| 1. |
- Remberger, Mats, et al.
(författare)
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Improved survival after allogeneic hematopoietic stem cell transplantation in recent years : A single-center study
- 2011
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Ingår i: Biology of blood and marrow transplantation. - : Elsevier BV. - 1083-8791 .- 1523-6536. ; 17:11, s. 1688-1697
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) over the past 2 decades. Between 1992 and 2009, 953 patients were treated with HSCT, mainly for a hematologic malignancy. They were divided according to 4 different time periods of treatment: 1992 to 1995, 1996 to 2000, 2001 to 2005, and 2006 to 2009. Over the years, many factors have changed considerably regarding patient age, diagnosis, disease stage, type of donor, stem cell source, genomic HLA typing, cell dose, type of conditioning, treatment of infections, use of granulocyte-colony stimulating factor (G-CSF), use of mesenchymal stem cells, use of cytotoxic T cells, and home care. When we compared the last period (2006-2009) with earlier periods, we found slower neutrophil engraftment, a higher incidence of acute graft-versus-host disease (aGVHD) of grades II-IV, and less chronic GVHD (cGHVD). The incidence of relapse was unchanged over the 4 periods (22%-25%). Overall survival (OS) and transplant-related mortality (TRM) improved significantly in the more recent periods, with the best results during the last period (2006-2009) and a 100-day TRM of 5.5%. This improvement was also apparent in a multivariate analysis. When correcting for differences between the 4 groups, the hazard ratio for mortality in the last period was 0.59 (95% confidence interval [CI]: 0.44-0.79; P < .001) and for TRM it was 0.63 (CI: 0.43-0.92; P = .02). This study shows that the combined efforts to improve outcome after HSCT have been very effective. Even though we now treat older patients with more advanced disease and use more alternative HLA nonidentical donors, OS and TRM have improved. The problem of relapse still has to be remedied. Thus, several different developments together have resulted in significantly lower TRM and improved survival after HSCT over the last few years.
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| 2. |
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| 3. |
- Papakokkinou, Eleni, et al.
(författare)
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Excess Morbidity Persists in Patients With Cushing’s Disease During Long-term Remission : A Swedish Nationwide Study
- 2020
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - Washington : Oxford University Press. - 0021-972X .- 1945-7197. ; 105:8, s. 2616-2624
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Tidskriftsartikel (refereegranskat)abstract
- Context: Whether multisystem morbidity in Cushing's disease (CD) remains elevated during long-term remission is still undetermined.Objective: To investigate comorbidities in patients with CD.Design, setting, and patients: A retrospective, nationwide study of patients with CD identified in the Swedish National Patient Register between 1987 and 2013. Individual medical records were reviewed to verify diagnosis and remission status.Main outcomes: Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by using the Swedish general population as reference. Comorbidities were investigated during three different time periods: (i) during the 3 years before diagnosis, (ii) from diagnosis to 1 year after remission, and (iii) during long-term remission.Results: We included 502 patients with confirmed CD, of whom 419 were in remission for a median of 10 (interquartile range 4 to 21) years. SIRs (95% CI) for myocardial infarction (4.4; 1.2 to 11.4), fractures (4.9; 2.7 to 8.3), and deep vein thrombosis (13.8; 3.8 to 35.3) were increased during the 3-year period before diagnosis. From diagnosis until 1 year after remission, SIRs (95% CI were increased for thromboembolism (18.3; 7.9 to 36.0), stroke (4.9; 1.3 to 12.5), and sepsis (13.6; 3.7 to 34.8). SIRs for thromboembolism (4.9; 2.6 to 8.4), stroke (3.1; 1.8 to 4.9), and sepsis (6.0; 3.1 to 10.6) remained increased during long-term remission.Conclusion: Patients with CD have an increased incidence of stroke, thromboembolism, and sepsis even after remission, emphasizing the importance of early identification and management of risk factors for these comorbidities during long-term follow-up.
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| 4. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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Overall and Disease-Specific Mortality in Patients With Cushing Disease: A Swedish Nationwide Study
- 2019
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : ENDOCRINE SOC. - 0021-972X .- 1945-7197. ; 104:6, s. 2375-2384
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Tidskriftsartikel (refereegranskat)abstract
- Context: Whether patients with Cushing disease (CD) in remission have increased mortality is still debatable. Objective: To study overall and disease-specific mortality and predictive factors in an unselected nationwide cohort of patients with CD. Design, Patients, and Methods: A retrospective study of patients diagnosed with CD, identified in the Swedish National Patient Registry between 1987 and 2013. Medical records were systematically reviewed to verify the diagnosis. Standardized mortality ratios (SMRs) with 95% CIs were calculated and Cox regression models were used to identify predictors of mortality. Results: Of 502 identified patients with CD (n = 387 women; 77%), 419 (83%) were confirmed to be in remission. Mean age at diagnosis was 43 (SD, 16) years and median follow-up was 13 (interquartile range, 6 to 23) years. The observed number of deaths was 133 vs 54 expected, resulting in an overall SMR of 2.5 (95% CI, 2.1 to 2.9). The commonest cause of death was cardiovascular diseases (SMR, 3.3; 95% CI, 2.6 to 4.3). Excess mortality was also found associated with infections and suicide. For patients in remission, the SMR was 1.9 (95% CI, 1.5 to 2.3); bilateral adrenalectomy and glucocorticoid replacement therapy were independently associated with increased mortality, whereas GH replacement was associated with improved outcome. Conclusion: Findings from this large nationwide study indicate that patients with CD have excess mortality. The findings illustrate the importance of achieving remission and continued active surveillance, along with adequate hormone replacement and evaluation of cardiovascular risk and mental health.
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| 5. |
- Ragnarsson, Oskar, 1971, et al.
(författare)
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The incidence of Cushing’s disease : a nationwide Swedish study
- 2019
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Ingår i: Pituitary. - : Springer. - 1386-341X .- 1573-7403. ; 22:2, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies on the incidence of Cushing’s disease (CD) are few and usually limited by a small number of patients. The aim of this study was to assess the annual incidence in a nationwide cohort of patients with presumed CD in Sweden.Methods: Patients registered with a diagnostic code for Cushing’s syndrome (CS) or CD, between 1987 and 2013 were identified in the Swedish National Patient Registry. The CD diagnosis was validated by reviewing clinical, biochemical, imaging, and histopathological data.Results: Of 1317 patients identified, 534 (41%) had confirmed CD. One-hundred-and-fifty-six (12%) patients had other forms of CS, 41 (3%) had probable but unconfirmed CD, and 334 (25%) had diagnoses unrelated to CS. The mean (95% confidence interval) annual incidence between 1987 and 2013 of confirmed CD was 1.6 (1.4–1.8) cases per million. 1987–1995, 1996–2004, and 2005–2013, the mean annual incidence was 1.5 (1.1–1.8), 1.4 (1.0–1.7) and 2.0 (1.7–2.3) cases per million, respectively. During the last time period the incidence was higher than during the first and second time periods (P < 0.05).Conclusion: The incidence of CD in Sweden (1.6 cases per million) is in agreement with most previous reports. A higher incidence between 2005 and 2013 compared to 1987–2004 was noticed. Whether this reflects a truly increased incidence of the disease, or simply an increased awareness, earlier recognition, and earlier diagnosis can, however, not be answered. This study also illustrates the importance of validation of the diagnosis of CD in epidemiological research.
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| 6. |
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| 7. |
- Burgos, Jonathan R, et al.
(författare)
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LPS immune challenge reduces arcuate nucleus TSHR and CART mRNA and elevates plasma CART peptides.
- 2019
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Ingår i: BMC neuroscience. - : Springer Science and Business Media LLC. - 1471-2202. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to examine the impact of lipopolysaccharide-induced systemic inflammation on expression of mRNA for cocaine- and amphetamine-regulated transcript (CART) and the thyrotropin receptor (TSHR) and its ligands in CNS areas of relevance for feeding controls and metabolism. Lipopolysaccharide effects on plasma levels of TSH and CART peptides were also examined.Lipopolysaccharide (150-200μg/mouse) was injected in C57BL/6J mice and tissue and plasma samples taken after 24h. To establish if plasma increase in CART peptide levels were prostanoid dependent, indomethacin was given via the drinking water beginning 48h prior to LPS. We evaluated mRNA expression for CART, TSHR, TSHβ, and thyrostimulin in brain and pituitary extracts. Plasma levels of TSH, CARTp, and serum amyloid P component were analyzed by ELISA.Lipopolysaccharide suppressed TSHR mRNA expression in the arcuate nucleus and the pituitary. CART mRNA expression was reduced in the arcuate nucleus but elevated in the pituitary of mice treated with Lipopolysaccharide, whereas plasma TSH remained unchanged. Plasma CART peptide concentration increased after LPS treatment in a prostanoid-independent manner, and CART peptide levels correlated positively to degree of inflammation.Our findings suggest that central and peripheral CART is affected by acute inflammation. Considering the role of the arcuate nucleus in feeding controls, our data highlight TSHR and CART as putative neuroendocrine signaling components that respond to inflammation, perhaps to maintain weight and metabolic homeostasis during states of disease.
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| 8. |
- Calles, Olle, 1974-, et al.
(författare)
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Ål i Ätran : En fallstudie för svensk ålförvaltning
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det europeiska ålbeståndet har minskat drastiskt under de senaste årtiondena och år 2007 antog därför EU en förordning, som innehåller åtgärder för återhämtning av beståndet av europeisk ål och som innebar att alla medlemsländer måste upprätta en nationell ålförvaltningsplan. I Sveriges ålförvaltningsplan anges minskad dödlighet i vattenkraftverk som en viktig åtgärd för att öka mängden blankålar som når havet. För att sådana åtgärder ska få stor effekt, måste man veta var mest ål produceras och vilken skada som orsakas av de kraftverk ålen passerar på sin väg mot havet. Denna kunskap är bristfällig för de flesta vattendrag i Sverige.Ätran har en lång historia som ett ålproducerande vattendrag soch lämpar sig väl för en fallstudie för svensk ålförvaltning för att belysa ålproduktionens omfattning, dess lokalisering och därmed åtgärdsnyttan. Blankålsfångst på sex platser i Ätrans avrinningsområde under 2010-2011 visade att Ätran prducerar minst 950 blankålar/år och den totala produktionen för hela Åtrans avrinningsområde skulle kunna vara >5500 blankålar/år. Vår studie visar att man utöver redan genomförda och beslutade åtgärder endast behöver åtgärda ytterligare ett kraftverk för att merparten av Åtyrans blankålar ska nå havet.
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| 9. |
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| 10. |
- Cansby, Emmelie, 1984, et al.
(författare)
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Silencing of STE20-type kinase STK25 in human aortic endothelial and smooth muscle cells is atheroprotective
- 2022
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Ingår i: Communications Biology. - : Springer Science and Business Media LLC. - 2399-3642. ; 5, s. 1-14
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Tidskriftsartikel (refereegranskat)abstract
- Recent studies highlight the importance of lipotoxic damage in aortic cells as the major pathogenetic contributor to atherosclerotic disease. Since the STE20-type kinase STK25 has been shown to exacerbate ectopic lipid storage and associated cell injury in several metabolic organs, we here investigate its role in the main cell types of vasculature. We depleted STK25 by small interfering RNA in human aortic endothelial and smooth muscle cells exposed to oleic acid and oxidized LDL. In both cell types, the silencing of STK25 reduces lipid accumulation and suppresses activation of inflammatory and fibrotic pathways as well as lowering oxidative and endoplasmic reticulum stress. Notably, in smooth muscle cells, STK25 inactivation hinders the shift from a contractile to a synthetic phenotype. Together, we provide several lines of evidence that antagonizing STK25 signaling in human aortic endothelial and smooth muscle cells is atheroprotective, highlighting this kinase as a new potential therapeutic target for atherosclerotic disease.
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| 11. |
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| 12. |
- Chursa, Urszula, et al.
(författare)
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Overexpression of protein kinase STK25 in mice exacerbates ectopic lipid accumulation, mitochondrial dysfunction and insulin resistance in skeletal muscle.
- 2017
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 60:3, s. 553-567
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Tidskriftsartikel (refereegranskat)abstract
- Understanding the molecular networks controlling ectopic lipid deposition and insulin responsiveness in skeletal muscle is essential for developing new strategies to treat type 2 diabetes. We recently identified serine/threonine protein kinase 25 (STK25) as a critical regulator of liver steatosis, hepatic lipid metabolism and whole body glucose and insulin homeostasis. Here, we assessed the role of STK25 in control of ectopic fat storage and insulin responsiveness in skeletal muscle.Skeletal muscle morphology was studied by histological examination, exercise performance and insulin sensitivity were assessed by treadmill running and euglycaemic-hyperinsulinaemic clamp, respectively, and muscle lipid metabolism was analysed by ex vivo assays in Stk25 transgenic and wild-type mice fed a high-fat diet. Lipid accumulation and mitochondrial function were also studied in rodent myoblasts overexpressing STK25. Global quantitative phosphoproteomics was performed in skeletal muscle of Stk25 transgenic and wild-type mice fed a high-fat diet to identify potential downstream mediators of STK25 action.We found that overexpression of STK25 in transgenic mice fed a high-fat diet increases intramyocellular lipid accumulation, impairs skeletal muscle mitochondrial function and sarcomeric ultrastructure, and induces perimysial and endomysial fibrosis, thereby reducing endurance exercise capacity and muscle insulin sensitivity. Furthermore, we observed enhanced lipid accumulation and impaired mitochondrial function in rodent myoblasts overexpressing STK25, demonstrating an autonomous action for STK25 within cells. Global phosphoproteomic analysis revealed alterations in the total abundance and phosphorylation status of different target proteins located predominantly to mitochondria and sarcomeric contractile elements in Stk25 transgenic vs wild-type muscle, respectively, providing a possible molecular mechanism for the observed phenotype.STK25 emerges as a new regulator of the complex interplay between lipid storage, mitochondrial energetics and insulin action in skeletal muscle, highlighting the potential of STK25 antagonists for type 2 diabetes treatment.
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| 13. |
- Eriksson, Britt, et al.
(författare)
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Body composition and energy expenditure in response to physical activity in 1.5-year-old children studied by means of the doubly labeled water method
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- During recent decades the prevalence of overweight and obesity in childhood has increased and studies of the mechanisms involved are motivated. Previous research has shown a correlation between total body fat (TBF) (%) and physical activity level (PAL) but the assessment of PAL has often involved a risk for spurious correlations. Thus we compared PAL calculated using basal metabolic rate (BMR) predicted from equations, based on body weight (PALBMR) and associated with a risk for spurious correlations, with PAL calculated using sleeping metabolic rate (SMR) assessed using indirect calorimetry (PALSMR) in 20 healthy children aged 1.5 years. Total energy expenditure and body fatness were assessed using the doubly labelled water method. Body fatness of these children was also assessed at one week and three months of age. PALBMR was significantly (r=-0.48, p=0.03) correlated with TBF (%) while PALSMR was not. Furthermore, the increase in body fatness between three months and 1.5 years was significantly (r=-0.52, p=0.02) correlated with PALSMR at the age of 1.5 years. Our results indicate complex relationships between body fatness and physical activity in early life. When conducting studies in this area, resting energy metabolism should be measured rather than predicted using equations based on body weight.
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| 14. |
- Eriksson, Britt, 1967-, et al.
(författare)
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Body composition and energy expenditure in response to physical activity in 1.5-year-old children studied by means of the doubly labeled water method
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- During recent decades the prevalence of overweight and obesity in childhood has increased and studies of the mechanisms involved are motivated. Previous research has shown a correlation between total body fat (TBF) (%) and physical activity level (PAL) but the assessment of PAL has often involved a risk for spurious correlations. Thus we compared PAL calculated using basal metabolic rate (BMR) predicted from equations, based on body weight (PALBMR) and associated with a risk for spurious correlations, with PAL calculated using sleeping metabolic rate (SMR) assessed using indirect calorimetry (PALSMR) in 20 healthy children aged 1.5 years. Total energy expenditure and body fatness were assessed using the doubly labelled water method. Body fatness of these children was also assessed at one week and three months of age. PALBMR was significantly (r=-0.48, p=0.03) correlated with TBF (%) while PALSMR was not. Furthermore, the increase in body fatness between three months and 1.5 years was significantly (r=-0.52, p=0.02) correlated with PALSMR at the age of 1.5 years. Our results indicate complex relationships between body fatness and physical activity in early life. When conducting studies in this area, resting energy metabolism should be measured rather than predicted using equations based on body weight.
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| 15. |
- Halldén, Britt-Marie, et al.
(författare)
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Early abortion as narrated by young Swedish women
- 2009
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 23:2, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of the study was to illuminate meanings of having had an induced abortion among young Swedish women. METHODS: Narrative interviews were conducted with ten 18-20-year-old women 2-6 weeks after a medical or surgical abortion in the sixth to twelfth week of pregnancy. Data were analysed according to a phenomenological hermeneutic method. RESULTS: The study disclosed a multitude of complex meanings in the young women's lived experiences of induced abortion. Four themes were revealed: having cared for and protected the unimagined pregnancy, taking the life of my child-to-be with pain, being sensitive to the approval of others and imagining the taken away child-to-be. The results are discussed in light of Nussbaum's theory of development ethics. The young women's ability to be responsible for their choices regarding their own welfare and others' well-being in a life cycle perspective was disclosed, despite the pain inherent in the responsibility of taking the life of their own child-to-be. CONCLUSIONS: The young women's narratives were replete with ethical reasoning regarding existential matters related to their responsibility of choosing between induced abortion and parenthood and how to live their lives with this experience. Health-care professionals could promote young women's capability to be responsible, as well as the development of trust in their own fertility and constructive relationships with significant others. In the development of the prevention of unintended pregnancies and the sexual education of young people in Sweden existential dimensions of undergoing an abortion should be given attention.
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| 16. |
- Halldén, Britt-Marie, et al.
(författare)
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Meanings of being pregnant and having decided on abortion : young Swedish women's experiences.
- 2005
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Ingår i: Health Care for Women International. - : Informa UK Limited. - 0739-9332 .- 1096-4665. ; 26:9, s. 788-806
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Tidskriftsartikel (refereegranskat)abstract
- In-depth interviews about the experience of being pregnant and having decided on abortion were conducted with 10 young Swedish women. A phenomenological-hermeneutic study disclosed a complex life world summarised as "I'm happy about my fertility but I choose not to give life now." Four themes were revealed: encountering an unexpected understanding of oneself and one's fertility, desiring to be understood by trusted others, trying out different positions in relation to pregnancy and abortion, and approaching planned adult motherhood. The results indicate that addressing young women's concerns about fertility might be important in reproductive care.
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| 17. |
- Hellner, Britt Marie, et al.
(författare)
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Systematiskt arbete för äldres säkerhet : om fall, trafikolyckor och bränder
- 2007
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Bok (refereegranskat)abstract
- Äldre personer är överrepresenterade i nästan alla olyckor. Förutom stort personligt lidande för individen leder skadorna ofta till omfattande kostnader för samhället. Därför har Räddningsverket och IMS/Socialstyrelsen tilsammans med forskare vid Umeå Universitet, Karlstad Universitet, Krolinska Insitutet, FoU Välfärd Örebro samt Vägverket gemensamt sammaställt denna bok. Syftet är att inspirera och vägleda ett systematiskt arbete i samhället för att öka säkerheten och minska skadorna till följd av olyckor bland äldre. Boken riktar sig till verksamma inom vård och omsorg för äldre, tjänstemän och politiker på olika nivåer i samhället
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| 18. |
- Hellström, Mats, et al.
(författare)
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Towards the development of a bioengineered uterus : Comparison of different protocols for rat uterus decellularization
- 2014
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Ingår i: Acta Biomaterialia. - : Elsevier BV. - 1742-7061 .- 1878-7568. ; 10:12, s. 5034-5042
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Tidskriftsartikel (refereegranskat)abstract
- Uterus transplantation (UTx) may be the only possible curative treatment for absolute uterine factor infertility, which affects 1 in every 500 females of fertile age. We recently presented the 6-month results from the first clinical UTx trial, describing nine live-donor procedures. This routine involves complicated surgery and requires potentially harmful immune suppression to prevent rejection. However, tissue engineering applications using biomaterials and stem cells may replace the need for a live donor, and could prevent the required immunosuppressive treatment. To investigate the basic aspects of this, we developed a novel whole-uterus scaffold design for uterus tissue engineering experiments in the rat. Decellularization was achieved by perfusion of detergents and ionic solutions. The remaining matrix and its biochemical and mechanical properties were quantitatively compared from using three different protocols. The constructs were further compared with native uterus tissue composition. Perfusion with Triton X-100/dimethyl sulfoxide/H2O led to a compact, weaker scaffold that showed evidence of a compromised matrix organization. Sodium deoxycholate/dH2O perfusion gave rise to a porous scaffold that structurally and mechanically resembled native uterus better. An innovative combination of two proteomic analyses revealed higher fibronectin and versican content in these porous scaffolds, which may explain the improved scaffold organization. Together with other important protocol-dependent differences, our results can contribute to the development of improved decellularization protocols for assorted organs. Furthermore, our study shows the first available data on decellularized whole uterus, and creates new opportunities for numerous in vitro and in vivo whole-uterus tissue engineering applications.
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| 19. |
- Johansson, Anneli, et al.
(författare)
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Remaining connected despite separation : former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home
- 2014
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Ingår i: Aging & Mental Health. - : Routledge. - 1360-7863 .- 1364-6915. ; 18:8, s. 1029-1036
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This qualitative study aimed to illuminate former family caregivers’ experiences of aspects that facilitate and hinder the process of relinquishing the care of a person with dementia to a nursing home. METHOD: Ten narrative interviews with former family caregivers were performed and subjected to qualitative content analysis. RESULTS: An overall theme showed that family caregivers were remaining connected to the person with dementia despite separation. They experienced being ‘caught by surprise’ when the placement occurred. Negative expectations of dementia care made the separation more difficult. Lacking adequate information increased feelings of insecurity. Despite these hurdles, family caregivers found meaning in the new situation as they felt that they could remain connected to their loved one. Being recognized as partners in care of the person with dementia after placement was a facilitating aspect. Family caregivers regarded a well-functioning interaction with staff and a supportive social network as reassuring since they facilitated staying in touch. CONCLUSION: Knowledge of the relinquishing process and adequate information about dementia and its progression may help family caregivers better prepare for and adapt to the situation. Family caregivers need to be recognized as partners in care and a welcoming nursing home environment is of utmost importance.
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| 20. |
- Melander, Catharina, et al.
(författare)
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Assessing BPSD with the support of the NPI-NH: a discourse analysis of clinical reasoning
- 2018
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Ingår i: International psychogeriatrics. - : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 30:4, s. 581-589
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Tidskriftsartikel (refereegranskat)abstract
- The ability of nursing staff to assess and evaluate behavioral and psychological symptoms of dementia (BPSD) to determine when intervention is needed is essential. In order to assist with the assessment process, the current use of the Neuropsychiatric Inventory Nursing Home version (NPI-NH) is internationally accepted. Even though the NPI-NH is thoroughly validated and has several advantages, there are also various challenges when implementing this system in practice. Thus, the aim of this study was to explore clinical reasoning employed by assistant nurses when utilizing the NPI-NH as a tool to assess frequency and severity of BPSD in individuals with advanced dementia.Twenty structured assessment sessions in which assistant nurses used the NPI-NH were audio recorded and analyzed with a discourse analysis focusing on the activities in the communication.Four categories were identified to convey assistant nurses' clinical reasoning when assessing and evaluating BPSD using the NPI-NH: considering deteriorations in ability and awareness, incorporating individual and contextual factors, overcoming variations in behaviors and ambiguous formulations in the instrument, and sense-making interactions with colleagues.The NPI-NH served as a supportive frame and structure for the clinical reasoning performed during the assessment. The clinical reasoning employed by assistant nurses became a way to reach a consensual and broader understanding of the individual with dementia, with the support of NPI-NH as an important framework.
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| 21. |
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| 22. |
- Melander, Catharina, et al.
(författare)
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Human capabilities in advanced dementia: Nussbaum's approach
- 2018
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Ingår i: International Journal of Older People Nursing. - : John Wiley & Sons. - 1748-3735 .- 1748-3743. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo explore how Martha Nussbaum's approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes.BackgroundChallenges experienced when supporting people with advanced dementia who express problematic behaviours include understanding their needs and ensuring a dignified life for them.Design and methodsData were gathered using an ethnographic approach based on participatory observation. Nussbaum's capability approach was then used as a framework for the analysis. Four women diagnosed with advanced dementia who also expressed problematic behaviours were recruited from a nursing home in Northern Sweden. The data collection was performed during 2015.FindingsIndividuals with advanced dementia had difficulties in participating in the planning of their lives and achieving the human capability of practical reasoning. They were also at risk of being placed outside the social group, thus hindering them from attaining the human capability of affiliation. A dignified life for individuals with advanced dementia requires nursing staff to be present and to provide adapted support to ensure that the individual can actually pursue human capabilities.ConclusionCreating opportunities for the human capabilities of practical reasoning and affiliation is essential as they permeate all other human capabilities. For these individuals, it was crucial not only to create opportunities for human capabilities but also to attend to their expressions and needs and to guide and steer them towards a dignified life.Implications for PracticeThe normative structure of the capability approach described by Nussbaum can ensure that nursing staffs move beyond fulfilling patients’ basic needs to consider other capabilities vital for a dignified life.
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| 23. |
- Melander, Catharina
(författare)
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Piecing together a fragmented world : Structures to promote the understanding of people with advanced dementia
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Understanding people with dementia whose verbal ability has been impaired is a complex and challenging task, even for professional nursing staff. The aim of this PhD thesis was to explore structures that may promote the understanding of people with advanced dementia living in nursing homes. It focusses specifically on (I) the clinical reasoning employed by assistant nurses when utilizing the NPI-NH (Neuropsychiatric Inventory Nursing Home version) as a tool to assess frequency and severity of BPSD (behavioural and psychological symptoms in dementia, i.e. problematic behaviours) in people with advanced dementia, (II) whether a sensor measuring electrodermal activity (EDA) can improve the identification of agitation in individuals with dementia, (III) how an EDA sensor impacts assistant nurses’ structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions, and (IV) how Martha Nussbaum’s approach to human capabilities can apply to dignity in the lives of people with advanced dementia living in nursing homes. Study I used a method of discourse analysis that focussed on clinical reasoning utilized by assistant nurses when assessing problematic behaviours. In study II, a nonexperimental and correlational observation of the relationship between a sensor measuring EDA and assistant nurses’ structured observations of agitation in people with advanced dementia was applied. Study III used both quantitative and qualitative approaches; data were collected during structured assessments of problematic behaviours conducted by assistant nurses, as well as by focus group interviews with assistant nurses. Study IV took an ethnographic approach with participatory observations that were analyzed with a recursive analysis using a theoretical framework for the conditions necessary for a dignified human life. The structure of the NPI-NH provided a supportive framework that encouraged assistant nurses to discuss and broaden their understanding of the person with dementia (I). The EDA sensor provided continuous information regardless of staff presence and the potential to identify EDA prior to observing these behaviours (II, III), which supported the understanding of the person and when to introduce timely interventions to prevent the onset of problematic behaviours (III). The structure of Nussbaum’s approach to human capabilities illuminated that people with advanced dementia were at risk of living a life in which their opportunities for human capabilities were limited, and hence, the possibility to live a dignified life (IV). An overview of the findings in this thesis indicates that the studied structures were used to piece together fragments of information to create a comprehensive understanding of the needs of the person with dementia. For the structures to support the understanding of the person with dementia, it was crucial that nursing staff were present, attentive and engaged in each person’s situation in order for them to figure out how to piece together and integrate the structures into the overall understanding of the person and, based on that, formulate caring actions in daily life that are meaningful from the perspective of the person with advanced dementia.
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| 24. |
- Melander, Catharina, et al.
(författare)
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The impact of using measurements of electrodermal activity in the assessment of problematic behaviour in dementia
- 2018
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Ingår i: Dementia and Geriatric Cognitive Disorders Extra. - Basel : S. Karger. - 1664-5464. ; 8:3, s. 333-347
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Tidskriftsartikel (refereegranskat)abstract
- Background: A major and complex challenge when trying to support individuals with dementia is meeting the needs of those who experience changes in behaviour and mood. Aim: To explore how a sensor measuring electrodermal activity (EDA) impacts assistant nurses' structured assessments of problematic behaviours amongst people with dementia and their choices of care interventions. Methods: Fourteen individuals with dementia wore a sensor that measured EDA. The information from the sensor was presented to assistant nurses during structured assessments of problematic behaviours. The evaluation process included scorings with the instrument NPI-NH (Neuropsychiatric Inventory-Nursing Home version), the care interventions suggested by assistant nurses to decrease problematic behaviours, and the assistant nurses' experiences obtained by focus group interviews. Results: The information from the sensor measuring EDA was perceived to make behavioural patterns more visual and clear, which enhanced assistant nurses' understanding of time-related patterns of behaviours. In turn, this enhancement facilitated timely care interventions to prevent the patterns and decrease the levels of problematic behaviour. Conclusion: With the addition of information from the sensor, nursing staff could target causes and triggers in a better way, making care interventions more specific and directed towards certain times throughout the day to prevent patterns of problematic behaviours.
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| 25. |
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| 26. |
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| 27. |
- Nilsson, Jonas, 1970, et al.
(författare)
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Expression of influenza A virus glycan receptor candidates in mallard, chicken, and tufted duck
- 2024
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Ingår i: GLYCOBIOLOGY. - 0959-6658 .- 1460-2423. ; 34:3
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Tidskriftsartikel (refereegranskat)abstract
- Influenza A virus (IAV) pandemics result from interspecies transmission events within the avian reservoir and further into mammals including humans. Receptor incompatibility due to differently expressed glycan structures between species has been suggested to limit zoonotic IAV transmission from the wild bird reservoir as well as between different bird species. Using glycoproteomics, we have studied the repertoires of expressed glycan structures with focus on putative sialic acid-containing glycan receptors for IAV in mallard, chicken and tufted duck; three bird species with different roles in the zoonotic ecology of IAV. The methodology used pinpoints specific glycan structures to specific glycosylation sites of identified glycoproteins and was also used to successfully discriminate alpha 2-3- from alpha 2-6-linked terminal sialic acids by careful analysis of oxonium ions released from glycopeptides in tandem MS/MS (MS2), and MS/MS/MS (MS3). Our analysis clearly demonstrated that all three bird species can produce complex N-glycans including alpha 2-3-linked sialyl Lewis structures, as well as both N- and O- glycans terminated with both alpha 2-3- and alpha 2-6-linked Neu5Ac. We also found the recently identified putative IAV receptor structures, Man-6P N-glycopeptides, in all tissues of the three bird species. Furthermore, we found many similarities in the repertoires of expressed receptors both between the bird species investigated and to previously published data from pigs and humans. Our findings of sialylated glycan structures, previously anticipated to be mammalian specific, in all three bird species may have major implications for our understanding of the role of receptor incompatibility in interspecies transmission of IAV.
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| 28. |
- Olsson, Annakarin, et al.
(författare)
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“Longing to be independent again” – A qualitative study on older adults’ experiences of life after hospitalization
- 2020
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Ingår i: Geriatric Nursing. - : Elsevier BV. - 0197-4572 .- 1528-3984. ; 41:6, s. 942-948
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Tidskriftsartikel (refereegranskat)abstract
- It is important to support older adults’ independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults’ experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again” based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults’ experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.
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| 29. |
- Olsson, Britt-Marie, et al.
(författare)
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Resultat från inventeringar av flodpärlmussla i Värmlands län 2008-2011
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Flodpärlmusslan, Margaritifera margaritifera, är en fridlyst och rödlistad art som är föremål för Naturvårdsverkets åtgärdsprogram. För att kunna utföra relevanta skydds-, restaurerings och skötselåtgärder i Värmlands län, behövs bland annat ett förbättrat underlag om artens förekomst i länet. Genom Naturvårdsverkets anslag för arbete med åtgärdsprogram, miljöövervakning samt EU´s ramdirektiv för vatten (2000/60/EG) möjliggjordes en länsinventering av flodpärlmussla.Denna rapport redovisar resultatet från de inventeringar som utförts av Länsstyrelsen i Värmlands län under åren 2008-2011 samt de, fram till idag, kartlagda bestånd av flodpärlmussla i Värmlands län. De valda vattendragen för inventeringen prioriterades bland annat utifrån rykten om förekomst, anknytning till kända bestånd och klassning som särskilt värdefull vattenförekomst. Två personer har vadat uppströms cirka 90 mil vattendrag under fyra somrar för att med lampförsedd vattenkikare söka musslor. Alla fynd har rapporterats in till musselportalen.Värmlands län har idag 44 kända vattendrag med bestånd av flodpärlmussla. Av totalt ca 180 inventerade vattendrag i länet upptäcktes 9 vattendrag med bestånd av flodpärlmussla, vilket ger en fyndfrekvens på ca 4 %. De nya fynden består till största delen av enstaka individer och dessa små populationer bör skyddas och säkerställas för framtiden med olika naturvårdande åtgärder. Flera djupa vattendrag har inte inventerats än, men dessa kräver hjälp av båt, kamera och dykning.
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| 30. |
- Olsson, Gunnel, et al.
(författare)
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Microbial Desulfurization of Coal and Oxidation of Pure Pyrite by T. ferrooxidans and Acidianus brierleyi
- 1995
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Ingår i: Journal of Industrial Microbiology. - 0169-4146. ; 14:5, s. 420-423
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Tidskriftsartikel (refereegranskat)abstract
- Thiobacillus ferrooxidans and Acidianus brierleyi were capable of oxidizing pure pyrite as well as oxidizing sulfur in coal. First order reactions were assumed in the kinetic analysis performed. For oxidation of pure pyrite the rate constant was higher for A. brierleyi than for T. ferrooxidans. For sulfur removal from coal the values of the rate constants were comparable far the two microorganisms.
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| 31. |
- Olsson, G, et al.
(författare)
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Microbial Desulfurization of Coal by T. ferrooxidans and Thermophilic Archaea
- 1994
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Ingår i: Fuel Processing Technology. - : Elsevier BV. - 0378-3820. ; 40:2-3, s. 277-282
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Tidskriftsartikel (refereegranskat)abstract
- Several different microorganisms have been suggested for coal desulfurization. In the present investigation, the thermophilic archaea Acidianus brierleyi (DSM 1651), Sulfolobus acidocaldarius (DSM 639) and Sulfolobus solfataricus (DSM 1616) were compared with the mesophilic bacterium Thiobacillus ferrooxidans (DSM 583) concerning their capability of removing sulfur from coal. The desulfurization rate as well as the amount of sulfur removed by the microorganisms was studied. Two of the investigated microorganisms, Thiobacillus ferrooxidans and Acidianus brierleyi, were capable of oxidizing pure pyrite as well as oxidizing sulfur in coal. A kinetic analysis was performed assuming first order reactions. The rate constant for oxidation of pure pyrite by A. brierleyi was observed to be higher than for T. ferrooxidans, The values of the rate constants for sulfur removal from coal were comparable for the two microorganisms, but were higher than for oxidation of pure pyrite.
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| 32. |
- Papakokkinou, Eleni, et al.
(författare)
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Prevalence of Nelson's syndrome after bilateral adrenalectomy in patients with cushing's disease: a systematic review and meta-analysis
- 2021
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Ingår i: Pituitary. - : Springer Science and Business Media LLC. - 1386-341X .- 1573-7403.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Bilateral adrenalectomy (BA) still plays an important role in the management of Cushing's disease (CD). Nelson's syndrome (NS) is a severe complication of BA, but conflicting data on its prevalence and predicting factors have been reported. The aim of this study was to determine the prevalence of NS, and identify factors associated with its development. Data sources Systematic literature search in four databases. Study Selection Observational studies reporting the prevalence of NS after BA in adult patients with CD. Data extraction Data extraction and risk of bias assessment were performed by three independent investigators. Data synthesis Thirty-six studies, with a total of 1316 CD patients treated with BA, were included for the primary outcome. Pooled prevalence of NS was 26% (95% CI 22-31%), with moderate to high heterogeneity (I-2 67%, P < 0.01). The time from BA to NS varied from 2 months to 39 years. The prevalence of NS in the most recently published studies, where magnet resonance imaging was used, was 38% (95% CI 27-50%). The prevalence of treatment for NS was 21% (95% CI 18-26%). Relative risk for NS was not significantly affected by prior pituitary radiotherapy [0.9 (95% CI 0.5-1.6)] or pituitary surgery [0.6 (95% CI 0.4-1.0)]. Conclusions Every fourth patient with CD treated with BA develops NS, and every fifth patient requires pituitary-specific treatment. The risk of NS may persist for up to four decades after BA. Life-long follow-up is essential for early detection and adequate treatment of NS.
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| 33. |
- Pett, C., et al.
(författare)
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Effective Assignment of alpha 2,3/alpha 2,6-Sialic Acid Isomers by LC-MS/MS-Based Glycoproteomics
- 2018
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Ingår i: Angewandte Chemie International Edition. - : Wiley. - 1433-7851 .- 1521-3773. ; 57:30, s. 9320-9324
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Tidskriftsartikel (refereegranskat)abstract
- Distinct structural changes of the alpha 2,3/alpha 2,6-sialic acid glycosidic linkages on glycoproteins are of importance in cancer biology, inflammatory diseases, and virus tropism. Current glycoproteomic methodologies are, however, not amenable toward high-throughput characterization of sialic acid isomers. To enable such assignments, a mass spectrometry method utilizing synthetic model glycopeptides for the analysis of oxonium ion intensity ratios was developed. This method was successfully applied in large-scale glycoproteomics, thus allowing the site-specific structural characterization of sialic acid isomers.
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| 34. |
- Pett, Christian, et al.
(författare)
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Effective Assignment of α2,3/α2,6-Sialic Acid Isomers by LC-MS/MS-Based Glycoproteomics
- 2018
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Ingår i: Angewandte Chemie International Edition. - : Wiley-VCH Verlagsgesellschaft. - 1433-7851 .- 1521-3773. ; 57:30, s. 9320-9324
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Tidskriftsartikel (refereegranskat)abstract
- Distinct structural changes of the α2,3/α2,6-sialic acid glycosidic linkages on glycoproteins are of importance in cancer biology, inflammatory diseases, and virus tropism. Current glycoproteomic methodologies are, however, not amenable toward high-throughput characterization of sialic acid isomers. To enable such assignments, a mass spectrometry method utilizing synthetic model glycopeptides for the analysis of oxonium ion intensity ratios was developed. This method was successfully applied in large-scale glycoproteomics, thus allowing the site-specific structural characterization of sialic acid isomers.
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| 35. |
- Sjölund, Britt-Marie, 1958-, et al.
(författare)
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Factors associated with improvement in depressive symptoms among older persons after hospitalisation - a prospective design with two follow-ups
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:3, s. 923-928
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Tidskriftsartikel (refereegranskat)abstract
- Background Depression is a common disorder in old age and increases with hospitalisation. The aim was to investigate whether improvement in depressive symptoms after hospitalisation is associated with education level, age, gender, living situation, self-efficacy, activities in daily living and quality of life by (1) examining the prevalence of depressive symptoms at baseline and at 1st and 2nd follow-up (2) examining different factors' association with depressive symptoms at baseline and (3) examining different factors' association with improvement in depressive symptoms at baseline and at 1st and 2nd follow-up. Methods The study consisted of 145 patients, 65 years and older. Data were collected between February 2015 and September 2016 through interviews conducted using structured protocols. The instrument used was Katz index of ADL, Geriatric Depression Scale-20, Life Satisfaction Questionnaire and the General Self-Efficacy Scale. The participants were interviewed before discharge from hospital, after 1.5 month and after 3 months. Results The prevalence of depressive symptoms in older persons was high after hospitalisation. Factors associated with improvement of depressive symptoms after hospitalisation were higher educational level, improvement in activities in daily living and quality of life. Non-significant results were found for improvement of depressive symptoms and gender, age, living situation or self-efficacy. Conclusions Depression is a common health problem in older persons, especially after hospitalisation. It is therefore important that healthcare staff screen older persons for depression during hospitalisation, as this allows identification of those in need and a possibility to help them in an appropriate manner. Persons with lower educational level and depressive symptoms need special attention.
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| 36. |
- Sundblad, Britt-Marie, et al.
(författare)
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Effect of respirators equipped with particle or particle-and-gas filters during exposure in a pig confinement building
- 2006
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Ingår i: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 32:2, s. 145-53
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study compared the protective effect of two respiratory protection devices during exposure in a pig confinement building. METHODS: Thirty-six healthy persons were exposed for 3 hours in the building, 12 without any protection, 12 with a particle-filter mask, and 12 with a mask filtering both particles and gases. Symptoms, body temperature, nasal lavage fluid, exhaled nitric oxide, and bronchial responsiveness to methacholine were assessed before and after the exposure. Pre- and postexposure urine and blood samples were collected. RESULTS: After the exposure, the participants with respirators reported fewer symptoms than those without. Wearing a mask also reduced the inflammatory response assessed with nasal lavage (cell concentration, interleukins 6 and 8) and peripheral blood (cell number). Lung function was significantly impaired only in the unprotected group; postexposure vital capacity and forced expiratory volume in 1 second showed a decrease of 3-4% from the preexposure levels (P=0.006 and P=0.002, respectively). Bronchial responsiveness (P<0.01) and body temperature (P<0.001) increased similarly in the three groups. Bronchial responsiveness to methacholine increased 2.7, 2.4, and 2.1 doubling concentration steps for those unprotected, those using a particle-filter mask, and those using a mask with particle and gas filters, respectively. The prostaglandin D2 metabolite, 9a, 11b-PGF2 increased significantly (P=0.003) only in those unprotected. CONCLUSIONS: Wearing a respirator in a pig confinement building reduces the inflammatory reaction but does not influence the increase in bronchial responsiveness, with no difference between the use of a particle-filter mask or a mask with a particle-gas filter combination.
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| 37. |
- Torell, Erik, et al.
(författare)
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Clonality among ampicillin-resistant Enterococcus faecium in Sweden and relation to ciprofloxacin resistance
- 2003
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Ingår i: Clinical Microbiology and Infection. - : Elsevier BV. - 1198-743X .- 1469-0691. ; 9:10, s. 1011-1019
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate clonal relationships in a nationwide sample of human Enterococcus faecium isolates. Methods Biochemical fingerprinting (PhP (PhenePlate) typing) was used to compare 180 fecal ampicillin-resistant E. faecium (ARE) isolates with 169 matched fecal ampicillin-susceptible E. faecium (ASE) isolates from patients in 23 hospitals, collected in 1998, and to study 39 fecal ARE isolates from non-hospitalized individuals collected in 1998, and five ARE and 29 ASE isolates from the early 1990s. Representative ARE and ASE isolates were subjected to pulsed-field gel electrophoresis (PFGE) analysis of genomic DNA and sequencing of the regions encoding the fluoroquinolone targets of the enzymes GyrA and ParC. Results Both PhP and PFGE results showed a higher homogeneity among ARE than among ASE isolates (P < 0.001). One PhP type (FMSE1) comprised 73% of the hospital ARE isolates (53% of ARE isolates from non-hospitalized individuals, and four of five ARE isolates from the early 1990s), but only 1% of the ASE isolates. PFGE of the hospital E. faecium isolates revealed that 23 of the 25 ARE isolates and one of the 22 ASE isolates were of one dominating type. High-level resistance to ciprofloxacin (MIC > 16 mg/L) was present in 91% of ARE isolates, whereas only low-level resistance (MIC 4–16 mg/L; 35% of isolates) was found among ASE isolates. One mutation in parC (codon 80) and one of two mutations in gyrA (codons 83 or 87) were detected in all ARE isolates tested with high-level ciprofloxacin resistance, but were lacking in ARE and ASE isolates with low-level ciprofloxacin resistance. Conclusion Most ARE isolates in Sweden were clonally related. High-level ciprofloxacin resistance was found in ARE isolates of PhP type FMSE1 as well as in other PhP types, but never in ASE isolates.
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| 38. |
- Torell, Erik, et al.
(författare)
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Near absence of VRE but high carriage rates of quinolone-resistant ampicillin-resistant enterococci among hospitalized patients and non-hospitalized individuals in Sweden
- 1999
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Ingår i: Journal of Clinical Microbiology. - 0095-1137 .- 1098-660X. ; 37:11, s. 3509-3513
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Tidskriftsartikel (refereegranskat)abstract
- Rates of colonization with enterococci with acquired resistance to vancomycin (vancomycin-resistant enterococci [VRE]) and ampicillin (ampicillin-resistant enterococci [ARE]) were determined by using fecal samples from 670 nonhospitalized individuals and 841 patients in 27 major hospitals. Of the hospitalized patients, 181 (21.5%) were carriers of ARE and 9 (1.1%) were carriers of VRE. In univariate analyses, length of hospital stay (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.5 to 8.9) and antimicrobial therapy (OR, 4.7; 95% CI, 3.3 to 6.7) were associated with ARE colonization, as were prior treatment with penicillins (OR, 3.1; 95% CI, 1.8 to 5. 5), cephalosporins (OR, 2.9; 95% CI, 1.7 to 5.0), or quinolones (OR, 2.7; 95% CI, 1.5 to 4.7). In logistic regression analysis, antimicrobial therapy for at least 5 days was independently associated with ARE carriage (adjusted OR, 3.8; 95% CI, 2.6 to 5.4). Over 90% of the ARE isolates were fluoroquinolone resistant, whereas 14% of the ampicillin-susceptible Enterococcus faecium isolates were fluoroquinolone resistant. ARE carriage rates correlated with the use of fluoroquinolones (P = 0.04) but not with the use of ampicillin (P = 0.68) or cephalosporins (P = 0.40). All nine VRE isolates were E. faecium vanB and were found in one hospital. Seven of these isolates were related according to their types as determined by pulsed-field gel electrophoresis. Among the nonhospitalized individuals, the ARE carriage rate was lower (6%; P < 0.05), and only one person, who had recently returned from Africa, harbored VRE (E. faecium vanA). The absence of VRE colonization in nonhospitalized individuals reflects an epidemiological situation in Sweden radically different from that in countries in continental Europe where glycopeptides have been widely used for nonmedical purposes.
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| 39. |
- Öberg, Britt-Marie, et al.
(författare)
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Changing Worlds and the Ageing Subject. : Dimensions in the Study of Ageing and Later Life
- 2004
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Considers the humanistic-historical dimension of ageing and substantiates new perspectives on family roles and intergenerational relationships. Also examines age discrimination, the impact of the increase in early retirement, the effect of old and new technology on older people's lives, and more.Show more Show less
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