fertile women were studied for comparison. Platelet aggregation was determined with multiple electrode impedance aggregometry and analyzed at inclusion, 4 times during pregnancy and after at least 3 months postpartum. Platelet aggregation postpartum was compared with gestational weeks 8-15 and 37-40, respectively, and with nonpregnant, fertile women. Hemoglobin, leucocyte count, platelet count, prothrombin time, and activated partial thromboplastin time were determined at inclusion in order to verify normal hemostasis. Activation of platelets by arachidonic acid, adenosine diphosphate (ADP), and thrombin receptor activating peptide (trap-6) resulted in less aggregation during pregnancy, compared with postpartum (p<0.03-<0.001). Platelet aggregation following activation by collagen was unchanged. A minor increase in aggregation as pregnancy continued was found related to ADP (p<0.021). Positive correlations were found between platelet counts and platelet aggregation. Postpartum platelet aggregation after activation with arachidonic acid, collagen, and trap-6 was lower than in the non-puerperal fertile state. Other hemostatic analyses were normal. In conclusion, there is a minor decrease in platelet aggregation after activation with arachidonic acid, trap-6, and ADP, measured with multiple electrode impedance aggregometry during normal pregnancy resulting in healthy babies, compared with the postpartum period. The small changes in platelet aggregation may be a consequence of a minor decrease in platelet count and probably lack clinical significance under normal conditions. Interindividual variations at certain time-points are substantial, which limits the usefulness of the multiple electrode impedance aggregometry for determining minor changes in platelet function.
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| 5. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Acetylsalicylic acid does not prevent first-trimester unexplained recurrent pregnancy loss: A randomized controlled trial
- 2018
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Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - : Wiley. - 0001-6349. ; 97:11, s. 1365-1372
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Recurrent pregnancy loss occurs in about 1% of fertile couples. Without proper evidence for an effect, different treatments have been used when no etiological factor has been detected. The present trial is the first randomized trial to compare 75 mg acetylsalicylic acid with placebo for women with recurrent pregnancy loss. Material and methods: This randomized, double-blind, placebo-controlled trial was conducted at a single center between 2008 and 2015. Recurrent pregnancy loss was defined as at least 3 consecutive first-trimester miscarriages within the couple. Women < 40 years old with a body mass index < 35 kg/m(2) were eligible if the workup was negative. Randomization was through a third party, who manufactured and delivered the study drugs, and occurred when fetal heartbeat was detected, to either 75 mg acetylsalicylic acid or placebo; 200 women in each group. Group allocation was concealed until all the study participants had a pregnancy outcome registered. All women attended the same control program. Primary outcome was live birth. Statistical analyses were according to intention-to-treat. Results: All 400 women completed the follow up. Live birth rate was 83.0% (n=166) and 85.5% (n=171) for the acetylsalicylic acid and placebo groups, respectively (P=0.58). The difference was -2.5% (95% CI -10.1% to 5.1%). The risk ratio was 0.97 (95% CI 0.89-1.06). Conclusions: Treatment with acetylsalicylic acid did not prevent recurrent miscarriage in women with at least three consecutive miscarriages in the first trimester, of unknown reasons and in the same relationship. The fertility prognosis is very good, the live birth rate being > 80% with or without acetylsalicylic acid.
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| 6. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Arachidonic acid-induced platelet aggregation and acetylsalicylic acid treatment during pregnancy in women with recurrent miscarriage, a post hoc study
- 2022
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Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 33:2, s. 278-284
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Tidskriftsartikel (refereegranskat)abstract
- In this post hoc study, arachidonic acid (AA)-induced platelet aggregation during pregnancy with and without acetylsalicylic acid (ASA) treatment was studied in 323 women with unexplained recurrent first-trimester miscarriage and in 59 healthy women with normal pregnancies. All women had normal AA-induced platelet aggregation in the non-pregnant state. Women with recurrent miscarriage were treated with 75 mg ASA or placebo daily. AA-induced platelet aggregation was measured with multiple electrode impedance aggregometry and presented in units (U), where 1 U = 10 aggregation units x minutes. There were no significant differences in platelet aggregation between placebo-treated women with recurrent miscarriage and healthy women. The mean differences were -0.7 (95%CI; -7.0; 5.6) U in the non-pregnant state, 3.8 (95%CI; -4.6; 12.2) U during the late first trimester and 1.7 (95%CI; -6.7; 10.3) U and 4.1 (95%CI; -3.9; 12.0) U during the early and late third trimester, respectively. ASA reduced platelet aggregation by median -84.0% (Q1; Q3; -89.8; -76.3), -79.9% (-84.7; -69.2) and -75.7% (-83.5; -49.5), respectively, during pregnancy. The degree of inhibition by ASA decreased during the third trimester (p < .0001). There were two (1.9%) complete non-responders to ASA and 32.1% with a partial response. The rate of subsequent miscarriage was not affected by ASA, which did not seem to influence the rate of early miscarriage if treatment was initiated when a viable pregnancy was detectable by ultrasound.
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| 7. |
- Blomqvist, Lennart, 1947, et al.
(författare)
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Preconceptual thyroid peroxidase antibody positivity in women with recurrent pregnancy losses may contribute to an increased risk for another miscarriage.
- 2023
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Ingår i: Clinical endocrinology. - : Wiley. - 0300-0664 .- 1365-2265. ; 98:2, s. 259-269
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Tidskriftsartikel (refereegranskat)abstract
- To investigate preconceptual thyroid peroxidase antibody (TPO-ab) positivity and/or thyroid stimulating hormone (TSH) levels in the upper range of normal as risk factors for recurrent unexplained first-trimester miscarriage.A post-hoc study of a randomized trial, in which acetylsalicylic acid did not affect the risk of a new miscarriage.Women (n=483) with at least three unexplained recurrent first-trimester miscarriages investigated at a Swedish secondary referral center.The levels of TPO-ab and TSH were determined before pregnancy. The occurrence of a new first-trimester miscarriage was analyzed by logistic regression with adjustments when applicable, for age, number of previous miscarriages, obesity and the investigated covariates levels of TPO-ab and TSH.Including all first trimester miscarriages, odds ratio (OR) according to presence of TPO-ab was 1.60 (95% confidence interval [CI]; 0.99-2.57), after adjustment 1.54 (95% CI; 0.94-2.53). Very early (biochemical) pregnancy losses occurred more often in women with than without preconceptual TPO-ab (6.8% vs. 2.0%), OR 3.51 (95% CI; 1.15-10.71), after adjustment 2.91 (95% CI; 0.91-9.29). There was no association between TSH in the upper range of normal and a new miscarriage, adjusted OR 0.76 (95% CI; 0.32-1.83). A prediction model for a new miscarriage included number of previous miscarriages, woman's age and presence of TPO-ab.In women with at least three recurrent unexplained pregnancy losses, the presence of TPO-ab may contribute to an increased risk of a first-trimester miscarriage, possibly more pronounced in very early pregnancy. TSH levels 2.5-4.0 mU/L do not seem to increase the miscarriage risk.
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