| 1. |
- Sundelin, Kaarina, 1967-
(författare)
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Head and Neck Cancer : Factors Affecting Tumour Growth
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Head and neck cancer is the fifth most common cancer worldwide with an estimated annual global incidence of over 500 000 cases. These malignant tumours develop in the mucosal linings of the upper respiratory tract or in the salivary glands. The most common sites are in the oral cavity and larynx. Treatment modalities comprising surgery and chemoradiotherapy have improved significantly during the last 20 years, but not the long-term survival of patients. The aim of this thesis was to study the different factors affecting tumour growth in head and neck cancer that may have clinical implications in the future. Factors involving apoptosis, cell cycle activity, inflammation, and enzyme activity were of special interest.The results of the thesis indicate that patients with malignant salivary gland tumours having the lowest level of actively replicating cells have the best prognosis. The largest amount of replicating cells in tongue cancer specimens was found in the peripheral areas of tumour nests. Metallothionein, a protein that can hinder apoptosis, was found in excess in the same areas, whereas apoptosis activity was considerably lower. Taken together, these results indicate that the most aggressive cancer cells are found in the peripheral areas of tumours where apoptosis may be hindered.The expression of the death receptor Fas was higher in tongue cancer specimens than in normal mucosa. The expression of this receptor was studied further in two cell lines established from oral cancers. When a low dose of cisplatin was added to cell cultures, the Fas expression was enhanced in both cell lines and, furthermore, the Fas-induced apoptosis was increased in one of the cell lines. The results show that a common chemotherapeutic drug given in a low, less toxic dose may enhance receptor-mediated apoptosis of cancer cells.Malignant solid tumours are often distinguished by an increased proteolytic activity resulting in invasive growth, neo-angiogenesis, and metastases. This activity is conducted by enzymes that are secreted from tumour cells, or from normal cells in the tumour microenvironment. The regulation of enzyme secretion may be mediated by cytokines, small signalling molecules also present in cancer tissue. The results of this thesis show that two cytokines can synergistically induce enzyme secretion (matrix metalloproteinase-1 and -9) from oral cancer cells. Cytokine tumour necrosis factor-alpha and hepatocyte growth factor added alone to cell cultures strongly stimulated secretion of these enzymes. Thus, the tested cytokines, which are commonly secreted by fibroblasts and immune cells, may promote tumour growth.This thesis has contributed to an increased understanding of factors affecting tumour growth in head and neck cancer. The upcoming cancer therapies will be based on the increasing knowledge of these and other aberrant cellular mechanisms that may vary between different cancer forms.
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| 2. |
- Wadell, Karin, et al.
(författare)
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Group training in patients with COPD : long-term effects of decreased training frequency
- 2005
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 27:10, s. 571-581
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Tidskriftsartikel (refereegranskat)abstract
- Purpose.To investigate effects of decreased training frequency in patients with COPD. Methods.Forty-three COPD patients participated in a controlled study. The intervention group (30 patients) trained 3 times a week during 3 months and once a week during 6 months. Before, after 3 and 9 months all patients performed walking tests, cycle ergometer tests and responded questionnaires on health-related quality of life (HRQoL) (SGRQ, SF-36). Results.At 9 months compared to 3 months there were no changes in distance walked in the groups. Both groups decreased their VO2peak and the training group deteriorated in HRQoL. At 9 months compared to baseline the training group showed increased distance walked compared to the control group. In the disease-specific SGRQ the training group tended to improve their activity score while the control group tended to deteriorate in total score. In SF-36 the control group decreased their physical component score. Conclusion.Training once a week does not seem to be sufficient to maintain the level achieved after the 3-month period of training in COPD patients. However, training once a week during 6 months preceded by 3 months of high frequency training seems to prevent deterioration in physical capacity and HRQoL compared to baseline. Further studies are needed to investigate how to best sustain the benefits gained after physical training.
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| 3. |
- Wadell, Karin, et al.
(författare)
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High intensity physical training in water : an effective training modality for patients with COPD
- 2004
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Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 98:5, s. 428-438
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the effect of high intensity physical group training in water and on land for patients with COPD with regard to physical capacity and health related quality of life (HRQoL). A controlled, semi-randomised study was conducted where 30 patients were randomised to training either in water or on land. Thirteen patients constituted a control group. Forty-three outpatients, with moderate to severe COPD (27w/16m), from two local hospitals in northern Sweden, were included in the study. High intensity physical group training in water (water group) or on land (land group) was performed for 12weeks, three times per week, 45min per session. The control group received no intervention. Pre- and post-intervention, all patients performed incremental and endurance shuttle walking tests (ISWT and ESWT), cycle ergometer tests and responded questionnaires about HRQoL (St. Georges Respiratory Questionnaire--SGRQ and SF-36). The patients trained with a mean heart rate of 80-90% of peak heart rate. Both training groups increased the distance walked, i.e. land group in ISWT (25m) and water group in ESWT (179m). The water group increased the distance in ESWT significantly more that both the land and the control groups. Both training groups increased the time cycled (40-85s) and work load (10-20W) in the cycle ergometer test. The control group deteriorated in HRQoL according to total score in SGRQ while the training groups remained constant. The water group improved their activity score in SGRQ and their physical health score in SF-36 and those improvements were significant as compared to the land and the control groups. In conclusion, high intensity physical group training in water is of benefit for patients with COPD. It was in some areas found to be even more effective regarding improvements in physical capacity and experienced physical health compared to the same kind of training on land.
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| 4. |
- Wadell, Karin, et al.
(författare)
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Muscle performance in patients with chronic obstructive pulmonary disease : Effects of a physical training programme
- 2005
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Ingår i: Advances in Physiotherapy. - : Informa UK Limited. - 1403-8196 .- 1651-1948. ; 7:2, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- The main aim was to evaluate how thigh muscle performance in patients with chronic obstructive pulmonary disease (COPD) is affected after a 3-month training programme. Another aim was to investigate if responders to training could be discriminated from non-responders. Thirty patients participated in high-intensity physical training in water or on land, three times per week, and 13 patients constituted a non-training control group. Maximal dynamic strength and endurance in thigh muscles were tested in an isokinetic dynamometer (KinCom) before and after training. At baseline, physical and pulmonary function were tested and used in the analysis of responders/non-responders. Maximal knee flexion strength improved in both training groups, whereas knee extension was improved in the land and control group. Sixty-four percent of all patients were not able to complete the muscle endurance test at baseline and no change was seen in muscle endurance after training within or between groups. A normal body mass index seemed to predict an improvement in muscle performance in responders. We conclude that physical training in water and on land is effective regarding maximal thigh muscle strength in COPD patients. BMI seems to be a discriminating factor for an increased muscle strength. Thigh muscle endurance was decreased in the majority of the patients and did not improve with the evaluated training programme.
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| 5. |
- Aguilar, Ximena, et al.
(författare)
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Myofibroblasts in the normal conjunctival surface.
- 2010
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Ingår i: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 88:4, s. 407-12
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate the occurrence of myofibroblasts (MFBs) in the normal conjunctival surface and to evaluate any anatomical and time-related variations. METHODS: MFBs were screened among healthy individuals (35 eyes) by collecting impression cytology (IC) samples from the bulbar conjunctiva. A cohort of volunteers (12 eyes) was followed for 1 year by taking two to five imprints every month. MFBs were identified by immunohistochemical localization of the MFB marker alpha-smooth-muscle actin (alpha-SMA). RESULTS: Using a filter imprint technique, MFBs were found consistently in 94% of samples from the conjunctival surface of participating individuals. The overall MFB levels, expressed as percentage of all cells on the filter, were highest in March-May [mean 4.1%, standard deviation (SD) +/- 1.5] and lowest in December-February (mean 1.2%, SD +/- 0.5). The difference was statistically significant [p < 0.0005, Friedman test, one-way repeated measures analysis of variance (anova)]. Moreover, there was a clear divergence of MFB density between the nasal, temporal, superior and inferior bulbar conjunctiva (mean 1.7%, 1.9%, 22% and 9.7%, respectively). CONCLUSION: MFBs, known as a cellular constituent of granulation tissue in wound healing, occur in the normal conjunctival surface, which is a novel finding. Our results also show that MFB level follows a seasonal variation pattern in a temperate climate, increasing in April-September and decreasing in October-March. This variation might reflect a degree of a transient or ongoing state of tissue repair after conjunctival trauma or stress caused by exposure to environmental factors.
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| 6. |
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| 7. |
- Alm, Anna-Karin, et al.
(författare)
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Extrapancreatic trypsin-2 cleaves proteinase-activated receptor-2.
- 2000
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Ingår i: Biochemical and Biophysical Research Communications. - : Elsevier BV. - 1090-2104 .- 0006-291X. ; 275:1, s. 77-83
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Tidskriftsartikel (refereegranskat)abstract
- Proteinase-activated receptors (PARs) are activated by proteolytic removal of a short amino terminal peptide, thus exposing a new amino terminus that functions as a tethered ligand that activates the receptor. With the aim to identify and study potential activators of PAR-2 we have developed a new method to measure proteolytic cleavage of PARs. PAR-2 was tagged with the insulin C-peptide that upon receptor cleavage is released and quantified using an ELISA. The modified receptor, shown to be functional in mouse 3T3 cells, was expressed in an insect cell line and the ability of different proteinases to cleave PAR-2 was studied. Two different mast cell tryptases cleaved PAR-2 in a concentration dependent manner, but were much less potent than pancreatic trypsin and trypsin-2 isolated from a carcinoma cell line. Pancreatic trypsin and trypsin-2 were almost equally effective at cleaving PAR-2 suggesting that extrapancreatic trypsins are potential in vivo activators of PAR-2.
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| 8. |
- Arvidsson, Åsa, et al.
(författare)
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The cascade of care for pregnant women with latent tuberculosis infection in a high-income country
- 2023
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Ingår i: Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 2374-4243. ; 55:9, s. 635-645
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In ostergotland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in ostergotland county.Methods: Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in ostergotland County between 2013 and 2018. The Public Health Agency of Swedens national database for active TB was used to analyse if any women developed active TB up to two years after the screening process.Results: A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects.Conclusion: Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.
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| 9. |
- Enberg, Birgit, 1956-
(författare)
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Work experiences among healthcare professionals in the beginning of their professional careers : a gender perspective
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Swedish healthcare organizations have undergone substantial organizational and economic restructuring during the 1990s due to financial cutbacks. Little is known about recently graduated healthcare professionals´ work experience in healthcare and their future career preferences. The overall aims of this thesis was, to increase knowledge about how recently graduated healthcare professionals in Sweden perceive their work in healthcare organizations. A gender perspective is adopted. In this national cross-sectional study, four stratified random samples were separately drawn from the 1999 Swedish university graduates who were nurses (NS), occupational therapists (OT), physical therapists (PT) and (registered) physicians (PN) and who at the time of the sampling procedure were living in Sweden. Stratification was performed by sex. A total of 3989 were eligible and of those, 1434 were selected: 535 NS, 250 OT, 250 PT and 399 PN. A questionnaire was constructed containing questions about socio-demographic factors, working conditions, career preferences, work satisfaction and questions about the responsibility for and actual work with home and family, the so called unpaid household work. The questionnaires also contained questions measuring psychosocial working conditions: the effort-reward imbalance questionnaire (ERI-Q) and the demand-control questionnaire (DCQ). Collection of the data for NS, OT and PT was completed in March 2002 and for PN in May 2003. The response rate was 81% and 76% respectively. The total sample thus consists of 1145 participants; 423 nurses, 212 occupational therapists, 205 physiotherapists and 305 physicians. Most of the respondents were employed in the public sector, but many desired privately employment within the coming five year period, men more often than women. Career preferences for future work differed between women and men. A majority indicated that they did not have the opportunity to pursue knowledge development in the professional field during working hours and nearly one half could not work as independently as they wished. Satisfaction with work in general was high, but many were dissatisfied with management at work and a majority was dissatisfied with the work organization. This dissatisfaction was associated with the opportunity to work as independently as they wished and the opportunity to pursue knowledge development in the professional field. Significantly more women than men had the main responsibility for home and family and did most of the unpaid household work. Among the OT and PT working for county councils and municipalities, the results revealed that those working for municipalities, experienced low control at work compared with those working for county councils. No differences were found between OT and PT or between men and women in the two professions regarding the DCQ and the ERI-Q except for the WOC scale. Women had significantly higher scores on the WOC scale compared with men. Logistic regression analyses revealed a significant association between WOC and ERI, effort, reward and sex. One fourth of the OT and PT working for county councils and municipalities was dissatisfied with their job and this dissatisfaction was significantly associated with type of employer, reward and effort-reward imbalance (in the ERI-Q) and control (in the DCQ). Differences regarding scoring on the ERI-Q were found between nurses and physicians working in county councils but not between women and men in the same group, with the exception of the scores on overcommitment. Significantly more nurses were defined as having high effort, low reward and effort-reward imbalance compared with the physicians. More women in the NS and PN group were defined as experiencing WOC compared to men. Logistic regression analyses revealed significant associations between experiences of WOC and ERI, effort and reward. Nearly one fifth in the NS and PN group were dissatisfied with work and this dissatisfaction was particularly high among those with high effort, low reward, those with the greatest imbalance between effort and reward and those who experienced high overcommitment. In conclusion, in order to limit future work related problems and to be able to retain well educated professionals in healthcare work, dissatisfaction among the recently graduated must be taken seriously. Healthcare employers should better utilize the knowledge that recently graduated possess, regarding for example how to be a part of the development of the profession and the job. It is also important that healthcare employers address gender (in) equality at work and that work environments allow both women and men to combine careers with family duties.
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| 10. |
- Hirasawa, Karin, et al.
(författare)
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Föreställningar om skola-arbetslilv
- 2003
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I denna rapport redovisas resultaten av en intervjustudie om elevers, lärares och studie- och yrkesvägledares föreställningar om området skola-arbetsliv. Det övergripande syftet med projektet har varit att ge bilder av hur man vid tre grundskolor i Stockholmsområdet arbetar med och önskar arbeta med frågor som rör området skola- arbetsliv. Projektet har initierats och finansierats av Skolverket och ska ses som en fortsättning på tre tidigare studier inom området som genomförts vid Lärarhögskolan i Stockholm med finansiering av Skolverket.
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| 11. |
- Hirasawa, Karin, et al.
(författare)
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Utvärdering av uppsökande studie- och yrkesvägledning samt studie- och yrkesvägledning inom Arbetsforum Sydost
- 2006
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna rapport har varit att sammanställa de kunskaper och erfarenheter som finns från den uppsökande studie- och yrkesvägledningen, beskriva vad som har fungerat och vilka förutsättningar som behövs för verksamheten. Rapporten strävar efter att ge svar på följande frågor: Hur arbetar studievägledarna med att genomföra uppdraget? Vad är centralt i arbetet och vad kan utvecklas? Hur samarbetar olika yrkesgrupper med studie- och yrkesvägledarna? Vad kan utvecklas? Vilka förutsättningar är av betydelse för att den uppsökande studievägledningen/AFSO ska fungera? Resultatet av den uppsökande studievägledningen/AFSO – Nås målen för verksamheten?
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| 12. |
- Jakobsson, Gunnar, et al.
(författare)
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Increased Levels of Inflammatory Immune Mediators in Vitreous From Pseudophakic Eyes
- 2015
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Ingår i: Investigative Ophthalmology & Visual Science. - : Association for Research in Vision and Ophthalmology (ARVO). - 0146-0404 .- 1552-5783. ; 56:5, s. 3407-3414
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE. To determine if pseudophakic eyes have an increased and sustained level of inflammatory immune mediators in the vitreous compared to phakic eyes. METHODS. Vitreous fluid samples were obtained from 73 patients undergoing elective pars plana vitrectomy (PPV) as a result of a macular hole, epiretinal membrane, vitreous macular traction, or vitreous floaters. Forty eyes were pseudophakic and had previously undergone uncomplicated cataract surgery, ranging from a few months to several years prior to PPV. The vitreous samples were analyzed for 29 different inflammatory immune mediators using multiplex bead immunoassays. RESULTS. A total of 14 cytokines (eotaxin, interferon-c-induced protein-10 [IP-10], monocyte chemotactic protein-1 [MCP-1], macrophage derived chemokine [MDC], macrophage inflammatory protein [MIP]-1 alpha, MIP-1 beta, thymus activation regulated chemokine [TARC], IL-12p40, IL-15, IL-16, IL-7, VEGF, IL-6, and IL-8) were detected in the vitreous of both study groups. Using multiple linear regression analysis, pseudophakiawas significantly correlated with higher levels of vitreous immune mediators compared to phakia. Elevated vitreous levels were estimated to decrease over time for IL-6, IL-8, IL-15, IL-16, and VEGF, though they remained elevated for many months and even years compared to the levels detected in phakic eyes. CONCLUSIONS. This is the first study to demonstrate that cataract surgery and pseudophakia can induce increased vitreous levels of a substantial range of inflammatory immune mediators. The elevated levels seem to be maintained for a long period of time. These increased levels of cytokines may be involved in inflammatory processes leading to several complications to cataract surgery, both early and late.
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| 13. |
- Jakobsson, Gunnar, et al.
(författare)
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Late dislocation of in-the-bag and out-of-the bag intraocular lenses: ocular and surgical characteristics and time to lens repositioning.
- 2010
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Ingår i: Journal of cataract and refractive surgery. - : Ovid Technologies (Wolters Kluwer Health). - 1873-4502 .- 0886-3350. ; 36:10, s. 1637-44
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To characterize patients with late intraocular lens (IOL) dislocation to evaluate possible risk factors, determine the time between cataract surgery and IOL repositioning, describe the surgical management, and estimate the incidence. SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden. DESIGN: Case series. METHODS: Medical records from the cataract surgery and IOL repositioning were reviewed. RESULTS: The study enrolled 84 eyes, 63 with in-the-bag IOL dislocation and 21 with out-of-the-bag IOL dislocation. The prevalence of pseudoexfoliation (PXF) was 60% and of glaucoma, 36%. A high proportion of eyes with IOL dislocation (37%) had zonular dehiscence at cataract surgery. The median time from cataract surgery to IOL repositioning surgery was significantly shorter in eyes with out-of-the-bag IOL dislocation (3.2 years) than in eyes with in-the-bag IOL dislocation (6.7 years) (P = .029). The interval was also significantly shorter in eyes with zonular dehiscence. Using data from the National Cataract Register, the calculated incidence of IOL repositioning surgery per pseudophakic individuals in western Sweden was 0.050%. CONCLUSIONS: The possible major predisposing factors for late IOL dislocation were PXF, glaucoma, and cataract surgery complicated by zonular dehiscence. Primary placement of the IOL in the ciliary sulcus was associated with earlier IOL dislocation. Intraocular lens repositioning surgery using a posterior or anterior approach was successful in many cases. FINANCIAL
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| 14. |
- Jakobsson, Gunnar, et al.
(författare)
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Surgical repositioning of intraocular lenses after late dislocation: Complications, effect on intraocular pressure, and visual outcomes
- 2013
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Ingår i: Journal of Cataract and Refractive Surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0886-3350. ; 39:12, s. 1879-1885
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study outcomes after surgery for late intraocular lens (IOL) dislocation and, more specifically, to evaluate different surgical techniques to find predictors of worse visual outcomes, describe postoperative complications, and analyze the effect on intraocular pressure (IOP). SETTING: Department of Ophthalmology, Sahlgrenska University Hospital, Molndal, Sweden. METHODS: Medical records from cataract surgery, IOL repositioning, and follow-up examinations were reviewed. RESULTS: Ninety-one eyes with in-the-bag (80) or out-of-the-bag (11) late IOL dislocation were consecutively included. In 94% of eyes, the IOLs were repositioned using scleral sutures; 76% of cases were operated on with a posterior approach, including pars plana vitrectomy. The median follow-up was 17 months. Pseudoexfoliation was detected in 57% of eyes. A significant decrease in IOP (mean 3.0 mm Hg) from preoperative values (P=.028) was seen in glaucoma patients. Thirteen eyes had additional surgical procedures. Three cases of retinal detachment occurred. Of the eyes, 59% obtained a Snellen corrected distance visual acuity (CDVA) of 0.5 or more at followup; 23% of eyes had worse CDVA during the follow-up than preoperatively. CONCLUSIONS: Repositioning surgery for late IOL dislocation with a posterior pars plana approach using scleral suturing of the preexisting IOL appears to be a safe and effective method for restoring visual acuity. Postoperative complications were comparable to previous findings in this field. Patients with glaucoma may have improved IOP regulation. (C) 2013 ASCRS and ESCRS
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| 15. |
- Janaudis-Ferreira, Tania, 1976-, et al.
(författare)
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Comparison of the 6-minute walk distance test performed on a non-motorised treadmill and in a corridor in healthy elderly subjects
- 2010
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Ingår i: Physiotherapy. - : Elsevier BV. - 0031-9406 .- 1873-1465. ; 96:3, s. 234-239
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the 6-minute walk distance (6MWD) test performed on a non-motorised treadmill (6MWD-T) with the 6MWD test performed in a corridor (6MWD-C) in healthy elderly subjects. PARTICIPANTS: Sixteen healthy elderly individuals. DESIGN: Participants performed three 6MWD-T tests and three 6MWD-C tests on two different days. OUTCOME MEASURES: Distance walked was recorded in metres. Perceived exertion and leg fatigue were rated on the modified Borg scale before and after each test. RESULTS: Using the Bland and Altman limits of agreement analysis method, the mean difference between the two methods was 153.3m (limits of agreement: 28 to 278). The mean difference between days 1 and 2 for the 6MWD-C test was -7.2m (limits of agreement: -45.4 to 30.8), and the mean difference between days 1 and 2 for the 6MWD-T test was -1.6m (limits of agreement: -64.0 to 60.7). The mean difference between the first and second repetitions of the 6MWD-C test was -5m (limits of agreement: -41 to 31), and the mean difference between the first and second repetitions of the 6MWD-T test was -17m (limits of agreement: -85 to 51). CONCLUSIONS: The 6MWD-C and 6MWD-T tests are not interchangeable. However, the results showed good test-retest reliability between days and between test repetitions for both tests. Therefore, the 6MWD-T test may offer an alternative option to the 6MWD-C test when a 30-m corridor is not available. These findings may have implications for execution of the 6MWT-T test within cardiac and pulmonary rehabilitation.
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| 16. |
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| 17. |
- Ludvigsson, Jonas F., 1969-, et al.
(författare)
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Adaptation of the Charlson Comorbidity Index for Register-Based Research in Sweden
- 2021
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Ingår i: Clinical Epidemiology. - : Dove Medical Press Ltd.. - 1179-1349. ; 13, s. 21-41
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Comorbidity indices are often used to measure comorbidities in register-based research. We aimed to adapt the Charlson comorbidity index (CCI) to a Swedish setting.Methods: Four versions of the CCI were compared and evaluated by disease-specific experts.Results: We created a cohesive coding system for CCI to 1) harmonize the content between different international classification of disease codes (ICD-7,8,9,10), 2) delete incorrect codes, 3) enhance the distinction between mild, moderate or severe disease (and between diabetes with and without end-organ damage), 4) minimize duplication of codes, and 5) briefly explain the meaning of individual codes in writing.Conclusion: This work may provide an integrated and efficient coding algorithm for CCI to be used in medical register-based research in Sweden.
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| 18. |
- Lundberg, Ulf, et al.
(författare)
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Arbetsmiljöns betydelse för ryggproblem : En systematisk litteraturöversikt
- 2014
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Rapport (refereegranskat)abstract
- The Swedish Council on Health Technology Assessment (SBU) conducted a systematic literature review of research on the association between occupational exposures and back disorders. In this review, we use back disorders as an umbrella term to include the more specific terms back trouble (a subjective experience of pain, ache or discomfort in the back), symptoms of sciatica, intervertebral disc changes and diseases of the back. The report is focused on disorders of the thoracic and lumbar spine. A wide range of occupational exposures were investigated, including: physical work load, vibration, organizational and psychosocial factors, chemical and biological factors, noise, environmental factors and contagious substances.Background: Since 2011 SBU has had a mandate from the Swedish government to systematically assess the evidence associating occupational exposures to health issues. The objective of this review was to assess the scientific basis describing the influence of occupational exposures on back disorders. Back disorders are common. Between 60 and 70 percent of the general population world-wide suffer from back pain at least once in their life. For affected individuals, back disorders are the source of both suffering and decreased functioning. The costs to society are also considerable in terms of direct health care costs, financial support to individuals with work disability, as well as costs due to loss of production.Method: A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to an occupational context. A literature search covering years 1980 to January 2014 was conducted in international medical and occupational data bases. The review assessed almost 8 000 abstracts. Studies that fulfilled strict inclusion criteria were assessed for relevance and quality, using pre-set protocols. Relevance and quality assessments were conducted by two experts, working in an evaluation pair. After conducting independent assessments, the two experts had to agree on a mutual relevance and quality classification. Some articles required that all exporters participated in discussion and made a collective assessment. A total of 109 studies were classified as moderate or high quality, representing more than 150 000 study participants. The strength of the scientific evidence was assessed with the GRADE system.Results: There is an association between occupational exposure and back disorders. This result is based on investigations of a large variety of work environments, mainly in Europe and North America. In most studies passing the quality criteria, researchers investigated occupational exposure and back disorders in populations consisting of both women and men with at least one year of follow up.Conclusions: People in the following groups develop more back trouble over time than those who are not subjected to the specified exposure at work:– Those who work with manual handling (e.g. lift) or in a posture where the back is bent or rotated– Those who work in a kneeling or squatting posture, or have physically demanding work tasks– Those exposed to whole body vibration– Those who experience work as mentally stressful; or those who find their work demanding, but lack decision latitude (personal control of their own working situation); or those who have insufficient opportunities for personal development– Those who work outside standard office hours.In some work environments, people have less back trouble. Those who experience high influence over work-related decisions, those who get social support at work and those with high job satisfaction develop less back trouble than others.Women and men with similar occupational exposures develop back troubles to the same extent.Those who work in forward bent postures or are exposed to whole body vibration in their work develop more symptoms of sciatica than others, while those with high job satisfaction develop less such symptoms. Those whose work entails manual handling develop more intervertebral disc changes than others.This systematic literature review has uncovered a substantial body of knowledge concerning occupational exposures and back disorders. Future research should include intervention studies, i.e. studies that scientifically test the effect of well defined interventions on back disorders over extended periods of time in authentic work situations.Project groupExperts: Karin Harms-Ringdahl (Chair), Sven Ove Hanson (Ethics), Olle Hägg, Ulf Lundberg, Svend Erik Mathiasen, Gunnevi Sundelin, Magnus Svartengren, and Hans Tropp.SBU: Charlotte Hall (Project Director), Karin Stenström (Assistant Project Director), Agneta Brolund (Information Specialist), Therese Kedebring (Project Administrator), Laura Lintamo (Investigator), Maria Skogholm (Project Administrator), Lena Wallgren (Scientific Writer)Scientific reviewers: Eva Denison, Mats Hagberg, Gunnar Nemeth, Esa-Pekka Takala.
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| 19. |
- Strömland, Kerstin, 1934, et al.
(författare)
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Paediatric and ophthalmologic observations in offspring of alcohol abusing mothers
- 1996
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 85:12, s. 1463-1468
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Tidskriftsartikel (refereegranskat)abstract
- The offspring of nine women who had abused alcohol and drugs during pregnancy were studied. Of the 30 children, 10 had fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). Ophthalmological impairments associated with FAS--impaired vision, optic nerve hypoplasia, cataract, increased tortuosity of retinal vessels--were common. The severity of teratogenic lesions varied among the children and was often related to the level of abuse during pregnancy. Most women were unable to take care of their children during periods of substance abuse. All children with FAS/FAE had learning difficulties. Four mothers abstained from alcohol or drugs during some of their pregnancies and gave birth to children without birth defects.
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| 20. |
- Sundelin, Kaarina, et al.
(författare)
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Effects of cisplatin, interferon-alpha and 13-cis retinoic acid on the expression of Fas (CD95), intercellular adhesion molecule-1 (ICAM-1) and epidermal growth factor receptor (EGFR) in oral cancer cell lines
- 2007
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Ingår i: Journal of Oral Pathology & Medicine. - : Blackwell Publishing. - 0904-2512 .- 1600-0714. ; 36:3, s. 177-183
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies showed that many chemotherapeutic agents can induce immuno-suppression at therapeutic drug concentrations whereas low drug doses induce immuno-augmentation.Methods: The effect of low-dose cisplatin, interferon-alpha, and 13-cis retinoic acid on receptors involved in immune-mediated apoptosis (Fas/CD95), cell growth (epidermal growth factor receptor) and lymphocyte adhesion (intercellular adhesion molecule-1) was investigated in two oral cancer cell lines (UT-SCC-20A and UT-SCC-24A). Different methods for cell preparation were studied: mechanical and enzymatic detachment, and culture on chamber slides. Receptor expression was investigated using immunohistochemical staining. The amount of soluble and cell-bound Fas was determined with the ELISA technique, and the functional relevance of Fas expression, apoptosis induction, was analyzed.Results: Cisplatin enhanced cytoplasm and membrane staining for Fas in both cell lines. After cisplatin treatment, the amount of soluble Fas was increased in UT-SCC-20A cultures, but no effect was observed in the UT-SCC-24A cell line. Apoptosis, measured as enhanced caspase-3 activity, was induced by an agonistic Fas antibody (CH11) after cisplatin treatment in UT-SCC-24A cells.Conclusions: Low-dose cisplatin treatment enhanced Fas expression in both cell lines and increased susceptibility to apoptosis in one of them.
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| 21. |
- Sundelin, Kaarina, et al.
(författare)
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Effects of cytokines on matrix metalloproteinase expression in squamous cell carcinoma in vitro
- 2007
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 125:7, s. 765-773
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Tidskriftsartikel (refereegranskat)abstract
- Objective: MMPs play an important role in enhanced intra-tumoral proteolytic activity, promoting angiogenesis and invasion by acting on extracellular matrix substances. Cytokines secreted by tumour-infiltrating immune cells, fibroblasts and tumour cells can modulate MMP expression and secretion by cancer cells. The objective of this study was to investigate the effects of IL-6, soluble IL-6 receptor (sIL-6R), HGF, TNF- and IL-8 on MMP-1, -2 and -9 expression by two oral squamous cell carcinoma cell lines (UT-SCC-20A and -24A). Material and methods: ELISA was used to analyse secretion of total MMP protein and gelatin zymography was used for activity analysis. Results: IL-6 had a moderate stimulatory effect on MMP-1 secretion in both cell lines, whereas sIL-6R had no effect. When these cytokines were added together, a dose-dependent, synergistic stimulatory effect was observed. HGF also upregulated MMP-1 secretion, especially in one cell line (UT-SCC-24A), and a synergistic effect was observed when HGF was added to IL-6 in both cell lines. MMP-9 secretion by UT-SCC-24A was increased when stimulated with HGF and IL-6 combined with sIL-6R, whereas no effect was found in the other cell line. TNF- stimulated MMP-9 secretion in both cell lines, but only stimulated MMP-1 secretion in one (UT-SCC-24A). The zymographic results were consistent with the ELISA results, indicating an upregulation of active enzyme when a stimulatory effect on protein expression was detected. Conclusions: The intra-tumoral cytokines IL-6, hepatocyte growth factor (HGF) and tumour necrosis factor- (TNF-) stimulate oral cancer cells to enhanced secretion of matrix metalloproteinase (MMP)-1 and -9. These results contribute to an understanding of the extracellular events necessary for tumour progression.
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| 22. |
- Sundelin, Karin, et al.
(författare)
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Enlargement of extraocular muscles during treatment with amiodarone
- 1997
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Ingår i: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907. ; 75:3, s. 333-334
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Tidskriftsartikel (refereegranskat)abstract
- A case of extraocular muscle enlargement diagnosed 2 months after the start of treatment with amiodarone is presented. The orbital CT scan was typical of endocrine ophthalmopathy. The patient had no history of hyperthyroidism and during a follow-up period of 2 years no laboratory evidence of irregularities in the thyroid hormone metabolism was discovered.
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| 23. |
- Sundelin, Karin, et al.
(författare)
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Eye injuries from fireworks in Western Sweden
- 2000
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Ingår i: Acta Ophthalmologica Scandinavica. - : Wiley. - 1395-3907. ; 78:1, s. 61-64
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate the extent and type of as well as the circumstances connected with, ocular injuries caused by pyrotechnical products in the Western region of Sweden (1 750 000 inhabitants). METHODS: A three-year prospective observational study was carried out to register, interview and follow-up all patients with ocular injuries caused by fireworks. The patients were reported by all ophthalmologists in the area. RESULTS: 52 patients (72 injured eyes) were reported, 49 males and 3 females. 39 of 52 (75%) were younger than 18 years. 15 patients (including the three females) were bystanders. The injuries ranged from conjunctivitis to complete loss of the eye. The pyrotechnical device had been manipulated or misused in 19 (37%) of the 52 accidents. Seriousness of injury could not be correlated to type of device or to whether the injured person was active in launching the firework or not. 20 (38%) of the 52 patients had permanent damage to the eye. CONCLUSION: Ocular injuries from fireworks remain a problem. Preventive measures such as protective glasses and legislation are being discussed.
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| 24. |
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| 25. |
- Sundelin, Karin, et al.
(författare)
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Five-year incidence of Nd:YAG laser capsulotomy and association with in vitro proliferation of lens epithelial cells from individual specimens: a case control study
- 2014
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Ingår i: Bmc Ophthalmology. - : Springer Science and Business Media LLC. - 1471-2415. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aims of this study were to determine the 5-year incidence of posterior capsule opacification (PCO) requiring Nd:YAG laser capsulotomy in a representative mixed cohort of cataract patients, to determine risk factors for PCO and to investigate possible association with growth of human lens epithelial cells (HLEC) in vitro. Methods: Pieces of the anterior lens capsule and adhering HLEC were obtained at cataract surgery and cultured individually. After one and two weeks respectively, cultured cells were stained with carboxy-fluorescein diacetate succinimidyl ester (CFDA SE), after which image processing software was used to determine the area of the confluent cell layer. The 5-year incidence of Nd: YAG laser capsulotomy in this cohort was determined through medical records and by mail or telephone interviews. For statistic analyses Mann-Whitney U-test, Fisher's exact test and binary logistic regression were used. Results: Data on treatment/no treatment for PCO was obtained from 270 patients with a median follow-up time of 57 months (range 50-64 months). The three-year cumulative incidence of PCO was 5.2% and the cumulative 5-year incidence was 11.9%. Patients who had undergone Nd: YAG laser capsulotomy were significantly younger (median 71 years) than patients who did not receive treatment for PCO (median 75 years, p = 0.022). Logistic regression demonstrated that apart from younger age, follow-up time and type of intraocular lens (IOL) were associated with risk of PCO, with hydrophilic 1-piece IOLs conferring a higher risk than hydrophobic acrylic 1-piece or 3-piece IOLs (adjusted OR = 9.4, 95% CI 2.5-35.7, p = 0.001). Of the 270 patients from whom information could be retrieved regarding PCO treatment, in vitro cell culture could be established and quantified from 185 patients. No significant difference in cell growth in vitro was shown between patients subsequently requiring/not requiring Nd: YAG laser capsulotomy. Conclusions: The cumulative 5-year incidence of 11.9% is comparable or slightly higher than reported in other recent studies. The type of IOL was the most important risk factor for PCO in this study, whereas intrinsic proliferative capacity of the individual's lens epithelial cells seems to be less important for subsequent PCO development.
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