| 1. |
- Axfors, Cathrine, et al.
(författare)
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Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden
- 2023
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Ingår i: Sexuality Research & Social Policy. - : Springer Nature. - 1868-9884 .- 1553-6610. ; 20:2, s. 479-490
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionGender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.MethodsCross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.ResultsThe proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.ConclusionsIn this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.Policy ImplicationsThe study fndings underline the need for individualized care and fexible gender afrming treatmentoptions. The role of somatic comorbidities should be further explored, and support should be ofered to transgender peoplein need. There is an unmet need for facial surgery among aM
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| 2. |
- Berg, Lotta, et al.
(författare)
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Killing of spent laying hens using CO2 in poultry barns
- 2014
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Ingår i: Animal Welfare. - : Cambridge University Press (CUP). - 0962-7286 .- 2054-1538. ; 23, s. 445-457
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Tidskriftsartikel (refereegranskat)abstract
- In Sweden, laying hens are killed using the following methods: i) traditional slaughter; ii) on-farm with CO2 in a mobile container combined with a grinder; or iii) with CO2 inside the barn. The number of hens killed using the latter method has increased. During these killings a veterinarian is required to be present and report to the Swedish Board of Agriculture. Data were registered during four commercial killings and extracted from all official veterinary reports at CO2 whole-house killings in 2008-2010. On-farm monitoring showed that temperature decreased greatly and with high variability. The time until birds became unconscious after coming into contact with the gas, based on time until loss of balance, was 3-5 min. Veterinary reports show that 1.5 million laying hens were killed, in 150 separate instances. The most common non-compliance with legislation was failure to notify the regional animal welfare authorities prior to the killings. Six out of 150 killings were defined as animal welfare failures, eg delivery of insufficient CO2 or failure to seal buildings to achieve adequate gas concentration. Eleven were either potentially or completely unacceptable from the perspective of animal welfare. We conclude that, on the whole, the CO2 whole-house gas killing of spent hens was carried out in accordance with the appropriate legislation. Death was achieved reliably. However, there remain several risks to animal welfare and increased knowledge would appear vital in order to limit mistakes related to miscalculations of house volume, improper sealing or premature ventilation turn-off.
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| 3. |
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| 4. |
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| 5. |
- Häggström Lundevaller, Erling, Filosofie doktor, PhD, 1968-, et al.
(författare)
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Long-term Health Outcomes from Inbreeding : Longevity, Fertility and Impairment
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the paper is to investigate if inbreeding had any health effects on individuals born 1890–1905 in Skellefteå, Sweden, with a follow-up period until 1950. The effects on longevity, fertility and impairments as outcome variables is of particular interest to clarify, as they provide a comprehensive picture of howinbreeding affects human demographic behaviour and health during this period. The effect on longevity was not strong but caused higher mortality for men above one year of age. The risk of stillbirths showed a substantial association with inbreeding, with a higher risk for highly inbred. The probability of having children was lower for persons representing high levels of inbreeding. However, the number of children given that at leastone child is born is not affected. No significant effect of the parents being related is noted on fertility. With respect to an individual’s own inbreeding we find that the higher the level of inbreeding, the higher the risk of impairments.
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| 6. |
- Högberg, Lotta, et al.
(författare)
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Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine
- 2011
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Ingår i: ACTA PAEDIATRICA. - : Blackwell Publishing Ltd. - 0803-5253 .- 1651-2227. ; 100:7, s. 1023-1027
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern. Methods: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied. Results: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p andlt; 0.001). Conclusion: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.
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| 7. |
- Idenfors, Annika, et al.
(författare)
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När det brister : En studie av dammsäkehet och säkerhetsarbete mot översvämningar längs Skellefte- och Umeälven
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport sammanfattar resultat från en studie om dammsäkerhet och säkerhetsarbete mot översvämningar längs två reglerade älvar i Västerbotten. Syftet med studien är att undersöka hur dammsäkerhetsarbetet, när det gäller dammbrott, säkerhetsarbete mot översvämningar och incidenter relaterade till nyttjandet av älvarna, är organiserat och fungerar längs Skellefte- och Umeälven. Övriga älvar i länet samt gruvdammar ingår inte i undersökningen. Det ansvar som Statens geotekniska institut (SGI), Sveriges meteorologiska och hydrologiska institut (SMHI), försvarsmakten, Boverket, Vägverket och polisen har för att förebygga och agera i samband med översvämningar behandlas inte heller i studien.Rapporten baseras på en litteraturöversikt rörande den senaste forskningen på området, dokumentstudier, intervjuer med säkerhetsansvariga vid Länsstyrelsen Västerbotten, Umeå, Vännäs, Lycksele och Skellefteå kommun, samt två vattenregleringsföretag.Studien tar sin utgångspunkt i begreppet mänsklig säkerhet och analyserar dammsäkerhet och säkerhetsarbete utifrån ett sociotekniskt perspektiv. Det innebär att varje teknisk konstruktion, varje tekniskt system, såsom vattenkraftverk och dammar, där olika tekniska instrument används för att kontrollera och reglera vattenflöden och producera elektricitet, också utgör sociala system. Det innebär att rapporten uppmärksammar deltagande och delaktighet som en central aspekt av säkerhetsarbetet.Utifrån resultaten drar studien följande slutsatser:Dammsäkerhetsarbetet och säkerhetsarbetet mot översvämningar längs Skellefte- och Umeälven uppvisar brister ifråga om resurser, kompetens och insyn.Dammsäkerhetsarbetet inkluderar inte allmänhetens säkerhet vid och på dammar (public safety around dams).Det finns oklarheter rörande vem som har ansvar för dammsäkerhet och för säkerhetsarbete mot översvämningar.Dammsäkerhetsarbetet i Västerbotten inkluderar endast i begränsad omfattning sociala aspekter, lokal kunskap tas inte tillvara, och allmänhet och rättighetsinnehavare ignoreras i stor utsträckning i säkerhetsarbetet.Det är generellt svårt att bedöma effekter av säkerhetsarbetet kring dammar och längs älvarna, men klart är att pågående säkerhetsarbete, i form av till exempel enskilda projekt och övningar, ökar kunskaperna om risker och ansvar, samt stärker samverkan mellan olika aktörer.Dammsäkerhet uppfattas främst handla om tekniska konstruktioner medan människa-maskin- natur och mellanmänskliga och organisatoriska säkerhetsaspekter hamnar i skymundan.
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| 8. |
- Iliadis, Stavros I., 1983-, et al.
(författare)
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Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting
- 2020
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- The Transgender Congruence Scale (TCS) is a non-binary tool used in Sweden for gender dysphoria (GD) assessment; however, its Swedish version has not been validated. To investigate the psychometric properties of the TCS, its capacity to distinguish individuals with GD and its concurrent validity compared to other scales. Patients with GD (n=135) and controls (n=443) filled in a questionnaire containing sociodemographic questions, the TCS, the Utrecht Gender Dysphoria Scale (UGDS), and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). TCS had good discriminatory validity and internal consistency. Patients with GD, stratified by birth-assigned sex, had lower TCS scores compared to controls. Confirmatory factor analysis (CFA) supported the two-factor model of the TCS. Multiple-group CFA suggested measurement invariance between birth-assigned sexes and configural invariance between patients with GD and controls. Area under the ROC curve for birth-assigned males was 0.991 and for females 0.994. A TCS mean value of three provided sensitivity 94.3% and 95.1% as well as specificity 98.6% and 98% for aM and aF, respectively. The TCS was significantly correlated to UGDS and GIDYQ-AA. The TCS may be a valuable tool in the clinical assessment of individuals with GD.
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| 9. |
- Ivarsson, Anneli, et al.
(författare)
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Prevalence of Childhood Celiac Disease and Changes in Infant Feeding
- 2013
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 131:3, s. E687-E694
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Between 1984 and 1996, Sweden experienced an "epidemic" of clinical celiac disease in children andlt;2 years of age, attributed partly to changes in infant feeding. Whether infant feeding affects disease occurrence and/or the clinical presentation remains unknown. We investigated and compared the total prevalence of celiac disease in 2 birth cohorts of 12-year-olds and related the findings to each cohorts ascertained infant feeding. less thanbrgreater than less thanbrgreater thanMETHODS: A 2-phase cross-sectional screening study was performed in which 13 279 children from 2 birth cohorts participated: children born during the epidemic (1993) and children born after the epidemic (1997). Previously diagnosed cases were reported and confirmed. Blood samples were analyzed for serological markers and children with positive values were referred for small intestinal biopsy. Infant feeding practices in the cohorts were ascertained via questionnaires. Prevalence comparisons were expressed as prevalence ratios. less thanbrgreater than less thanbrgreater thanRESULTS: The total prevalence of celiac disease was 29 in 1000 and 22 in 1000 for the 1993 and 1997 cohorts, respectively. Children born in 1997 had a significantly lower risk of having celiac disease compared with those born in 1993 (prevalence ratio: 0.75; 95% confidence interval: 0.60-0.93; P = .01). The cohorts differed in infant feeding (specifically, in the proportion of infants introduced to dietary gluten in small amounts during ongoing breastfeeding). less thanbrgreater than less thanbrgreater thanCONCLUSIONS: A significantly reduced prevalence of celiac disease in 12-year-olds indicates an option for disease prevention. Our findings suggest that the present infant feeding recommendation to gradually introduce gluten-containing foods from 4 months of age, preferably during ongoing breastfeeding, is favorable. Pediatrics 2013;131:e687-e694
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| 10. |
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| 11. |
- Junkka, Johan, 1981-, et al.
(författare)
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The emergence of social gaps in mental health : a longitudinal population study in Sweden, 1900-1959
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 15:4
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Tidskriftsartikel (refereegranskat)abstract
- During the recent decades, social inequalities in mental health have increased and are now one of the most persistent features of contemporary society. There is limited knowledge about when this pattern emerged or whether it has been a historically fixed feature. The objective of this study was to assess whether socioeconomic and gender gaps in mental health changed during the period 1900–1959 in Sweden. We used historical micro data which report all necessary information on individuals’ demographic characteristics, occupational attainment and mental disorders (N = 2,450) in a Swedish population of 193,893. Changes over time was tested using multilevel Cox proportional hazard models. We tested how gender-specific risks of mental disorder changed and how gender-specific socioeconomic status was related to risks of mental disorder later in life. We found a reversal in gender gaps in mental health during the study period. Women had a lower risk than men in 1900 and higher risks in 1959. For men, we found a negative gradient in SES risks in 1900 and a positive gradient in 1959. For women, we found no clear SES gradient in the risk of mental disorder. These findings suggest that the contemporary patterns in socioeconomic and gender gaps in mental disorder emerged during the 1940s and 1950s and have since then persisted.
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| 12. |
- Liselotte, Eriksson, 1978-, et al.
(författare)
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Supply or demand? : Institutionalization of the mentally ill in the emerging Swedish welfare state, 1900–1959
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Historical studies on the institutionalization of the mentally ill have primarily relied on data on institutionalized patients rather than the population at risk. Consequently, the underlying factors of institutionalization are unclear. Using Swedish longitudinal microdata from 1900–1959 reporting mental disorders, we examine whether supply-side factors such as distance to institutions and number of asylum beds influenced the risk of institutionalization, in addition to demand-side factors such as access to family. Institutionalization risks were associated with the supply of beds and proximity to an asylum, but also dependent on families’ unmet demand for care of relatives. As the supply of mental care met this family-driven demand in the 1930s, the relative risk of institutionalization increased among those lacking family networks.
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| 13. |
- Liselotte, Eriksson, 1978-, et al.
(författare)
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Supply or demand? Institutionalization of the mentally ill in the emerging Swedish welfare state, 1900–59
- 2022
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Ingår i: History of Psychiatry. - : Sage Publications. - 0957-154X .- 1740-2360. ; 33:2, s. 180-199
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Tidskriftsartikel (refereegranskat)abstract
- Historical studies on the institutionalization of the mentally ill have primarily relied on data for institutionalized patients rather than the population at risk. Consequently, the underlying factors of institutionalization are unclear. Using Swedish longitudinal microdata from 1900–59 reporting mental disorders, we examine whether supply factors, such as distance to institutions and number of asylum beds, influenced the risk of institutionalization, in addition to demand factors such as access to family. Institutionalization risks were associated with the supply of beds and proximity to an asylum, but also dependent on families’ unmet demand for care of relatives. As the supply of mental care met this family-driven demand in the 1930s, the relative risk of institutionalization increased among those lacking family networks.
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| 14. |
- Marklund, Emil, 1985-
(författare)
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Teachers’ lives in transition : gendered experiences of work and family among primary school teachers in northern Sweden, c. 1860–1940
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis, primary school teachers in a coastal area of northern Sweden c. 1860–1940 are studied with the overarching purpose to investigate the link between professional work and private life. Four sub-studies provide results on who the teachers were with regard to gender, professional status (teacher qualification) and socio-economic background, and on their family formation during the study period. Dis(similarities) over time and between the genders are analysed and discussed within a life-course framework, especially concerning women’s possibility to become teachers and combine their employment with family formation. The findings are obtained through quantitative as well as qualitative analyses of multiple sources like digitised parish records, censuses, teacher registers and a diary. The latter provides unique insights into the everyday life of a young woman and her interaction with the local community through her teacher position and social networks. The results show both continuity and change. The recruitment pattern of primary school teachers in terms of social origin remained stable throughout the study period. A farming origin was most typical while children of higher professionals were most likely to become teachers, but this group alone could not cover the need for new teachers. National reforms of the teacher training and its increasing accessibility on a regional level had a big impact on the number, qualification, and gender composition of primary school teachers in the study area. Results on the dynamic link between work and family formation show that female teachers were among the first middle-class women to increase their share in experiencing motherhood. In the 20th century, an increasing proportion of women who entered the teaching profession returned to it after having children. Overall, the thesis results show that women teachers in contrast to their male counterparts experienced fundamental transitions in their professional as well as family life. This indicates a shift in the perception of a respectable woman teacher. In the 19th century, she could be either a teacher or a mother but rarely both at the same time. Along with changes in societal structures and gendered norms during the 20th century, teaching mothers became far more common suggesting that they enjoyed respectability. The variety of findings of this thesis and its mix of methods allow it to contribute to several fields within history, such as social history, historical demography, gender history and history of education.
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| 15. |
- Myléus, Anna, 1978-, et al.
(författare)
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Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic
- 2009
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - New York : Raven P. - 0277-2116 .- 1536-4801. ; 49:2, s. 170-176
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Tidskriftsartikel (refereegranskat)abstract
- Objetive: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases.Patients and methods: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease.Results: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33).Conclusions: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
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| 16. |
- Myléus, Anna, MD PhD, et al.
(författare)
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Questionnaire showed that Swedish paediatric clinics complied well with the revised European guidelines for diagnosing coeliac disease
- 2019
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 108:6, s. 1140-1143
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Tidskriftsartikel (refereegranskat)abstract
- Aim: In 2012, revised criteria for diagnosing childhood coeliac disease were published by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition and incorporated into the revised Swedish guidelines the same year. These made it possible, in certain cases, to diagnose coeliac disease without taking small bowel biopsies. This survey assessed the extent to which the new guidelines were implemented by Swedish paediatric clinics two years after their introduction.Methods: In October 2014, we distributed a paper questionnaire including five questions on diagnostic routines to the 40 paediatric clinics in university or regional hospitals in Sweden that perform small bowel biopsies.Results: All 36 (90%) clinics that responded used anti-tissue transglutaminase antibodies as the initial diagnostic test and some also used serological markers. Most clinics (81%) used endoscopy and took multiple duodenal biopsies, whereas only a few (19%) occasionally employed a suction capsule. Almost all clinics (86%) omitted taking small bowel biopsies in symptomatic children with repeatedly high coeliac serology and positive genotyping, thereby avoiding the need for invasive endoscopy under anaesthesia.Conclusion: The 2012 Swedish Paediatric Coeliac Disease Diagnostic Guidelines had been widely accepted and implemented in routine health care two years after their introduction.
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| 17. |
- Nimmermark, Sven, et al.
(författare)
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Koldioxidavlivning av värphöns i inhysningsstallar : studier av tekniska faktorer samt bedövnings- och avlivningskvalitet vid gasning
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Dagens värphöns producerar ägg till en ålder av c:a 75-80 veckor, varefter flocken avlivas eller slaktas och ersätts med unga, produktiva höns. I detta sammanhang brukar man benämna de äldre djuren som ”uttjänta” eller utslagshöns. Alltsedan de senaste 60 årens utveckling av den moderna köttraskycklingen har marknaden för kött och andra produkter från värphöns försämrats. Uttjänta värphöns har också relativt skör benstomme, vilket bland annat medför köttkvalitetsproblem till följd av skador från benfragment och djurskyddsproblem kopplat till risken för frakturer i samband med utlastning och transport. I många länder har utslagshöns idag inget ekonomiskt värde, utan att göra sig av med dem innebär istället både kostnader och arbete för producenten. En flock som ska transporteras till slakt måste fångas in med hjälp av handkraft, placeras i transportburar och köras till slakteri. Dessa arbets- och kostnadskrävande moment undviks vid gasavlivning i djurstallar, där arbetet istället består i att förbereda och assistera gasning samt att plocka ut och transportera döda djur. Med gasavlivning i stallet undviks riskerna för vingbrott och andra skador till följd av insamling av djuren, lastning i lådor, transport, urlastning och hantering vid bedövning vilka utgör påtagliga risker för försämrad djurvälfärd. Ett alternativ till slakt är således att avliva uttjänta höns i de stallar där de hålls, genom att administrera gas direkt i byggnaden. Detta tillvägagångssätt har används det senaste årtiondet och var ursprungligen ett sätt att angripa problemet med storskalig avlivning av fjäderfä i samband med smittsamma sjukdomsutbrott. Koldioxidavlivning av fjäderfä har huvudsakligen studerats under förhållanden där gas administreras i mer eller mindre kontrollerad atmosfär i ett begränsat utrymme (s.k. Controlled Atmosphere Stunning/Killing, CAS/CAK), Endast ett fåtal studier behandlar situationer där gas administreras direkt i stallar. Även om det numera finns en generell acceptans av gasavlivning direkt i stallet som en jämförelsevis effektiv och djurskyddsmässigt acceptabel metod för avlivning av höns och kycklingar så finns det alltså fortfarande en hel del skillnader vad gäller detaljerna. Det handlar bland annat om vad olika forskare anser om framför allt effekten av koldioxid på djurvälfärden i förhållande till ädelgaser, betydelsen av koncentrationshöjning och inblandning av syre samt hur man bedömer relevansen av de traditionella välfärdsindikatorerna. Pågående forskning fortgår för att utöka kunskaperna inom dessa områden och med hjälp av förfinade mätmetoder stärks kunskaperna om inträdandet av medvetslöshet och död. Detta är av största vikt eftersom att indikatorerna måste bedömas i förhållande till djurens medvetandegrad. För närvarande saknas möjlighet till övervakning för att säkerställa djurvälfärden under gasavlivning. Den visuella kontrollen begränsas i praktiken till att notera att gasen sprids i byggnaden samt en bedömning av djuren efter avslutad avlivning, medan det är mycket svårt att bedöma det pågående förloppet hos enskilda djur. Genom att bättre kunna förutsäga och kontrollera gaskoncentration och spridning kan även bättre kunskap och förutsägbarhet genereras i förhållande till bedövnings- och avlivningseffekt. Detta kan i sin tur medföra möjlighet till förbättringar ur djurvälfärdssynpunkt, såväl som ur ekonomisk synpunkt, genom kostnadseffektivisering av gasningsförfarandet. Behovet av kunskapsökning inom dessa områden ligger till grund för den aktuella studien. Studier av koldioxidavlivning och mätningar utfördes vid avlivning i kommersiella stallar. På Gård 1 studerades avlivningen av uttjänta värphöns i två likartade stallar (stall 1 och 2). I stall 1 observerades hönsen och temperatur mättes på ett antal ställen. I stall 2 gjordes enbart visuella studier. På Gård 2 gjordes mätningar och observationer i samband med koldioxidavlivning av kalkoner och på Gård 3 i samband med avlivning av uttjänta värphöns. På dessa gårdar gjordes mätningar av temperaturfördelning, koldioxidhalt och övertryck vid tillförsel av koldioxid. På gårdarna 4 och 5 studerades beteendereaktioner och fördelning av gas vid avlivning med CO2 i ett av respektive gårds inhysningsstall för kommersiella värphöns, som var i slutet av sin produktion. Slutsatser och rekommendationer med avseende på tekniska aspekter Mängd gas och gasflöde • Gjorda mätningar visar på att en halt på c:a 80 % koldioxid kan åstadkommas i stallet då mängden gas beräknas enligt den idag använda texten i föreskrifterna: ”Mängden koldioxid (kg) för att uppnå 80 % koncentration kan beräknas med hjälp av formeln [stallvolym (m3) x 1,8 x 0,80]”. • Koldioxidflöden av storleksordningen 400-600 kg/min används idag. Vid val av gasflöde måste tekniskt betraktat en snabb ökning av gashalterna i stallet vägas mot tryckökning, öppningsarea till det fria och tidsförlopp för sänkning av koldioxidhalterna efter gastillförsel till följd av ofrivillig ventilation. De idag använda flödena är en kompromiss som tycks fungera relativt väl. Med tanke på bl.a. behov av öppningar och avklingning av gashalter bör lägre flöden (400 kg/min eller lägre) väljas i mindre (c:a 50 m långa) stallar och högre flöden (upp till c:a 600 kg/min) i större (c:a 100 m långa) stallar. Metod för gasinblåsning • Inblåsning i munstycken (ɸinv 37 mm) i stallets längdriktning under kraftigt tryck såsom sker idag ger vid aktuella flöden (400-600 kg CO2 per minut) upphov till en stråle med kastlängder av storleksordningen 30 m. I stallar med en längd på 40-50 m finns i ett sådant system förutsättning för att koldioxidhalterna skall öka ungefär samtidigt och med samma ökningstakt i hela stallet. • Inblåsning i munstycken (ɸinv 37 mm) i stallets längdriktning och aktuella flöden (400-600 kg CO2 per minut) innebär för långa stall (100 m) att det dröjer ett antal minuter innan koldioxidhalterna ökar i stallets bortre del. System där gasen tillförs mitt på långsidan i munstycken (T-rör) med öppningar riktade mot var sin gavel (flöden c:a 600 kg/min) kan då ge en jämnare fördelning av koldioxiden. Öppningar till det fria • Om öppningar till det fria är stora sjunker koldioxidhalterna snabbt efter avslutad gastillförsel. • Övertrycket vid tillförsel av koldioxid behöver begränsas för att undvika risk för skador. Ett lämpligt övertryck bör rimligen vara av storleksordningen 25 – 100 Pa. Enligt överslagsberäkningar ger en öppningsarea på 25 respektive 50 cm2 per kg koldioxid som tillförs per minut upphov till ett tryckfall på c:a 100 respektive c:a 25 Pa. • Om öppningar till det fria kan stängas efter avslutad tillförsel av gas kan den ofrivilliga luftomsättningen hållas låg och gaskoncentrationen kan hållas hög under lång tid. • Spårgasmätningar och teoretiska beräkningar visar på att ofrivillig ventilation ökar kraftigt med ökande vind. Om det är kraftig vind, är små öppningar, som motsvarar tryckfall på c:a 100 Pa eller något mer att föredra. • Öppningar i tak är att föredra då de jämfört med öppningar i ytterväggarna ger avsevärt lägre ofrivillig luftomsättning efter att gas slutat tillföras. En sådan lägre luftomsättning innebär att gashalterna kan hållas höga under längre tid. • Öppningar nära platsen för inblåsning av koldioxid bör om möjligt undvikas då viss ökad risk för läckage av uteluft in i stallet kan finnas i denna zon. Övrigt: • De studerade fallen tyder på att erforderlig mängd koldioxid kan beräknas felaktigt, då folk kan missförstå formeln. Om 80 % koldioxid krävs kan texten: ”Mängden koldioxid (kg) för att uppnå 80 % koncentration kan beräknas med hjälp av formeln [stallvolym (m3) x 1,44]” kanske vara bättre. • Säkerhetsaspekter är viktiga och måste beaktas. Den djurhållare som genomför koldioxidavlivning av fjäderfä måste vara väl införstådd med riskerna och kunna förmedla detta till berörd personal och andra inblandade. Slutsatser och rekommendationer med avseende på djurvälfärdsaspekter • En checklista för djurhållare som ämnar genomföra koldioxidavlivning bör tas fram och distribueras, för att säkerställa att gasavlivningar av fjäderfä i stall genomförs på ett korrekt sätt och för att undvika misstag som kan medföra onödig fara eller skaderisk för människor, andra djur eller utrustning. • Veterinärens kontrollerande funktion bör stärkas med avseende på förberedelser inför gasning, såsom manipulering av ventilation, avskärmning framför gasinförseln samt tätning för att undvika gasläckage till anslutande avdelningar. Kompetensutveckling av veterinärerna är angeläget. • Rutiner för nödsituationer borde ses över och vidareutvecklas (såsom icke fullgod avlivningseffekt efter gasning samt åtgärder vid eventuellt gasläckage till andra avdelningar). • Djur som befinner sig i området nära platsen där gas tillförs löper risk att skadas av gasstrålen och i detta samt i andra kritiska områden finns risk för mycket låga temperaturer. Behovet av att spärra av området närmast införingsröret eller vidta andra motsvarande åtgärder måste därför betonas. • Mot bakgrund av resultaten från denna och andra studier kan omfattningen av det lidande som djuren genomgår i samband med planerad koldioxidavlivning i stallet anses vara mindre i förhållande till de alternativ som innebär hantering vid insamling, lastning, transport och slakt/avlivning på annan plats än i stallet under förutsättning att gasavlivningen utförts på ett korrekt sätt. Dock kan hävdas att perioder av potentiellt • Det finns ett stort behov av fortsa
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| 18. |
- Norström, Fredrik, et al.
(författare)
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Is mass screening for coeliac disease a wise use of resources? A health economic evaluation
- 2021
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Ingår i: BMC Gastroenterology. - : Springer Science and Business Media LLC. - 1471-230X. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Living with undiagnosed symptomatic coeliac disease is connected with deteriorated health, and persons with coeliac disease often wait a long time for their diagnosis. A mass screening would lower the delay, but its cost-effectiveness is still unclear. Our aim was to determine the cost-effectiveness of a coeliac disease mass screening at 12 years of age, taking a life course perspective on future benefits and drawbacks. Methods: The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model. As a basis for our assumptions, we mainly used information from the Exploring the Iceberg of Celiacs in Sweden (ETICS) study, a school-based screening conducted in 2005/2006 and 2009/2010, where 13,279 12-year-old children participated and 240 were diagnosed with coeliac disease, and a study involving members of the Swedish Coeliac Association with 1031 adult participants. Results: The cost for coeliac disease screening was 40,105 Euro per gained QALY. Sensitivity analyses support screening based on high compliance to a gluten-free diet, rapid progression from symptom-free coeliac disease to coeliac disease with symptoms, long delay from celiac disease with symptoms to diagnosis, and a low QALY score for undiagnosed coeliac disease cases. Conclusions: A coeliac disease mass screening is cost-effective based on the commonly used threshold of 50,000 Euro per gained QALY. However, this is based on many assumptions, especially regarding the natural history of coeliac disease and the effects on long-term health for individuals with coeliac disease still eating gluten.
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| 19. |
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| 20. |
- Rosén, Anna, et al.
(författare)
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Usefulness of symptoms to screen for celiac disease
- 2014
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 133:2, s. 211-218
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the frequency of symptoms and associated conditions among screening-detected celiac disease (CD) cases and non-CD children and to evaluate questionnaire-based case-finding targeting the general population.METHODS: In a population-based CD screening of 12-year-olds, children and their parents completed questionnaires on CD-associated symptoms and conditions before knowledge of CD status. Questionnaire data for those who had their CD detected in the screening (n = 153) were compared with those of children with normal levels of CD markers (n = 7016). Hypothetical case-finding strategies were also evaluated. Questionnaires were returned by 7054 (98%) of the children and by 6294 (88%) of their parents.RESULTS: Symptoms were as common among screening-detected CD cases as among non-CD children. The frequency of children with screening-detected CD was similar when comparing the groups with and without any CD-related symptoms (2.1% vs 2.1%; P = .930) or CD-associated conditions (3.6% vs 2.1%; P = .07). Case-finding by asking for CD-associated symptoms and/or conditions would have identified 52 cases (38% of all cases) at a cost of analyzing blood samples for 2282 children (37%) in the study population.CONCLUSIONS: The current recommended guidelines for finding undiagnosed CD cases, so-called active case-finding, fail to identify the majority of previously undiagnosed cases if applied in the general population of Swedish 12-year-olds. Our results warrant further studies on the effectiveness of CD case-finding in the pediatric population, both at the clinical and population-based levels.
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| 21. |
- Sandström, Glenn, et al.
(författare)
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Sex preference for children in German villages during the fertility transition
- 2015
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Ingår i: Population Studies. - : Routledge. - 0032-4728 .- 1477-4747. ; 69:1, s. 57-71
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Tidskriftsartikel (refereegranskat)abstract
- In the past, parents' sex preferences for their children have proved difficult to verify. This study used John Knodel's German village genealogies of couples married between 1815 and 1899 to investigate sex preferences for children during the fertility transition. Event history analyses of couples' propensity to progress to a fifth parity was used to test whether the probability of having additional children was influenced by the sex composition of surviving children. It appears that son preference influenced reproductive behaviour: couples having only girls experienced significantly higher transition rates than those having only boys or a mixed sibset. However, couples who married after about 1870 began to exhibit fertility behaviour consistent with the choice to have at least one surviving boy and girl. This result represents a surprisingly early move towards the symmetrical sex preference typical of modern European populations.
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| 22. |
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| 23. |
- Sandström, Olof, et al.
(författare)
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Five-year follow-up of new cases after a coeliac disease mass screening
- 2022
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Ingår i: Archives of Disease in Childhood. - : BMJ Publishing Group Ltd. - 0003-9888 .- 1468-2044. ; 107:6, s. 596-600
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We previously performed a population-based mass screening of coeliac disease in children aged 12 years in two birth cohorts resulting in 296 seropositive children, of whom 242 were diagnosed with coeliac disease after duodenal biopsies. In this follow-up study, we wanted to identify new cases in the screening population that tested negative-either converting from potential coeliac disease (seropositive but normal duodenal mucosa) or converting from seronegative at screening to diagnosed coeliac disease.METHODS: All seropositive children were invited to a follow-up appointment 5 years after the screening with renewed serological testing and recommended endoscopic investigation if seropositive. Seronegative children in the screening study (n=12 353) were linked to the National Swedish Childhood Coeliac Disease Register to find cases diagnosed in healthcare during the same period.RESULTS: In total, 230 (77%) came to the follow-up appointment, including 34 of 39 with potential coeliac disease. Of these, 11 (32%) had converted to coeliac disease. One new case was found in the National Swedish Childhood Coeliac Disease Register who received the diagnosis through routine screening in children with type 1 diabetes.CONCLUSIONS: There is a high risk of conversion to coeliac disease among those with potential disease. However, a negative screening test was associated with a very low risk for a clinical diagnosis within a follow-up period of 5 years.
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| 24. |
- Sandström, Olof, et al.
(författare)
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Transglutaminase IgA antibodies in a celiac disease mass screening and the role of HLA-DQ genotyping and endomysial antibodies in a sequential testing
- 2013
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 57:4, s. 472-476
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of this study was to evaluate hypothetical screening strategies in a Swedish celiac disease (CD) mass screening.Methods: Of 10,041 Swedish sixth graders born in 1993 invited to a population-based CD mass screening, 7208 participated. Anti-tissue transglutaminase (tTG) immunoglobulin (Ig) A were analyzed in all children and total serum IgA (s-IgA) in 7161 children. Additional analyses of tTG-IgG, endomysial antibodies (EMA) IgA and IgG, and human leukocyte antigen (HLA) alleles were performed according to a standardized protocol. Children with elevated levels of serological markers were recommended to undergo a small intestinal biopsy to verify diagnosis, and 153 children with CD were thus identified. Sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and receiver operating characteristic curves were plotted.Results: By lowering the cutoff for tTG-IgA, 17 additional cases of CD were identified at the cost of 32 biopsies. All children with tTG-IgA >50 U/mL (10 times the recommended upper limit of normal) had gluten enteropathy. Area under the receiver operating characteristic curve for tTG-IgA was 0.988. All cases carried HLA-DQ2 or HLA-DQ8, as did 53% of the controls. For different hypothetical screening strategies, sensitivity, specificity, PPV, and NPV ranged between 87.6% and 100%, 99.5% and 99.9%, 79.7% and 89.7%, and 99.7% and 100%, respectively. Efforts to increase sensitivity by lowering tTG-IgA cutoff would result in increased number of small intestinal biopsies and lower PPV. Sequential testing for both EMA and HLA-DQ genotyping would reduce the number of negative small intestinal biopsies.Conclusions: tTG-IgA is a robust marker when used in CD mass screening and its performance can be enhanced by sequential testing for EMA or HLA-DQ genotyping.
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| 25. |
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| 26. |
- Sjöberg, Veronika, et al.
(författare)
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Noncontaminated dietary oats may hamper normalization of the intestinal immune status in childhood celiac disease
- 2014
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Ingår i: Clinical and Translational Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 2155-384X. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Life-long, strict gluten-free diet (GFD) is the only treatment for celiac disease (CD). Because there is still uncertainty regarding the safety of oats for CD patients, the aim was to investigate whether dietary oats influence the immune status of their intestinal mucosa.METHODS: Paired small intestinal biopsies, before and after >11 months on a GFD, were collected from children with CD who were enrolled in a randomized, double-blind intervention trial to either of two diets: standard GFD (GFD-std; n=13) and noncontaminated oat-containing GFD (GFD-oats; n=15). Expression levels of mRNAs for 22 different immune effector molecules and tight junction proteins were determined by quantitative reverse transcriptase (RT)-PCR.RESULTS: The number of mRNAs that remained elevated was higher in the GFD-oats group (P=0.05). In particular, mRNAs for the regulatory T cell (Treg) signature molecules interleukin-10 (IL-10) and transforming growth factor-β1 (TGF-β1), the cytotoxicity-activating natural killer (NK) receptors KLRC2/NKG2C and KLRC3/NKG2E, and the tight junction protein claudin-4 remained elevated. Between the two groups, most significant differences were seen for claudin-4 (P=0.003) and KLRC3/NKG2E (P=0.04).CONCLUSIONS: A substantial fraction of pediatric CD patients seem to not tolerate oats. In these patients, dietary oats influence the immune status of the intestinal mucosa with an mRNA profile suggesting presence of activated cytotoxic lymphocytes and Tregs and a stressed epithelium with affected tight junctions. Assessment of changes in levels of mRNA for claudin-4 and KLC3/NKG2E from onset to after a year on oats containing GFD shows promise to identify these CD patients.
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| 27. |
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| 28. |
- Söderberg, Lotta, et al.
(författare)
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A Validation Study of an Interviewer-Administered Short Food Frequency Questionnaire in Assessing Dietary Vitamin D and Calcium Intake in Swedish Children
- 2017
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Ingår i: Nutrients. - : MDPI AG. - 2072-6643. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- Vitamin D and calcium are essential nutrients with a range of biological effects of public health relevance. This study aimed to validate a short food frequency questionnaire (SFFQ) against a three-day food record (3D record), assessing the intake of vitamin D and calcium in Swedish children during wintertime. In a double-blinded, randomized food-based intervention study on the effect of feeding different daily doses of vitamin D supplement to 5-7-year-old children (n = 85), 79 (93%) participants completed SFFQ1 at baseline and SFFQ2 after the intervention, and 72 were informed to fill in a 3D record. The 28 (39%) children who completed the 3D record were included in this validation study. The baseline level of serum-25 hydroxy vitamin D [S-25(OH)D] was used as a biomarker. The correlation between all three instruments were moderate to strong. SFFQ2 and the 3D record correlated moderately to S-25(OH)D. Bland-Altman analysis showed that SFFQ2 overestimated vitamin D intake by on average 0.6 mu g/day, (limits of agreement (LOA) 5.7 and -4.6 mu g/day), whereas the intake of calcium was underestimated by on average 29 mg/day, (LOA 808 and -865 mg/day). Finally, the validity coefficient calculated for vitamin D using the method of triad was high (0.75). In conclusion, this SFFQ, assessed by a dietician, is a valid tool to assess dietary vitamin D and calcium intake in groups of young children.
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| 29. |
- Vikström, Lotta, 1971-, et al.
(författare)
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Demographic outcomes during colonisation : Migration and mortality among indigenous and non-indigenous populations in nineteenth-century Sweden
- 2016
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Ingår i: Journal of Migration History. - : Brill Academic Publishers. - 2351-9916 .- 2351-9924. ; 2:1, s. 148-176
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Tidskriftsartikel (refereegranskat)abstract
- Due to insufficient historical population data, there is limited knowledge about the demographic outcomes of colonisation. This study provides demographic evidence of the difficulties faced by the Sami – an indigenous population in Sweden – during nineteenth-century colonisation, as indicated by (1) high risks of migration and (2) low survival rates compared to non-Sami. The digitised parish registers of the Demographic Data Base (Umeå University) provide longitudinal, individual-level data on migration, mortality, and ethnic origin. Event history analysis reveals that the Sami were vulnerable, with a higher mortality rate than non-Sami, and that they were more prone to migrate from areas overcrowded due to an increased competition for land. However, regardless of ethnic origin, it was primarily the settlers who migrated, and who ran the lowest mortality risks. This result suggests a ‘healthy settler effect’, and diverse consequences of colonisation that did not always follow ethnic lines.
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| 30. |
- Vikström, Lotta, 1971-, et al.
(författare)
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Demographic responses to colonization among indigenous populations : Migration and mortality in 19th century northernmost Sweden
- 2013
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Ingår i: XXVII IUSSP International Population Conference. ; , s. 221-221
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Although history shows how colonization has exposed indigenous populations to vulnerability, there is a narrow quantitative knowledge of how they demographically responded to colonization. Swedish parish registers are unique in providing longitudinal demographic data on the indigenous populations in northernmost Sweden: the Sami. The Demographic Data Base, Umeå University, has digitized these registers, which allows this study to conduct event history analyses of the Sami’s colonial experiences during the 19th century. If colonization added to the Sami’s difficulties to maintain their traditional use of land and lifestyle, it would be indicated by (1) untimely death among them; (2) a desire to leave their space as it was increasingly colonized. However, the propensity to depart was significantly higher among the Non-Sami people, primarily settlers, probably because it was a tough task to establish a farm in these remote cold areas. Additionally, ‘lock-in’ mechanisms might have reduced the Sami’s inclination to relocate, if this meant giving up a lifestyle and occupation difficult to perform in other settings. Their survival chances were higher than those of the Non-Sami, especially among women. In all, the findings propose that the Non-Sami individuals suffered from an ‘unhealthy migrant effect’.
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| 31. |
- Vikström, Lotta, 1971-, et al.
(författare)
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Was there any gendered preferences for children during the fertility transition? : Results from Germany 1825-1900
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Demographers demonstrate an increasing interest for studying parental gender preferences in developing countries and more developed societies. They find an association between the sex-composition of living offspring and the probability of having an additional child. In history, parents’ gender preferences have proven difficult to verify. This study makes use of John Knodel’s German village genealogies to obtain knowledge on this issue during a period of fertility transition, 1825-1900. Couples at first marriage who gave birth to minimum four children are targeted. Event history analyses (Cox regression models) of couples’ duration and propensity to progress to fifth parity, helps us to test if the probability to have additional children was influenced by the sex-composition of surviving children at lower parities. It appears that sex preferences for son(s) did influence parents’ reproductive behavior, as those having only girls experienced the highest transition rates to fifth parity. However, couples who married from approximately 1870 onward started to exhibit a fertility behavior that consistent with the desire to have at least one surviving boy and girl. That the gendered preferences became more symmetrical already during the fertility decline we view as an surprisingly early move toward a modern European pattern.
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| 32. |
- Webb, Charlotta, et al.
(författare)
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Accuracy in Celiac Disease Diagnostics by Controlling the Small-bowel Biopsy Process
- 2011
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Ingår i: JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION. - : Lippincott, Williams and Wilkins. - 0277-2116 .- 1536-4801. ; 52:5, s. 549-553
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: In a Swedish celiac disease screening study (Exploring the Iceberg of Celiacs in Sweden), we systematically reviewed the clinical diagnostic procedures with the aim to evaluate the diagnostic accuracy and to take advantage of lessons learned for improving diagnostic routines. Materials and Methods: A school-based celiac disease screening study involving 5 Swedish centers, with 10,041 invited 12-year-olds with 7567 consenting participation. All 192 children with elevated serological markers were recommended to undergo small-bowel biopsy, performed and evaluated according to local clinical routines. All of the mucosal specimens were reevaluated by 1 and, when needed, 2 expert pathologists to reach diagnostic consensus. Results: Small-bowel biopsies were performed in 184 children: 130 by endoscopy and 54 by suction capsule. Endoscopic biopsies were inconclusive in 0.6%, compared with 7.4% of biopsies by suction capsule. A patchy enteropathy was found in 9.1%. Reevaluation by the expert pathologist resulted in 6 additional cases with celiac disease and 1 cleared. Sixteen children with normal or inconclusive biopsies, 4 after endoscopy, and 12 after suction capsule were endoscopically rebiopsied, resulting in another 8 cases. The celiac disease prevalence of 30 of 1000 (95% confidence interval 26-34) was not statistically different from that previously reported. Conclusions: The present review revealed the importance of controlling each step of the diagnostic procedure. Several cases would have been missed by relying only on local routines. To improve the quality of childhood celiac disease diagnostics, we recommend multiple endoscopic biopsies from both proximal and distal duodenum and standardized evaluation by a pathologist with good knowledge of celiac disease.
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| 33. |
- Webb, Charlotta, et al.
(författare)
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Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening
- 2015
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 60:6, s. 787-791
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate any potential correlation between anti-tissue transglutaminase antibodies of type immunoglobulin A (tTG-IgA) and the degree of gluten induced enteropathy in children participating in a screening study for celiac disease (CD) and to assess to what extent the revised ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) guidelines cover this group of patients.METHODS: This is a sub-study of a cross-sectional CD screening study, ETICS (Exploring the Iceberg of Celiacs in Sweden), a two-phased study performed during 2005-2006 and 2009-2010. The 13,279 participating children had a blood test obtained and those with positive tTG-IgA were recommended a small intestinal biopsy. The tTG-IgA levels at the time of biopsy were compared with the assessment of the biopsy.RESULTS: There were 267 children included, of whom 230 were diagnosed with CD. Out of all children, 67 children had low tTG-IgA levels (<5 U/mL), whereof 55% had Marsh 3 lesions. All children with tTG-IgA levels exceeding 10 times the upper limit of normal values of 5 U/mL, i.e. 50 U/mL, were diagnosed with CD. Lowering the cut-off to 3 U/mL, all but one child with 30 U/mL got CD diagnosis.CONCLUSION: By adapting the revised ESPGHAN criteria, biopsies could have been omitted in a fourth of all cases. Our results indicate, that the criteria might be useful even on screened children. Further studies are needed to confirm whether the 2012 ESPGHAN guidelines should be revised to also apply to the populations being screened.
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| 34. |
- Webb, Charlotta, et al.
(författare)
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High adherence to a gluten-free diet in adolescents with screening-detected celiac disease
- 2015
-
Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 60:1, s. 54-59
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the gluten-free diet (GFD) adherenceafter one year of follow-up in children with screening-detected celiac disease (CD) in a general population. METHODS: A total of 18,325 12 year olds were invited to participate in apopulation-based CD screening (ETICS- Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This sub-study included the 210 children with TG2-IgAevaluated both at the initialbiopsy occasion and at the one-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193). RESULTS: After one year, 83% (179/210) had normalizedTG2-IgA levels (<5U/mL). Among those who had >50 U/mL at diagnosis,25% (16/63) still had elevated TG2-IgA but for the majority their initial values were more than halved. Most reported a high level ofGFD adherence ('always' 75%(158/193) and 'often' 14%(30/193)), and 75% (145/193) reported always adhereingcombined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely, however, a majority of these initially had the highestTG2-IgA levels. CONCLUSIONS: GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12yearolds. Almost all had normalized serology and reported GFD adherenceat the one-year follow-up. However, a few adolescents whoreported GFD adherence still had elevated TG2-IgA levelssuggesting more severe disease and/or non-adherence.
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| 35. |
- Öhman, May-Britt, 1966-, et al.
(författare)
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Designing Dam Safeties : Perspectives on large scale dams within the intra-actions of technology, nature and human decision making
- 2013
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Ingår i: International Commission of Large Dams, ICOLD, Seattle, 2013. - Seattle : ICOLD.
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Konferensbidrag (refereegranskat)abstract
- Analyzing the intra-actions between the actors involved, this paper presents results from interviews and participatory observations with local authorities, local inhabitants, power companies representatives as well as dam operators. We argue that the Swedish model for dam safety currently is suffering from a major deficiency as the expertise and understanding of the technical constructions remain among the dam owners and that the societal authority in charge of supervising the dam owners work have no capability of achieving the same level of understanding and thus to take informed and relevant decisions. Furthermore we argue that the lack of technical understanding of dams and hydropower outside of the dam sector has become a huge threat to dam safety as state representatives and political decision makers currently allow and even encourage mining exploitation both next to high risk classified hydropower dams and even within existing hydropower reservoirs.We argue that the actual challenge to safeguard an increased dam safety is by bridging the gap between the multitude of different actors– engineers/operators, users, political decision makers - in order to generate new understandings and new methodologies to deal with risk, safety and security. It is necessary to bridge the gaps between the sectors and actors involved, and that this should be done through investment in close collaboration between the dam sector and engineering research on the one hand and social sciences and humanities on the other – to ensure understandings of political decision making as well as of technical artifacts and water flows.The geographical focus is on two rivers – the Ume River and the Lule River in the north of Sweden. Both rivers are of major importance for national production of electricity, and the rivers are water suppliers for a large amount of inhabitants.
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| 36. |
- Öhman, May-Britt, 1966-, et al.
(författare)
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Designing Dam Safeties : Perspectives on Large Scale Dams within the Intra-actions of Technology, Nature and Human Decision-Making
- 2016
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Ingår i: International Journal of Disaster Risk Reduction. - 2212-4209.
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Tidskriftsartikel (refereegranskat)abstract
- Analyzing the intra-actions between the actors involved, this paper presents results from interviews and participatory observations with local authorities, local inhabitants, power companies representatives as well as dam operators. We argue that the Swedish model for dam safety currently is suffering from a major deficiency as the expertise and understanding of the technical constructions remain among the dam owners and that the societal authority in charge of supervising the dam owners work have no capability of achieving the same level of understanding and thus to take informed and relevant decisions. Furthermore we argue that the lack of technical understanding of dams and hydropower outside of the dam sector has become a huge threat to dam safety as state representatives and political decision makers currently allow and even encourage mining exploitation both next to high risk classified hydropower dams and even within existing hydropower reservoirs.We argue that the actual challenge to safeguard an increased dam safety is by bridging the gap between the multitude of different actors– engineers/operators, users, political decision makers - in order to generate new understandings and new methodologies to deal with risk, safety and security. It is necessary to bridge the gaps between the sectors and actors involved, and that this should be done through investment in close collaboration between the dam sector and engineering research on the one hand and social sciences and humanities on the other – to ensure understandings of political decision making as well as of technical artifacts and water flows.The geographical focus is on two rivers – the Ume River and the Lule River in the north of Sweden. Both rivers are of major importance for national production of electricity, and the rivers are water suppliers for a large amount of inhabitants.
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| 37. |
- Öhman, May-Britt, et al.
(författare)
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Supradisciplinary conversations on Security, Risk and Resilience around Dams in Sub Arctica
- 2010
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Ingår i: International Commission for Large Dams International Symposium.
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Konferensbidrag (refereegranskat)abstract
- Hydropower is often promoted as an environmentally friendly and renewable energy resource. Yet, it is since long established that this energy source indeed has numerous negative environmental impacts, and the negative social impacts have been established by researchers in several cases. At the same time it is an ageing technology, within which aging dams are confronting climate change with the result that it is a carrier of number of threats against both human security and sustainable development.The paper forms the basis for a recently launched research project involving four scientific disciplines - history of science and technology; political science; gender, technology and organization and land and water resource management. In the paper, the possibilities for a supradisciplinary approach to analyze the sociotechnical aspects of security, safety and risk in regard to large dams within Sub Arctica are discussed. Supradisciplinarity refers in this case to the involvement of both social and natural/technical sciences as well as the involvement of practitioners/constructors/dam owners etc and local inhabitants around the dams.In focus is the question on how the current narrow and technically oriented dam safety concept could or maybe should be broadened to include differing attitudes and values, from different perspectives depending on gender, ethnicity and situated knowledge.Empirical examples are drawn from on an ongoing study of the Lule River, the most hydroexploited river in Sweden, located within the Swedish part of Sapmi, within which local reindeer herders are being interviewed along with interviews with actors within the Swedish setting of dam safety. Departing from these empirical examples, attempts to identify the current understandings of the socio-technical constructions of dams, scientific perceptions of water flows and a changing climate within the framing of dam safety and discuss how can these understandings could be influenced by supradisciplinary conversations and exchange.
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| 38. |
- Özel, Faith, et al.
(författare)
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Exploring gender dysphoria and related outcomes in a prospective cohort study: protocol for the Swedish Gender Dysphoria Study (SKDS)
- 2023
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Ingår i: Bmj Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin. Methods and analysis The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022. Ethics and dissemination The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.
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