| 1. |
- Backhaus, Erik, et al.
(författare)
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Antimicrobial susceptibility of invasive pneumococcal isolates from a region in south-west Sweden 1998-2001.
- 2007
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Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 39:1, s. 19-27
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Tidskriftsartikel (refereegranskat)abstract
- Invasive disease caused by antibiotic resistant pneumococci is a worldwide problem. All invasive pneumococcal strains in an area of south-west Sweden with 1.7 million inhabitants were collected prospectively during 1998-2001. Minimum inhibitory concentrations (MICs) were determined by E-test and correlated to serotypes and clinical characteristics. Of 827 strains, 744 (90%) were susceptible (S) to all agents tested and 83 (10%) were indeterminate (I) or resistant (R) to at least 1 agent. 22 isolates (2.7%) were I to penicillin (MIC >0.06 to < or = 1.0 mg/l), but none were R (MIC >1.0 mg/l). Numbers and proportions of decreased susceptibility against other agents tested were as follows: erythromycin R: 30 (3.6%), clindamycin R: 6 (0.7%), tetracycline R: 16 (1.9%), moxifloxacin R: 1 (0.1%), cotrimoxazole I: 17 (2%) and R: 31(4%). Non-susceptibility to at least 1 agent was not correlated with age, clinical manifestation, underlying diseases and outcome. The serotype distribution differed between non-susceptible and susceptible strains. The serotypes in the 7-valent pneumococcal conjugate vaccine covered 42% of all infections and 73% of those caused by non-susceptible strains. In conclusion, the impact of antibiotic resistance in invasive pneumococcal disease remains limited in south-west Sweden.
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| 2. |
- Emgård, Matilda, 1984, et al.
(författare)
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Co-occurrence of bacteria and viruses and serotype distribution of Streptococcus pneumoniae in the nasopharynx of Tanzanian children below 2 years of age following introduction of the PCV13
- 2024
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Ingår i: FRONTIERS IN PUBLIC HEALTH. - 2296-2565. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Pneumococcal conjugate vaccines have reduced severe disease attributed to vaccine-type pneumococci in children. However, the effect is dependent on serotype distribution in the population and disease development may be influenced by co-occurrence of viral and bacterial pathogens in the nasopharynx. Methods: Following introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in Tanzania we performed repeated cross-sectional surveys, including 775 children below 2 years of age attending primary healthcare centers. All children were sampled from nasopharynx and pneumococci were detected by single-target PCR. Pneumococcal serotypes/groups and presence of viruses and other bacteria were determined by two multiplex PCR assays. Results: The prevalence of PCV13 vaccine-type pneumococci decreased by 50%, but residual vaccine-types were still detected in 21% of the children 2 years after PCV13 introduction. An increase in the non-vaccine-type 15 BC was observed. Pneumococci were often co-occurring with Haemophilus influenzae, and detection of rhino/enterovirus was associated with higher pneumococcal load. Discussion: We conclude that presence of residual vaccine-type and emerging non-vaccine-type pneumococci in Tanzanian children demand continued pneumococcal surveillance. High co-occurrence of viral and bacterial pathogens may contribute to the disease burden and indicate the need of multiple public health interventions to improve child health in Tanzania.
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| 3. |
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| 4. |
- Abdulle, Sahra, 1970, et al.
(författare)
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Family support is important for adherence to antiretroviral therapy among HIV positive mothers in Dar es Salaam, Tanzania.
- 2019
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Ingår i: CLINICAL MICROBIOLOGY AND RESEARCH. ; 1:1, s. 1-3
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to antiretroviral treatment (ART) is of utmost importance to reduce the risk of vertical transmission of HIV. We enrolled 106 patients from two Prevention of mother-to-child transmission (PMTCT) clinics in Dar es Salaam in September- November 2016. Study participants were given structured standardized questionnaires regarding their self-estimated adherence and barriers and enablers to adherence. Good adherence was defined as taking ≥95% of the pills as prescribed. About 70% of the participants achieved this level of adherence. The odds ratios for poor adherence among women with medium and poor family support were 5.69 (95% CI: 1.36-23-75) and 6.86 (95% CI: 1.89-24.96) respectively compared to good support. A large portion of the women failed to reach the high set limit for adherence. Increased spousal involvement and support could help many women to achieve good adherence.
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| 5. |
- Abraha, Aynalem, et al.
(författare)
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Breaking bad news in cancer care: preferences of patients, family caregivers and general public in Ethiopia
- 2021
-
Ingår i: International Conference on Communication in Healthcare (ICCH) 2020 Part 2, 15-16 April, 2021.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This study explores the preferences of cancer patients, family caregivers, and the general public regarding breaking bad news in an Ethiopian oncology setting. The research was conducted at Tikur Anbessa (Black Lion) Specialized Hospital. The sample consists of patients with a confirmed cancer diagnosis, their family caregivers, and representatives from the general public with 150 subjects per cohort. A comparative cross-sectional study design and a multivariable analysis were used. The patients would like to be informed, which contradicts the perceptions of family caregivers. This creates an ethical dilemma for staff in terms of how much they involve their patients in clinical decision-making. The patients also indicate that information not to be withheld from them. In contrast, the general public prefers information about poor life expectancy to be communicated to family only, which may reflect widespread public perception of cancer as a deadly disease. The findings indicate the complexity of communication concerning breaking bad news in oncology care in Ethiopia. It requires oncologists to probe patient attitudes before information disclosure in order to find a balance between involving patients in communication at the same time as keeping a constructive alliance with family caregivers.
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| 6. |
- Abraha, Aynalem, et al.
(författare)
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Perceptions of cancer patients and their caregivers regarding COVID-19 pandemic in Ethiopia
- 2021
-
Ingår i: J Clin Oncol 39, 2021 (suppl 15; abstr e24116).
-
Konferensbidrag (refereegranskat)abstract
- Background: Limited research is available about COVID 19 pandemic in Ethiopia in general and in relation to cancer care in particular. Ethiopia reported the first COVID-19 in March, 2020. The number of cases is increasing, putting much pressure on oncology care. This study examines what the Ethiopian cancer patients and their caregivers knew about COVID 19 after the initial stages of the pandemic. It also assesses the information needs, psychological experiences as well as the impact of pandemic on oncologist-patient-caregiver communication and treatment process. Methods: A cross-sectional study was conducted among 200 participants (100 cancer patients and 100 caregivers) at the initial stage of pandemic (May 1 - June 30, 2020) at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. Data was collected using a pre-tested, structured questionnaire to assess knowledge and perceptions on COVID-19. Ethics approval was obtained from the Ethical Review Board of TASH (04/14/2015) and the Ethical Review Board of Western Sweden (DNR 520-18). Results: The results indicate that though both cancer patients and their caregivers show a high awareness of and knowledge about COVID 19, they need more information about the risks specific to cancer patients. The respondents are also concerned about the risks of pandemic outbreak in Ethiopia and its impact on availability of cancer care treatments in the country. The respondents report experiencing psychological concerns in relation to the pandemic. The higher educated patients and caregivers report being more concerned than the lower educated respondents. Delays in appointments and therapy are the main concerns in relation to cancer care. Further, both patients and caregivers experience that the restrictions on the number of caregivers present during interactions with oncologists negatively influence communication, resulting in relatives being excluded and patients experiencing loneliness and lack of support. Conclusions: Getting a better insight into knowledge and awareness of COVID-19 among cancer patients and their caregivers is essential for managing the effects of pandemic in cancer care. To our knowledge, there was no similar study in Ethiopia. The results of the study contribute to insights into patient and caregiver awareness of COVID 19, essential for adoption of health care protective practices, providing information and managing oncologist-patient-caregiver communication.
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| 7. |
- Abraha Woldemariam, Aynalem, et al.
(författare)
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Breaking Bad News in Cancer Care: Ethiopian Patients Want More Information Than What Family and the Public Want Them to Have.
- 2021
-
Ingår i: JCO global oncology. - 2687-8941. ; 7, s. 1341-1348
-
Tidskriftsartikel (refereegranskat)abstract
- This study explores the preferences of patients with cancer, family caregivers, and the general public regarding breaking bad news in an Ethiopian oncology setting.The study was conducted at Tikur Anbessa (Black Lion) Specialized Hospital. The sample consists of patients with a confirmed cancer diagnosis, their family caregivers, and representatives from the general public with 150 subjects per cohort. The study used a comparative cross-sectional design and multivariable data analysis.The patients would like to be informed, which contradicts the preferences of family caregivers. This creates an ethical dilemma for staff in terms of how much they involve their patients in clinical decision making. The patients also indicate that information should not be withheld from them. By contrast, the general public prefers information about poor life expectancy to be communicated to family only, which may reflect a widespread public perception of cancer as a deadly disease.The findings indicate the complexity of communication-related preferences concerning breaking bad news in oncology care in Ethiopia. It requires oncologists to probe patient attitudes before information disclosure to find a balance between involving patients in communication at the same time as keeping a constructive alliance with family caregivers.
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| 8. |
- Ahlberg, Eva-Lena, et al.
(författare)
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Learning From Incident Reporting? : Analysis of Incidents Resulting in Patient Injuries in a Web-Based System in Swedish Health Care
- 2020
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Ingår i: Journal of patient safety. - : Wolters Kluwer. - 1549-8417 .- 1549-8425. ; 16:4, s. 264-268
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Incident reporting (IR) systems have the potential to improve patient safety if they enable learningfrom the reported risks and incidents. The aim of this study was to investigate incidents registered in an IR system in a Swedish county council.Methods The study was conducted in the County Council of Östergötland, Sweden. Data were retrieved from the IR system, which included 4755 incidents occurring in somatic care that resulted in patient injuries from 2004 to 2012. One hundred correctly classified patient injuries were randomly sampled from 3 injury severity levels: injuries leading to deaths, permanent harm, and temporary harm. Three aspects were analyzed: handling of the incident, causes of the incident, and actions taken to prevent its recurrence.Results Of the 300 injuries, 79% were handled in the departments where they occurred. The department head decided what actions should be taken to prevent recurrence in response to 95% of the injuries. A total of 448 causes were identified for the injuries; problems associated with procedures, routines, and guidelines were most common. Decisions taken for 80% of the injuries could be classified using the IR system documentation and root cause analysis. The most commonly pursued type of action was change of work routine or guideline.Conclusions The handling, causes, and actions taken to prevent recurrence were similar for injuries of different severity levels. Various forms of feedback (information, education, and dialogue) were an integral aspect of the IR system. However, this feedback was primarily intradepartmental and did not yield much organizational learning.
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| 9. |
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| 10. |
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| 11. |
- Alestig, Kjell, 1931, et al.
(författare)
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Ceftazidime and renal function.
- 1984
-
Ingår i: The Journal of antimicrobial chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 13:2, s. 177-81
-
Tidskriftsartikel (refereegranskat)abstract
- Glomerular filtration rate (GFR) as measured by 51Chrome-EDTA clearance, decreased with a mean of 10 ml/min during therapy with ceftazidime 2 g bid in 16 patients with initial GFR of 30 to 110 ml/min. A significant increase in the excretion of urinary alanine aminopeptidase was also found. In another three patients with initial GFR of 17-22 ml/min increases in serum creatinine during therapy were noted. These observations indicate that ceftazidime should be used with caution in patients with impaired renal function and not be combined with nephrotoxic drugs until the safety of such combinations has been studied.
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| 12. |
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| 13. |
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| 14. |
- Andersson, Christer, et al.
(författare)
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Mortalitet bland sjukhusvårdade tycktes inte öka under sommaren [Mortality among hospitalized patients did not appear to increase during the summer]
- 2019
-
Ingår i: Läkartidningen. - Stockholm, Sweden : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- A retrospective review of medical records (2017-2018) at Linköping University Hospital compared hospital mortality for the 2-month period of summer vacations (group A) with two months of regular activity (group B). The mortality was 163 patients in group A and 216 in group B. Emergency admittance dominated (95%) in both groups. Comorbidity was found in 81%, and at admittance the risk for death during the hospital stay was estimated to more than 50% in three out of four patients. There was no difference between the groups regarding demography, hospital stay, or diagnosis. Due to a 30% reduction of hospital beds during the summer some patients were relocated to other specialties. No relocated patient died in group A but six in group B. Eight deaths were judged as probably preventable, but none definitely preventable. The similarity between the groups regarding mortality does not allow estimations of differences in adverse events in general. Low mortality among relocated patients is probably due to identification of high-risk patients not suitable for relocation.
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| 15. |
- Andersson, Catrin, 1970-
(författare)
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Tudelad trots allt : dualismens överlevnad i den svenska staten 1718-1987
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- On May 1, 1720 the Swedish Riksdag took a seemingly peripheral decision which would however prove to have great and enduring consequences for the organization of the country’s central state administration. The model adopted then is today often referred to as the ‘dualism’ of the Swedish state. In international comparison this dualism – expressed primarily in the organizational division between a set of quite small ministries and a large number of autonomous government agencies in combination with the constitutional prohibition of individual ministers to issue authoritative orders to the agencies – is probably unique.This dualism has been characterized as “one of the great mysteries of Swedish political life” and one aspect of this mysteriousness concerns its very longevity. The main research question of this thesis is why this model has been able to survive for such a long period despite the heavy and recurring critique that has been levelled at it. Through analyses of the public debate on the issue of the dualist character of the Swedish state during four selected periods (1809-1829, 1905-1920, 1963-1972 and 1983-1987) when the critical voices have been particularly loud and articulate, a systematic picture is provided of both the participants and the argument of the debates. It is shown that critics of dualism have blamed it for being “anti-democratic”, “antiquated”, and “a threat against the rule of law” while defenders of dualism have often portrayed it as “modern”, “effective”, and “a guarantee for the rule of law”.The answer to the main research question of why the political institution of dualism has persisted for so long may briefly be summarized in the statement that it has survived by changing. In theoretical terms the thesis is inspired by historical institutionalism, a tradition which has so far mostly contributed to our understanding of institutional stability. Recently, however, theoretical developments in historical institutionalism have rather aimed at an improved analysis of change. This thesis appropriates these new ideas, especially those developed by political scientist Kathleen Thelen, in the analysis of Swedish dualism. In particular the two concepts of institutional conversion and institutional layering are tested. In the thesis it is argued that the new analytical tools were indeed instrumental in understanding and explaining institutional change but also that further elaboration of them seems necessary. Using a both longitudinal and process-oriented approach focussing on the arguments of the actors this thesis has contributed to such an elaboration of the tools for the analysis of change within the tradition of historical institutionalism.
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| 16. |
- Andersson, Carina, 1970-
(författare)
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Upplevelser av budskap : Fallstudier av hur användare upplever och förstår information i användargränssnitt
- 2007
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- När användbarheten studeras av den information som presenteras i ett användargränssnitt på en datorskärm kan det framkomma vad som fungerar effektivt och korrekt. I sådana sammanhang förs sällan någon diskussion om hur den information som presenteras kommunicerar med en användare.Syftet med detta forskningsprojekt är att på ett generellt plan öka kunskapen om olika analytiska perspektiv för att studera den information som presenteras i ett användargränssnitt på en datorskärm, som ett led till att skapa begriplig information för människor. Mer preciserat är syftet att få en djupare förståelse för hur en informationslämnare kan kommunicera med en informationsanvändare genom den information som presenteras i ett användargränssnitt. Målet med forskningsprojektet är att presentera ett antal relevanta analytiska perspektiv som kan användas för att beskriva hur presenterad information i ett användargränssnitt kan kommunicera med en användare. Forskningsresultatet bidrar med ett ramverk som kan ligga till grund för ett analysstöd. Forskningsresultatet bidrar även med en ansats för framtida forskning inom området.Forskningsprojektet bygger på fyra fallstudier. Analysobjekten i fallstudierna utgörs av fyra olika användargränssnitt på datorskärm, vilka används inom olika myndigheter, organisationer och företag. Vartdera användargränssnittet och dess informationsdesign studeras med hänsyn till: informationslämnarnas önskemål och intentioner, informationsanvändarnas upplevelse och förståelse av information och kontexters påverkan.De slutsatser som dras är bland annat att informationsdesign i ett användargränssnitt på datorskärm upplevs och förstås av användare i samklang med inre, när och yttre kontext. Dessa kontexter kan studeras utifrån tre olika perspektiv, ett semiotiskt, ett retoriskt och ett narrativt perspektiv. En sådan analys kan framhäva den kommunikation som sker mellan de budskap som informationslämnaren vill berätta, hur den presenterade informationen i användargränssnittet arrangeras och komponeras och hur olika kontexter påverkar användarnas upplevelse och förståelse av den information som presenteras.
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| 17. |
- Andersson, Helena, et al.
(författare)
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Active recovery training does not affect the antioxidant response to soccer games in elite female players
- 2010
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Ingår i: British Journal of Nutrition. - Cambridge, United Kingdom : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 104:10, s. 1492-1499
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Tidskriftsartikel (refereegranskat)abstract
- Changes in plasma endogenous and dietary antioxidants and oxidative stress markers were studied following two 90 min elite female soccer games separated by 72 h of either active or passive recovery. The active recovery group (n 8) trained for 1 h at 22 and 46 h after the first game (low-intensity cycling and resistance training), while the passive group rested (n 8). Blood samples were taken before the games; immediately after the games; 21, 45 and 69 h after the first game; and immediately after the second game. The oxidative stress markers and antioxidants were not affected by active recovery. The oxidative stress marker GSSG increased by the same extent after both the games, while the lipid peroxidation marker diacron-reactive oxygen metabolite remained unchanged. The endogenous antioxidants total glutathione and uric acid and ferric reducing/antioxidant power increased immediately after both the games with the same amplitude, while increases in cysteine, cysteine-glycine and total thiols reached significant levels only after the second game. The changes in dietary antioxidants after the first game were either rapid and persistent (tocopherols and ascorbic acid (AA) increased; polyphenols decreased) or delayed (carotenoids). This resulted in high pre-second game levels of tocopherols, AA and carotenoids. Polyphenols returned to baseline at 69 h, and were not affected by the second game. In conclusion, the soccer-associated dietary antioxidant defence, but not the endogenous antioxidant defence, is persistent. Similar acute oxidative stress and endogenous antioxidant responses and dissimilar dietary antioxidant reactions occur during two repeated female soccer games. Finally, the complex antioxidant response to soccer is not affected by active recovery training.
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| 18. |
- Andersson, Helena M., 1973-, et al.
(författare)
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Active recovery training does not affect the antioxidant response to soccer games in elite female players
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Changes in plasma endogenous and dietary antioxidants and oxidative stress markers were studied following two 90-min elite female soccer games separated by 72 h of either active or passive recovery. The active recovery group (n=8) trained for one hour at 22 and 46 h after the first game (low-intensity cycling and resistance training)while the passive group rested(n=8). Blood samples were taken before, immediately after, 21, 45 and 69 h after the first and immediately after the second game. The oxidative stress markers and antioxidants were not affected by active recovery. The oxidative stress marker oxidized glutathione increased by the same extent after both games, while the lipid peroxidation marker diacrons reactive-oxygen metabolites remained unchanged. The endogenous antioxidants total glutathione, uric acid and ferric reducing/antioxidant power assay increased immediately after both games with the same amplitude, while increases in cysteine, cysteine-glycine and total thiols reached significant levels only after the second game. The changes in dietary antioxidants after the first game were either rapid and persistent (tocopherols, ascorbic acid increased; polyphenols decreased) or delayed (carotenoids). This resulted in high pre-second game levels of tocopherols, ascorbic acid and carotenoids. Polyphenols returned to baseline at 69 h and were not affected by the second game. In conclusion, the soccer-associated dietary but not endogenous antioxidant defence is persistent. Similar acute oxidative stress and endogenous antioxidant responses and dissimilar dietary antioxidant reactions occur during two repeated female soccer games. Finally, the complex antioxidant response to soccer is not affected by active recovery training.
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| 19. |
- Andersson, Jakob, 1974-, et al.
(författare)
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Geomapping Landscapes of Writing (GLoW) : Large-Scale Spatial Analysis of the Cuneiform Corpus (c. 3400 BCE to 100 CE)
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The cuneiform record ranks among the largest preserved bodies of historical documentation from the ancient world (Streck 2010). Conveyed on omnipresent and extremely durable types of material, cuneiform texts are preserved in immense, extending over all of the Middle East and a historical period of more than three millennia of early human history. Drawing on recent advances in digital humanities and geospatial data mapping, GLoW aims to survey, analyse, and investigate broader, macrohistorical patterns in the formation and preservation of this unique historical record. As a first quantifiable, comprehensive study of the cuneiform corpus, GLoW will provide a benchmark example of the application of digital and spatial computing tools to the study of writing in early human history. This poster offers an introduction to key research foci and the project research programme, including an introduction to data infrastructure, dissemination, and key collaborators.
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| 20. |
- Andersson, Jakob, 1974-, et al.
(författare)
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Geomapping Landscapes of Writing (GLoW): Large-Scale Spatial Analysis of the Cuneiform Corpus (c. 3400 BCE to 100 CE)
- 2019
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Cuneiform writing ranks among the largest bodies of ancient historical documentation. No attempt has hitherto been made to fully geomap this corpus. Combining philology, archaeology, and comparative linguistics, GLoW assembles and analyses a full digital record of this corpus drawing on recent advances in digital humanities. As a first quantifiable, comprehensive study of the cuneiform corpus, GLoW provides a benchmark example of applying digital and spatial computing tools to the study of early writing. Engaging with artifacts marred by years of recent conflict, it also serves as a key reference document for protecting part of the common heritage of humankind.
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| 21. |
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| 22. |
- Andersson, Jakob, 1974-, et al.
(författare)
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The Big Picture: Large-Scale Trends in the Distribution and Composition of the Cuneiform Corpus
- 2020
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Histories of the ancient world are founded on the assumption that historical documents are products of unique circumstances of production, deposition, and preservation, unlikely to be repeated and therefore particular in nature. The idiographic position of the written word as a source of knowledge about the past rests upon this notion of uniqueness and exclusivity, as opposed to the omnipresence and perceived vulgarity of material culture. Counting a conservative half million individual texts, the cuneiform corpus ranks among the largest discrete bodies of writing from the ancient world. This plethora of records, its noticeable diversity of genres, and its impressive temporal and spatial extent suggest regularity, rather than coincidence, in its formation and distribution as a historical artefact. Yet, because of its immense size and extreme temporal and spatial spread, no attempt has ever been made to map this corpus in full.This paper introduces the structure, programme, and preliminary observations of a three-year research project at Uppsala University which aims to produce an updated, global survey of cuneiform inscriptions in collaboration with existing text catalogues and data repositories. Harnessing GIS-aided remote sensing and spatial analysis coupled with digital humanities research tools, the project aims to explore our newfound technological ability to accurately capture, assess, and quantify the material imprint of this immense corpus. In so doing, the project will aim to make available an updated suite of attribute, spatial, and temporal metadata resources for free dissemination and reuse, as well as dedicated studies of corpus composition, linguistic landscapes, and the materiality of texts.
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| 23. |
- Andersson, Lena, 1980, et al.
(författare)
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Urinary proteins in children with urinary tract infection
- 2009
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Ingår i: Pediatric Nephrology. - : Springer Science and Business Media LLC. - 0931-041X .- 1432-198X. ; 24:8, s. 1533-1538
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Tidskriftsartikel (refereegranskat)abstract
- Abstract The aim of this study was to test our hypothesis that the urinary excretion of C-reactive protein (CRP), alpha 1-microglobulin (A1M), retinol-binding protein (RBP) and Clara cell protein (CC16) is increased in children with urinary tract infection (UTI) and relates to renal damage as measured by acute dimercaptosuccinic acid (DMSA) scintigraphy. Fifty-two children <2 years of age with UTI were enrolled in the study, 44 of whom were febrile. The control group consisted of 23 patients with non-UTI infection and elevated serum CRP (s-CRP) levels. Thirty-six patients had abnormal DMSA uptake, classified as mild, moderate or severe damage (DMSA class 1, 2, 3, respectively). There was a significant association between DMSA class and the excretion of urinary RBP (u-RBP) and u-CC16. There was also a significant difference in u-CRP levels between children with UTI and control children with non-UTI infections, although u-CRP excretion was not significantly correlated to DMSA class. In conclusion, the urinary excretion of the low-molecular-weight proteins RBP and CC16 showed a strong association with uptake defects on renal DMSA scans. The urinary level of CRP seems to distinguish between children with UTI and other febrile conditions. A combination of these biomarkers may be useful in the clinical assessment of children with UTI.
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| 24. |
- Andersson, Monica, 1948-
(författare)
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Politik och stadsbyggande : Modernismen och byggnadslagstiftningen
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this dissertation is to describe, understand and explain the role of modernism in Swedish urban planning, and analyze if modernist urban planning ideas influenced building legislation in ways that can explain the structural changes of our cities during post-war period. Earlier epochs were characterized by intense construction of working-class housing in garden cities and large courtyard housing blocks with double-sided lighting in residences. The dissertation has been carried out within the tradition of historical institutionalism with a counterfactual approach. It covers the time from 1928 to the present with a focus on the period 1928-1975. The object of study is the formal regulations in building legislation. The central analytical instruments are formative moments and path dependence. A formative moment should be characterized by uncertainty, significance and unpredictability. Path dependence is studied with the help of theories of experience-based learning and the power of bureaucracy. The dissertation shows that modernist ideas were written into the building code of 1931 in accordance with functional partitioning and a diagram by Walter Gropius from the 1920s calling for relative distances between houses, the longer the higher houses, and direct sunlight on facades, permitting one-sided lighting in residences. Instead of prevailing praxis, cities were built in conformity with principles of buildings-in-the-park with slab blocks. These regulations were gradually tightened over time and also guided redevelopment policy. In the sixties higher slab blocks and tower blocks began to be frequently built and functional partitioning assumed a unique guiding role in traffic policy and urban planning. Starting in the middle of the 1970s, modernist ideas gradually were dismissed in government policy. Leading modernist architects where driving forces in the formative moment, supported by the Association of Property Owners. Their colleagues could, in the path dependent process, augment the modernist ideas by virtue of their profession. They led state agencies, participated in commissions on building legislation and wrote referral comments on proposals, as well as sitting on building committees together with building contractors, entrepreneurs and construction workers.
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| 25. |
- Andersson, Peter, et al.
(författare)
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Continent Ileostomy
- 2008
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Ingår i: Seminars in Colon and Rectal Surgery. - Maryland Heights, MO, United States : W.B. Saunders Co.. - 1043-1489. ; 19:3, s. 124-131
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Continent ileostomy reservoir is today still an alternative to a standard (conventional) ileostomy in patients where ileal pouch-anal anastomosis is contraindicated or malfunctioning. It eliminates a protruding stoma, obviates the need for a stoma bag, and permits controlled evacuation of bowel contents. A well-functioning continent ileostomy also is entirely continent for gas and feces in the elderly. The reservoir is emptied three to five times a day. Obvious benefits are improved sexual life and facilitated leisure activities. The main drawbacks are frequent complications requiring reoperations in about 50% of the patients. Slippage of the nipple valve occurs in about one-third but in the majority of patients reoperations are successful in the long run. Other complications are pouchitis, enterocutaneous fistula, and stomal stricture. Modifications of the original Kock pouch have been developed as the Barnett pouch and the T-pouch to reduce complications associated with dysfunction of the nipple valve. Cancer of a continent ileostomy reservoir has been reported only in one patient and there seems to be no risk of high-grade dysplasia even after long-term follow-up. At present there are few indications for creating a continent ileostomy reservoir but it is still recommended in very select patients. © 2008 Elsevier Inc. All rights reserved.
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| 26. |
- Andersson, Peter, 1957-, et al.
(författare)
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Crohn´s Disease
- 2008. - 1
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Ingår i: Coloproctology. - Berlin : Springer. - 9783540712176 - 354071216X ; , s. 145-158
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- EMM: Coloproctology presents the state-of-the-art in coloproctology. The topics covered include anatomy, physiology, anal disorders, dermatology, functional disorders, inflammatory bowel disease, benign and malignant tumours, endoscopy, emergencies and pain syndromes. All chapters give a comprehensive overview of aetiology, incidence, epidemiology, diagnostics, medical and surgical treatment, complications and individual special considerations. This work presents surgical trainees with a comprehensive and condensed guide to the core knowledge required for the European Board of Surgery Qualification (EBSQ) examination. The manual will also be of assistance to practising coloproctologists across Europe and beyond who have an interest in continued professional development. Written by an international team of experts who have each made noteworthy contributions in their field, the coverage of most aspects of coloproctology in an easy-to-follow format also makes this manual valuable to other specialists.
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| 27. |
- Andersson, Peter, 1957-, et al.
(författare)
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Health related quality of life in Crohn's proctocolitis does not differ from a general population when in remission
- 2003
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Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 5:1, s. 56-62
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Tidskriftsartikel (refereegranskat)abstract
- Objective All treatment in Crohn's disease, although palliative, aims at restoring full health. The objective of this study was to compare health-related quality of life and psychosocial conditions in patients with Crohn's proctocolitis with a general population.Patients and methods One hundred and twenty-seven patients with Crohn's proctocolitis (median age 44 years, 44.1% men) were compared with 266 controls (median age 45 years, 50.7% men). A questionnaire consisting of the Short Form-36 (SF-36), the Psychological General Well-Being Index (PGWB) and a visual analogue scale (VAS) evaluating general health as well as questions regarding psychosocial conditions was used. Disease activity was evaluated by Best's modification of the classical Crohn's Disease Activity Index.Results Patients in remission had a health related quality of life similar to controls according to the SF-36 apart from general health where scores were lower (P < 0.01). Patients with active disease scored lower in all aspects of the SF-36 (P < 0.001 or P < 0.0001) as well as the PGWB (P < 0.0001). In a model for multiple regression including age, gender, concomitant small bowel disease, permanent stoma, previous colonic surgery, disease activity, duration, and aggressiveness, disease activity was the only variable negatively predicting all 8 domains of the SF-36 in the patient group (P < 0.001). The mean annual sick-leave for patients and controls were 33.9 and 9.5 days (P < 0.0001), respectively. Sixty-eight percent of the patients and 78.4% of the controls (P = 0.04) were married or cohabited, 67.7% and 78.0% (P = 0.04), respectively, had children.Conclusion The health related quality of life for patients with Crohn's proctocolitis in remission does not differ from the general population. The disease has, however, a negative impact on parenthood, family life and professional performance.
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| 28. |
- Andersson, Peter, 1957-, et al.
(författare)
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Increased anal resting pressure and rectal sensitivity in Crohn's disease
- 2003
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Ingår i: Diseases of the Colon & Rectum. - 0012-3706 .- 1530-0358. ; 46:12, s. 1685-1689
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Anal pathology occurs in 20 to 80 percent of patients with Crohn's disease in which abscesses, fistulas, and fissures account for considerable morbidity. The etiology is not clearly defined, but altered anorectal pressures may play a role. This study was designed to investigate anorectal physiologic conditions in patients with Crohn's disease compared with healthy controls.METHODS: Twenty patients with Crohn's disease located in the ileum (n = 9) or the colon (n = 11) without macroscopic proctitis or perianal disease were included. All were subjected to rectal examination, anorectal manometry, manovolumetry, and rectoscopy. Comparison was made with a reference group of 173 healthy controls of whom 128 underwent anorectal manometry, 29 manovolumetry, and 16 both examinations.RESULTS: Maximum resting pressure and resting pressure area were higher in patients than in controls (P = 0.017 and P = 0.011, respectively), whereas maximum squeeze pressure and squeeze pressure area were similar. Rectal sensitivity was increased in patients expressed as lower values both for volume and pressure for urge (P = 0.013 and P = 0.014, respectively) as well as maximum tolerable pressure (P = 0.025).CONCLUSIONS: This study demonstrates how patients with Crohn's disease without macroscopic proctitis have increased anal pressures in conjunction with increased rectal sensitivity. This may contribute to later development of anal pathology, because increased intra-anal pressures may compromise anal circulation, causing fissures, and also discharging of fecal matter into the perirectal tracts, which may have a role in infection and fistula development.
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| 29. |
- Andersson, Peter, et al.
(författare)
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Low symptomatic load in Crohn's disease with surgery and medicine as complementary treatments
- 1998
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa Healthcare. - 0036-5521 .- 1502-7708. ; 33:4, s. 423-429
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Tidskriftsartikel (refereegranskat)abstract
- Background: The treatment of Crohn's disease has changed owing to the recognition of its chronicity. Medical maintenance treatment and limited resections have evolved as major concepts of management, regarded as complementary, and both aim at reducing the symptoms.Methods: We investigated the symptomatic load in Crohn's disease as reflected in a cross-sectional study of the symptom index, physicians' assessment, and the patients' perception of health. A cohort of 212 patients from the primary catchment area and 125 referred patients were studied.Results: Of catchment area patients, 83% were receiving medication, and the annual rate of abdominal surgery was 5.7%. Corresponding figures for the referred patients were 82% and 10.3%. According to the symptom index, 87% of catchment area patients were in remission or had only mild symptoms; according to the physicians' assessment, 90% were. The patients' median perception of health was 90% of perfect health according to the visual analogue scale. The figures were similar for referred patients, except that referrals were considered more diseased by the physician.Conclusion: The great majority of patients with Crohn's disease are able to live in remission or experience only mild symptoms.
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| 30. |
- Andersson, Peter, 1957-, et al.
(författare)
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Segmental resection or subtotal colectomy in Crohn's colitis?
- 2002
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Ingår i: Diseases of the Colon & Rectum. - : Ovid Technologies (Wolters Kluwer Health). - 0012-3706 .- 1530-0358. ; 45:1, s. 47-53
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Segmental resection for Crohn's colitis is controversial. Compared with subtotal colectomy, segmental resection is reported to be associated with a higher rate of re-resection. Few studies address this issue, and postoperative functional outcome has not been reported previously. This study compared segmental resection to subtotal colectomy with anastomosis with regard to re-resection, postoperative symptoms, and anorectal function.METHODS: Fifty-seven patients operated on between 1970 and 1997 with segmental resection (n = 31) or subtotal colectomy (n = 26) were included. Reoperative procedures were analyzed by a life-table technique. Segmentally resected patients were also compared separately with a subgroup of subtotally colectomized patients (n = 12) with similarly limited colonic involvement. Symptoms were assessed according to Best's modified Crohn's Disease Activity Index and an anorectal function score.RESULTS: The re-resection rate did not differ between groups in either the entire study population (P = 0.46) or the subgroup of patients with comparable colonic involvement (P = 0.78). Segmentally resected patients had fewer symptoms (P = 0.039), fewer loose stools (P = 0.002), and better anorectal function (P = 0.027). Multivariate analysis revealed the number of colonic segments removed to be the strongest predictive factor for postoperative symptoms and anorectal function (P = 0.026 and P = 0.013, respectively).CONCLUSION: Segmental resection should be considered in limited Crohn's colitis.
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| 31. |
- Andersson, Peter, 1957-, et al.
(författare)
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Surgery for Crohn colitis over a twenty-eight-year period : fewer stomas and the replacement of total colectomy by segmental resection
- 2002
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 37:1, s. 68-73
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced.Methods: A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods.Results: Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% ( P < 0.01) while stricture as an indication increased from 9% to 50% ( P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years ( P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery ( P = 0.017), permanent stoma ( P < 0.01) and total colectomy ( P < 0.01). Findings were similar in the population-based cohort.Conclusions: Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.
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| 32. |
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| 33. |
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| 35. |
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| 36. |
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| 37. |
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| 38. |
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| 39. |
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| 40. |
- Ariander, Annaclara, et al.
(författare)
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Ethical challenges causing moral distress: nursing home staff's experiences of working during the COVID-19 pandemic
- 2024
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Ingår i: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.DesignIndividual interviews. Latent qualitative content analysis.SettingTen nursing homes in Sweden.SubjectsPhysicians, nurses and nurse assistants working in Swedish nursing homes.Main outcome measuresParticipants' experiences of working in nursing homes during the COVID-19 pandemic.ResultsFour manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.ConclusionDuring the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce. The COVID-19 pandemic has affected both patients and staff in nursing homes, in Sweden and worldwide.Our study highlights that during the COVID-19 pandemic, nursing home staff encountered several ethical challenges which caused moral distress.Moral distress stemmed from not being given adequate conditions to perform their work, thus not giving the residents appropriate care.Moral distress could also originate from nursing home staff's feeling of being forced to act against their moral values.
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| 41. |
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| 42. |
- Backhaus, Erik, et al.
(författare)
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Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated to age, gender and risk factors
- 2016
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Ingår i: Bmc Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Incidence, manifestations and case-fatality rate (CFR) of invasive pneumococcal disease (IPD) vary with age and comorbidities. New vaccines, changing age distribution, prolonged survival among immunocompromised patients and improved sepsis management have created a need for an update of basic facts to inform vaccine recommendations. Methods: Age, gender and comorbidities were related to manifestations and death for 2977 consecutive patients with IPD in a Swedish region with 1.5 million inhabitants during 13 years before introduction of pneumococcal conjugate vaccines (PCV) in the infant vaccination program. These data were related to population statistics and prevalence of several comorbidities, and compared with two previous studies giving a total follow-up of 45 years in the same area. Results: The annual incidence was 15/100,000 for any IPD and 1.1/100,000 for meningitis; highest among elderly followed by children < 2 years. It was 2238/100,000 among myeloma patients, followed by chronic lymphatic leukemia, hemodialysis and lung cancer, but not elevated among asthma patients. CFR was 10 % among all patients, varying from 3 % below 18 years to 22 %>= 80 years. During 45 years, the IPD incidence increased threefold and CFR dropped from 20 to 10 %. Meningitis incidence remained stable (1.1/100,000/year) but CFR dropped from 33 to 13 %. IPD-specific mortality decreased among children < 2 years from 3.1 to 0.46/100,000/year but tripled among those >= 65 years. Conclusions: IPD incidence and CFR vary widely between age and risk groups and over time even without general infant vaccination. Knowledge about specific epidemiological characteristics is important for informing and evaluating vaccination policies.
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| 43. |
- Beck-Friis, Josefine, et al.
(författare)
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Increased risk of hepatotoxicity and temporary drug withdrawal during treatment of active tuberculosis in pregnant women.
- 2020
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Ingår i: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. - : Elsevier BV. - 1878-3511. ; 98, s. 138-143
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Tidskriftsartikel (refereegranskat)abstract
- Few studies have focused on the treatment of tuberculosis (TB) during pregnancy. This study aimed to evaluate the risk of adverse events, particularly liver toxicity, in pregnant women during treatment for active TB.We conducted a retrospective study on pregnant and age-matched non-pregnant women receiving treatment for active TB at four hospitals in Western Sweden between 1992 and 2017.A total of 135 women were included, 40 pregnant and 95 non-pregnant. The frequency of severe hepatotoxicity was 40% in pregnant women and 6% among non-pregnant women (p < 0.001) (odds ratio 9.9; 95% confidence interval 3.5-28.0). Temporary drug withdrawal due to elevated transaminase levels was more frequent for pregnant than non-pregnant women (40% vs 9.5%; p < 0.001) (odds ratio 6.4; 95% confidence interval 2.5-16.2). There was one fatal case of hepatotoxicity in a pregnant woman.Severe hepatotoxicity was significantly more frequent in pregnant women compared to non-pregnant women. Careful monitoring of liver transaminases while receiving TB treatment during pregnancy is mandatory, as well as ensuring adequate measures with adjustment of drug regimen and temporary drug withdrawals when a rise in liver enzymes is noted.
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| 44. |
- Berbyuk Lindström, Nataliya, 1978, et al.
(författare)
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Person- and Family-Centeredness in Ethiopian Cancer Care: Improving Communication, Ethics, Decision Making and Health
- 2020
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Ingår i: JMIR Research Protocols. - : JMIR Publications Inc.. - 1929-0748. ; 9:5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital (TASH) in Addis Ababa is the country's sole specialist unit for cancer care. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential in order to help patients as much as possible within such limitations. OBJECTIVE: The project addresses three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice, and (3) to plan and evaluate interventions in this area. METHODS: This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making, and ethical tensions between patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semi-structured interviews with the Ethiopian staff, patients, and family caregivers (91), survey data on cancer awareness (150) and attitudes to breaking bad news (450), and video-recordings of medical consultations (45). In addition, we will also develop clinical and methodological solutions to formulate educational interventions. RESULTS: The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018-2021. The research ethics board in Sweden and in Ethiopia approved the conduct of the project in May 2018. The results from the studies will be published in 2020 and 2021. CONCLUSIONS: The project is a first step towards producing unique and seminal knowledge for the specific context of Ethiopia in the area of physician-patient communication research and ethics. It contributes to an understanding of the complexity around the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low resource settings in Africa and the Middle East, which share central cultural prerequisites (such as a strong patriarchal family structure, combined with strong and devout religiosity). The project will also serve to develop greater understanding about current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will also contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.
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| 45. |
- Bergman, Karin, et al.
(författare)
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Invasive pneumococcal disease in persons with predisposing factors is dominated by non-vaccine serotypes in Southwest Sweden
- 2021
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Ingår i: Bmc Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe pneumococcal conjugate vaccine PCV7 was introduced in Southwest Sweden in the child vaccination program in 2009, followed by PCV13 in 2010 and PCV10 in 2015. In this retrospective cohort study we assessed the pneumococcal serotype distribution in relation to predisposing factors, clinical manifestations and outcome during seven years after PCV introduction.MethodsClinical data from 1278 patients with 1304 episodes of invasive pneumococcal disease (IPD) between January 2009 and December 2015 in Region Vastra Gotaland, Sweden, were retrospectively collected from medical records. Pneumococcal isolates were serotyped by gel diffusion and/or Quellung reactions performed at the Public Health Agency in Sweden. Associations between serotypes and clinical characteristics were statistically evaluated by use of Fisher's exact test, Mann-Whitney U test and Logistic regression analysis, whereas IPD episodes caused by serotypes over time were analyzed by Mantel-Haenszel chi-square test.ResultsWith the exception of serotype 3, the prevalence of PCV13 serotypes decreased during the study period, from 76% (n=157) of all IPD episodes in 2009 to 25% (n=42) in 2015 (p<0.001) while non-PCV13 serotypes increased, mainly among patients 65years and in patients with predisposing factors, including cardiovascular disease, pulmonary disease and malignancy (p<0.001 for all). Patients with predisposing factors, including those with malignancy, immune deficiency or renal disease, were more likely to have IPD caused by a serotype not included in PCV13 rather than a vaccine-included serotype. Serotype 3 was associated with intensive care unit admissions while serotype 1 and 7F caused IPD among healthier and younger patients. PCV13 serotypes were associated with invasive pneumonia, and non-PCV13 serotypes were associated with bacteremia with unknown focus and with manifestations other than pneumonia or meningitis.ConclusionsNon-PCV13 serotypes caused the majority of IPD cases in Southwest Sweden, especially in patients 65years and in patients with predisposing factors. Serotype 3, included in PCV13, was prevalent and often caused severe disease.
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| 46. |
- Birindwa, Archippe M., et al.
(författare)
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Bacteria and viruses in the upper respiratory tract of Congolese children with radiologically confirmed pneumonia
- 2021
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Ingår i: Bmc Infectious Diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Acute pneumonia remains a leading cause of death among children below 5 years of age in the Democratic Republic of the Congo (DR Congo), despite introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. Potential pathogens in the nasopharynx of hospitalised children with pneumonia have not been studied previously in DR Congo. Here we compare clinical characteristics, risk factors and nasopharyngeal occurrence of bacteria and viruses between children with severe and non-severe pneumonia. Methods Between June 2015 and June 2017, 116 children aged from 2 to 59 months hospitalised due to radiologically confirmed pneumonia at Panzi referral university hospital, Bukavu, Eastern DR Congo were included in the study and sampled from nasopharynx. A multiplex real-time PCR assay for detection of 15 different viruses and 5 bacterial species was performed and another multiplex PCR assay was used for pneumococcal serotype/serogroup determination. Results During the study period 85 (73%) of the children with radiologically confirmed pneumonia met the WHO classification criteria of severe pneumonia and 31 (27%) had non-severe pneumonia. The fatality rate was 9.5%. Almost all (87%) children were treated with antibiotics before they were hospitalised, in most cases with amoxicillin (58%) or trimethoprim-sulfamethoxazole (20%). The frequency of potential pathogens in the nasopharynx of the children was high, and any viral or bacterial nucleic acids present at high levels, irrespective of species or type, were significantly associated with severe pneumonia as compared with non-severe cases (52% versus 29%, p = 0.032). White blood cell count > 20,000/mu L and C-Reactive Protein > 75 mg/dL were associated with severe pneumonia at admission. Fatal outcome was in the multivariable analysis associated with having a congenital disease as an underlying condition. One or more pneumococcal serotypes/serogroups could be identified in 61 patients, and out of all identified serotypes 31/83 (37%) were non-PCV13 serotypes. Conclusions The occurrence of any bacteria or any viruses at high levels was associated with severe pneumonia at admission. Children with congenital disorders might need a higher attention when having symptoms of acute respiratory infection, as developed pneumonia could lead to fatal outcome.
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| 47. |
- Birindwa, Archippe M., et al.
(författare)
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Decreased number of hospitalized children with severe acute lower respiratory infection after introduction of the pneumococcal conjugate vaccine in the Eastern Democratic Republic of the Congo.
- 2020
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Ingår i: Pan African Medical Journal. - : Pan African Medical Journal. - 1937-8688. ; 37
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: acute lower respiratory infections (ALRI) are a leading killer of children under five worldwide including the Democratic Republic of the Congo (DR Congo). We aimed to determine the morbidity and case fatality rate due to ALRI before and after introduction of the 13-valent pneumococcal conjugate vaccine (PVC13) in DR Congo 2013. Methods: data were collected from medical records of children with a diagnosis of ALRI, aged from 2 to 59 months, treated at four hospitals in the eastern DR Congo. Two study periods were defined; from 2010 to 2012 (before introduction of PCV13) and from 2014 to 2015 (after PCV13 introduction). Results: out of 21,478 children admitted to the hospitals during 2010-2015, 2,007 were treated for ALRI. The case fatality rate among these children was 4.9%. Death was significantly and independently associated with malnutrition, severe ALRI, congenital disease and symptoms of fatigue. Among the ALRI hospitalised children severe ALRI decreased from 31% per year to 18% per year after vaccine introduction (p = 0.0002) while the fatality rate remained unchanged between the two study periods. Following introduction of PCV13, 63% of the children diagnosed with ALRI were treated with ampicillin combined with gentamicin while 33% received ceftriaxone and gentamicin. Conclusion: three years after PCV13 introduction in the Eastern part of the DR Congo, we found a reduced risk of severe ALRI among children below five years. Broad-spectrum antibiotics were frequently used for the treatment of ALRI in the absence of any microbiological diagnostic support.
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| 48. |
- Birindwa, Archippe M., et al.
(författare)
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High bacterial and viral load in the upper respiratory tract of children in the Democratic Republic of the Congo
- 2020
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:10
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 Muhandule Birindwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Respiratory pathogens including Streptococcus pneumoniae and Haemophilus influenzae, are implicated in the pathogenicity of acute lower respiratory infection (ALRI). These are also commonly found in both healthy and sick children. In this study, we describe the first data on the most frequent bacteria and viruses detected in the nasopharynx of children from the general population in the Eastern DR Congo. Methods From January 2014 to June 2015, nasopharyngeal samples from 375 children aged from 2 to 60 months attending health centres for immunisation or growth monitoring were included in the study. Multiplex real-time PCR assays were used for detection of 15 different viruses and 5 bacterial species and for determination of pneumococcal serotypes/serogroups in the nasopharyngeal secretions. Results High levels of S. pneumoniae were detected in 77% of cases, and H. influenzae in 51%. Rhinovirus and enterovirus were the most commonly found viruses, while respiratory syncytial virus (RSV) was rare (1%). Co-occurrence of both bacteria and viruses at high levels was detected in 33% of the children. The pneumococcal load was higher in those children who lived in a dwelling with an indoor kitchen area with an open fire, i.e. a kitchen with an open fire for cooking located inside the dwelling with the resultant smoke passing to the living room and/or bedrooms; this was also higher in children from rural areas as compared to children from urban areas or children not living in a dwelling with an indoor kitchen area with an open fire/not living in this type of dwelling. Immunization with 2–3 doses of PCV13 was associated with lower rates of pneumococcal detection. Half of the identified serotypes were non-PCV13 serotypes. The most common non-PCV13 serotypes/serogroups were 15BC, 10A, and 12F, while 5, 6, and 19F were the most prevalent PCV13 serotypes/serogroups. Conclusions The burden of respiratory pathogens including S. pneumoniae in Congolese children was high but relatively few children had RSV. Non-PCV13 serotypes/serogroups became predominant soon after PCV13 was introduced in DR Congo.
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| 49. |
- Birindwa, Archippe M., et al.
(författare)
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High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo
- 2018
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Ingår i: Bmc Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPneumococcal conjugate vaccines have been introduced in the infant immunisation programmes in many countries to reduce the rate of fatal pneumococcal infections. In the Democratic Republic of the Congo (DR Congo) a 13-valent vaccine (PCV13) was introduced in 2013. Data on the burden of circulating pneumococci among children after this introduction are lacking. In this study, we aimed to determine the risk factors related to pneumococcal carriage in healthy Congolese children after the vaccine introduction and to assess the antibiotic resistance rates and serotype distribution among the isolated pneumococci.MethodsIn 2014 and 2015, 794 healthy children aged one to 60months attending health centres in the eastern part of DR Congo for immunisation or growth monitoring were included in the study. Data on socio-demographic and medical factors were collected by interviews with the children's caregivers. Nasopharyngeal swabs were obtained from all the children for bacterial culture, and isolated pneumococci were further tested for antimicrobial resistance using disc diffusion tests and, when indicated, minimal inhibitory concentration (MIC) determination, and for serotype/serogroup by molecular testing.ResultsThe pneumococcal detection rate was 21%, being higher among children who had not received PCV13 vaccination, lived in rural areas, had an enclosed kitchen, were malnourished or presented with fever (p value <0.05). The predominant serotypes were 19F, 11, 6A/B/C/D and 10A. More than 50% of the pneumococcal isolates belonged to a serotype/serogroup not included in PCV13.Eighty per cent of the isolates were not susceptible to benzylpenicillin and non-susceptibility to ampicillin and ceftriaxone was also high (42 and 37% respectively). Almost all the isolates (94%) were resistant to trimethoprim-sulphamethoxazole, while 43% of the strains were resistant to 3 antibiotics.ConclusionsOur study shows alarmingly high levels of reduced susceptibility to commonly used antibiotics in pneumococci carried by healthy Congolese children. This highlights the importance of local antibiotic resistance surveillance and indicates the needs for the more appropriate use of antibiotics in the area. The results further indicate that improved living conditions are needed to reduce the pneumococcal burden, in addition to PCV13 vaccination.
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| 50. |
- Björck, Lennart, et al.
(författare)
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Tveksam vinst med ekolantbruk
- 2009
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Ingår i: Svenska dagbladet. - 1101-2412. ; -
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Tidskriftsartikel (populärvet., debatt m.m.)
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