| 1. |
- Ludvigsson, Johnny, 1943-, et al.
(författare)
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GAD treatment and insulin secretion in recent-onset type 1 diabetes
- 2008
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Ingår i: New England Journal of Medicine. - Boston, Mass : Massachusetts medical society. - 0028-4793 .- 1533-4406. ; 359:18, s. 1909-1920
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Tidskriftsartikel (refereegranskat)abstract
- Background The 65-kD isoform of glutamic acid decarboxylase (GAD) is a major autoantigen in patients with type 1 diabetes mellitus. This trial assessed the ability of alum-formulated GAD (GAD-alum) to reverse recent-onset type 1 diabetes in patients 10 to 18 years of age. Methods We randomly assigned 70 patients with type 1 diabetes who had fasting C-peptide levels above 0.1 nmol per liter (0.3 ng per milliliter) and GAD autoantibodies, recruited within 18 months after receiving the diagnosis of diabetes, to receive subcutaneous injections of 20 μg of GAD-alum (35 patients) or placebo (alum alone, 35 patients) on study days 1 and 30. At day 1 and months 3, 9, 15, 21, and 30, patients underwent a mixed-meal tolerance test to stimulate residual insulin secretion (measured as the C-peptide level). The effect of GAD-alum on the immune system was also studied. Results Insulin secretion gradually decreased in both study groups. The study treatment had no significant effect on change in fasting C-peptide level after 15 months (the primary end point). Fasting C-peptide levels declined from baseline levels significantly less over 30 months in the GAD-alum group than in the placebo group (−0.21 vs. −0.27 nmol per liter [−0.62 vs. −0.81 ng per milliliter], P = 0.045), as did stimulated secretion measured as the area under the curve (−0.72 vs. −1.02 nmol per liter per 2 hours [−2.20 vs. −3.08 ng per milliliter per 2 hours], P = 0.04). No protective effect was seen in patients treated 6 months or more after receiving the diagnosis. Adverse events appeared to be mild and similar in frequency between the two groups. The GAD-alum treatment induced a GAD-specific immune response. Conclusions GAD-alum may contribute to the preservation of residual insulin secretion in patients with recent-onset type 1 diabetes, although it did not change the insulin requirement. (ClinicalTrials.gov number, NCT00435981.)
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| 2. |
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| 3. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Stockholm Preterm Interaction-based Intervention (SPIBI) – Av RCT Assessing Parent-Infant Interaction at 12 Months Corrected Age in Extremely Preterm Born Infants and Their Parents
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundParental responsiveness is of great importance for positive effects of behavioral and cognitive development in preterm infants and the Emotional availability scales (EAS) is a clinically relevant assessment measure, for early neurodevelopment. The EAS is an observational measure which reflects the quality of parent–child relationship and the child’s socio-emotional development. It has 4 adult domains (sensitivity, structuring, non-intrusiveness, non-hostility) and 2 child domains (responsiveness, involvement) (Biringen 2014). In an ongoing RCT of an intervention for extremely preterm (EPT) born infants and their parents, the Stockholm Preterm Interaction-Based Intervention (SPIBI), the primary outcome measure is EAS used at 12 months corrected age (CA). The aim for this sub-study is to evaluate the inter-rater reliability of EAS in this cohort.MethodDuring the first year after discharge, ten home visits were carried out from specially educated interventionists of our multidisciplinary team. 130 EPT infants were recruited and 115 have been filmed and assessed at 12 months CA. The parent was instructed to play with the infant for 10 minutes. Dyads were filmed, videos assessed and scored by a trained EAS-accredited team member. 20% of the videos (23/115) were assessed by an additional EAS-accreditor to evaluate inter-rater-reliability. Interclass Correlation Coefficient (ICC) were used. To obtain authenticity with real-life, the videos were filmed in a home setting with opportunity to choose study parent. Interaction were encouraged to proceed in an ordinary pattern.ResultsICC values range 0,86 - 0,96 within all dimensions, all individual values, 95%CI (Table 1). This indicates high inter-rater reliability, although some of the subscales had lower ICC (0,73-0,98). ConclusionThe SPIBI study corresponds well with EAS scoring assessment method for reflection of parent-infant interaction at 12 months CA in EPT born infants.
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| 4. |
- Broström, Eva, et al.
(författare)
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Trunk and center of mass movements during gait in children with juvenile idiopathic arthritis
- 2007
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Ingår i: Human Movement Science. - : Elsevier BV. - 0167-9457 .- 1872-7646. ; 26:2, s. 296-305
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Tidskriftsartikel (refereegranskat)abstract
- Motion of the body center of mass (CoM) can often indicate the overall effect of the strategy of forward progression used. In the present study, focus is placed on trunk movements in the sagittal, coronal, and transverse/rotation plane, as well as placement of the CoM, during gait in children with juvenile idiopathic arthritis (JIA). Seventeen children with JIA, all with polyarticular lower extremity involvement were examined before and approximately two weeks after treatment with intra-articular cortico-steroid injections. Movement was recorded with a 6-camera 3D motion analysis system in both the children with JIA and in 21 healthy controls. Trunk and center of mass movements were compared between JIA and controls, and effects of intra-articular cortico-steroid treatment were evaluated. Children with JIA were more posteriorly tilted in the trunk, contrary to the common clinical impression, and had their CoM placed more posterior and off-centred, which may have been a result of pain. With such knowledge, it might be possible to better understand the effects of their pain and involvement, and ultimately to plan a treatment strategy for improving their gait patterns.
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| 5. |
- KC, Ashish, 1982-, et al.
(författare)
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Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.
- 2023
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Ingår i: Nature human behaviour. - : Springer Science and Business Media LLC. - 2397-3374. ; 7:4, s. 529-544
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Tidskriftsartikel (refereegranskat)abstract
- Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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| 6. |
- Nosko, Daniela, 1986-, et al.
(författare)
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Changes in prevalence of non-optimal neurological condition between 6.5 and 12 years in children born extremely preterm
- 2023
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Ingår i: European journal of paediatric neurology. - : Elsevier. - 1090-3798 .- 1532-2130. ; 45, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To assess prevalence of non-optimal neurological condition and associations with motor function in children born extremely preterm (EPT) up to early adolescence, and to examine potential changes in neurological con-dition between 6.5 and 12 years.Method: A prospective cohort of one hundred six children (EPT n = 62, term n = 44) was assessed at 6.5 and 12 years. Four domains derived from the Touwen Neurological Examination (coordination and balance, posture and muscle tone, reflexes, and nerve function of the eyes and face) were used to assess the presence of a non-optimal neurological condition (defined as the presence of any abnormal domain). The Movement Assessment Battery for Children 2nd ed. was used to evaluate motor function.Results: Twenty-seven children born EPT (44%) were assessed as having a non-optimal neurological condition compared with 4 (9%) in the control group (p=<0.001) at 12 years. Between age 6.5 and 12 years the number of children born EPT with a non-optimal neurological condition decreased from 37 to 27 (p = 0.007). At 12 years these children also had significantly lower MABC-2 total test scores, compared to those with normal neurology: median (range) 57 (32-79) versus 75 (43-99), respectively (p=<0.001). The same was shown for subscale scores; manual dexterity (p=<0.001), aiming/catching (p = 0.004), and balance (p = 0.004).Conclusion: The prevalence of a non-optimal neurological condition reduced with increasing age. However, still, at 12 years, these neurological impairments remained significantly more common in the EPT group than in their term-born peers and was shown to be related to a reduced motor function.
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| 7. |
- Nosko, Daniela, 1986-, et al.
(författare)
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Discrete white matter abnormalities at age 8-11 years in children born extremely preterm are not associated with adverse cognitive or motor outcomes
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:3, s. 566-575
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Little is known about the prevalence of discrete white matter abnormalities (WMA) beyond the first years in children born extremely preterm (EPT) and the relation to neurodevelopmental outcomes. Our aim was to investigate the prevalence of discrete WMA in children born EPT and the relationship to neonatal white matter injuries (WMI), white matter (WM) volume, WM diffusivity and neurodevelopment.Methods: The study was a part of a longitudinal follow-up study of EPT neonates. All children were scanned at Karolinska University hospital 2004-2007 (neonates) and 2014-2015 (children at 8-11 years). WMA was qualitatively assessed by visual inspection. Developmental assessment was conducted at 12 years.Results: In total, 112 children (median age 10.3 years, 56 girls) underwent MRI of the brain (68 EPT, 45 controls). In the EPT group, a subset had MRI around term equivalent age (n = 61). In the EPT group, the prevalence of discrete WMA at 8-11 years was 52%. There was a positive association between WMI at TEA and 8-11 years. There was no association between WMI and WM volumes or diffusivity at 8-11 years. Discrete WMA was not related to neurodevelopmental outcomes.Conclusion: Discrete WMA was prevalent in children born EPT at 8-11 years but were not related to neurodevelopmental outcomes.
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| 8. |
- Svensson, Katarina, et al.
(författare)
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Usability and inter-rater reliability of the NeuroMotion app : A tool in General Movements Assessments
- 2021
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Ingår i: European journal of paediatric neurology. - : Elsevier Science Ltd. - 1090-3798 .- 1532-2130. ; 33, s. 29-35
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early intervention after perinatal brain insults requires early detection of infants with cerebral palsy (CP). General Movements Assessments (GMA) in the fidgety movement period has a high predictive value for CP. Aim: To investigate the NeuroMotionTM apps usability regarding film quality and user experience and to assess the inter-rater reliability of GMA in a neonatal risk group. Methods: GMA, inter-rater reliability and film quality was assessed in a cohort consisting of 37 infants enrolled in a multicentre study of GMA as part of the Swedish neonatal follow-up program for high-risk infants. Some of these infants were filmed twice. For evaluation of user experience 95 parents of 52 infants were addressed with a web-based questionnaire. A GMA expert assessed film quality and performed GMA and three on-site assessors, individually performed GMA. Inter-rater reliability was computed using Krippendorffs alpha (k-alpha). Results: In all, 45 films showed good or excellent quality. The response rate of the questionnaire survey was 40% and revealed predominantly positive perceptions of the NeuroMotionTM app. GMA in 36 infants resulted in substantial agreement (k-alpha = 0.72, 95%CI = 0.3-1.0) between the three on-site assessors consensus and the GMA expert. Inter-rater reliability for GMA between the on-site assessors was moderate (k-alpha = 0.48, 0.18-0.74). Conclusion: The NeuroMotionTM app produces good technical quality films and the app user experience was overall positive. High agreement was observed between the on-site assessors and the GMA expert. The study design is feasible for more extensive GMA studies in cohorts of infants at risk of CP. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 9. |
- Örtqvist, Daniel, et al.
(författare)
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Board composition and firm performance : a test of the upper echelon perspective of entrepreneurship, innovation and competitiveness
- 2012
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Konferensbidrag (refereegranskat)abstract
- Principal TopicThe role and influence of board composition on firm performance and development has been extensively debated over the last decades. In 1984, Hambrick and Mason published their seminal work introducing the perspective of upper echelons. This perspective suggests that the demographic characteristics of firm boards may exert influence over firm performance since the demographics are associated with many cognitive bases, values, and perceptions thatguide and direct board members decision-making and functions. Several studies have found empirical results supporting these arguments and have further developed the conceptual reasoning for a relationship between upper echelon characteristics and firm performance. However, the wide array of theoretical underpinnings and perspectives combined with diverse empirical evidence has presented further questions over time in relation to how board composition influences firm performance and entrepreneurial levels in firms.In an attempt to address these questions, we model and test the relationship between board composition and firm performance and entrepreneurial levels. We propose a set of hypotheses that suggest that board composition can influence the potential of the boards to support effective monitoring and that composition also have influence of the human and relational capital of the boards. Overall, we suggest that board monitoring and board capital mediates the relationship between board composition and firm performance.MethodThe hypotheses were tested in a three year longitudinal data set including full responses from a sample of 296 firms drawn from a population of Swedish firms. In total were 1167 firms surveyed in the study and approximate 25% responded with completed surveys for the time period. A structural equation modeling approach including mediation models and control for lagged effects were adopted to perform tests.In the light of previous findings, we examine the relationship of both subjective and objective measures of firm performance and we also include longitudinal data to account for potential lagged effects. Besides examining board composition influence over traditional measures of performance, we examine how board composition influences firm levels of entrepreneurial orientation and innovation as well.In doing this we include a set of competing models where board composition variables are hypothesized to influence firm performance and entrepreneurial levels through board functions as board monitoring and board capital. Nested model tests are adopted to determine mediation and to decide how competing models and theories work in predicting firm performance through board composition.Results and ImplicationsResults indicate that board composition exerts influences over both firm performance and entrepreneurial levels in the studied firms. Overall, board composition both influences the firms’ ability to exert effective monitoring and contribute with human and relational capital to the firm that in turn are vital areas for the firms in order to perform well. The study has implications for entrepreneurship as it shows the importance of board composition upon firm performance and entrepreneurial levels. The study also contributes to current debates in upper echelon literature by including models of how the relationship between board composition and firm performance is mediated by board functions in terms of board monitoring and board capital. The study includes competing models and tests arguments from alternative theories when examining the role of board composition.
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| 10. |
- Örtqvist, Daniel, et al.
(författare)
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Regional innovation and development : a latent growth model of regional innovation determinants
- 2011
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Konferensbidrag (refereegranskat)abstract
- We propose arguments supporting regional innovation to be dependent upon the simultaneous influence of movement of citizens and the industry structure within the region. Our hypotheses state that regions with a high industry concentration gain relatively more from individuals moving in respectively out from the region compared to regions with a low industry concentration. We tested our model and hypotheses on a four year longitudinal data from official registers on the complete population of 290 Swedish municipalities. Results support that regions with a high industry concentration gain innovation activity from increases in both in- and outflows of citizens from the region. Results on regions with a low industry concentration are inconclusive but indicate, in support of our arguments, that such regions gain relatively more from stability (i.e., low movement) in the region.
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| 11. |
- Örtqvist, Maria
(författare)
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Development and evaluation of outcome measures in children with knee disorders
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: The knee joint is one of the most common sites for injury in children. Severe knee injuries are often associated with long-term symptoms, functional impairment and disability. Today there is a lack of appropriate clinical outcome measures to evaluate knee function in children with knee disorder. As a result, instruments developed for adults are often used. Unfortunately, this may lead to inaccurate evaluation and selection of treatment. The overall aim of this thesis was to develop and evaluate outcome measures for use in children with knee disorders. In Study I, the aim was to evaluate the reliability of knee muscle strength measurements in healthy subjects using the Strength Measuring Chair (SMC) and to evaluate the agreement between the SMC and an Isokinetic Dynamometer (ID). The aims of Study II, were to evaluate the Single-limb mini squat test and the Quadriceps-angle (Q-angle), as discriminative tests of medio-lateral knee position, with respect to reliability and reference values. In Studies III and IV the aim was to evaluate the comprehensibility of the Knee Injury and Osteoarthritis Outcome Score (KOOS) when used in children, to suggest modification for a pediatric version (KOOS-Child), as well as to evaluate the psychometric properties of the KOOS-Child when used in children with knee disorders. Patients and Methods: In Studies I and II, healthy children and adults were recruited and a test- retest design was used. In Study I, muscle strength tests were performed in 20 children and 23 adults during three sessions; two in the SMC and one in the ID. In Study II, 246 children were included and dynamic and static medio-lateral knee position was assessed by the Single-limb mini squat test and by the Q-angle respectively. In Study III and IV, children with various knee disorders were recruited. In Study III, cognitive interviews were conducted with 34 Swedish children to evaluate the comprehensibility of the KOOS when used in children. According to the findings the KOOS was modified and the KOOS-Child was developed. In Study IV, 115 children participated in three sessions to evaluate the psychometric properties of the KOOS-Child. Results: In Study I, the SMC was found to reliably measure knee muscle strength in children and adults; however, a large disagreement was found between the instruments. In Study II, the reliability of the Single-limb mini squat test was determined moderate and a fair to moderate reliability of the Q-angle measurements was found. Q-angle reference values varied with age and sex, however the difference may not be clinically relevant. Findings from Studies III and IV, showed that the KOOS was not well understood by children, thus the KOOS-Child was developed. The KOOS-Child demonstrated good psychometric properties, i.e. it is valid, reliable and responsive to clinical change when used in children with knee disorders. Conclusion: Outcome measures for the evaluation of different aspects of knee function, specifically developed for a pediatric population is very important and necessary. In the present thesis, existing measures originally designed for adults were evaluated for use in children and new outcome measures were developed. The studies have highlighted the importance of using instruments that are specifically designated for the study population when measuring knee muscle strength, and emphasized the difficulties encountered when comparing results from different strength measuring devices. Evaluation of medio-lateral knee position showed that the Single- limb mini squat test can be used in a pediatric population however the Q-angle needs further investigation before its use can be justified. A new patient-reported outcome measure, the KOOS-Child, was also developed to measure knee function and knee-related quality of life in children with various knee disorders. KOOS-Child is recommended to be used whenever studies intend to evaluate patient reported outcomes in children with knee disorders.
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| 12. |
- Örtqvist, Maria, et al.
(författare)
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Reliability of a new instrument for measuring plantarflexor muscle strength
- 2007
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Ingår i: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 88:9, s. 1164-1170
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To test the reliability of a new muscle strength testing instrument (the Strength Measuring Chair [SMC]) designed to quantify isometric strength in the lower extremities, and to determine the agreement between the SMC and an isokinetic dynamometer (Biodex). Design: Isometric strength tests were performed in plantar-flexors with 2 different knee positions (60 degrees, 30 degrees). Measurements were taken at 3 different sessions. Setting: Strength testing laboratory. Participants: Twenty-three able-bodied adults and 15 able-bodied children. Interventions: Not applicable. Main Outcome Measure: Isometric plantarflexor strength. Results: The reliability of isometric strength measurements of plantarflexors taken in the SMC was excellent for both the adult and children groups (intraclass correlation coefficient range,.84-.87). A Bland-Altman 95% limit of agreement test showed no systematic variation in 3 of the 4 SMC test observations; systematic variation was only observed in the adult group at a knee position of 30 degrees. There was no systematic difference in the adult group between the SMC and the isokinetic dynamometer, but there was a systematic variation in the children's group. Conclusions: The SMC reliably measured isometric plantarflexor strength in the tested populations.
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