| 1. |
- Marganiec, J., et al.
(författare)
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Coulomb breakup of 17Ne from the viewpoint of nuclear astrophysics
- 2012
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Ingår i: Proceedings of Science. - Proceedings of Science : Sissa. - 1824-8039.
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Konferensbidrag (refereegranskat)abstract
- By the Coulomb breakup of 17Ne, the time-reversed reaction 15O(2p,γ)17Ne has been studied. This reaction might play an important role in the rp process, as a break-out reaction of the hot CNO cycle. The secondary 17Ne ion beam with an energy of 500 MeV/nucleon has been dissociated in a Pb target. The reaction products have been detected with the LAND-R3B experimental setup at GSI. The preliminary differential and integral Coulomb dissociation cross section sCoul has been determined, which then will be converted into a photo-absorption cross section sphoto, and a two-proton radiative capture cross section σcap. Additionally, information about the structure of the 17Ne, a potential two-proton halo nucleus, will be received. The analysis is in progress. © Copyright owned by the author(s) under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike Licence.
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| 2. |
- Alfredsson, Joakim, et al.
(författare)
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Individual long-term variation of platelet reactivity in patients with dual antiplatelet therapy after myocardial infarction.
- 2019
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Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 30:5, s. 572-578
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Tidskriftsartikel (refereegranskat)abstract
- There is a large inter-individual variation in response to clopidogrel treatment, and previous studies have indicated higher risk of thrombotic events in those with high residual platelet reactivity (HPR). Less is known about individual variation over time. The aim of this prospective cohort study was to investigate intra-individual variation in platelet reactivity. Platelet aggregation in whole blood was assessed in 77 patients, at 3 days, 8 days and 6 months after admission for acute myocardial infarction and loading dose of clopidogrel. All patients were treated with aspirin and clopidogrel through 6-month follow-up. We found a significant increase in median ADP-stimulated aggregation from third to eighth day (195 vs. 250 AU*min, p-value = 0.001) but not from day 8 to 6 months (250 vs. 223 AU*min, p-value = 0.666). There was no significant change in the overall rate of HPR (15.6% vs 20.8%, p-value 0.503) or low platelet reactivity (LPR) (37.7% vs 33.8%, p-value = 0.609) from day 8 to 6-month follow-up. In contrast, more than one in four changed HPR status, 15.6% from non-HPR to HPR and 10.4% HPR to non-HPR. A shift in LPR status appeared even more frequent, occurring in about one of three patients. In spite of similar median aggregation and rate of HPR during 6-month follow-up, about one in four of the patients changed HPR status and one in three changed LPR status. This may be important information for a concept of risk stratification based on a single aggregation value early after an acute coronary syndromes.
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| 3. |
- Alfredsson, Joakim, et al.
(författare)
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Large early variation of residual platelet reactivity in Acute Coronary Syndrome patients treated with clopidogrel : Results from Assessing Platelet Activity in Coronary Heart Disease (APACHE).
- 2015
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Ingår i: Thrombosis Research. - : Pergamon Press. - 0049-3848 .- 1879-2472. ; 136:2, s. 335-340
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: There is a large inter-individual variation in response to clopidogrel treatment and previous studies have indicated higher risk of thrombotic events in patients with high residual platelet reactivity (HRPR), but the optimal time-point for testing is not established. The aim of this study was to investigate the optimal time-point for aggregometry testing and the risk of major adverse cardiac events associated with HRPR.METHOD AND RESULTS: We included 125 patients with ACS (73 with STEMI, and 71 received abciximab). The prevalence of HRPR varied substantially over time. The rate of HRPR in patients treated and not treated with abciximab were 43% vs 67% (p=0.01) before, 2% vs 23% (p=0.001) 6-8h after, 8% vs 9% (p=0.749) 3days after, and 23% vs 12% (p=0.138) 7-9 days after loading dose of clopidogrel. We found HRPR in 18% of the patients but only four ischemic events during 6months follow-up, with no significant difference between HRPR patients compared to the rest of the population. There were 3 TIMI major bleedings, all of which occurred in the low residual platelet reactivity (LRPR) group.CONCLUSION: There is a large variation in platelet reactivity over time, also depending on adjunctive therapy, which has a large impact on optimal time-point for assessment. We found HRPR in almost 1 in 5 patients, but very few MACE, and not significantly higher in HRPR patients. In a contemporary ACS population, with low risk for stent thrombosis, the predictive value of HRPR for ischemic events will probably be low.
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| 4. |
- Atterby, Clara, et al.
(författare)
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Carriage of carbapenemase- and extended-spectrum cephalosporinase-producing Escherichia coli and Klebsiella pneumoniae in humans and livestock in rural Cambodia; gender and age differences and detection of blaOXA-48 in humans.
- 2019
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Ingår i: Zoonoses and Public Health. - : Wiley-VCH Verlagsgesellschaft. - 1863-1959 .- 1863-2378. ; 66:6, s. 603-617
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study investigates the frequency and characteristics of carbapenemase-producing Escherichia coli/Klebsiella pneumoniae (CPE/K) and extended-spectrum cephalosporinase-producing E. coli/K. pneumoniae (ESCE/K) in healthy humans and livestock in rural Cambodia. Additionally, household practices as risk factors for faecal carriage of ESCE/K are identified.METHODS: Faecal samples were obtained from 307 humans and 285 livestock including large ruminants, pigs and poultry living in 100 households in rural Cambodia in 2011. Each household was interviewed, and multilevel logistic model determined associations between household practices/meat consumption and faecal carriage of ESCE/K. CPE and ESCE/K were detected and further screened for colistin resistance genes.RESULTS: CPE/K isolates harbouring blaOXA-48 were identified in two humans. The community carriage of ESCE/K was 20% in humans and 23% in livestock. The same ESBL genes: blaCTX-M-15 , blaCTX-M-14 , blaCTX-M-27 , blaCTX-M-55 , blaSHV-2 , blaSHV-12 , blaSHV-28 ; AmpC genes: blaCMY-2 , blaCMY-42, blaDHA-1 ; and colistin resistance genes: mcr-1-like and mcr-3-like were detected in humans and livestock. ESCE/K was frequently detected in women, young children, pigs and poultry, which are groups in close contact. The practice of burning or burying meat waste and not collecting animal manure indoors and outdoors daily were identified as risk factors for faecal carriage of ESCE/K.CONCLUSIONS: Faecal carriage of E. coli and K. pneumoniae harbouring extended-spectrum cephalosporinase genes are common in the Cambodian community, especially in women and young children. Exposure to animal manure and slaughter products are risk factors for intestinal colonization of ESCE/K in humans.
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| 5. |
- Bernerstedt, Thomas, et al.
(författare)
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3500 kyrkor : Problem eller möjlighet. 8 Restuareringsexempel
- 2014
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Rapport (populärvet., debatt m.m.)abstract
- I kyrkorna finner man de högsta kvaliteterna av arkitektur och konst som har stått i mänsklig makt att uppbringa. Kulturarvets värde är högt. Arkitektur är en konstart som förstärker funktionen/verksamheten – på samma sätt som t.ex. musik, poesi, skulptur eller måleri. Konstarterna går utöver funktionerna/verksamheterna, därför finns det alltid nya möjligheter att bearbeta. Restaureringskonstens uppgift är att tillvara arkitekturkvaliteterna, utveckla dem och förhöja dem. Det finns ungefär 3 500 kyrkor inom Svenska kyrkan, en tredjedel medeltida och entredjedel från 1950–60-talen. Sammantaget är det en komplex samling byggnader. Majoriteten av 6,4 miljoner medlemmar i Svenska kyrkan är intresserade av att kyrkobyggnaderna tas om hand. Färre säger sig vara intresserade av att aktivt delta i kyrkans kärnverksamhet. Men kyrkobyggnaden och verksamheten hänger samman; de enda byggnader som haft enoch samma användning i 1000 år är kyrkor. Att vårda och utveckla kyrkobyggnadsmiljöernaingår inte i kyrkans kärnverksamheter. Varför inte? Sedan relationsförändringen år 2000 då kyrkan skildes från staten har inga långsiktiga visioner eller strategier om förvaltningen av Sveriges mest tillgängliga kulturskatt framkommit. Inget drastiskt hände år 2000; antalet gudstjänstbesökare började minska långt tidigare. Varför ska vi vara så oroliga nu när vi inte var det förut? Våra kyrkor är i bättre skick än i något annat land i Europa, vi har aldrig haft det så bra som nu, ändå är det först nu som vi inte anser oss ha råd att sköta denna del av kulturarvet. Andra länder har en mängd olika sätt att finansiera och arbeta med kyrkobyggnader. Sverige har bara ett sätt, statsbidrag. En mängd oprövade möjligheter finns – ett gyllene ägg att förvalta! 20 studenter i Restaureringskonst har arbetat med kunskapsuppbyggnad i teori och praktik under året. Våra studier har innefattat tre innerstadskyrkor och fem andra kyrkor i Stockholms stift, praktiskt nåbara för våra studier. Vi är väl medvetna om de helt olikartade förutsättningar som finns i vårt avlånga land med Europas snabbaste urbaniseringstakt, även om vi haft ett begränsat antal fallstudier när vi tränat arbetsprocess och metodik. Året har förutom projektarbete omfattat föreläsningar, seminarier, workshops och studieresor inom restaureringshistoria, dokumentation med 3D-laserscanning, kulturhistoriskvärdering och analys, material och metoder för restaurering, gestaltning och bevarande,presentation och kommunikation. Av årets studenter är tio arkitekter, en ingenjör, sex antikvarier, två konservatorer och en förvaltare. Tack vare kursens blandade professioner är inledningdiskussionerna och det interna kunskapsutbytet en viktig del av utbildningen, liksom det nätverk som erbjuds genom inbjudna föreläsare och specialister inom praktisk restaurering och i forskningsfronten. Genom studiebesök och studieresor får studenterna kontakter ochintryck av hur restaurering tillämpas och diskuteras i olika sammanhang. I år har vi gjort studieresor till Tyskland och England samt inom Sverige. Kyrkan har i alla tider stått för högsta kvalitet i arkitektur och konst – årets kurs vill visa värdet av denna resurs och hur vi kan arbeta med uppgiften att upprätthålla och gärna öka kulturarvets kvaliteter genomrestaureringskonst.Vi tackar alla som bidragit till genomförandet av vår kurs i år; särskilt Stockholms stift och de församlingar som har gett oss tillgång till sina kyrkor.
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| 6. |
- Björntorp, Elisabeth, et al.
(författare)
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The helix-loop-helix transcription factor Id1 is highly expressed in psoriatic involved skin.
- 2003
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 83:6, s. 403-9
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Tidskriftsartikel (refereegranskat)abstract
- The helix-loop-helix transcription factor Id1 (inhibitor of differentiation/inhibitor of DNA binding) functions as an inhibitor of differentiation. We have examined Id1 gene expression in cultured keratinocytes in punch biopsies from psoriatic involved and uninvolved skin, and in skin specimens from normal individuals. Id1 mRNA expression was measured with an RNase protection assay and with Northern blot. Id1 immunoreactivity was determined in skin biopsies by immunofluorescence using a polyclonal antibody directed against the Id1 protein. In cultured keratinocytes, the expression of Id1 mRNA was strongest in small cells with high proliferative potential, whereas in large cells, which are terminally differentiated, the expression was low. Expression of the Id1 mRNA in psoriatic involved skin (n = 9) was significantly elevated compared to uninvolved skin from the same patient (n = 5) and to skin from normal controls (n = 9). Id1 immunoreactivity was intranuclear throughout all the layers in psoriatic involved epidermis, except in the stratum corneum, while no immunoreactivity was detected in uninvolved epidermis. In normal controls, cytoplasmatic Id1 immunoreactivity was detected in the basal layer in epidermis obtained from newborns, while no immunoreactivity was detected in epidermis obtained from the adults in the control group. We conclude that Id1 is expressed in cells with high proliferative potential, and is downregulated in cells that undergo terminal differentiation. Along with the overexpression of the Id1 gene in psoriatic involved skin, these observations suggest that Id1 is involved in the process of differentiation of keratinocytes seen in normal skin and that the Id1 pathway is activated in psoriasis.
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| 7. |
- Björntorp Mark, Elisabeth, 1964, et al.
(författare)
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Expression of genes involved in the regulation of p16 in psoriatic involved skin
- 2006
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Ingår i: Arch Dermatol Res. - : Springer Science and Business Media LLC. - 0340-3696. ; 297:10, s. 459-67
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Tidskriftsartikel (refereegranskat)abstract
- It has been suggested that the up-regulation of the tumour suppressor p16 gene and induction of senescence protect the phenotype of psoriatic involved skin from malignant transformation. On the other hand, Id1, which is inversely correlated with p16 has been shown to be up-regulated in psoriatic involved skin. To test the hypothesis that there may be an altered regulation of p16 in psoriatic involved skin, we have measured genes involved in the Igf-1 receptor signalling through the Ras/MAPK cascade. Igf-1R, IGFBP3, hRas, Ets2, JunB, Egr-1, Id1, MIDA1 and p16 gene expressions were measured using quantitative real-time PCR in total RNA isolated from punch biopsies from psoriatic involved (n = 9) and uninvolved skin (n = 9) and from cutaneous squamous cell cancer (SCC) involved (n = 8) and uninvolved skin (n = 8). The IGFBP3, hRas, JunB, Egr-1, Id1 and MIDA1 genes were up-regulated in psoriatic involved skin compared with uninvolved skin. The p16, JunB and MIDA1 genes were up-regulated in SCC involved skin compared with uninvolved skin. Our results indicate that there may be a balance between the proliferation and induction of senescence in psoriasis. This balance may vary and the psoriatic involved skin represented in this study appears to be in a proliferative state rather than senescence. Furthermore, we suggest that the noted up-regulation of JunB, which has been shown to up-regulate p16, in combination with the previously reported elevation of p16 expression in psoriatic involved skin, may indicate activation of a pathway by which JunB may protect the psoriatic plaque by inducing p16 in an event of malignant stress.
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| 8. |
- Boqvist, Sofia, et al.
(författare)
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Prevalence of and factors associated with Brucella sero-positivity in cattle in urban and peri-urban Gulu and Soroti towns of Uganda
- 2015
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Ingår i: Journal of Veterinary Medical Science. - : Japanese Society of Veterinary Science. - 0916-7250 .- 1347-7439. ; 77, s. 557-564
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Tidskriftsartikel (refereegranskat)abstract
- Brucellosis is a key zoonosis of major public health, animal welfare and economic significance, and is endemic in livestock in Uganda. A cross-sectional epidemiological study was carried out to estimate the sero-prevalence of brucellosis and identify factors associated with sero-positivity in cattle in urban and pen-urban Gulu and Soroti towns of Northern and Eastern Uganda, respectively. A total of 1007 sera and data on biologically plausible risk factors from 166 herds and their spatial locations, were collected from cattle reared in urban and pen-urban Gulu and Soroti towns of Uganda. The sera were analyzed using indirect ELISA and sero-positive reactors confirmed by competitive ELISA. Multivariable models were used to investigate for risk factors. The overall animal-level and herd-level sero-prevalence was 7.5% (76/1007, 95% Confidence Interval (CI): 6.15-9.4%) and 27.1% (45/166, 95% CI: 20.9-34.3%), respectively. Herd-level sero-prevalence was significantly (P<0.001) higher in Soroti than Gulu. In Gulu town, sero-positivity increased with an increase in herd size (P=0.03) and age (P=0.002), and was higher in cattle brought in from western Uganda (P<0.0001). In Soroti town, introduction of new cattle into a herd was significantly (P=0.027) associated with herd sero-positivity. There was a geographically differential risk (clustering) of Brucella sero- positivity in herds in Soroti, while sero-positivity was homogeneously distributed in Gulu. The data highlight brucellosis occurrence and major risk factors for its transmission in cattle in urban and pen-urban areas.
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| 9. |
- Claesson Lingehall, Helena, 1965-
(författare)
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Delirium in older people after cardiac surgery : risk factors, dementia, patients’ experiences and assessments
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background:Delirium is common in older people undergoing cardiac surgery. Delirium is an acute or subacute neuro-psychiatric syndrome, characterized by a change in cognition, disturbances in consciousness; it fluctuates, develops over a short period of time and always has an underlying cause. It is associated with a disturbance in psychomotor activity, and is classified according to different clinical profiles such as hypoactive, hyperactive and mixed delirium. Delirium after cardiac surgery is not harmless, it increases the risk of complications such as prolonged stay in hospital, falls, reduced quality of life, reduced cognitive function and increased mortality.Aim:The overall aim of this thesis was to investigate postoperative delirium in older people undergoing cardiac surgery with Cardiopulmonary Bypass (CPB), focusing on risk factors, dementia and patients’ experiences; and to evaluate an assessment for screening delirium.Methods:This thesis compromises four studies. All participants (n=142) were scheduled for cardiac surgery with use of CPB at the Cardiothoracic Surgery Department, Heart Centre, Umeå University Hospital, Sweden, between February and October 2009. Six structured interviews were conducted preoperatively, day one and day four postoperatively, and in home visits, one, three and five years after surgery (2010, 2012 and 2014). The assessment scales used in Studies I, II and IV were: the Mini-Mental State Examination (MMSE) for cognition, the Organic Brain Syndrome Scale (OBS) for delirium, Geriatric Depression Scale 15 (GDS-15) for depression, Katz staircase with Activities of Daily Living (ADL) for participants’ functional status and the Numerical Rating Scale (NRS) for pain. During the hospital stay, nursing staff used the Swedish version of the Nursing Delirium Screening Scale (Nu-DESC) to assess delirium. Semi-structured interviews were also carried out (III) in the one-year follow up. Delirium, dementia and depression were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV TR).Results: Out of 142 participants 54.9% (78/142) developed delirium after cardiac surgery (I). Independent risk factors, predisposing and precipitating, associated with delirium were: age, diabetes, gastritis/peptic ulcer, volume load during operation, longer time on ventilator in intensive care, increased temperature and plasma sodium concentration in the intensive care unit. Out of 114 participants thirty (26.3%) developed dementia within the five years of follow-up. It was shown that a lower preoperative MMSE score and postoperative delirium were factors independently associated with development of dementia (II). One year after cardiac surgery, participants diagnosed with postoperative delirium described in detail feelings of extreme vulnerability and frailty. Despite this, the participants were grateful for the care they had received (III). Hypoactive was the most common symptom profile for delirium. The Swedish version of Nu-DESC showed high sensitivity in detecting hyperactive delirium, but low sensitivity in detecting hypoactive delirium (IV).Conclusion:Delirium was common among older patients undergoing cardiac surgery. Both predisposing and precipitating factors contributed to postoperative delirium. Preventive strategies should be considered in future randomized studies. It might also be suggested that cognitive function should be screened for preoperatively and patients who develop delirium should be followed up to enable early detection of symptoms of dementia. Whether prevention of postoperative delirium can reduce the risk of future dementia remains to be studied. To minimise unnecessary suffering, patients and next of kin should be informed about and prepared for the risk of delirium developing during hospitalization. The Swedish version of Nu-DESC should be combined with cognitive testing to improve detection of hypoactive delirium, but further research is needed. Healthcare professionals need knowledge concerning postoperative delirium in order to prevent, detect and treat delirium so as to avoid and relieve the suffering it might cause.
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| 10. |
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| 11. |
- Claesson Lingehall, Helena, et al.
(författare)
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Experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium : one year follow-up
- 2015
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Ingår i: BMC Nursing. - : BioMed Central. - 1472-6955. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cardiovascular disease is common among old people and many undergo cardiac surgery. Scientific knowledge is available on cardiac surgery from several perspectives. However, we found few studies focusing on older patients' experiences of cardiac surgery. The aim of this study was to illuminate experiences of undergoing cardiac surgery among older people diagnosed with postoperative delirium, a one year follow-up.METHODS: Qualitative interviews were conducted with 49 participants (aged ≥70 years) diagnosed with delirium after cardiac surgery. Data were collected in Sweden during 2010 through individual, semi-structured interviews in participants' homes one year after surgery. The interviews were analyzed using qualitative content analysis.RESULTS: Four themes with sub-themes were formulated: Feeling drained of viability includes having a body under attack, losing strength and being close to death. Feeling trapped in a weird world describes participants having hallucinations, being in a nightmare and being remorseful for their behavior. Being met with disrespect includes feeling disappointed, being forced, and feeling like cargo. On the other hand, Feeling safe, including being in supportive hands and feeling grateful, points to participants' experiences of good care and the gift of getting a second chance in life.CONCLUSIONS: Even one year after cardiac surgery, participants described in detail feelings of extreme vulnerability and frailty. They also had felt completely in the hands of the health care professionals. Participants described experiences of hallucinations and nightmares during hospitalization. Cardiac surgery was a unique, fearful, traumatic and unpleasant experience yet could also include pleasant or rewarding aspects. It seems that health care professionals need deeper knowledge on postoperative delirium in order to prevent, detect and treat delirium to avoid and relieve the suffering these experiences might cause.
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| 12. |
- Claesson Lingehall, Helena, et al.
(författare)
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Preoperative Cognitive Performance and Postoperative Delirium Are independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery : A Longitudinal Cohort Study
- 2017
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Ingår i: Critical Care Medicine. - 0090-3493 .- 1530-0293. ; 45:8, s. 1295-1303
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.Design: Longitudinal cohort study.Setting: Cardiothoracic Division, Umeå University Hospital, Sweden.Patients: Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.Intervention: Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.Measurements and Main Results: Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.Conclusions: Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.
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| 13. |
- Dahlborg Lyckhage, Elisabeth, 1974-, et al.
(författare)
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A Theoretical Framework for Emancipatory Nursing With a Focus on Environment and Persons’ Own and Shared Lifeworld : A Theoretical Framework for Emancipatory Nursing
- 2018
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Ingår i: Advances in Nursing Science. - 0161-9268 .- 1550-5014. ; 41:4, s. 340-350
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Tidskriftsartikel (refereegranskat)abstract
- By giving a brief overview of the meta concepts in nursing, with a focus on environment, we sketch a theoretical framework for an emancipatory perspective in nursing care practice. To meet the requirements of equality in care and treatment, we have in our theoretical framework added a critical lifeworld perspective to the anti oppressive practice, to meet requirements of equity in health care encounter. The proposed model of emancipatory nursing goes from overall ideological structures to ontological aspects of the everyday world. Based on the model, nurses could identify what kind of theoretical critical knowledge and thinking they require to conduct equal care and encounter the person behind the patient role.
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| 14. |
- Dahlborg Lyckhage, Elisabeth, 1956-, et al.
(författare)
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Living in Liminality : Being Simultaneously Visible and Invisible: Caregivers' Narratives of Palliative Care
- 2013
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Ingår i: Journal of Social Work in End-of-Life & Palliative Care. - : Routledge. - 1552-4256 .- 1552-4264. ; 9:4, s. 272-288
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Tidskriftsartikel (refereegranskat)abstract
- Palliative care is an integral part of care and takes place in many settings—including the home, special accommodations, and hospitals. However, research shows that palliative care often ends with a death in the hospital due to the heavy burden on the primary caregiver. This study explores the meaning of being the primary caregiver of a close one who is terminally ill and is based on qualitative interviews with six primary caregivers of a terminally ill individual at home. The findings are discussed in the light of the theoretical concepts of liminality, lived body, and power. A potential impending risk exists of being abandoned when one is the primary caregiver to a close one who is terminally ill. This situation calls for professional caregivers to take responsibility and to respond to these, often unspoken, needs. This is particularly important concerning bodily care and the medical treatment regimen. In addition, when friends and relatives are absent, there is an ethical demand on professional caregivers to compensate for this lack and to compensate for this need. Palliative home care demands care that is person-centered—including the individual’s history, family and loved ones, and individual strengths and weaknesses.
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| 15. |
- Dahlqvist, Vera, et al.
(författare)
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Development of the perceptions of conscience questionnaire.
- 2007
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 14:2, s. 181-193
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Tidskriftsartikel (refereegranskat)abstract
- Health care often involves ethically difficult situations that may disquiet the conscience. The purpose of this study was to develop a questionnaire for identifying various perceptions of conscience within a framework based on the literature and on explorative interviews about perceptions of conscience (Perceptions of Conscience Questionnaire). The questionnaire was tested on a sample of 444 registered nurses, enrolled nurses, nurses' assistants and physicians. The data were analysed using principal component analysis to explore possible dimensions of perceptions of conscience. The results showed six dimensions, found also in theory and empirical health care studies. Conscience was perceived as authority, a warning signal, demanding sensitivity, an asset, a burden and depending on culture. We conclude that the Perceptions of Conscience Questionnaire is valid for assessing some perceptions of conscience relevant to health care providers.
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| 16. |
- Eriksson, Johan, et al.
(författare)
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Newly trained operating room nurses' experiences of nursing care in the operating room
- 2020
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 34:4, s. 1074-1082
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Tidskriftsartikel (refereegranskat)abstract
- There is limited research on nurses' experiences of nursing care in the operating room. The operating room nurses' responsibility is to ensure good nursing care before, during and after surgery. In an increasingly technological health care environment, there is always a risk of turning the focus away from nursing care towards technology and medicine. Integration of past experiences into the role as an operating room nurse becomes a challenge for those who recently worked as general nurses. The present study aimed to explore newly trained operating room nurses' experiences of nursing care in an operating room. Semi-structured interviews were performed with ten operating room nurses with a maximum three years' work experience from an operating room. The interviews were subjected to qualitative content analysis. The findings revealed three themes describing operating room nurses' searching for their new role. They experienced a gap between theory and practice, felt alone and insignificant and had to find their own place. The operating room nurses' experienced threats to safe nursing when they lacked time for the patients as well as for their own recovery, and they lacked feedback in order to improve care. They ensured security for patients by establishing one-to-one contact, protecting patients' well-being and working in teams for the patients' best interest, participants also focused on the task at hand instead of the patient as a person. New ways of organising work in operating units, and well-functioning teams can be a key to a successful integration of experiences from ward nurse to an operating room nurse, and provide support so that they feel more visible, at ease and safe in their new profession.
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| 17. |
- Fuglsang, Katrine, et al.
(författare)
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Cervical cancer staging, pretreatment planning, and surgical treatment in the Nordic countriesSurvey from the Surgical Subcommittee of the Nordic Society of Gynecological Oncology
- 2018
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 97:10, s. 1178-1184
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionWomen with cervical cancer in the Nordic countries are increasingly undergoing pretreatment imaging by ultrasound, magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT) or computed tomography, or sentinel lymph node procedure. The present survey reports the influence of pretreatment imaging findings on the recorded clinical International Federation of Gynecology and Obstetrics (FIGO) stage in Nordic countries and its impact on treatment planning and preferred surgical approach in cervical cancer. Material and methodsThe Nordic Society of Gynecological Oncology Surgical Subcommittee developed a questionnaire-based survey that was conducted from 1 January to 31 March 2017. All the 22 Nordic Gynecological Oncology Centers (Denmark 5, Finland 5, Iceland 1, Norway 4, and Sweden 7) were invited to participate. ResultsThe questionnaires were returned by 19 of 22 (86.3%) centers. The median number (range) of women with cervical cancer treated at each center annually was 32 (15-120). In 58% (11/19) of the centers, imaging findings were reported to influence the clinical staging. MRI in combination with PET-CT was the preferred imaging method and the results influenced treatment planning. Robotic-assisted radical hysterectomy was the preferred surgical method in 72% (13/18) of the centers. Sentinel lymph node procedure was not routinely implemented in the majority of the Nordic centers. ConclusionMore than half of the Nordic Gynecological Oncology Centers already report a clinical FIGO stage influenced by pretreatment imaging findings. The trend in preferred treatment is robotic-assisted radical hysterectomy and the sentinel lymph node procedure is gradually being introduced.
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| 18. |
- Gard, Anton, et al.
(författare)
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Interphysician agreement on subclassification of myocardial infarction.
- 2018
-
Ingår i: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:15, s. 1284-1291
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement.METHODS: A total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI.RESULTS: Overall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016).CONCLUSION: Distinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed.
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| 19. |
- Glasberg, Ann-Louise, et al.
(författare)
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Development and initial validation of the Stress of Conscience Questionnaire.
- 2006
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 13:6, s. 633-48
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Tidskriftsartikel (refereegranskat)abstract
- Stress in health care is affected by moral factors. When people are prevented from doing 'good' they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach's alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: 'internal demands' and 'external demands and restrictions'. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts.
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| 20. |
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| 21. |
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| 22. |
- Järemo, Petter, et al.
(författare)
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Inverse relationship between platelet density and reactivity alterations at coronary angiography
- 2001
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Ingår i: Haemostasis. - Basel : S. Karger. - 0301-0147 .- 1423-0038. ; 31:1, s. 55-60
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Tidskriftsartikel (refereegranskat)abstract
- This work investigates relationships between platelet density and reactivity. 21 individuals subject to coronary angiography were studied. Peak platelet density was analyzed using a newly developed electronic device. The apparatus measures light transmission through test tubes containing density-separated platelets, thus allowing an estimation of the platelet distribution in the gradient. A flow cytometry technique was used for determining platelet reactivity after stimulating with ADP. Platelet counts, mean platelet volumes, peak platelet density and platelet reactivity were determined immediately before (day 1) and 24 h after cardiac catheterization (day 2). For all parameters changes during the day of angiography were compared with platelet density alterations. The subjects were divided into two groups according to density changes at angiography. Group 1 individuals showed density alterations (i.e. day 2 – day 1 value) ≥–8 × 10–5 kg/l. In contrast, group 2 subjects either displayed density changes <–8 × 10–5 kg/l or grossly disturbed platelet density patterns on day 2. Before angiography both groups had similar platelet counts and volumes. Then platelet reactivity when stimulating with ADP did not differ significantly between the two groups. After angiography, the number of fibrinogen-positive cells when stimulating with ADP rose by 6 ± 8% for group 2 patients. The corresponding figure for group 1 was –1 ± 6%. The difference was significant (p = 0.01). No such relationships were found when comparing density alterations and changes of platelet counts and volumes. We conclude that in this study platelet density alterations at coronary angiography are inversely related to variations of platelet reactivity.
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| 23. |
- Kendall, Anna, et al.
(författare)
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Nerve growth factor in the equine joint
- 2021
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Ingår i: Veterinary Journal. - : Elsevier BV. - 1090-0233 .- 1532-2971. ; 267
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Tidskriftsartikel (refereegranskat)abstract
- Nerve growth factor (NGF) is a neurotrophin with many functions. In humans, it is involved in inflammation, nerve growth, apoptosis and pain signalling. Increased concentrations of NGF in synovial fluid has been shown in humans and dogs with osteoarthritis. Despite osteoarthritis being a common problem in horses, no studies have previously been published on NGF in the equine joint. The aim of this study was to quantify NGF in equine synovial fluid from healthy joints, acutely inflamed septic joints and joints with structural changes associated with osteoarthritis. A secondary aim was to identify the localisation of NGF and its two receptors, TrkA and p75(NTR) in healthy and osteoarthritic articular cartilage. NGF concentrations in synovial fluid from osteoarthritic joints (n = 27), septic joints (n = 9) and healthy joints (n = 16) were determined by ELISA. In addition, articular cartilage from osteoarthritic and healthy joints was examined for NGF, TrkA and P75(NTR) using immunohistochemistry staining. NGF was present in equine synovial fluid and articular cartilage. Compared to synovial fluid from healthy joints, NGF concentration was higher in synovial fluid from joints with structural osteoarthritic changes (P = 0.032) or acute septic inflammation (P = 0.006). In articular cartilage with severe osteoarthritic changes, there was more abundant positive immunohistochemistry staining for NGF and its receptors than in normal articular cartilage. Further studies should focus on identifying precursor forms of NGF, and on receptor expression and downstream signalling of TrkA and P75(NTR) in health and disease. (C) 2020 The Author(s). Published by Elsevier Ltd.
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| 24. |
- Lindahl, Berit, et al.
(författare)
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Att vårda på evidensbaserad grund
- 2010
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Ingår i: Att bli sjuksköterska - en introduktion till yrke och ämne. - : Lund: Studentlitteratur AB. - 9789144054117 ; , s. 181-204
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 25. |
- Lindahl, Berit, et al.
(författare)
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Spring 2020, Editorial
- 2020
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 34:2, s. 265-266
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 26. |
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| 27. |
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| 28. |
- Lindahl, Elisabeth, et al.
(författare)
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Nurses' ethical reflections on caring for people with malodorous exuding ulcers.
- 2010
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Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 17:6, s. 777-790
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.
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| 29. |
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| 30. |
- Lindahl, Elisabeth, 1952-
(författare)
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Striving for purity : interviews with people with malodorous exuding ulcers and their nurses
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall purpose of this thesis is two-fold; to illuminate the meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in people’s homes. The thesis comprises four papers based on studies using qualitative methods. To illuminate nursing care as narrated by 27 retired care providers in northern Sweden, seven audio recorded group dialogues were performed (I). The transcribed group dialogues were analysed using a hermeneutic approach. The findings formulated as cleanliness, order and clear conscience point to purity. By cleaning patients and their surroundings repeatedly, by preserving order in various ways and by keeping a clear conscience, nurses committed to preserving purity. This study opened up for questions concerning the meaning of ‘impurity’ and‘purity’ in nursing today leading to papers II-IV. Learning about ‘purity’ is possible through studying ‘impurity’. Audio recorded narrative interviews were performed to illuminate the meaning of living with malodorous exuding ulcers (II) and the meaning of caring for people with malodorous exuding ulcers (III). A phenomenological-hermeneutic method was used to analyse the nine transcribed interviews with patients (II) and 10 transcribed interviews with nurses (III). The comprehensive understanding of living with malodorous exuding ulcers (II) was formulated as being trapped in a debilitating process that slowly strikes one down. There is a longing for wholeness and purity. When finding consolation, i.e., encountering genuineness and feeling loved, regarded and respected as fully human despite ulcers, patients feel purified. The comprehensive understanding of caring for people with malodorous exuding ulcers (III) was formulated as being exposed to, and overwhelmed by suffering that is invading. One runs the risk of experiencing desolation when one cannot make the ulcers and malodour disappear and fails to protect patients from additional suffering. To illuminate nurses’ reflections on obstacles and possibilities providing care as desired by people with malodorous ulcers (IV), six nurses from a previous study (III) were interviewed. An illustration with findings from paper II was shown and participants were asked to reflect on obstacles and possibilities providing the care desired by patients. The 12 audio recorded transcribed interviews were analysed using qualitative content analyses. The interpretations were presented as one theme ‘striving to do ‘good’ and be good’. The sub-themes related to the obstacles were ‘experiencing clinical competence constraints’, ‘experiencing organisational constraints’, ‘experiencing ineffective communication’, ‘fearing failure’ and ‘experiencing powerlessness’. The sub themes related to possibilities were ‘spreading knowledge on ulcer treatments’, ‘considering wholeness’ and ‘creating clear channels of communication’. The meaning of living with ‘impurity’ in terms of malodorous exuding ulcers, and the meaning of caring for people with ‘impure’ bodies in institutions and in patients’ homes is interpreted as striving for purity. Patients experience impurity when feeling dirty, losing hope, and not being respected and regarded as fully human. Nurses experience impurity when failing to shield patients’ vulnerability and their own defencelessness, and when facing obstacles preventing them from providing good care and being good nurses. Both patients and nurses may experience purity through consolation. For nurses, mediating consolation presupposes being consoled by being recognised for their challenging work, being respected and included in multiprofessional teams supported by the health care organisation and the leaders. Then patients can become consoled, and feel restored and fully human again despite their contaminated body.
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| 31. |
- Lindahl, Elisabeth, et al.
(författare)
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Striving for purity : shared understandings in retired Swedish care providers' narratives on nursing care around 1950.
- 2004
-
Ingår i: Journal of Holistic Nursing. - : SAGE Publications. - 0898-0101 .- 1552-5724. ; 22:4, s. 333-350
-
Tidskriftsartikel (refereegranskat)abstract
- Caring for the sick has been important throughout all times. Nursing care has been illuminated from various perspectives. The aim of this study was to illuminate nursing care as narrated by 27 retired care providers in northern Sweden. The themes of cleanliness, order, and clear conscience stood out as important in the text. The results are interpreted as pointing to purity. Purity is a complex phenomenon within the cultural context. Some literature states that in the past, physical cleanliness, moral purity, and order were closely interrelated. Nurses were expected to be religious, morally pure persons in clean and perfect uniforms, always prepared to serve and do their duty. Purity is not always readily apparent. It is often revealed through its absence or opposite. Purity and conscience are seldom addressed in contemporary nursing research. More research is needed to further reflect on purity and its significance for nursing care today.
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| 32. |
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| 33. |
- Lindahl, Elisabeth, et al.
(författare)
-
The meaning of living with malodorous exuding ulcers.
- 2007
-
Ingår i: Journal of Nursing and Healthcare of Chronic Illnes in association with Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 16:3A, s. 68-75
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Tidskriftsartikel (refereegranskat)
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| 34. |
- Lindahl, Göran, et al.
(författare)
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Bergslagen : Arbetsplatser och bostäder under hundra år
- 1983
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Rapport (populärvet., debatt m.m.)abstract
- Denna skrift utgör resultatet av Arkitekturskolans studier läsåret 1978-79. Att redigera manuskripten visade sig arbetskrävande och har också dragit ut på tiden. Att vissa av de uppgifter som lämnas inte är helt aktuella spelar ändå inte så stor roll - tyngdpunkten i framställningen ligger på det historiska materialet och de långa tidsperspektiven.Arbetet inleds med en demografisk översikt över ett brett bälte tvärs över Mellansverige från Värmland till Upplandskusten. Där antyds utvecklingens huvudriktning både i Bergslagens gamla kärnområden och i yttre zoner av delvis annan karaktär. Därefter följer åtta från varandra fristående kapitel som dock alla har ett gemensamt mål, att granska och analysera bebyggelseu.tvecklingen inom ett tydligt avgränsat område. Konkretion och åskådlighet har eftersträvats - därför har också stor möda nedlagts på bildmaterialet i form av kartor, ritningar och foton. Valet av undersökningsobjekt har gjorts av författarna själva, som också utformat sina avsnitt självständigt.
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| 35. |
- Lindahl, Lise M., et al.
(författare)
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STAT5 induces miR-21 expression in cutaneous T cell lymphoma
- 2016
-
Ingår i: Oncotarget. - : Impact Journals, LLC. - 1949-2553. ; 7:29, s. 45730-45744
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Tidskriftsartikel (refereegranskat)abstract
- In cutaneous T cell lymphomas (CTCL), miR-21 is aberrantly expressed in skin and peripheral blood and displays anti-apoptotic properties in malignant T cells. It is, however, unclear exactly which cells express miR-21 and what mechanisms regulate miR-21. Here, we demonstrate miR-21 expression in situ in both malignant and reactive lymphocytes as well as stromal cells. qRT-PCR analysis of 47 patients with mycosis fungoides (MF) and Sezary Syndrome (SS) confirmed an increased miR- 21 expression that correlated with progressive disease. In cultured malignant T cells miR-21 expression was inhibited by Tofacitinib (CP-690550), a clinical-grade JAK3 inhibitor. Chromatin immunoprecipitation (ChIP) analysis showed direct binding of STAT5 to the miR-21 promoter. Cytokine starvation ex vivo triggered a decrease in miR-21 expression, whereas IL-2 induced an increased miR-21 expression in primary SS T cells and cultured cytokine-dependent SS cells (SeAx). siRNA-mediated depletion of STAT5 inhibited constitutive- and IL-2- induced miR-21 expression in cytokine- independent and dependent T cell lines, respectively. IL-15 and IL-2 were more potent than IL-21 in inducing miR-21 expression in the cytokine-dependent T cells. In conclusion, we provide first evidence that miR-21 is expressed in situ in CTCL skin lesions, induced by IL-2 and IL-15 cytokines, and is regulated by STAT5 in malignant T cells. Thus, our data provide novel evidence for a pathological role of IL-2Rg cytokines in promoting expression of the oncogenic miR-21 in CTCL.
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| 36. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
-
A field-study on Leptospira seroprevalence in dairy cows in four geographical areas in Sweden
- 2011
-
Ingår i: Acta Veterinaria Scandinavica. - : Springer Science and Business Media LLC. - 0044-605X .- 1751-0147. ; 53
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Tidskriftsartikel (refereegranskat)abstract
- Conclusions: The present data indicate that there is a low seroprevalence of Leptospira in Swedish dairy cows. These findings can be used as baseline data to investigate the effects of, for instance, climatic change or alterations in wildlife reservoir populations on the seroprevalence of Leptospira in the future.
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| 37. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
-
A Study of Knowledge, Attitudes and Practices Relating to Brucellosis among Small-Scale Dairy Farmers in an Urban and Peri-Urban Area of Tajikistan
- 2015
-
Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10
-
Tidskriftsartikel (refereegranskat)abstract
- Improvement of knowledge, attitudes and practices among urban livestock farmers could have a significant impact on the reduction of many zoonotic infections in urban farming. This study aimed to describe and evaluate weak areas in knowledge, attitudes and practices with regards to brucellosis among urban and peri-urban small-scale dairy farmers in a low income country to generate information essential for control programmes and public health interventions. The cross-sectional study was conducted during six weeks in 2011. The study subjects were small-scale dairy farmers living in the urban and peri-urban area of the capital Dushanbe in Tajikistan. In total, 441 farmers were interviewed using a questionnaire with questions about demographic characteristics, knowledge, attitudes and practices relating to brucellosis. Descriptive statistics were used and a logistic regression model applied to evaluate potential predictors to knowledge about brucellosis. The majority (85%) of the farmers had never heard of brucellosis. Low educational level was found to be associated with low awareness of brucellosis (P = < 0.001). Respondents who talked about animal health issues with family members or friends were less likely to have heard of brucellosis compared to those who often talked to veterinarians (P = 0.03). Sixty three per cent of the participants wanted more information about brucellosis. Seventeen per cent sold unpasteurized dairy products on a regular basis direct to consumers. Almost 30% of the households consumed unpasteurized dairy products on regular basis. A majority of the respondents did not use any protection when handling cows having an abortion or when dealing with aborted materials. Poor knowledge, high-risk behaviours and a willingness to learn more strengthens the logic for including health education as part of control programmes.
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| 38. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Bovine leptospirosis in urban and peri-urban dairy farming in low-income countries: a "One Health" issue?
- 2017
-
Ingår i: Acta Veterinaria Scandinavica. - : Springer Science and Business Media LLC. - 0044-605X .- 1751-0147. ; 59
-
Tidskriftsartikel (refereegranskat)abstract
- Global trends in urbanization are increasing the spread of neglected zoonotic infections such as leptospirosis, and reducing the number of human cases of leptospirosis is best accomplished by controlling the infection in the animal reservoir. The aim of this study was to determine the seroprevalence of Leptospira borgpetersenii serovar Hardjo and L. interrogans serovar Hardjo (L Hardjo) exposure and to assess the associated risk factors for infection in small-scale dairy farming in the urban and peri-urban area of Dushanbe, Tajikistan. The true individual seroprevalence among the dairy cows was 13%, and the level of seroprevalence was positively associated with older cows and with communal grazing practices. The study shows that dairy cows are commonly exposed to L. Hardjo in the study region, and this constitutes a public health risk and demonstrates the importance of including urban and peri-urban areas, where large numbers of humans and animals coexist, when investigating zoonotic infections and when planning and implementing control measures for cattle-associated leptospirosis.
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| 39. |
- Lindahl Rajala, Elisabeth
(författare)
-
Brucella in Tajikistan : zoonotic risks of urbanized livestock in a low-income country
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the most powerful megatrends of our time is urbanization. Urban and peri-urban (UPU) farming is a common practice in many low-income countries because it increases the incomes of families that are often restrained by limited economic resources. However, there is a concern that the growing number of people and livestock living close together in UPU areas will increase the transmission of different zoonotic pathogens such as Brucella. Brucellosis is one of the most common and economically important zoonoses globally and Central Asia represents an area with high incidence among humans and livestock. This thesis aims to assess the occurrence of Brucella among livestock in an UPU area and to elucidate how farmers understand and respond to this zoonosis. The results of this thesis might contribute to raising awareness of how livestock in urban areas can constitute a public health risk if they are infected with Brucella or other zoonoses. The four studies included in this thesis were conducted among small-scale livestock farmers in the UPU region of Dushanbe, the capital of Tajikistan. Blood samples were collected from 904 dairy cows and 667 sheep and goats and analysed with enzyme-linked immunosorbent assay (ELISA). The Brucella seroprevalence was 4.1% among the dairy cows at the herd level and ranged between 1.0% and 15.6% among sheep and goats at the individual level in the four included districts. Furthermore, 564 cow milk samples were analysed for Brucella DNA by IS711-based real-time PCR and 13.7% were found to be positive. All seropositive cows were positive by PCR, but 11.8% of the seronegative cows were also positive by PCR. Further characterization of the Brucella DNA suggests that there is a reservoir of B. abortus in the cattle population and a spillover of B. melitensis from small ruminants to cattle. A knowledge, attitudes and practice study targeting 441 households revealed poor knowledge of brucellosis and several high-risk behaviours, such as consumption of unpasteurized dairy products and not wearing protective clothing when handling potentially infectious materials like aborted foetuses and discharges. Brucella is widespread among the livestock in the UPU area of Dushanbe and this might constitute a serious risk to public health and cause significant economic losses. The discrepancy between serology and PCR results suggests that implementing complementary diagnostic strategies to detect false serological negative individuals might be warranted in Brucella control programmes. Poor knowledge, several high-risk behaviours and a willingness to learn more provide the rationale for developing campaigns to raise awareness of brucellosis and its associated risks among farmers.
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| 40. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
-
Detection and characterization of Brucella spp. in bovine milk in small-scale urban and peri-urban farming in Tajikistan
- 2017
-
Ingår i: PLoS Neglected Tropical Diseases. - : Public Library of Science (PLoS). - 1935-2727 .- 1935-2735. ; 11:3
-
Tidskriftsartikel (refereegranskat)abstract
- Brucellosis is one of the most common zoonoses globally, and Central Asia remains a Brucella hotspot. The World Health Organization classifies brucellosis as a neglected zoonotic disease that is rarely in the spotlight for research and mainly affects poor, marginalized people. Urban and peri-urban farming is a common practice in many low-income countries, and it increases the incomes of families that are often restrained by limited economic resources. However, there is a concern that the growing number of people and livestock living close together in these areas will increase the transmission of zoonotic pathogens such as Brucella. This study investigates the presence of Brucella DNA in bovine milk in the urban and peri-urban area of Dushanbe, Tajikistan. Brucella DNA was detected in 10.3% of 564 cow milk samples by IS711-based real-time PCR. This finding is concerning because consumption of unpasteurized dairy products is common in the region. Furthermore, Brucella DNA was detected in the milk of all seropositive cows, but 8.3% of the seronegative cows also showed the presence of Brucella DNA. In addition, sequence analysis of the rpoB gene suggests that one cow was infected with B. abortus and another cow was most likely infected with B. melitensis. The discrepancies between the serology and real-time PCR results highlight the need to further investigate whether there is a need for implementing complementary diagnostic strategies to detect false serological negative individuals in Brucella surveillance, control, and eradication programmes. Furthermore, vaccination of cattle with S19 in addition to vaccination of small ruminants with Rev 1 might be needed in order to control Brucella infections in the livestock population but further research focusing on the isolation of Brucella is required to obtain a comprehensive understanding of the Brucella spp. circulating among the livestock in this region.
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| 41. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
-
How can agricultural research translation projects targeting smallholder production systems be strengthened by using Theory of Change?
- 2021
-
Ingår i: Global Food Security. - : Elsevier BV. - 2211-9124. ; 28
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Tidskriftsartikel (refereegranskat)abstract
- Sustainable development of smallholder agriculture production in low and lower middle-income countries are crucial for improving food security. To accommodate this science based evidence needs to bridge with agricultural practices and policy development, which requires coordinated actions and long term strategies involving multiple stakeholders. This paper argues that using a Theory of Change (ToC) approach, with strong emphasis on communication and stakeholder engagement, science based knowledge can be more effectively integrated in agricultural development, but also in policy development. Three projects addressing different challenges within livestock production are used to illustrate the use of and challenges with using a ToC framework. A key for reaching outcome was early involvement of relevant stakeholders in implementing teams and using the flexibility included in the ToC approach from design to implementation.
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| 42. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Prevalence and risk factors for Brucella seropositivity among sheep and goats in a peri-urban region of Tajikistan
- 2016
-
Ingår i: Tropical Animal Health and Production. - : Springer Science and Business Media LLC. - 0049-4747 .- 1573-7438. ; 48, s. 553-558
-
Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study aimed to estimate the seroprevalence of Brucella infection among sheep and goats on small-scale farms in a peri-urban area of Tajikistan and identify factors associated with seropositivity. The study population was 667 female sheep and goats > 6 months of age from 21 villages in four districts surrounding the capital city, Dushanbe. Individual blood samples were collected during October and November 2012 and analysed with indirect enzyme linked immunosorbent assay (ELISA). Positive samples were confirmed with competitive ELISA. To identify factors associated with seropositivity at an individual level, a generalised linear mixed model was applied to account for clustering of individuals within villages and districts. The true individual seroprevalence was 6.7 % and ranged from 1.0 to 15.6 % between the four districts. Fourteen villages had at least one seropositive sheep or goat, resulting in apparent prevalence of 67 % at village level. The seroprevalence at individual level was significantly lower in Rudaki district (odds ratio (OR) = 0.1; 95 % confidence interval (CI) 0.03-0.4) and Varzob district (OR = 0.3; 95 % CI 0.09-0.8) than in Vahdat district. Sheep were more likely than goats to be seropositive (OR = 2.7; 95 % CI 1.3-5.5). Increasing age was significantly associated with seropositivity (OR = 1.4; 95 % CI 1.2-1.6). These results indicate high prevalence of Brucella infection among sheep and goats in the peri-urban area of the capital city in Tajikistan. Given the dense human population in such areas, this could constitute a threat to public health, besides causing significant production losses.
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| 43. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Prevalence of antibodies against Brucella spp. in West Greenland polar bears (Ursus maritimus) and East Greenland muskoxen (Ovibos moschatus)
- 2018
-
Ingår i: Polar Biology. - : Springer Science and Business Media LLC. - 0722-4060 .- 1432-2056. ; 41, s. 1671-1680
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Tidskriftsartikel (refereegranskat)abstract
- Zoonotic infections transmitted from terrestrial and marine mammals to humans in European Arctic are of unknown significance, despite considerable potential for transmission due to local hunt and a rapidly changing environment. As an example, infection with Brucella bacteria may have significant impact on human health due to consumption of raw meat or otherwise contact with tissues and fluids of infected game species such as muskoxen and polar bears. Here, we present serological results for Baffin Bay polar bears (Ursus maritimus) (n=96) and North East Greenland muskoxen (Ovibos moschatus) (n=32) for antibodies against Brucella spp. The analysis was a two-step trial initially using the Rose Bengal Test (RBT), followed by confirmative competitive enzyme-linked immunosorbent assays of RBT-positive samples. No muskoxen had antibodies against Brucella spp., while antibodies were detected in six polar bears (6.25%) rendering a seroprevalence in line with previous findings in other Arctic regions. Seropositivity was not related to sex, age or biometrics i.e. size and body condition. Whether Brucella spp. antibodies found in polar bears were due to either prey spill over or true recurrent Brucella spp. infections is unknown. Our results therefore highlight the importance of further research into the zoonotic aspects of Brucella spp. infections, and the impact on wildlife and human health in the Arctic region.
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| 44. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Seropositivity and risk factors for Brucella in dairy cows in urban and peri-urban small-scale farming in Tajikistan
- 2014
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Ingår i: Tropical Animal Health and Production. - : Springer Science and Business Media LLC. - 0049-4747 .- 1573-7438. ; 46, s. 563-569
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Tidskriftsartikel (refereegranskat)abstract
- In this cross-sectional study, we assessed and mapped the seroprevalence of brucellosis in small-scale dairy farming in an urban and peri-urban area of Tajikistan and investigated factors associated with seropositivity. As urban and peri-urban farming is both an opportunity to improve the livelihood for small-scale farmers and a potential public health hazard, studies are warranted to reveal possible peculiarities in the epidemiology of brucellosis in this type of dairy farming. In total, 904 cows of breeding age belonging to 443 herds in 32 villages were serologically tested with indirect enzyme-linked immunosorbent assay (ELISA) and positive samples confirmed with competitive ELISA. Two logistic regression models were used to investigate an association between seropositivity and risk factors at herd and individual level. The herd and individual seroprevalences were 4.1 and 2.0 %, respectively. Herds with a history of abortions were found to be associated with seropositivity [odds ratio (OR)=5.3; 95 % confidence interval (CI), 1.3-21.3]. Large herds with more than eight cattle were more likely to be seropositive compared to smaller herds with one to two cattle (OR=13.9; 95 % CI, 1.6-119). The number of calves produced per cow (indicating age) was found to be associated with seropositivity. Younger cows with one to two produced calves were less likely to be seropositive compared to older cows with more than six produced calves (OR=0.24; 95 % CI, 0.06-1.0). Neither introduction of new cattle to the herd nor communal grazing was associated with seropositivity. This study shows that infection with Brucella (1) is present in small-scale urban and peri-urban dairy farming in Tajikistan and (2) has significant negative effects on reproductive performance in this farming system and (3) that some previously known risk factors for seropositivity in rural farming system were absent here.
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| 45. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Seroprevalence for Brucella spp. in Baltic ringed seals (Phoca hispida) and East Greenland harp (Pagophilus groenlandicus) and hooded (Cystophora cristata) seals
- 2018
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Ingår i: Veterinary Immunology and Immunopathology. - : Elsevier BV. - 0165-2427 .- 1873-2534. ; 198, s. 14-18
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Tidskriftsartikel (refereegranskat)abstract
- Zoonotic infections transmitted from marine mammals to humans in the Baltic and European Arctic are of unknown significance, despite given considerable potential for transmission due to local hunt. Here we present results of an initial screening for Brucella spp. in Arctic and Baltic seal species. Baltic ringed seals (Pusa hispida, n = 12) sampled in October 2015 and Greenland Sea harp seals (Pagophilus groenlandicus, n = 6) and hooded seals (Cystophora cristata, n = 3) sampled in March 2015 were serologically analysed for antibodies against Brucella spp. The serological analyses were performed using the Rose Bengal Test (RBT) followed by a confirmatory testing of RBT-positive samples by a competitive-enzyme linked immunosorbent assay (C-ELISA). Two of the Baltic ringed seals (a juvenile male and a juvenile female) were seropositive thus indicating previous exposure to a Brucella spp. The findings indicate that ringed seals in the Baltic ecosystem may be exposed to and possibly infected by Brucella spp. No seropositive individuals were detected among the Greenland harp and hooded seals. Although our initial screening shows a zoonotic hazard to Baltic locals, a more in-depth epidemiological investigation is needed in order to determine the human risk associated with this.
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| 46. |
- Lindahl Rajala, Elisabeth, et al.
(författare)
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Skewness in the literature on infectious livestock diseases in an emerging economy - the case of Vietnam
- 2021
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Ingår i: Animal Health Research Reviews. - 1466-2523 .- 1475-2654. ; 22, s. 1-13
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Forskningsöversikt (refereegranskat)abstract
- Livestock production has increased in many emerging economies, but productivity is often substantially impaired by infectious diseases. The first step towards improved livestock health and productivity is to map the presence of livestock diseases. The objective of this review was to summarize studies conducted on such diseases in an emerging economy, Vietnam, and thereby identifying knowledge gaps that may inform the design of surveillance and control programs. Few studies were found to evaluate the distribution of infectious livestock diseases other than avian influenza. Also, many regions with dense livestock populations had received little attention in terms of disease investigation. A large proportion of the studies dealt with zoonoses and food-borne infections which might be due to funding agencies priorities. On the contrary, studies targeting infections that affect livestock and their productivity were few. We think that this limitation in scientific reports on infectious diseases that only affect livestock productivity is a common phenomenon in low and lower middle income countries. More science-based data on such diseases would help policymakers to prioritize which livestock diseases should be subject to animal health programs aimed to support rural livelihoods and economic development.
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| 47. |
- Lindberg, Elisabeth, et al.
(författare)
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Editorial September 2020
- 2020
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 34:3, s. 537-538
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 48. |
- Marganiec, C., et al.
(författare)
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Coulomb breakup of 17Ne from the viewpoint of nuclear astrophysics
- 2013
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Ingår i: Proceedings of Science.
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Konferensbidrag (refereegranskat)abstract
- By the Coulomb breakup of 17Ne, the time-reversed reaction 15O(2p,γ)17Ne has been studied. This reaction might play an important role in the rp process, as a break-out reaction of the hot CNO cycle. The secondary 17Ne ion beam with an energy of 500 MeV/nucleon has been dissociated in a Pb target. The reaction products have been detected with the LAND-R3B experimental setup at GSI. The preliminary differential and integral Coulomb dissociation cross section sCoul has been determined, which then will be converted into a photo-absorption cross section sphot o, and a two-proton radiative capture cross section σcap. Additionally, information about the structure of the 17Ne, a potential two-proton halo nucleus, will be received. The analysis is in progress.
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| 49. |
- Mirza, Mansoor Raza, et al.
(författare)
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Niraparib plus bevacizumab versus niraparib alone for platinum-sensitive recurrent ovarian cancer (NSGO-AVANOVA2/ENGOT-ov24): a randomised, phase 2, superiority trial
- 2019
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Ingår i: The Lancet Oncology. - : ELSEVIER SCIENCE INC. - 1470-2045 .- 1474-5488. ; 20:10, s. 1409-1419
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Tidskriftsartikel (refereegranskat)abstract
- Background Platinum-based chemotherapy is the foundation of treatment for platinum-sensitive recurrent ovarian cancer, but has substantial toxicity. Bevacizumab and maintenance poly(ADP-ribose) polymerase (PARP) inhibitors both significantly improve efficacy versus standard therapy, primarily in terms of progression-free survival, and offer the potential for chemotherapy-free treatment. AVANOVA2 compared niraparib and bevacizumab versus niraparib alone as definitive treatment for platinum-sensitive recurrent ovarian cancer. Methods This open-label, randomised, phase 2, superiority trial in 15 university hospitals in Denmark, Sweden, Finland, Norway, and the USA enrolled women aged 18 years or older with measurable or evaluable high-grade serous or endometrioid platinum-sensitive recurrent ovarian cancer. Patients had to have an Eastern Cooperative Oncology Group performance status of 0-2, and had to have previously received platinum-containing therapy for primary disease but amp;lt;= 1 prior non-platinum-containing regimen for recurrent disease. Previous treatment with bevacizumab or first-line maintenance PARP inhibitors was permitted. Eligible patients were randomly assigned 1:1 (by random permuted blocks with block sizes of two and four, no masking), stratified by homologous recombination deficiency status and chemotherapy-free interval, to receive once-daily oral niraparib 300 mg alone or with intravenous bevacizumab 15 mg/kg once every 3 weeks until disease progression. The primary endpoint was progression-free survival, assessed by the investigators in the intention-to-treat population after events in at least 62 patients. Safety was analysed in all patients who received at least one dose of study drug. This ongoing trial is registered with ClinicalTrials.gov , number NCT02354131. Findings Between May 23,2016, and March 6,2017,97 patients were enrolled and randomly assigned: 48 to niraparib plus bevacizumab and 49 to single-agent niraparib. Median follow-up was 16.9 months (IQR 15.4-20.9). Niraparib plus bevacizumab significantly improved progression-free survival compared with niraparib alone (median progression-free survival 11.9 months [95% CI 8.5-16.7] vs 5.5 months [3.8-6.3], respectively; adjusted hazard ratio [HR] 0.35 [95% CI 0.21-0.57], pamp;lt;0.0001). Grade 3 or worse adverse events occurred in 31 (65%) of 48 patients who received niraparib plus bevacizumab and 22 (45%) of 49 who received single-agent niraparib. The most common grade 3 or worse adverse events in both groups were anaemia (7 [15%] of 48 vs 9 [18%] of 49) and thrombocytopenia (5 [10%] vs 6 [12%]), and hypertension in the combination group (10 [21%] vs 0). Niraparib plus bevacizumab was associated with increased incidences of any-grade proteinuria (10 [21%] of 48 patients vs 0) and hypertension (27[56%] of 48 vs 11 [22%] of 49) compared with niraparib alone. No treatment-related deaths occurred. Interpretation The efficacy observed with this chemotherapy-free combination of approved agents in women with platinum-sensitive recurrent ovarian cancer warrants further evaluation. A randomised phase 3 trial investigating niraparib plus bevacizumab versus chemotherapy plus bevacizumab in platinum-sensitive recurrent ovarian cancer is planned. Copyright (C) 2019 Elsevier Ltd. All rights reserved.
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| 50. |
- Ornemark, Ulf, et al.
(författare)
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Calibration services in the frame of accredited coagulation EQA schemes - Meeting the IVD directive
- 2006
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Ingår i: Accreditation and Quality Assurance. - : Springer Science and Business Media LLC. - 0949-1775 .- 1432-0517. ; 11:8-9, s. 451-454
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Tidskriftsartikel (refereegranskat)abstract
- Organisers of external quality assurance programmes may, for various reasons, also manufacture in vitro diagnostic medical devices, or provide calibration services. This paper describes measures taken by a Swedish organiser to meet the requirements of the European Commission's directive 98/79/EC for a national calibration of prothrombin time. Quality management system requirements and interactions with coagulation experts are summarised.
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