| 1. |
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- 2019
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Tidskriftsartikel (refereegranskat)
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| 2. |
- Lampinen, Maria, et al.
(författare)
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Different regulation of eosinophil activity in Crohn's disease compared with ulcerative colitis
- 2008
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Ingår i: Journal of Leukocyte Biology. - : Oxford University Press (OUP). - 0741-5400 .- 1938-3673. ; 84:6, s. 1392-1399
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this investigation was to study the involvement of eosinophil and neutrophil granulocytes in different stages of Crohn's disease (CD) and ulcerative colitis (UC). Biopsy samples were taken from the right flexure of the colon and from the rectum in patients with active (n=12) and inactive colonic CD (n=7), patients with active (n=33) and inactive UC (n=24), and from control subjects (n=11). Cell suspensions from biopsies and blood were analyzed by flow cytometry with regards to activation markers and viability. Immunohistochemistry was used to evaluate cell number and degranulation. Blood eosinophils were cultured with Th1 and Th2 cytokines, and the expression of activity markers was assessed by flow cytometry. Eosinophil number, viability, and activity were increased during active CD and UC compared with controls. The activity, assessed as CD44 expression, tended to diminish during inactive CD but was increased further in quiescent UC. Neutrophil number and activity were increased only during inflammation in both diseases. Culture of blood eosinophils with IL-5 and IL-13 caused increased CD44 expression, whereas IL-5 and IFN-gamma induced elevated CD69 expression. We observed different patterns of eosinophil activation in CD and UC, with the highest CD44 expression during quiescent UC. Our in vitro experiments with recombinant cytokines suggest that the diverse mechanisms of eosinophil activation in CD and UC are a result of different cytokine milieus (Th1 vs. Th2). In contrast, neutrophil activation reflects the disease activity in CD and UC, irrespective of Th cell skewing.
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| 3. |
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| 4. |
- Allinson, James, et al.
(författare)
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Collating data from major European population studies - The CADSET (Chronic airway disease early stratification) clinical research collaboration
- 2020
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 56:suppl 64
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: European population cohorts continue to expand our understanding of chronic airways disease and inter-study collaboration may help address the inevitable limitations of study size, duration, era and geography. Towards this aim, CADSET has collated data from ten major general population European cohorts: Asklepios; Copenhagen City Heart Study; Copenhagen General Population Study; ECRHS; HUNT; LEAD; Lifelines, OLIN, Rotterdam Study and WSAS. We included males and females aged 20 to 95 years with baseline demographic and spirometry data.Results: Data from 262,829 individuals (44% male) from multiple European countries provided good coverage across all adult ages (Fig.1A). Recruitment occurred in every year from 1976 through 2020. 23% were current-smokers and 42% were never-smokers, a pattern varying with advancing age (Fig.1B). The prevalence of airflow limitation varied according to whether lower limit of normal (LLN) or <0.70 thresholds were applied, increasing with age if the latter was used (Fig.1C).Interpretation: These results fit with previous reports, however the size, geographical reach and span of recruitment provided by this collaboration provides a unique opportunity to explore chronic airways disease development. Together, we are now pursuing research questions previously beyond the scope of individual cohort studies.
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| 5. |
- Allinson, James P, et al.
(författare)
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Changes in lung function in European adults born between 1884 and 1996 and implications for the diagnosis of lung disease: a cross-sectional analysis of ten population-based studies.
- 2022
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Ingår i: The Lancet. Respiratory medicine. - : Elsevier. - 2213-2619 .- 2213-2600. ; 10:1, s. 83-94
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Tidskriftsartikel (refereegranskat)abstract
- During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements.In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20-94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV1, forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV1/FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year.Across the ten included studies, we included 243465 European participants (mean age 51·4 years, 95% CI 51·4-51·5) in our analysis, of whom 136275 (56·0%) were female and 107190 (44·0%) were male. After full adjustment, FEV1 increased by 4·8 mL/birth year (95% CI 2·6-7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7-12·0; p<0·0001). Birth year-related increases in the FEV1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV1/FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09-0·14; p<0·0001).If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity.The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme.
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| 6. |
- Andersson, Charlotta, et al.
(författare)
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Testbäddar för utveckling av högskolepedagogik i framtidens lärandemijöer
- 2024
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Konferensbidrag (refereegranskat)abstract
- Learning Lab är Akademiska Hus koncept med testbäddar som i nära samverkan med lärosäten utformas för att främja innovation, forskning om och utveckling av framtidens lärandemiljöer. En testbädd utgörs av en fysisk plats där rumsdesign, pedagogik, teknik, m.m ges utrymme att prototypas, utforskas och utvärderas för att generera erfarenheter och kunskaper om våra lärandemiljöer. För närvarande driver Akademiska Hus Learning Lab på tre orter tillsammans med Göteborgs universitet, Umeå universitet och Örebro universitet. Miljöerna är designade med olika fokusområden men med en gemensam inriktning – att utforska samspelet mellan pedagogik, sociala förutsättningar, rum och teknik – i syfte att driva högskolepedagogisk utveckling.Syftet med rundabordssamtalet äratt diskutera hur konceptet med testbäddar kan spridas vidare samtatt dela erfarenheter från testbäddarnas arbete med att arbeta med högskolepedagogisk utveckling och utforskandet av fysiska och hybrida lärandemiljöer samtatt stimulera erfarenhetsutbyte inför gemensamma frågeställningar kring högskolepedagogisk utveckling i skärningspunkt mellan pedagogik, rum & teknikRundabordssamtalet genomförs genom att representanter från respektive Learning Lab tillsammans med projektgruppen från Akademiska hus leder ett samtal om hur vi kan sätta pedagogiken i centrum vid utveckling av lärandemiljöer, hur vi skapar nödvändiga stödstrukturer för lärare som utforskar lärandemiljöer och utmaningarna i samverkan inom och mellan lärosätena.Rundabordssamtalet avslutas genom en gemensam digital dokumentation av deltagarnas samtal som görs tillgänglig för konferensens deltagare genom qr-kod/länk efter rundabordssamtalet.För att uppmuntra till deltagande så synliggörs några frågeställningar som rundabordssamtalet strävar efter att behandla:Learning Lab är ett uttryck för en kontext där högskolepedagogisk utveckling uppmuntras, stöttas och utvärderas. Hur uttrycker sig samma fenomen på andra håll utanför Learning Labs ramar?Vilka samtalsforum finns idag där fokus omfattar didaktisk spatial kompetens?Hur upplevs samverkan/samarbete mellan stödfunktioner som IT, lokalförsörjning m.m. i relation till högskolepedagogisk utveckling vid lärosätet? Mellan lärosäten?Hur ser den idealiska lärmiljön ut för en given undervisningssituation med förankring i min pedagogiska grundsyn?
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| 7. |
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| 8. |
- Backman, Annica C., 1972-, et al.
(författare)
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Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes
- 2023
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702.
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Tidskriftsartikel (refereegranskat)abstract
- Aims and ObjectivesTo explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave. BackgroundThe number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor. DesignCross-sectional design. MethodsA sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied. ResultsNursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction. ConclusionsNursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction. Relevance to clinical practiceManagers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health. No patient or public contributionNo patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.
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| 9. |
- Backman, Annica C., 1972-, et al.
(författare)
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Longitudinal changes in nursing home leadership, direct care staff job strain and social support in Swedish nursing homes : findings from the U-AGE SWENIS study
- 2023
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration.Objectives: To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support.Methods: This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted.Results: A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up.Conclusions: Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work. Implications for Practice: Stakeholder and policy makers in nursing home care may reflect on how managers' leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.
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| 10. |
- Backman, Annica C., 1972-, et al.
(författare)
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The influence of nursing home managers’ leadership on person-centred care and stress of conscience: A cross-sectional study
- 2021
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Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Leadership and stress are common concepts in nursing, and this study explores empirically the connection between leadership and stress of conscience in the context of aged care practice. Previous literature has shown that when staff are unable to carry out their ethical liabilities towards the residents, feelings of guilt may occur among staff, which may be an expression of stress of conscience. Although leadership has been described as crucial for staff’s work perceptions of stress as well as for person-centred practices, the influence of nursing home managers’ leadership on stress of conscience among staff and person-centred practices is still not fully explored. This study attempts to address that knowledge gap by exploring the relationship between leadership, person-centred care, and stress of conscience.Methods: This study was based on a cross-sectional national survey of 2985 staff and their managers in 190 nursing homes throughout Sweden. Descriptive statistics and regression modelling were used to explore associations.Results: Leadership was associated with a higher degree of person-centred care and less stress of conscience. A higher degree of person-centred care was also associated with less stress of conscience. The results also showed that leadership as well as person-centred care were individually associated with lower levels of stress of conscience when adjusting for potential confounders.Conclusion: Nursing home managers’ leadership was significantly associated with less staff stress of conscience and more person-centred care. This indicates that a leadership most prominently characterised by coaching and giving feedback, relying on staff and handling conflicts constructively, experimenting with new ideas, and controlling work individually can contribute to less staff stress as well as higher degree of person-centred care provision.
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| 11. |
- Backman, Annica C., 1972-, et al.
(författare)
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The significance of nursing home managers' leadership : longitudinal changes, characteristics and qualifications for perceived leadership, person-centredness and climate
- 2022
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Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 31:9-10, s. 1377-1388
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives: The aim was to explore changes in nursing home managers' leadership, person-centred care and psychosocial climate comparing matched units in a five-year follow-up and to explore the significance of managers' educational qualifications and the ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate in the follow-up data.Background: Leadership has been described as crucial for person-centred care and psychosocial climate even though longitudinal data are lacking. The significance of managerial leadership, its characteristics, managerial qualifications and ownership of nursing homes for perceived leadership, person-centred care and psychosocial climate also needs further exploration.Design: Repeated cross-sectional study.Methods: This study used valid and reliable measures of leadership, person-centred care, psychosocial climate and demographic variables collected from managers and staff n = 3605 in 2014 and n = 2985 in 2019. Descriptive and regression analyses were used. The STROBE checklist was used in reporting this study.Results: Leadership was still positively significantly associated to person-centred care in a five-year follow-up, but no changes in strength were seen. Leadership was still positively significantly associated with psychosocial climate, with stronger associations at follow-up. Six leadership characteristics increased over time. It was also shown that a targeted education for nursing home managers was positively associated with person-centred care.Conclusions: Leadership is still pivotal for person-centred care and psychosocial climate. Knowledge of nursing home managers' leadership, characteristics and educational qualifications of significance for person-centred delivery provides important insights when striving to improve such services.Relevance to clinical practice: The findings can be used for management and clinical practice development initiatives because it was shown that nursing home managers' leadership is vital to person-centred care practices and improves the climate for both staff and residents in these environments.
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| 12. |
- Backman, Annica, et al.
(författare)
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Characteristics of highly rated leadership in nursing homes using item response theory
- 2017
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 73:12, s. 2903-2913
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify characteristics of highly rated leadership in nursing homes. Background: An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviours and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care. Design: Cross-sectional. Method: From 290 municipalities, 60 were randomly selected and 35 agreed to participate, providing a sample of 3605 direct-care staff employed in 169 Swedish nursing homes. The staff assessed their managers' (n = 191) leadership behaviours using the Leadership Behaviour Questionnaire. Data were collected from November 2013 - September 2014, and the study was completed in November 2016. A two-parameter item response theory approach and regression analyses were used to identify specific characteristics of highly rated leadership. Results: Five specific behaviours of highly rated nursing home leadership were identified; that the manager: experiments with new ideas; controls work closely; relies on subordinates; coaches and gives direct feedback; and handles conflicts constructively. The regression analyses revealed that managers with social work backgrounds and privately run homes were significantly associated with higher leadership ratings. Conclusion: This study highlights the five most important leadership behaviours that characterize those nursing home managers rated highest in terms of leadership. Managers in privately run nursing homes and managers with social work backgrounds were associated with higher leadership ratings. Further work is needed to explore these behaviours and factors predictive of higher leadership ratings.
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| 13. |
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| 14. |
- Backman, Annica, et al.
(författare)
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Towards person-centredness in aged-care : exploring the impact of leadership
- 2016
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Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 24:6, s. 766-774
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the association between leadership behaviours among managers in aged care, and person‐centredness of care and the psychosocial climate.Background: Theory suggests that leadership is important for improving person‐centredness in aged care, however, empirical evidence is lacking.Methods: A cross‐sectional design was used to collect data from Swedish aged care staff (n = 3661). Valid and reliable questionnaires assessing leadership behaviours, person‐centeredness of care and the psychosocial climate were used. Data were analysed using multiple linear regression including interaction terms.Results: Leadership behaviours were significantly related to the person‐centredness of care and the psychosocial climate. The level of person‐centredness of care moderated the impact of leadership on the psychosocial climate.Conclusions and implications for nursing management: The leadership behaviour of managers significantly impacts person‐centred care practice and contributes to the psychosocial climate for both staff and residents in aged care. This study is the first empirically to confirm that middle managers have a central leadership role in developing and supporting person‐centred care practice, thereby creating a positive psychosocial climate and high quality care.
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| 15. |
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| 16. |
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| 17. |
- Backman, Ellen, 1981-, et al.
(författare)
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Metoder för att stimulera språk och kommunikation hos barn, ungdomar och vuxna inom habiliteringen
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Språkliga och kommunikativa begränsningar är vanligt förekommande vid ett flertal av de diagnoser och tillstånd som återfinns hos personer inom habiliteringsverksamheter i Sverige och förutsätter en tvärprofessionell och långvarig insats. Syftet med föreliggande arbete är att systematiskt beskriva bästa tillgängliga evidens avseende interventioner fokuserade på språklig och kommunikativ förmåga för personer med medfödda funktionsnedsättningar från sex års ålder och uppåt inom habiliteringsverksamhet. Arbetet kan ses som en fortsättning på EBH-rapporten ”Tidiga kommunikations- och språkinsatser till förskolebarn”.Internationellt publicerade interventionsstudier från de senaste 15 åren med fokus på språkliga och kommunikativa förmågor vid typiskt förekommande diagnoser inom habiliteringsverksamhet granskades och sammanfattades. Initialt inkluderades endast översiktsartiklar och metaanalyser, men då dessa till största delen hade fokus på autism och/eller Alternativ och Kompletterande Kommunikation (AKK) utökades sökningen till att även inkludera ett antal primärstudier med annat fokus. Rapporten omfattar 67 studier.Resultatet visar att ”stark rekommendation att använda” (enligt GRADE) endast förekommer i begränsad utsträckning, och när det förekommer är det vid insatser relaterade till autism och/eller AKK. ”Stark rekommendation att inte använda” finns vid insatser relaterade till akupunktur/akupressur och faciliterad kommunikation. Det kan konstateras att det finns en stor brist på studier avseende vuxna personer respektive intellektuell funktionsnedsättning.Detta arbete tillför ytterligare kunskap till området för evidensbaserade insatser vid svårigheter när det gäller kommunikation och språk, och visar att evidens i strikt bemärkelse är svår att erhålla bland annat beroende på de små och heterogena patientgrupperna och, som en konsekvens av detta, en brist på stora randomiserade studier.
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| 18. |
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| 19. |
- Backman, Helena, et al.
(författare)
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Severe asthma : A population study perspective
- 2019
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Ingår i: Clinical and Experimental Allergy. - : John Wiley & Sons. - 0954-7894 .- 1365-2222. ; 49:6, s. 819-828
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSevere asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.ObjectiveTo describe characteristics and estimate the prevalence of severe asthma in a large adult population‐based asthma cohort followed for 10‐28 years.MethodsN=1006 subjects with asthma participated in a follow‐up during 2012‐14, when 830 (mean age 59y, 56% women) still had current asthma. Severe asthma was defined according to three internationally well‐known criteria: the ATS workshop definition from 2000 used in the US Severe Asthma Research Program (SARP), the 2014 ATS/ERS Task force definition and the GINA 2017. All subjects with severe asthma according to any of these criteria were undergoing respiratory specialist care, and were also contacted by telephone to verify treatment adherence.ResultsThe prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS Taskforce), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma according to the asthma control test. Severe asthma was related to age >50 years, nasal polyposis, impaired lung function, sensitization to aspergillus, and tended to be more common in women. Further, neutrophils in blood significantly discriminated severe asthma from other asthma.Conclusions and clinical relevanceSevere asthma differed significantly from other asthma in terms of demographic, clinical and inflammatory characteristics, results suggesting possibilities for improved treatment regimens of severe asthma. The prevalence of severe asthma in this asthma cohort was 4‐6%, corresponding to approximately 0.5% of the general population.
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| 20. |
- Backman, Helena, et al.
(författare)
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Severe asthma among adults : Prevalence and clinical characteristics
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Severe asthma is a considerable challenge for patients, health care professionals and society. Few studies have estimated the prevalence of severe asthma according to modern definitions of which none based on a population study.Methods: We estimated the prevalence and studied characteristics of severe asthma in a large adult population-based asthma cohort followed for 10-28 years in northern Sweden: 1006 subjects participated in a follow-up during 2012-14, when 830 (82.5%) still had current asthma (mean age 59y, 32-92y, 56% women). Severe asthma was defined according to three internationally well-known criteria: the US SARP, ATS/ERS and GINA. All subjects with severe asthma were undergoing respiratory specialist care, and were also contacted by telephone to verify adherence to treatment.Results: The prevalence of severe asthma according to the three definitions was 3.6% (US SARP), 4.8% (ERS/ATS), and 6.1% (GINA) among subjects with current asthma. Although all were using high ICS doses and other maintenance treatment, >40% had uncontrolled asthma and <10% had controlled asthma according to the ACT. Severe asthma was related to age >50 years, nasal polyposis, decreased FEV1, not fully reversible airway obstruction, sensitization to aspergillus, elevated neutrophils and partly to eosinophils, and tended to be more common in women.Conclusion: The prevalence of severe asthma in this asthma cohort was 4-6%, corresponding to approximately 0.5% of the population in northern Sweden. A substantial proportion of those with severe asthma had uncontrolled disease, and severe asthma differed significantly from other asthma in terms of both clinical and inflammatory characteristics.
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| 21. |
- Beltran, Catherine, et al.
(författare)
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Paleoenvironmental conditions for the development of calcareous nannofossil acme during the late Miocene in the eastern equatorial Pacific
- 2014
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Ingår i: Paleoceanography. - 0883-8305 .- 1944-9186. ; 29:3, s. 210-222
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Tidskriftsartikel (refereegranskat)abstract
- Repeated monospecific coccolithophore dominance intervals (acmes) of specimens belonging to the Noelaerhabdaceae familyincluding the genus Reticulofenestra and modern descendants Emiliania and Gephyrocapsaoccurred during the Neogene. Such acme was recognized during the late Miocene (similar to 8.6Ma), at a time of a major reorganization of nannofossil assemblages resulting in a worldwide temporary disappearance of larger forms of the genus Reticulofenestra (R. pseudoumbilicus) and the gradual recovery and dominance of its smaller forms (< 5 mu m). In this study we present a multiproxy investigation of late Miocene sediments from the east equatorial Pacific Integrated Ocean Drilling Program Site U1338 where small reticulofenestrid-type placoliths with a closed central areaknown as small Dictyococcites spp. (< 3 mu m)formed an acme. We report on oxygen and carbon stable isotope records of multispecies planktic calcite and alkenone-derived sea surface temperature. Our data indicate that, during this 100 kyr long acme, the east equatorial Pacific thermocline remained deep and stable. Local surface stratification state fails to explain this acme and thus contradicts the model-based hypothesis of a Southern Ocean high-latitude nutrient control of the surface waters in the east equatorial Pacific. Instead, our findings suggest that external forcing such as an extended period of low eccentricity may have created favorable conditions for the small Dictyococcites spp. growth. Key Points < list list-type=bulleted id=palo20081-list-0001> < list-item id=palo20081-li-0001> EEP thermocline deep during the late Miocene small Dictyococcites acme Low eccentricity favorable for the small Dictyococcites spp. growth
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| 22. |
- Bengtsson, Daniel, 1975-, et al.
(författare)
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Corticotroph Pituitary Carcinoma in a Patient With Lynch Syndrome (LS) and Pituitary Tumors in a Nationwide LS Cohort
- 2017
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : OXFORD UNIV PRESS INC. - 0021-972X .- 1945-7197. ; 102:11, s. 3928-3932
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Tidskriftsartikel (refereegranskat)abstract
- Context: Lynch syndrome (LS) is a cancer-predisposing syndrome caused by germline mutations in genes involved in DNA mismatch repair (MMR). Patients are at high risk for several types of cancer, but pituitary tumors have not previously been reported. Case: A 51-year-old man with LS (MSH2 mutation) and a history of colon carcinoma presented with severe Cushing disease and a locally aggressive pituitary tumor. The tumor harbored a mutation consistent with the patients germline mutation and displayed defect MMR function. Sixteen months later, the tumor had developed into a carcinoma with widespread liver metastases. The patient prompted us to perform a nationwide study in LS. Nationwide Study: A diagnosis consistent with a pituitary tumor was sought for in the Swedish National Patient Registry. In 910 patients with LS, representing all known cases in Sweden, another two clinically relevant pituitary tumors were found: an invasive nonsecreting macroadenoma and a microprolactinoma (i.e., in total three tumors vs. one expected). Conclusion: Germline mutations in MMR genes may contribute to the development and/or the clinical course of pituitary tumors. Because tumors with MMR mutations are susceptible to treatment with immune checkpoint inhibitors, we suggest to actively ask for a family history of LS in the workup of patients with aggressive pituitary tumors.
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| 23. |
- Carlsson, Marianne, et al.
(författare)
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A five-year follow-up of quality of life in women with breast cancer in anthroposophic and conventional care
- 2006
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288. ; 3:4, s. 523-531
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Tidskriftsartikel (refereegranskat)abstract
- Complementary and alternative medicine is used by many cancer patients in most parts of the world, and its use is increasing. The aim of the present study was to examine, over 5 years, the perceived quality of life/life satisfaction in two samples of women with breast cancer who were treated with anthroposophic care or conventional medical treatment only. Data from admission, after I year and after 5 years are used for the comparisons. On admission to the study the women in anthroposophic care perceived their quality of life to be lower than that of the women in the conventional treatment group, especially for emotional, cognitive and social functioning and overall quality of life. Sixty women who actively chose treatment with anthroposophic medicine and 60 individually matched women treated with conventional medicine participated. Quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire. Twenty-six women within anthroposophic care and 31 women within conventional medicine survived the 5 years. Effect size (ES) estimation favored the anthroposophic group in seven of the subscales mostly measuring emotional functioning. The ES for four of the subscales favored the conventional treatment group, mostly concerning physical functioning. After 5 years there were improvements in overall quality of life and in emotional and social functioning compared to admission for the women in anthroposophic care. The improvements took place between admission and 1 year, but not further on. Only minor improvements were found in the matching group.
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| 24. |
- Carlsson, Marianne, et al.
(författare)
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Evaluation of quality of life/life satisfaction in women with breast cancer in complementary and conventional care
- 2004
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Ingår i: Acta Oncologica. - OSLO : TAYLOR & FRANCIS AS. - 0284-186X .- 1651-226X. ; 43:1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study the perceived quality of life/life satisfaction in a sample of women with breast cancer who were treated in a hospital with alternative/complementary care and the same variables in individually matched patients who received only conventional medical treatment. A non-randomized controlled trial design with repeated measurements was used. Sixty women with breast cancer treated with anthroposophic medicine (ABCW) and 60 with conventional medicine (CBCW) were included and 36 matched pairs took part on all occasions. The quality of life was measured by the EORTC QLQ-C30 and the Life Satisfaction Questionnaire (LSQ). The comparisons were calculated as effect sizes (ES). The women in the ABCW group reported small or moderate effects, expressed as ES, on their quality of life/life satisfaction compared to their matched "twins'' in the CBCW group at the 1-year follow-up in 15 out of 21 scales/factors. It was concluded that the women who had chosen anthroposophic care increased their perceived quality of life/life satisfaction according to the methodology of the study.
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| 25. |
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| 26. |
- Carlsson, Marianne, et al.
(författare)
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Perceived quality of life and coping for Swedish women with breast cancer who choose complementary medicine
- 2001
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Ingår i: Cancer Nursing. - PHILADELPHIA : LIPPINCOTT WILLIAMS & WILKINS. - 0162-220X .- 1538-9804. ; , s. 395-401
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study, which is part of a major clinical controlled study of the life situation of women with breast cancer, was to compare two groups of women concerning perceived quality of life and coping. The women were treated in two different cancer treatment programs: complementary treatment, which included anthroposophic therapy, and conventional cancer treatment. A total of 120 women were included, 60 women treated with anthroposophic medicine, and 60 individually matched women treated with conventional medicine only. Quality of life was measured by the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Core 30, and the Life Satisfaction Questionnaire. Coping was measured by the Mental Adjustment to Cancer scale. The results showed that the women who chose anthroposophic therapy perceived their quality of life to be lower on admission to the hospital and showed more anxious preoccupation than the women in conventional medicine. It can be concluded that, due to the careful matching procedure, the women in the two groups are comparable in a medical sense but not from the perspective of quality of life and coping.
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| 27. |
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| 28. |
- Colliander Celik, Å, et al.
(författare)
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Därför krävs det stora satsningar på geografi och geovetenskap
- 2021
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Ingår i: Läraren. - 1101-2633.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Som geografer, geovetare och geografilärare frågar vi oss varför kunskaper om vår livsmiljö, och de processer som styr den, är så styvmoderligt behandlade i skolan när vårt samhälle och stora delar av vår civilisation står inför många stora utmaningar, skriver 52 tunga företrädare.
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| 29. |
- Edvardsson, David, et al.
(författare)
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The Umeå Ageing and health research programme (U-age) : exploring person-centred care and health promoting living conditions for an ageing population
- 2016
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Ingår i: Nordic journal of nursing research. - : Sage Publications. - 2057-1585 .- 2057-1593. ; 36:3, s. 168-174
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to describe the Umeå ageing and health research programme that explores person-centred care and health-promoting living conditions for an ageing population in Sweden, and to place this research programme in a national and international context of available research evidence and trends in aged care policy and practice. Contemporary trends in aged care policy includes facilitating ageing in place and providing person-centred care across home and aged care settings, despite limited evidence on how person-centred care can be operationalised in home care services and sheltered housing accommodation for older people. The Umeå ageing and health research programme consists of four research projects employing controlled, cross-sectional and longitudinal designs across ageing in place, sheltered housing, and nursing homes. The research programme is expected to provide translational knowledge on the structure, content and outcomes of person-centred care and health-promoting living conditions in home care, sheltered housing models, and nursing homes for older people and people with dementia.
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| 30. |
- Eriksson, Kimmo, et al.
(författare)
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Perceptions of the appropriate response to norm violation in 57 societies
- 2021
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Ingår i: Nature Communications. - : Nature Research. - 2041-1723. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Norm enforcement may be important for resolving conflicts and promoting cooperation. However, little is known about how preferred responses to norm violations vary across cultures and across domains. In a preregistered study of 57 countries (using convenience samples of 22,863 students and non-students), we measured perceptions of the appropriateness of various responses to a violation of a cooperative norm and to atypical social behaviors. Our findings highlight both cultural universals and cultural variation. We find a universal negative relation between appropriateness ratings of norm violations and appropriateness ratings of responses in the form of confrontation, social ostracism and gossip. Moreover, we find the country variation in the appropriateness of sanctions to be consistent across different norm violations but not across different sanctions. Specifically, in those countries where use of physical confrontation and social ostracism is rated as less appropriate, gossip is rated as more appropriate. Little is known about peoples preferred responses to norm violations across countries. Here, in a study of 57 countries, the authors highlight cultural similarities and differences in peoples perception of the appropriateness of norm violations.
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| 31. |
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| 32. |
- Guldstrand, Marie, et al.
(författare)
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Alteration of the counterregulatory responses to insulin-induced hypoglycemia and of cognitive function after massive weight reduction in severely obese subjects
- 2003
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Ingår i: Metabolism, Clinical and Experimental. - 1532-8600. ; 52:7, s. 900-907
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Tidskriftsartikel (refereegranskat)abstract
- The autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis are reported as activated in excess in the morbidly obese state and, therefore, changes after weight loss can be anticipated. The aim of this study was to investigate the impact of a massive (similar to30%) weight reduction on the activation of the HPA axis and the ANS following bariatric surgery. Eight (7 women, 1 man) severely obese (125 +/- 12 kg; body mass index [BMI], 45 +/- 4 kg/m(2)) nondiabetic subjects, underwent a 3-hour hyperinsulinemic (1,034 pmol/kg/h) glucose clamp study at hypoglycemia of arterial B-glucose concentration of 3.4 mmol/L. Cognitive function was evaluated by a visuospatial computerized problem-solving test, the Perceptual Maze Test (PMT). The mean weight loss was 40 +/- 9 kg approximately 12 months postsurgery when their weight was stabilized (85 6 kg; BMI, 31 +/- 3 kg/m(2)), and insulin sensitivity improved to an average increase of 376% +/- 250% (P < .01) of initial value. Before weight reduction, all patients demonstrated brisk peak responses in glucagon, epinephrine, pancreatic polypeptide (PP), norepinephrine, and cortisol, indicative of preserved or exaggerated activation of ANS and HPA axis. In the reduced-obese state, all these responses were attenuated and most markedly so for glucagon, which was totally abolished. In contrast, the growth hormone (GH) response was increased after weight reduction. The cognitive function was clearly modified by weight reduction both during normoglycemia and hypoglycemia and was changed preferentially to a speed-preferring strategy in the reduced-obese state compared with a more accuracy preferred problem-solving process of PMT test presurgery. These results demonstrate a reduction of the glucose counterregulatory hormonal responses, increased insulin sensitivity, and perturbed cognitive function after massive weight reduction. It may be speculated on if the increased insulin sensitivity and reduced counterregulation to hypoglycemia could predispose to low plasma glucose concentrations.
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| 33. |
- Hivert, Marie-France, et al.
(författare)
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Pathophysiology from preconception, during pregnancy, and beyond
- 2024
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 404:10448, s. 158-174
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Forskningsöversikt (refereegranskat)abstract
- Gestational diabetes is the most common medical complication in pregnancy. Historically, gestational diabetes was considered a pregnancy complication involving treatment of rising glycaemia late in the second trimester. However, recent evidence challenges this view. Pre-pregnancy and pregnancy-specific factors influence gestational glycaemia, with open questions regarding roles of non-glycaemic factors in the aetiology and consequences of gestational diabetes. Varying patterns of insulin secretion and resistance in early and late pregnancy underlie a heterogeneity of gestational diabetes in the timing and pathophysiological subtypes with clinical implications: early gestational diabetes and insulin resistant gestational diabetes subtypes are associated with a higher risk of pregnancy complications. Metabolic perturbations of early gestational diabetes can affect early placental development, affecting maternal metabolism and fetal development. Fetal hyperinsulinaemia can affect the development of multiple fetal tissues, with short-term and long-term consequences. Pregnancy complications are prevented by managing glycaemia in early and late pregnancy in some, but not all women with gestational diabetes. A better understanding of the pathophysiology and heterogeneity of gestational diabetes will help to develop novel management approaches with focus on improved prevention of maternal and offspring short-term and long-term complications, from pre-conception, throughout pregnancy, and beyond.
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| 34. |
- Jalasto, Juuso, et al.
(författare)
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Occupation, socioeconomic status and chronic obstructive respiratory diseases – the EpiLung Study in Finland, Estonia and Sweden
- 2022
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Ingår i: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 191
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases.Methods: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (FENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined.Results: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For FENO, no associations with occupation were observed.Conclusions: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased FENO.
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| 35. |
- Jansson, Sven-Arne, et al.
(författare)
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Societal costs of severe asthma in Sweden
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Severe asthma is a disabling and costly disease, often poorly controlled despite high-dosage controller medications.Aims: We estimated societal costs from an adult severe asthma cohort, derived from a large-scale population survey in northern Sweden.Methods: Severe asthma was defined by US SARP criteria, and high-dosage inhaled corticosteroids (ICS) were defined by GINA 2014 criteria. The study sample was identified from general population cohorts examined within the OLIN (Obstructive Lung Disease in Northern Sweden) studies (n=1,006). Patient reported asthma-related direct (outpatient care, medicines, hospitalisations) and indirect (sick leave, early retirement) resource consumption were collected by quarterly pre-defined telephone interviews during one year. Unit costs from 2017 were applied.Results: In total, 32 patients with severe asthma (mean age 60.7y, 13 patients >65) were included. The mean annual total cost per patient was approximately €6,300. Two thirds of the costs (63%) was indirect costs (approximately €4,000). The main cost drivers in direct costs were hospitalisations and drugs: approximately €1,000 and €700, respectively. The main cost driver of indirect costs was productivity loss due to early retirement: €3,400. Patients who had received regular oral corticosteroid (OCS) treatment had greater costs compared with those without regular OCS treatment. In comparison with a previous Swedish study based on a sample of all asthmatics from the general population, a greater mean annual total cost per patient was observed.Conclusions: In this severe asthma population in Sweden, societal costs were substantial. The results indicate a need for improved treatment regimens for patients with severe asthma.
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| 36. |
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| 37. |
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| 38. |
- Lassmann-Klee, Paul, et al.
(författare)
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Differences of FENO in adult general populations of Nordic regions
- 2019
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 54:Suppl. 63
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Eventual differences of expiratory nitric oxide (FENO) levels in general populations of Nordic countries may reflect differences in eosinophilic inflammation at population level.Aim: To study the differences in FENO of Nordic regions and their epidemiological associations.Methods: From 1997 to 2003 we measured FENO (ppb) and conducted skin prick-tests for a random sample of adults (n=1498), aged 20-60 years from Finland (Helsinki), Sweden (Stockholm and Örebro) and Estonia (Narva and Saaremaa). We compared differences between regions by estimating odds ratios (OR) and 95% confidence intervals (CIs) for high FENO (>25 ppb) using logistic regression adjusted for gender, smoking and allergy. Finally, we estimated crude ORs and 95% CIs for high FENO and for asthma, rhinitis, current asthma symptoms and asthma medication.Results: The mean and standard deviation (SD) for FENO was 19(14) in Finland, 18(12) in Sweden and 16(15) in Estonia (p<0.001). Estonia had a lower mean FENO than other countries, with no differences between Finland and Sweden. Compared to Helsinki, the adjusted OR (95%CI) for high FENO was 0.42(0.21-0.81) in Stockholm, 0.65(0.43-0.98) in Örebro, 0.53(0.32-0.84) in Narva and 0.45(0.28-0.71) in Saaremaa. In Estonia, high FENO was associated with asthma, allergy, rhinitis, current asthma, and asthma medication; in Finland with rhinitis and use of short acting β-agonist; in Sweden with asthma and asthma medication. Smoking was associated with low FENO. Mean FENO in asthmatics was 24(19) in Finland, 20(12) in Sweden, and 43(49) in Estonia (p=0.07).Conclusions: We observed a higher mean FENO in Finland and Sweden compared to Estonia, and found no overall differences of FENO levels in asthmatics.
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| 39. |
- Molin, Johanna, 1970-
(författare)
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Metformin treatment during pregnancy : metabolic and immunological aspects
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Randomized controlled trials have shown that metformin treatment during pregnancy slows down gestational weight gain (GWG) and reduces the risk of preterm birth in women with polycystic ovary syndrome (PCOS), but these trials have not investigated why metformin treatment produces these effects. Studies of metformin's mechanisms of action have mostly been in-vitro studies of cell lines or animal models, or clinical studies of non-pregnant human populations, and it is unknown whether the results of these studies are applicable to human pregnancy. Neonatal outcomes following metformin treatment have been extensively evaluated against insulin treatment for gestational diabetes mellitus (GDM). However, previous assessments have generally combined results from participants treated with metformin alone and results from those who also required supplemental insulin, which makes it difficult to assess effects of metformin per se, and evaluations against diet and lifestyle treatment are lacking.Aim: The objectives of this thesis were to explore the potential mechanisms by which metformin treatment during pregnancy slows down GWG, affects fetal growth, and reduces the risk of preterm birth in women with PCOS, and to assess the risk of neonatal hypoglycemia following metformin-treated, insulin-treated, and diet-and-lifestyle-treated GDM.Method: In Studies I-III, we investigated appetite-regulating hormones and immunological factors in serum and placental tissue obtained from women with PCOS treated with either metformin or placebo. In addition, a group of healthy women with normal pregnancies were included as a reference group. In Study IV, we evaluated associations between metformin treatment and neonatal hypoglycemia, and other neonatal outcomes associated with fetal hyperinsulinemia. We used a register-based approach, and a population-based cohort that consisted of more than 16 000 women with GDM, and their singleton offspring. Metformin as a single adjunctive treatment was assessed separately from metformin combined with insulin treatment.Results: Women with excessive GWG were more leptin resistant throughout pregnancy, and displayed a lower physiological serum allopregnanolone increase in late pregnancy than women who maintained a healthy GWG (Paper I). Metformin treatment improved leptin sensitivity and counteracted excessive GWG in women with PCOS (Paper I). This treatment effect was uncorrelated with placental leptin and leptin-receptor mRNA expression in women with PCOS (Paper II). Placental leptin mRNA expression correlated positively with the birthweight/placental weight ratio in placebo-treated women with PCOS (Paper II). PCOS status was associated with enhanced decidual immune-cell mobilization, particularly greater abundance of CD4+ T cells, and with altered placental IL-18 and IL-5 cytokine mRNA expression (Paper III). Metformin treatment altered the immunological landscape at the maternal-fetal interface in women with PCOS. This was shown by greater abundance of decidual CD56+ cells, downregulation of placental IL-4 and IL-18 mRNA expression, fewer placental pro-inflammatory intra-class cytokine mRNA correlations, and different cytokine mRNA expression profiles compared with placebo (Paper III). Offspring exposed in utero to only metformin as a pharmacological treatment for GDM appeared to be at similar risk of neonatal hypoglycemia to infants exposed to diet and lifestyle treatment alone, and at lower risk compared to offspring exposed to insulin, regardless of whether the insulin was administered as monotherapy or in combination with metformin (Paper IV).Conclusions and implications: Metformin treatment effectively reduces the risk of excessive GWG and appears to counteract physiological leptin resistance during pregnancy in women with PCOS. However, a positive correlation between placental leptin mRNA expression and the placental-efficiency measure ‘birthweight/placental weight ratio’, was erased by metformin treatment. The clinical implication of this finding is unclear, and future research should aim for deeper insight into this mechanism for clarification. Metformin treatment induced complex immunomodulatory effects at the maternal-fetal interface in women with PCOS, but further research is required to determine if these findings can explain why metformin reduces the risk of preterm birth in PCOS. The similar risk of neonatal hypoglycemia to diet and lifestyle treatment is reassuring for all metformin-treated women with GDM that achieve glycemic targets without requiring supplemental insulin. In summary, this thesis contributes to increasing knowledge of how metformin treatment during pregnancy affects metabolic adaptations of importance for maternal weight gain and fetal growth in women with PCOS. Further, it provides some insights into how PCOS status and metformin treatment affect the immunological landscape at the maternal fetal interface; expands previous knowledge of how metformin treatment for GDM associates with neonatal hypoglycemia; and demonstrates the importance of differentiating between metformin with and without supplemental insulin when assessing treatment-associated risk of adverse outcomes.
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| 40. |
- Rankin, Linda, 1987-, et al.
(författare)
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Pharmacological treatment of pain in Swedish nursing homes : prevalence and associations with cognitive impairment and depressive mood
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Chronic pain is highly prevalent in nursing home residents and often occurs with depression as well as cognitive impairment, which can severely influence and limit the expression of pain.Methods: The present cross-sectional study aimed to estimate the prevalence of pain, depressive mood, and cognitive impairment in association with pharmacological treatment against pain and depressive symptoms among Swedish nursing home residents.Results: We found an overall pain prevalence of 52.8%, a prevalence of 63.1% for being in a depressive mood, and a prevalence of cognitive impairment of 68.3%. Among individuals assessed to have depressive mood, 60.5% were also assessed to have pain. The prevalence of pharmacological treatment for pain was 77.5 and 54.1% for antidepressants. Prescription of pharmacological treatment against pain was associated with reports of currently having pain, and paracetamol was the most prescribed drug. A higher cognitive function was associated with more filled prescriptions of drugs for neuropathic pain, paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs), which could indicate an undertreatment of pain in those cognitively impaired.Conclusion: It is important to further explore the relationship between pain, depressive mood, and cognitive impairment in regard to pain management in nursing home residents.
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| 41. |
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| 42. |
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| 43. |
- Strandberg, Maria, et al.
(författare)
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Pre-surgical epilepsy evaluation using 3T MRI. Do surface coils provide additional information?
- 2008
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Ingår i: Epileptic Disorders. - 1294-9361. ; 10:2, s. 83-92
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. To assess if 3T MRI can be further improved by adding surface coil imaging, in the context of detection and characterization of cerebral lesions in patients with drug-resistant epilepsy. Methods. Twenty five patients with drug-resistant epilepsy undergoing evaluation for epilepsy surgery were examined with high resolution 3T MRI. The patients were MRI-negative (n = 15), or had unclear findings (n = 10), on previous MRI at 1.0-1.5T. Surface coils were applied over the suspected epileptogenic zone after imaging in the head coil. In MRI-negative patients, placement of the coils was defined by semiological analysis, extracranial video-EEG, and, in selected cases, subtraction ictal SPECT co-registered with MRI and PET. Coil placement was re-analyzed and graded, based on the degree of convergence between different investigational modalities. Results. Surface coil MRI allowed visualization of the cortical lesions with somewhat better demarcation and detail, but did not contribute to detection of previously undiagnosed lesions and did not provide additional information regarding type of lesion. Possible epileptogenic lesions were detected on 3T MRI in 12 patients. No abnormalities were found in the remaining 13 patients. 3T MRI provided new or additional information about the cortex, compared with reports from previous 1.0-1.5T MRI in 5 patients (20%). Conclusion. 3T MRI with high resolution is valuable for lesion detection, especially MCD, in patients with drug-resistant epilepsy. We question the additional contribution from supplementary surface coil imaging at 3T MRI.
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| 44. |
- Stridsman, Caroline, et al.
(författare)
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Adolescent girls with asthma have worse asthma control and health-related quality of life than boys : A population based study
- 2017
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Ingår i: Pediatric Pulmonology. - : John Wiley & Sons. - 8755-6863 .- 1099-0496. ; 52:7, s. 866-872
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPopulation-based studies investigating health-related quality of life (HRQoL) among asthmatic adolescents are rare. Further, among subjects with asthma, HRQoL may be affected by asthma control and severity.AimTo investigate HRQoL in relation to asthma control and asthma severity among adolescents.MethodAs a part of the population-based OLIN pediatric study, 266 adolescents with current asthma (14-15 yr) were identified. N = 247 completed the DISABKIDS HRQoL asthma module, including the domains impact and worry. The Asthma Control Test (ACT) was used and a disease severity score was calculated based on symptoms and medicine use.ResultsThe prevalence of current asthma was 11%. Well-controlled asthma was reported by 15% of the adolescents, and 53% had partly controlled asthma. The prevalence of uncontrolled asthma was significantly higher among girls than boys (38% vs 25%), and girls also reported lower HRQoL scores. There was a fairly strong correlation between the ACT and DISABKIDS scores. Independent risk factors for low HRQoL impact (a score <67) were female sex (OR 4.66, 95%CI 1.82-9.54) and decreased ACT scores (1.38, 1.18-1.62). Risk factors for low HRQoL worry (a score <70) were female sex (3.33, 1.41-7.86), decreased ACT scores (1.35, 1.16-1.57), severe asthma (6.23, 1.46-16.50), and having current eczema (2.68, 1.00-7.24).ConclusionOnly a minority of the asthmatic adolescents reported well-controlled asthma, and poor asthma control and female sex were risk factors for low HRQoL. Our results demonstrate that evaluation of asthma control is of great importance for asthma management.
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| 45. |
- Stridsman, Caroline, et al.
(författare)
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Health status among adult asthmatics - a population-based study
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Women with asthma seem to report a worse health status then men. However, other factors associated to health have rarely been studied in population-based samples.Aim: To determine factors associated with generic health in a population-based adult asthma cohort.Methods: In 2012-2014, n=1425 subjects from a population-based adult asthma cohort (the OLIN-studies) were invited to a clinical follow-up including spirometry, blood sampling, a structured interview, and the SF-8 health survey, evaluating both physical and mental health. N=1006 subjects participated, of which n=830 had current asthma. Of these, n=816 answered the SF-8 and were further studied (56% women, 32-92yr).Results: In adjusted analyses, worse physical health was associated with female sex, increasing age, BMI, blood neutrophils ≥5*109/L, and health care contacts due to respiratory symptoms last 12 months, but not with blood eosinophils ≥0.3*109/L or eczema. A positive phadiatop (≥0.35kU/L) was associated with better physical health. Worse mental health was associated with female sex, increasing BMI, eczema and health care contacts due to respiratory symptoms last 12 months, but not with increasing age, blood eosinophils ≥0.3*109/L, blood neutrophils ≥5*109/L, or a positive phadiatop (≥0.35kU/L).Conclusion: Among adult asthmatics, female sex, a higher BMI and health care visits due to respiratory symptoms were associated with a worse health. Eczema was only associated with worse mental health, and blood neutrophils ≥5*109/L with physical health. Subjects with allergic asthma seem to have better physical health than those with non-allergic asthma.
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| 46. |
- Sweeting, Arianne, et al.
(författare)
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Epidemiology and management of gestational diabetes
- 2024
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 404:10448, s. 175-192
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Forskningsöversikt (refereegranskat)abstract
- Gestational diabetes is defined as hyperglycaemia first detected during pregnancy at glucose concentrations that are less than those of overt diabetes. Around 14% of pregnancies globally are affected by gestational diabetes; its prevalence varies with differences in risk factors and approaches to screening and diagnosis; and it is increasing in parallel with obesity and type 2 diabetes. Gestational diabetes direct costs are US$1·6 billion in the USA alone, largely due to complications including hypertensive disorders, preterm delivery, and neonatal metabolic and respiratory consequences. Between 30% and 70% of gestational diabetes is diagnosed in early pregnancy (ie, early gestational diabetes defined by hyperglycaemia before 20 weeks of gestation). Early gestational diabetes is associated with worse pregnancy outcomes compared with women diagnosed with late gestational diabetes (hyperglycaemia from 24 weeks to 28 weeks of gestation). Randomised controlled trials show benefits of treating gestational diabetes from 24 weeks to 28 weeks of gestation. The WHO 2013 recommendations for diagnosing gestational diabetes (one-step 75 gm 2-h oral glucose tolerance test at 24-28 weeks of gestation) are largely based on the Hyperglycemia and Adverse Pregnancy Outcomes Study, which confirmed the linear association between pregnancy complications and late-pregnancy maternal glycaemia: a phenomenon that has now also been shown in early pregnancy. Recently, the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) trial showed benefit in diagnosis and treatment of early gestational diabetes for women with risk factors. Given the diabesity epidemic, evidence for gestational diabetes heterogeneity by timing and subtype, and advances in technology, a life course precision medicine approach is urgently needed, using evidence-based prevention, diagnostic, and treatment strategies.
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| 47. |
- Tarnow, H., et al.
(författare)
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Outcome of renal transplantation subsequent to liver, heart, or lung transplantation
- 2006
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Ingår i: Transplantation proceedings. - : Elsevier BV. - 0041-1345. ; 38:8, s. 2649-50
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Tidskriftsartikel (refereegranskat)abstract
- Renal dysfunction is a growing problem after liver, heart, or lung transplantation with the subsequent need for dialysis or renal transplantation. The aim of this study was to analyze the outcome after a subsequent kidney transplantation (secondary kidney transplantation) in liver, heart, or lung transplantation recipients. All secondary kidney transplantation patients from 1985 to 2006 were identified for the cause of kidney failure, time after initial transplantation, and current kidney function. One thousand two hundred three patient charts were reviewed including 22 (1.8%) secondary kidney transplantations: eight after lung, eight after heart, and six after liver transplantation. Renal failure was the result of perioperative renal failure (n = 3), toxic effects of cyclosporine (n = 16), a combination of cyclosporine nephrotoxicity and vascular ischemia (n = 3), or chronic renal failure due to polycystic kidney disease (n = 1). The median time after the initial organ transplantation was 114 months (range 30 to 241 months). The most recent median creatinine value was 103 micromol/L (82 to 704 micromol/L). Renal transplant rejection was noted in five patients: four in the lung transplant group, and one after heart transplantation. Three patients were deceased, one from secondary renal failure. One renal allograft was removed after renal artery thrombosis. In conclusion, there is sometimes a need for subsequent kidney transplantation after liver, heart, or lung transplantation. The outcome of renal transplantation subsequent to liver, heart, or lung transplantation is good with satisfactory renal function in this study population.
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| 48. |
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| 49. |
- Vasar, Marie
(författare)
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Allergic diseases and bronchial hyperreactivity in Estonian children in relation to environmental influences
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is based on the cross-sectional and prospective study of Estonian children. The aim of this thesis was to assess the prevalence of allergic diseases and respiratory symptoms in Estonian schoolchildren and in young children, to study environmental risk factors for allergic diseases and repiratory symptoms. The cross-sectional study was a part of an epidemiological study in Northeastern part of Europe of the same age group and using standardised methodology in order to allow meaningful comparisons between the countries. The Estonian study was extended to include more extensive assessment of lung function to assess bronchial hyperreactivity (BHR) in Estonian schoolchildren.1580 schoolchildren from Tallinn and Tartu participated in a cross-sectional study which included parental questionnaires, skin-prick tests, serial peak-flow measurements, methacholine provocation and exercise challenge tests.Among 10-12 year-old schoolchildren the prevalence of asthma was lower than in children of similar age in Sweden (2.9% vs 8.1% ). In contrast to the low prevalence of atopic diseases, the frequent respiratory infections were more common among the Estonian schoolchildren than in Sweden. Respiratory symptoms and allergic disorders in Tall inn, compared to Tartu showed a similar tendency as the urban-rural gradient in Sundsvall, Sweden. These findings suggest an influence of air pollutants and other adjuvant factors, as related to urbanisation in both countries. Atopic heredity, current dampness and maternal smoking were significant risk factors for the respiratory symptoms in Estonia. The prevalence of BHR to methacholine was 19% in Tall inn and 32% in Tartu (pIn prospective study 298 healthy, consecutively born newborn babies werefollowed from birth up to 2 years of age. Skin-prick tests with fresh food allergens and inhaled allergens were carried out at 6, 12, and 24 months of age. Symptoms of allergy were searched by employing questionnaires at 3, 6, 9, 12 and 24 months of age.The prevalence of allergic diseases .increased from 8% at 6 months to 17% at 24 months. The cumulative incidence of allergy was 25%, and atopic dermatitis was the main manifestation of atopy with a peak prevalence of 15% at 2 years of life. Asthma was present in 4 children and allergic rhinoconjunctivitis in 2 children at 2 years. The results of our prospective study showed that prevalence of allergy among Estonian young children was not as low as would be expected. This could possibly indicate that 'western lifestyle' has already affected the infant population born in 1993/94.
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| 50. |
- Vikner, Pia, 1981, et al.
(författare)
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Att diagnostiseras med graviditetsdiabetes - påverkar det upplevelsen av graviditet, förlossning och amning?
- 2023
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Ingår i: Konferens Reproduktiv Hälsa 2023.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Graviditetsdiabetes uppkommer på grund av en ökad insulinresistens hos den gravida kvinnan. Sedan 2013 förespråkar WHO striktare diagnoskriterier för graviditetsdiabetes vilka även Socialstyrelsen rekommenderar sedan 2015. Trots rekommendationen används olika diagnoskriterier runtom i Sverige och förekomsten av graviditetsdiabetes varierar stort, allt från 1–22% (nationellt 6,2%). Att få diagnosen graviditetsdiabetes kan upplevas stigmatiserande och medföra ett ökat fokus på risker, övervakning och medicinska interventioner. Hur detta påverkar kvinnans upplevelse av graviditet, förlossning och amning är inte tillräckligt studerat. Syftet med studien är att undersöka om diagnosen graviditetsdiabetes påverkar kvinnans tillit till egen förmåga och känsla av sammanhang, hennes förlossningsupplevelse och tillit till egen förmåga att amma. Studien är en del av multicenterstudien CDC4G (ISRCTN 41918550) och förlossningsklinikerna i Örebro, Lund, Uppsala, Göteborg och Falun deltar. De kvinnor som enligt lokala riktlinjer för screening planeras för oralt glukostoleranstest (OGTT), kan tillfrågas om medverkan. Studien har etiktillstånd (2019–02080, 2020-00122). Studien pågår med insamling av enkäter som mäter känsla av sammanhang (SOC-13), tilltro till egen förmåga (GSE), förlossningsupplevelse (CEQ2) och tillit till egen förmåga att amma (BSE). Mätningarna sker före OGTT samt cirka åtta veckor postpartum. Jämförande analyser kommer att göras mellan svarande kvinnor som fått diagnosen (studiegrupp) med de som inte fått diagnosen (kontrollgrupp). Då diagnoskriterierna varierar på studieorterna kommer en andra kontrollgrupp bestå av kvinnor som inte fick diagnosen men vars resultat från OGTT överskred de rekommenderade diagnoskriterierna från Socialstyrelsen. Resultatet kommer att ge en ökad förståelse för om diagnosen graviditetsdiabetes påverkar kvinnans känsla av sammanhang och tilltro till egen förmåga under graviditet och amning samt fylla kunskapsluckan om diagnosen påverkar kvinnans förlossningsupplevelse. Slutsatserna kan bli ett viktigt bidrag i diskussionen om när och hur diagnosen graviditetsdiabetes ska användas under graviditet.
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