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- Eriksson, Karolina I. A., 1991-
(författare)
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Bacteria that escape predation : waterborne pathogens and their relatives
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The hidden presence of opportunistic bacterial pathogens in the environment evokes concerns about emerging diseases, especially in the light of climate change. The co-evolution of bacteria and their predators (protozoa) has led to bacterial defence strategies of which some contribute to the ability of bacteria to cause disease. To increase our understanding of the interplay between bacteria, protozoa, land use, and climate scenarios in Nordic brackish and freshwater, four studies were designed. The first study explored the co-occurrence patterns between predation resistant bacteria (PRB) and bacterivorous protozoa in a coastal area in the northern Baltic Sea. The results showed higher PRB diversity in the bays and freshwater inlets, than in the offshore waters. Further, genotype specific interactions between protozoa and bacteria were identified. The second study focused on Legionella species diversity and their association with humic substances and low salinity, potentially facilitated through the promotion of the heterotrophic microbial food web or by iron availability. The third study examined the impact of intensified land use on bacterial taxa abundance and community composition in lake inflows, demonstrating indirect downstream effects on water quality. Factors such as pastures, fields, farms, aluminium, iron, and humic substances were linked to increased Legionella abundance. The fourth study exposed aquatic organisms to climate change scenarios, causing eutrophication or brownification with elevated iron levels. Pseudomonas aeruginosa were found to be especially persistent to iron, likely linked to the same mechanism that enables survival in protozoan cells. This trait was shared with other observed intracellular pathogens and uncultured species, who showed elevated resilience to brownification and ability to survive outside host cells. These findings identified complex relationships, which improve our understanding of the intricate dynamics that shape aquatic ecosystems, and highlight the importance of considering multiple factors in managing water resources and maintaining ecosystem health. Human activities including intensified land use can have far-reaching consequences, jeopardizing the pristine nature of water bodies and escalate the presence of environmental and opportunistic bacterial pathogens.
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| 2. |
- Carlfjord, Siw, 1959-
(författare)
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The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
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| 3. |
- Höglund, Erik, 1983-
(författare)
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Non-conveyance within the Swedish ambulance service : A prehospital patient safety study
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThere is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.AimThe overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.MethodsAll non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.Conclusions Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused
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| 4. |
- Motwani, Nisha
(författare)
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Molecular evidence for metazooplankton feeding on filamentous cyanobacteria and picocyanobacteria in the Baltic Sea
- 2012
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Interactions between zooplankton and cyanobacteria are complex and system-specific. They play an important role in mediating responses of phytoplankton to changes in nutrient regime and top-down manipulations. Negative consequences associated with these interactions include massive blooms of diazotrophic blue-green algae and declines in zooplankton and fish stocks. With regard to filamentous cyanobacteria, toxicity, morphology, and poor nutritional quality have commonly been implicated as mechanisms hampering efficient grazing, whereas picocyanobacteria are generally considered as inaccessible for mesozooplankton grazers due to their small size. The evidence for these assumptions are, however, contradictory, and there are studies showing that both picocyanobacteria and filamentous cyanobacteria can contribute substantially to zooplankton diets. Moreover, by supplying nitrogen to non-diazotrophic phytoplankton, these cyanobacterial blooms fuel production of edible phytoplankton and picoplankton, including picocyanobacteria. Thus, cyanobacteria could have a neutral or even positive effect on growth of mesozooplankton. As zooplankton is the main trophic link between primary producers and higher trophic levels, it is important to understand whether mesozooplankton can efficiently utilize cyanobacterial production by direct grazing. Here, I used molecular approach in the field and laboratory studies to determine (1) whether pico- and filamentous cyanobacteria are ingested by mesozooplankton grazers, (2) what species/groups are particularly efficient in grazing on picocyanobacteria, and (3) consequences of feeding on toxic filamentous cyanobacterium for copepod physiological status.In Paper I, we experimentally studied effects of direct ingestion of toxic filamentous cyanobacteria on oxidative status, reproduction, and juvenile development in the copepod Acartia bifilosa. Moreover, using short- and long-term field observations on the egg production in Acartia tonsa and growth of nauplii in the common Baltic copepods Acartia spp. and Eurytemora affinis in relation to cyanobacteria abundance, we showed overall positive effects of diazotrophic filamentous cyanobacteria on oxidative balance, viable egg production and nauplial growth. These findings suggest that cyanobacterial blooms in the Baltic Sea might contribute, both directly and indirectly, to zooplankton nutrition. The indirect effects are most likely mediated through the stimulation of picoplankton communities by filamentous cyanobacteria blooms thus enhancing nutrition of zooplankton capable of utilizing picoplankton component of the microbial food webs.In Paper II, we evaluated the extent of the direct grazing by mesozooplankton on picocyanobacteria in the field as hypothesized in Paper I. The picocyanobacteria in ambient plankton communities and zooplankton guts were quantified by molecular diet analysis. The method is based on quantitative PCR (qPCR) targeting ITS-1 sequence of the picocyanobacteria Synechococcus that allowed us to measure picocyanobacterial DNA in the guts of major Baltic mesozooplankton groups (cladocerans, rotifers and various developmental stages of copepods). Also, a feeding experiment with laboratory reared copepod Acartia tonsa fed a mixture of the picocyanobacterium Synechococcus bacillaris and the cryptophyte alga Rhodomonas salina was conducted to measure picocyanobacteria consumption in the presence of the alternative food. All field-collected and experimental animals were found to consume Synechococcus spp. In terms of Synechococcus quantity, the individual gut content was highest in the cladocerans, whereas biomass-specific gut content was highest in the rotifers and the copepod nauplii. The amount of Synechococcus DNA in the guts of the field-collected copepods was positively related to the picocyanobacteria abundance and negatively to the total phytoplankton (> 2 µm) stocks at the time of sampling. This indicates that increased availability of picocyanobacteria resulted in the increased intake of this prey and that copepods may rely more on this prey when preferred food declines. These findings suggest that if abundant, picoplankton is an important component of mesozooplankton diet, which needs to be accounted for in food web models and productivity assessments.
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| 5. |
- Berggreen-Clausen, Aravinda, 1980-
(författare)
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Food environments in socioeconomically disadvantaged and immigrant populations through a non-communicable disease lens
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Globally, non-communicable diseases are increasing. With an evidenced link to the social determinants of health, this highlights a social gradient, whereby socioeconomic status, ethnicity and other factors influence poorer health outcomes. They are also linked to food environments, the interface of interaction between the food system and consumers.Aim: The aim of this thesis is to improve understanding of the food environment and its interactions with a focus on socioeconomic disadvantage and immigrant populations through a non-communicable disease lens.Methods: In Study I-III, the external food environment was mapped using a modified version of the Environmental Profile of a Community’s Health observation tool. Study I included under-resourced and socioeconomically disadvantaged sites, one urban and one rural, in a low- (Uganda), middle- (South Africa) and high-income (Sweden) country. Further, twenty-two lower and middle socioeconomic status neighborhoods of Stockholm were mapped in Study II and III. Descriptive and inferential statistical analyses were carried out. Study IV, a scoping review, used the Analysis Grid for Environments Linked to Obesity (ANGELO) framework to analyze and interpret the data on the interaction between personal and external food environments. Results: Across countries, food environments differed in the number of informal outlets present, the most found in Uganda and the least in Sweden. Primarily supermarkets, as well as other stores, were a source of both unhealthy and healthy food items, while advertising unhealthy items in store. Overall, outdoor advertisements of unhealthy foods were the most common and more prevalent in areas of higher socioeconomic disadvantage. Fruits and vegetables had similar prices across countries, though in the Swedish context, these cost less with lower neighborhood socioeconomic status. Structural and social factors like income, time, mobility and children’s preferences influenced the healthiness of foods acquired by immigrants from low-and middle-income countries living in high-income countries.Conclusion: Unhealthy items were both widely prevalent, as well as advertised across settings, at a higher rate in areas of higher disadvantage. Combined with structural and social factors that push consumers towards unhealthy practices, this could exacerbate existing health and nutrition inequities. Further research to better understand the food environment and its interactions with consumers are needed to facilitate healthier choices and improve health.
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