| 1. |
- Amoudruz, Petra, et al.
(författare)
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Maternal country of birth and previous pregnancies are associated with breast milk characteristics
- 2009
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 20:1, s. 19-29
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Tidskriftsartikel (refereegranskat)abstract
- Populations in high infectious exposure countries are at low risk of some immune-mediated diseases such as Crohn’s disease and allergy. This low risk is maintained upon immigration to an industrialized country, but the offspring of such immigrants have a higher immune-mediated disease risk than the indigenous population. We hypothesize that early life exposures in a developing country shape the maternal immune system, which could have implications for the offspring born in a developed country with a low infectious load. The aim of this study was to investigate if exposures in childhood (indicated by country of origin) and subsequent exposures influence immunologic characteristics relevant to stimulation of offspring. Breast milk components among 64 mothers resident in Sweden, 32 of whom immigrated from a developing country, were examined using the ELISA and Cytometric Bead Array methods. Immigrants from a developing country had statistically significantly higher levels of breast milk interleukin-6 (IL-6), IL-8 and transforming growth factor-β1. A larger number of previous pregnancies were associated with down-regulation of several substances, statistically significant for soluble CD14 and IL-8. The results suggest that maternal country of birth may influence adult immune characteristics, potentially relevant to disease risk in offspring. Such a mechanism may explain the higher immune-mediated disease risk among children of migrants from a developing to developed country. Older siblings may influence disease risk through the action of previous pregnancies on maternal immune characteristics.
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| 2. |
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| 3. |
- Bergqvist, L., et al.
(författare)
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Seeing through the blind! : ability of hospital staff to differentiate morphine from placebo, in neonates at a placebo controlled trial
- 2007
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 96:7, s. 1004-1007
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate whether professional training and/or clinical experience affect the ability of caregiver to assess clinical signs of pre-emptive morphine analgesia. METHODS: In the Neurological Outcomes & Pre-emptive Analgesia In Neonates trial preterm infants undergoing mechanical ventilation were randomized to receive continuous infusion, either of morphine or placebo blinded. Staff from centres in Sweden (Stockholm and Orebro) completed an assessment form. RESULTS: A total of 360 assessment forms were collected from 52 neonates. In 59% of the cases, caregivers correctly identified patients group. Comparable proportion of answers were correct between physicians, nurses and assistant nurses (63, 60 and 54%, respectively, p = 0.60). Staff with Neonatal intensive care unit experience <1 year identified 63%, as compared to 65% for working 1-5 year, and 55% that has been working >5 years (p = 0.28). Staff's ability to correctly identify group assignment was reduced by amount of additional morphine (p < 0.01) and severity of illness (p = 0.01). CONCLUSIONS: Clinical medical staffs, including neonatologists, have great difficulties in assessing the presence and severity of pain. Further studies should focus on the methods for assessment of prolonged pain in preterm neonates, define the effects of adequate analgesia, and investigate the clinical factors that may alter neonatal responses to acute and prolonged pain.
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| 4. |
- Björkman Hjalmarsson, Louise, 1984-
(författare)
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Aspects of neonatal septicaemia : prevention and complications
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Study I was part of the Extremely Preterm Infants in Sweden Study (EXPRESS), a prospective national study including all infants born <27 weeks in Sweden in 2004-2007 that survived their first year of life (n=497). Neonatal sepsis was evaluated as a risk factor for neonatal morbidities. Definite sepsis was associated with severe bronchopulmonary dysplasia and prolonged hospital stay, but not with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.Study II was a non-randomized single-centre intervention study evaluating possible preventive effects on coagulase-negative staphylococci (CoNS) sepsis when the scrub the hub method was used. During the intervention period, the incidence of CoNS sepsis decreased from 1.5% to 0% (CI: 0.53-2.58%, p=0.06).Study III was an in-vitro study evaluating leakage of isopropanol (IPA) and ethanol when alcohol caps and scrub the hub were used to disinfect hubs. Alcohol leakage was measured using gas chromatography. IPA was detected in all samples from cap circuits, and mean leakage increased over time. Ethanol levels were low, and scrub the hub therefore seems safe to use.Study IV was a survey study evaluating reported hygiene routines from Swedish neonatal intensive care units (NICUs) included in the EXPRESS study. Routines were compared between the EXPRESS period (2004- 2007) and 2013. Improvements were seen regarding basic hygiene routines, routines for work clothing, and follow-up of compliance. Antibiotic prophylaxis decreased while fungal prophylaxis increased, but the empiric treatment of suspected late-onset sepsis (LOS) showed heterogeneity.Study V investigated the association between incidence in LOS in the EXPRESS cohort and the hygiene routines previously evaluated in Study IV. Strict catheter routines, blood culture routines, and non-use of antibiotic prophylaxis were associated with decreased sepsis risk.
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| 5. |
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| 6. |
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| 7. |
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| 8. |
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| 9. |
- Björkqvist, Maria, 1959-, et al.
(författare)
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Colonization pattern of coagulase-negative staphylococci in preterm neonates and the relation to bacteremia
- 2010
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Ingår i: European Journal of Clinical Microbiology and Infectious Diseases. - : Springer. - 0934-9723 .- 1435-4373. ; 29:9, s. 1085-1093
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Tidskriftsartikel (refereegranskat)abstract
- Coagulase-negative staphylococci (CoNS) are the major cause of sepsis in extreme preterm (EPT) newborns, but data on the CoNS colonization in EPT newborns prior to invasive infection are limited. Our aim was to describe the early establishment of the CoNS microflora in EPT newborns and to compare the colonization pattern in neonates with and without positive CoNS blood cultures. From a cohort of 46 EPT neonates, newborns with positive CoNS blood culture were identified (n = 10) and compared with matched controls. Samples for bacterial cultures were obtained repetitively from nares, perineum, and umbilicus. All CoNS isolates were characterized using the PhenePlate system for biochemical fingerprinting. Persistent CoNS strains were found on day 2-3 after delivery in 7/20 newborns, and there was a tendency for earlier colonization in nares than in the perineum or umbilicus. The CoNS blood strains were prevalent in superficial sites prior to positive blood culture (11/14 blood strains), but no single invasive pathway was identified. Most CoNS blood strains (9/14) persisted on superficial sites after antibiotic treatment. We hypothesize that the invasive pathways in neonatal CoNS sepsis are complex and that the colonization of mucosal membranes and umbilical catheters might be of equal importance.
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| 10. |
- Björkqvist, Maria, et al.
(författare)
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Defective neutrophil oxidative burst in preterm newborns on exposure to coagulase-negative staphylococci
- 2004
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 55:6, s. 966-971
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Tidskriftsartikel (refereegranskat)abstract
- The neutrophil oxidative burst is a product of the regulated assembly of the multicomponent oxidase enzyme. Our aim was to compare the oxidative burst in term (n = 10) and preterm newborns <31 wk gestational age (n = 10) after stimulation with coagulase-negative staphylococci in vitro. Strains of Streptococcus epidermidis with different invasive and slime-producing properties, one strain of S. haemolyticus, and one strain of group B-streptococcus were investigated. A whole-blood flow cytometric assay using the oxidation of hydroethidine to ethidium bromide was used. The oxidative activity in unstimulated neutrophil granulocytes [polymorphonuclear leukocytes (PMNLs)] was similar in term and preterm newborns, but the preterm newborns showed a significantly lower capacity to up-regulate the oxidative burst intensity after bacterial stimulation (p = 0.004). In the term but not in the preterm group, the oxidative burst intensity after bacterial stimulation correlated with the baseline oxidative burst intensity. After bacterial stimulation, there was a trend toward a greater percentage of activated neutrophils in the term group than in the preterm group, but the difference was less pronounced than that in oxidative burst intensity. Significant differences in oxidative burst response to different bacterial strains were observed (p < 0.001), but the differences could not be correlated exclusively to invasive capacity or slime-producing properties. It is concluded that the baseline oxidative activity is similar in term and preterm PMNLs but that preterm PMNLs have a decreased capacity to increase the oxidative burst in response to bacterial stimulation.
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| 11. |
- Björkqvist, Maria, et al.
(författare)
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Phenotypic and genotypic characterisation of blood isolates of coagulase-negative staphylococci in the newborn
- 2002
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Ingår i: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS). - : Wiley. - 0903-4641 .- 1600-0463. ; 110:4, s. 332-339
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Tidskriftsartikel (refereegranskat)abstract
- Coagulase-negative staphylococci (CNS) are the leading cause of late-onset sepsis in newborns (>72 h of age). Our aim was to determine whether phenotypic and/or genotypic differences existed between blood isolates of CNS regarded as inducers of sepsis or as contaminants. Ninety-seven bloodisolates of CNS recovered from newborns at the neonatal intensive care unit, Örebro, Sweden in 1983–1997 were analysed. Twenty-nine of them (30%) were classified as sepsis isolates and 68 (70%) as contaminants. The most prevalent species was Staphylococcus epidermidis (n=59). Staphylococcus haemolyticus (n=16) was most often isolated from newborns with the lowest gestational age and birth weight. Biochemical typing using the Phene Plate system (PhP) and genotyping using pulsed-field gel electrophoresis (PFGE) showed that the S. epidermidis isolates regarded as inducers of sepsis (n=16) were more homogeneous than isolates considered contaminants (n=37). One main genotypic group, representing seven (44%) isolates, was identified among the sepsis isolates. Phenotypically the S. epidermidis sepsis isolates comprised three major clusters. In contrast, among the S. epidermidis contaminants, eight genotypic groups and two phenotypic clusters were identified. The dominating genotypic group among the sepsis isolates of S. epidermidis may represent strains with higher invasive capacity.
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| 12. |
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| 13. |
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| 14. |
- Eriksson, Mats, 1959-, et al.
(författare)
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Oral glucose and venepuncture reduce blood sampling pain in newborns
- 1999
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Ingår i: Early Human Development. - 0378-3782 .- 1872-6232. ; 55:3, s. 211-218
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Tidskriftsartikel (refereegranskat)abstract
- The objectives of this study were to measure pain symptoms in healthy fullterm newborns undergoing routine blood sampling with different methods. The 120 study subjects were randomly allocated to one of four groups with 30 babies in each, namely venepuncture or heel stick, with or without oral glucose administration. Pain was assessed from the duration of crying within the first 3 min, the Premature Infant Pain Profile (PIPP) and changes in heart rate. When the babies received 1 ml 30% glucose prior to skin puncture there was no significant difference between the heel stick and venepuncture group either in mean crying time (12.9 and 11.6 s, respectively) or in PIPP score (3.9 and 3.3). When no glucose was given crying time was 57.3 s in the heel stick group and 26.8 s in the venepuncture group (P=0.0041) and the mean PIPP scores were 8.4 and 6.0, respectively (P=0.0458). This study suggests that if oral glucose is given prior to skin puncture the choice of blood sampling method has no impact on the pain symptoms.
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| 15. |
- Eriksson, Mats, 1959-, et al.
(författare)
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Skin conductance compared to a combined behavioural and physiologicalpain measure in newborn infants
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:1, s. 27-30
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To assess the ability of galvanic skin response (GSR) to differentiate between tactile and painful stimulation in newborn infants, and to compare this with the ability of the premature infant pain profile (PIPP). METHODS: Thirty-two healthy full-term infants undergoing routine blood sampling were recruited. In a randomized order they were subjected to tactile and painful stimulation. The three GSR variables conductance baseline level, number of waves per second and mean amplitude of the waves were recorded together with the behavioural and physiological variables of PIPP. RESULTS: The GSR variables number of waves and amplitude of the waves increased more during painful stimulation than during tactile stimulation, as did also the PIPP score. Receiver operating characteristic curves analysis revealed no significant differences between the studied methods. CONCLUSION: GSR can differentiate painful from tactile stimulation, but more research is needed to achieve a clinically useful application.
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| 16. |
- Falk, Gabriella, 1955-, et al.
(författare)
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Teenage mothers : a high-risk group for new unintended pregnancies
- 2006
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Ingår i: Contraception. - : Elsevier BV. - 0010-7824 .- 1879-0518. ; 74:6, s. 471-475
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.PURPOSE: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.METHODS: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.RESULTS: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.
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| 17. |
- Frid, Christina, 1952-
(författare)
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Children with Down syndrome - : an epidemiological study with special focus on congenital heart defects
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- To assess the impact of congenital malformations in Down syndrome (DS) on morbidity, mortality and outcome at birth, information on all children with DS born in the northern part of Sweden in 1973-80 (n=211) and 1995-98 (n=88) was collected. Most common were congenital heart defects (CHD), dominated by atrioventricular septal defects (AVSD). Up to age 10 years, morbidity and mortality were more than 10 times higher in DS children with CHD than in healthy DS children. The DS children seemed more vulnerable at birth than Swedish children in general: they had increased frequencies of Cesarean sections, premature birth, asphyxia, and low birthweight, and higher proportions of children small for gestational age, regardless of the presence of CHD. Infant mortality decreased from 14.2% to 2.3% between the two periods.All children with AVSD with and without DS born in Sweden 1973-1997 (n=801) were followed up retrospectively to 2001. Children with isolated AVSD without complex additional CHDs were studied more closely (n=502). A reduction in age at operation and postoperative mortality (from 28 to 1%) was observed. No significant difference in 5-year postoperative mortality between genders or between DS and non-DS children was found. The 5-year postoperative mortality in DS decreased from 35% in 1973-77 to about 10% in 1993-97. CHD had a major influence on morbidity, infectionrate and mortality in DS, but not on DS birth variables. The formerly high mortality in CHD is now reduced. In isolated AVSD measures seem equally successful in DS and non-DS children. Mortality is still 3 times higher in DS children with isolated AVSD than in healthy DS children.
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| 18. |
- Fridström, Margareta, et al.
(författare)
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Evaluating Emdogain and healing of replanted teeth using an intra-individual experimental-control study design
- 2008
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Ingår i: Dental Traumatology. - : Wiley. - 1600-4469 .- 1600-9657. ; 24, s. 299-304
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present investigation was to use an intra-individual experimental-control study design to explore if application of Emdogain prior to re-plantation after a dry extra-alveolar period of 60 min would promote a favorable healing of the periodontal ligament cells. Ten patients, for whom already decisions had been taken to extract two maxillary premolars because of crowding, participated in the study. The teeth were extracted and endodontic treatment was performed extra orally. The experimental tooth and its alveolar socket were covered with Emdogain prior to replantation. The contra lateral tooth served as a control and was replanted without any prior treatment. The teeth were stabilized with a retainer for 3-7 days and the patients were followed up every third week. After 13 weeks, the teeth were finally extracted and prepared for histological examination. Radiographs were taken before the study period, at day 29 and prior to the final extraction. The results were in favor of Emdogain, but the overall difference between the Emdogain-treated tooth and its control was rather small, and it seemed questionable if the registered differences could be of any obvious practical clinical importance. Histologically, all the teeth showed some degree of pathology after such a long dry extra-oral time and the outcome seemed to be more correlated to the individual than to the treatment. Given more favorable conditions regarding storage medium and/or extra-oral time, Emdogain might still be of value for an uncomplicated healing after replantation.
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| 19. |
- Gradin, Maria, et al.
(författare)
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Feeding and oral glucose : additive effects on pain reduction in newborns
- 2004
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 77:1-2, s. 57-65
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study were to compare the pain reducing effect of oral glucose with that of being breast-fed shortly before venipuncture in newborns, and also the pain score and crying time with parents' assessment.Design: Randomised, controlled trial.Subjects: 120 full term newborns undergoing venipuncture randomly assigned to on of four groups: I, Breast-fed and 1-ml placebo; II, Breast-fed and 1-ml 30% glucose; III, Fasting and 1-ml placebo; and IV, Fasting and 1-ml 30% glucose.Outcome measures: Pain during venipuncture was measured with the Premature Infant Pain Profile (PIPP). Crying time was recorded. The parents assessed their babies' pain on a Visual Analogue Scale (VAS).Results: The PIPP score was significantly lower in the infants receiving glucose, than in those not given glucose (p=0.004). There was no significant difference in PIPP score between the infants who were fed and the fasting infants. The PIPP score was lower in group II (median 7) than in group I (md 10). There was a similar difference between group IV (md 9) and group III (md 11). The median crying times during the first 3 min in groups I, II, III, and IV were 63, 18, 142 and 93 s, respectively. There was low agreement between the parents' assessment of pain and the PIPP score and crying time.Conclusion: Breast-feeding shortly before venipuncture has no major impact on the pain score but on crying time. The combination of oral glucose and breast-feeding shows the lowest pain score and significantly shorter duration of crying.
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| 20. |
- Gradin, Maria, 1963-, et al.
(författare)
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Pain reduction at venipuncture in newborns : oral glucose compared with local anesthetic cream
- 2002
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 110:6, s. 1053-1057
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Tidskriftsartikel (refereegranskat)abstract
- Objective. A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.Methods. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.Results. There were no differences in background variables between the 2 groups.The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.Conclusions. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.
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| 21. |
- Gradin, Maria, et al.
(författare)
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The role of endogenous opioids in mediating pain reduction by orally administered glucose among newborns
- 2005
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 115:4, s. 1004-1007
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Tidskriftsartikel (refereegranskat)abstract
- Objective. It has been demonstrated clearly that sweet-tasting solutions given before a painful intervention can reduce pain among newborns. There is no fully accepted explanation for this effect, but activation of endogenous opioids has been suggested as a possible mechanism. The aim of this study was to obtain deeper knowledge of the underlying mechanism by investigating whether administration of an opioid antagonist would reduce the effect of orally administered glucose at heel stick among term newborns.Design. A randomized, placebo-controlled, double-blind trial with a validated, neonatal, pain-rating scale.Participants. The trial included 30 term newborns undergoing heel stick, who were assigned randomly to 1 of 2 groups, ie, group I, with naloxone hydrochloride (opioid antagonist) 0.01 mg/kg administered intravenously before oral administration of 1 mL of 30% glucose, or group II, with a corresponding amount of placebo (saline solution) administered intravenously before oral administration of glucose.Outcome Measures. Pain-related behavior during blood sampling was measured with the Premature Infants Pain Profile. Crying time and heart rate were also recorded.Results. The 2 groups did not differ significantly in Premature Infant Pain Profile scores during heel stick. The median crying time during the first 3 minutes was 14 seconds (range: 0–174 seconds) for the naloxone group and 105 seconds (range: 0–175 seconds) for the placebo group. There was no significant difference in heart rate between the 2 groups.Conclusion. Administration of an opioid antagonist did not decrease the analgesic effect of orally administered glucose given before blood sampling.
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| 22. |
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| 23. |
- Hjalmarsson, Louise Björkman, et al.
(författare)
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Leakage of isopropanol from port protectors used in neonatal care-Results from an in vitro study
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 15:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: To decrease contamination of needleless catheter hubs, caps or port protectors impregnated with isopropanol (IPA) have been developed and shown to be superior to other disinfection methods. The safety of the caps has been questioned, as they can be associated with alcohol leakage across the hub membrane.Objectives: We evaluated the use of IPA caps and the scrub-the-hub method from the safety standpoint of possible alcohol leakage across the hub membrane.Methods: Circuits imitating an intravenous line were constructed. Circuits with an IPA cap were flushed with sodium chloride after the hub had been exposed to the cap for 1 hour, 24 hours, and 7 days. At the end of each period the fluid was collected and amounts of IPA in it were measured, using gas chromatography. Scrub circuits without IPA caps were also tested and ethanol from these was measured using the same method.Results: In this in vitro study, IPA was detected in all samples from cap circuits, and ethanol was detected from all scrub circuits. Leakage increased over time in IPA circuits. After 24 hours and 7 days of exposure, the first injection resulted in higher amounts of IPA; thereafter, the levels decreased. The amounts of ethanol measured from the scrub circuits were low.Conclusions: IPA caps can cause leakage of alcohol across the hub membrane. Leakage increased over time, and a 30 sec drying time was not sufficient to solve the problem. Scrub-the-hub seems safe to use with regard to alcohol leakage.
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| 24. |
- Holmlund, U., et al.
(författare)
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Maternal country of origin, breast milk characteristics and potential influences on immunity in offspring
- 2010
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Ingår i: Clinical and Experimental Immunology. - Oxford, Untited Kingdom : Wiley-Blackwell Publishing Inc.. - 0009-9104 .- 1365-2249. ; 162:3, s. 500-509
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Tidskriftsartikel (refereegranskat)abstract
- Breast milk contains pro- and anti-inflammatory cytokines and chemokines with potential to influence immunological maturation in the child. We have shown previously that country of birth is associated with the cytokine/chemokine profile of breast milk. In this study we have investigated how these differences in breast milk affect the cellular response of cord blood mononuclear cells (CBMCs) and intestinal epithelial cells (IECs, cell line HT-29) to microbial challenge. Ninety-five women were included: 30 from Mali in West Africa, 32 Swedish immigrants and 33 native Swedish women. CBMCs or IECs were stimulated in vitro with breast milk, alone or in combination with lipopolysaccharide (LPS) or peptidoglycan (PGN). Breast milk in general abrogated the LPS-induced down-regulation of surface CD14 and Toll-like receptor (TLR)-4 expression on CB monocytes, while inhibiting the PGN-induced TLR-2 up-regulation. However, breast milk from immigrant women together with LPS induced a lower CBMC release of interleukin (IL)-6 (P = 0 center dot 034) and CXCL-8/IL-8 (P = 0 center dot 037) compared with breast milk from Swedish women, while breast milk from Swedish women and Mali women tended to increase the response. The same pattern of CXCL-8/IL-8 release could be seen after stimulation of IECs (HT-29). The lower CBMC and IEC (HT-29) responses to microbial compounds by breast milk from immigrant women could be explained by the fact that breast milk from the immigrant group showed a divergent pro- and anti-inflammatory content for CXCL-8/IL-8, transforming growth factor-beta 1 and soluble CD14, compared to the other two groups of women. This may have implications for maturation of their children's immune responses.
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| 25. |
- Ivarsson, Mikael, et al.
(författare)
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Staphylococcus epidermidis and Staphylococcus aureus trigger different interleukin-8 and intercellular adhesion molecule-1 in lung cells : implications for inflammatory complications following neonatal sepsis
- 2013
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 102:10, s. 1010-1016
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Staphylococci are a major contribution for neonatal sepsis, which is the main risk factor for bronchopulmonary dysplasia. This study investigated the expression of pro-inflammatory mediators in endothelial and respiratory cells from newborns exposed to staphylococci.Methods: Human vascular endothelial cells and small airway epithelial cells were incubated with neonatal blood isolates of Staphylococcus epidermidis (n = 14) and Staphylococcus aureus (n = 14). The extracellular release of IL-8, IL-10, sICAM-1, ICAM-1 mRNA and the expression of membrane bound ICAM-1 were assessed by ELISA, RT-PCR and immunofluorescence microscopy.Results: Staphylococcus epidermidis induced higher levels of IL-8 (mean 38.5 ng/mL) and ICAM-1 mRNA (mean ratio 1.037) in the small airway epithelial cells than S. aureus (IL-8 mean 22.2 ng/mL, p < 0.01 and ICAM-1 mRNA mean ratio 0.715, p < 0.01). In the endothelial cells, ICAM-1 remained more integrated in the cell membranes after exposure to S. epidermidis compared with S. aureus, which induced disintegration and release of soluble ICAM-1 into the supernatants.Conclusion: Staphylococcus epidermidis induced a higher chemoattractive response than S. aureus. A persistent transmigration of granulocytes into the lung tissue in neonatal S. epidermidis sepsis might contribute to the development of bronchopulmonary dysplasia.
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| 26. |
- Jackson, Karin, 1947-
(författare)
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Att vara förälder till ett för tidigt fött barn : en prospektiv studie om upplevelsen av föräldraskap och möten med vården
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present doctoral thesis focuses mainly on the experiences of 20 women and men of becoming and being parents of a prematurely born child and on their perceptions of their contacts with health and medical care services. An additional aim was to investigate the utilisation of health care during the first year of life and its relation to high-risk diagnoses in the neonatal period.Data were obtained by interviews of the 20 sets of parents to infants born at a gestational age of <34 weeks with no serious congenital defects. These parents were interviewed 1-2 weeks after the infant’s birth and at 2, 6 and 18 months of age. The interview texts were subjected to phenomenological and content analysis. Data was also obtained from the records of 36 infants born at a gestational age of <31 weeks and with a birth weight of <1500 g and 36 full-term infants. The records included information regarding contact with health care services including the child health centres (CHCs) and the outpatient clinics of the paediatric and ophthalmic clinics. Finally data from the other two quantitative studies were obtained from three questionnaires: Quality of Care from The Patient’s Perspective, The Swedish Parenthood Stress Questionnaire and The Toddler Behaviour Questionnaire.The result of the studies showed that the utilisation of health care by the very low birth weight infants was higher than that by the fullterm infants in paediatric and ophthalmic outpatient clinics. High-risk diagnoses in the neonatal period did not correlate with utilisation of care except for visits to the paediatric outpatient clinic, especially planned visits.The internalisation of parenthood was described by the parents as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity.The development and construction of the mothers’ and fathers’ parental identity followed a pattern that could be summarised into three themes: Unexpected start of parenthood, integration of parenthood into the sense of identity and recognition of parental identity. Important turning points in experiences of parenthood often occurred when the infant could be removed from the incubator, when it was discharged from the ward, and when the infant appeared normal compared to full-term infants.The quality of care was judged, from the parents’ and nurses’ perspective. In general the subjective importance of the given care was rated higher than the care actual given in both neonatal care and care at the CHCs. Higher ratings were given to neonatal care compared with the care at CHSs for medico-technical competence. It was also of importance, of both parents, to receive an optimal identity-oriented approach and socio-cultural atmosphere in the neonatal care and the care at the CHSs. High-risk diagnoses in the newborn did not affect the answers.Parental stress of very preterm children, at 18 months of age, did not differ notably from those parents of children born somewhat less premature, but they assessed their children as being rather later in the development of social behaviours. Parents of children who had had a difficult neonatal period were not more stressed when the child was 18 months old than those who had no problems in the neonatal period.In sum, this research project showed that the parents’ expectations and experiences of becoming mothers and fathers in preterm birth was a process of integrating the unexpected start of parenthood into the parents’ sense of identity and their way of being. When the parents developed a relationship with the infant, actively participated in its care on the basis of their own preferences, and received recognition as parents, this process was strengthened. It is therefore important that the professional caring of the staff should meet and involve the natural caring of the parents.
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| 27. |
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| 28. |
- Jackson, Karin, 1947-, et al.
(författare)
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From alienation to familiarity : experiences of mothers and fathers of preterm infants
- 2003
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 43:2, s. 120-129
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The birth of a preterm infant has a long-term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse.AIM: The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life.METHODS: Seven consecutively selected sets of parents of preterm infants born at FINDINGS: Internalization of parenthood was described as a time-dependent process, with four syntheses of experiences - alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full-term infants.CONCLUSIONS: The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents' expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.
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| 29. |
- Jackson, Karin, 1947-, et al.
(författare)
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Parental stress and toddler behaviour at age 18 months after pre-term birth
- 2007
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Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 96:2, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.
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| 30. |
- Jackson, Karin, 1947-, et al.
(författare)
-
Quality of care of the preterm infant : the parent and nurse perspective
- 2006
-
Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 95:1, s. 29-37
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.
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| 31. |
- Jackson, Karin, et al.
(författare)
-
Quality of care of the preterm infant--the parent and nurse perspective.
- 2006
-
Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 95:1, s. 29-37
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs. METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care. RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs. CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.
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| 32. |
- Jackson, Karin, 1947-, et al.
(författare)
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Utilization of healthcare by very-low-birthweight infants during their first year of life
- 2001
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 90:2, s. 213-217
-
Tidskriftsartikel (refereegranskat)abstract
- New knowledge in perinatal medicine has resulted in increased survival of very-low-birthweight (VLBW) infants. After leaving hospital, the child is seen at regular medical check-ups, but there is often a persistent worry about the child which affects the family as a whole. This can lead to an increased utilization of healthcare. Our objective was therefore to describe the utilization of healthcare by VLBW infants during their first year of life and its relation to high-risk diagnoses in the neonatal period. The study group comprised 36 infants born at gestational ages of < or = 31 wk and with a birthweight of < or = 1500 g, and was compared with a control group of 36 full-term infants. Utilization of healthcare by the VLBW infants was higher than that by the control group in paediatric and ophthalmic outpatient clinics. The total number of contacts with healthcare was on average 38.7 versus 17.4. High-risk diagnoses in the neonatal period did not correlate with utilization of care, except for visits to the paediatric outpatient clinic, especially planned visits. Further studies focusing on how to support these families after leaving hospital are therefore needed.
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| 33. |
- Liljedahl, Magnus, et al.
(författare)
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Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia : a pilot study
- 2008
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Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 97:7, s. 909-914
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).Methods: Children born at ≤ 30 weeks 1994–2000 were investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.
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| 34. |
- Lindgren, Stefan, et al.
(författare)
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Starten på det yrkeslivslånga lärandet som läkare - Den nya svenska grundutbildningen i ett internationellt perspektiv
- 2019
-
Ingår i: Läkartidningen. - 0023-7205. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- The Swedish Parliament and Government has recently sanctioned a new 6 year undergraduate medical degree leading directly to license, followed by a 12 month introduction to work as a certified doctor. The undergraduate education is internationally harmonized and the 23 learning outcomes address competence needs in future Swedish and international health-care. Particular attention is given to professional competence, critical thinking, team-work and health promotion. All 23 learning outcomes must be documented before the University can issue a MD degree. After license, the doctor applies for a 12 month introduction to employment as doctor in the Swedish health-care system. This introduction is mandatory for all, regardless of the country where the license was issued. The introduction comprises clinical service in general medicine, emergency medicine and elective disciplines. Assessment of 10 learning outcomes is carried out in a formative wav by experienced and trained clinicians during the clinical service. After the introduction, the doctor is duly qualified to apply for specialist training.
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| 35. |
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| 36. |
- Nahmias, André J., et al.
(författare)
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Evolutionary-developmental perspectives on immune system interactions among the pregnant woman, placenta, and fetus, and responses to sexually transmitted infectious agents
- 2011
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Ingår i: The evolution of infectious agents in relation to sex. - Oxford : Blackwell Science. - 9781573318198 ; , s. 25-47
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- A balance has evolved over deep time between the various immune systems of the "triad" that is linked together for a short period: the pregnant woman, the fetus, and the placenta. This balance is affected by, and helps to determine, the immune responses to maternal infectious agents that may be transmitted to the fetus/infant transplacentally, intrapartum, or via breast milk. This review identifies newer evolutionary concepts and processes related particularly to the human placenta, innate and adaptive immune systems involved in tolerance, and in responses to sexually transmitted infectious (STI) agents that may be pathogenic to the fetus/infant at different gestational periods and in the first year of life. An evolutionary developmental (EVO-DEVO) perspective has been applied to the complexities within, and among, the different actors and their beneficial or deleterious outcomes. Such a phylogenetic and ontogenic approach has helped to stimulate several basic questions and suggested possible explanations and novel practical interventions.
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| 37. |
- Navér, Lars, et al.
(författare)
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Profylax mot RS-virusinfektion
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99, s. 170-171
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 38. |
- Ohlin, Andreas
(författare)
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Aspects on early diagnosis of neonatal sepsis
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents four studies, all designed to improve the problematic diagnostic situation concerning infants with suspected sepsis. Study I included 401 neonates with suspected sepsis. Nine signs of sepsis and C-reactive protein were prospectively recorded and logistic regression was used to assess associations between these signs and a subsequently confirmed diagnosis of sepsis. C-reactive protein and five of the clinical signs were statistically significantly associated with a positive bloodculture. When the material was stratified by gestational age, differences between premature and full term infants were detected.Studies II and III were prospective studies that used samples collected from neonates with suspected sepsis to evaluate a novel real-timepolymerase chain reaction (PCR) method. The results where compared with simultaneously collected blood cultures. Study II used plasma samples and resulted in a sensitivity of 42% and specificity of 95%. In study III, the protocol was improved and adapted to whole blood samples which resulted in a sensitivity of 79% and specificity of 90%. Both protocols included species-specific probes and study III indicated that PCR has the potential to detect bacteria in culture-negative sepsis.Staphylococcus epidermidis is the most common pathogen in neonatal sepsis, but there is still a lack of typing methods suitable for large materials of S. epidermidis. In Study IV we therefore evaluated a new S. epidermidisgenotyping method based on PCR for the repeat regions of four genes thatencode for cell wall anchoring proteins. The method was applied to 49well-defined neonatal blood isolates of S. epidermidis. The combination ofsdrF and aap seemed to be optimal, resulting in a diversity index of 0.92.Conclusions• Bradycardia, apnoea, low blood pressure, feeding intolerance and distended abdomen are obvious early signs of neonatal sepsis. Premature and full-term infants differ in terms of the signs they display in neonatal sepsis.• Blood is superior to plasma for developing PCR methods for bacterial DNA detection. The PCR method described in study III can detect neonatal bacteraemia, but it can be further improved before it is used in routine care.• There has been a lack of useful typing methods for S. epidermidis.We can now present PCR of the genes for the cell wall anchoring proteins sdrF and aap as a novel and feasible approach when there is a need to type a large number of S. epidermidis isolates.
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| 39. |
- Ohlin, Andreas, et al.
(författare)
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Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
- 2010
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Ingår i: Acta Paediatrica. - Malden, USA : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 99:11, s. 1635-1640
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.
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| 40. |
- Ohlin, Andreas, et al.
(författare)
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Diagnosis of neonatal sepsis by broad range 16S real-time PCR
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.
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| 41. |
- Ohlin, Andreas, et al.
(författare)
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Diagnosis of neonatal sepsis by broad-range 16S real-time polymerase chain reaction
- 2012
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Ingår i: Neonatology. - Basel, Switzerland : Karger. - 1661-7800 .- 1661-7819. ; 101:4, s. 241-246
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Tidskriftsartikel (refereegranskat)abstract
- Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 16S polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis. Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Methods: Immediately after blood culture, a study sample of 0.5–1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis. Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PCR (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample. Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics.
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| 42. |
- Ohlin, Andreas, et al.
(författare)
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Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
- 2008
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Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 97:10, s. 1376-1380
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.
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| 43. |
- Ohlin, Andreas, 1972-, et al.
(författare)
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Sepsis as a risk factor for neonatal morbidity in extremely preterm infants
- 2015
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 104:11, s. 1070-1076
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.
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| 44. |
- Peerzada, Jehanna M., et al.
(författare)
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Delivery room decision-making for extremely preterm infants in Sweden
- 2006
-
Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 117:6, s. 1988-1995
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess neonatologists' attitudes and practices regarding treatment of extremely preterm infants in the delivery room, particularly in response to parental wishes. STUDY DESIGN: Cross-sectional survey of all neonatologists in Sweden registered with the Swedish Pediatric Society. RESULTS: The response rate was 71% (88 of 124 neonatologists). At 24[1/7] to 24[6/7] weeks of gestation, 68% of neonatologists considered treatment clearly beneficial; at 25[1/7] to 25[6/7] weeks of gestation, 93% considered it clearly beneficial. When respondents consider treatment clearly beneficial, 97% reported that they would resuscitate in the delivery room despite parental requests to withhold treatment. At or below 23[0/7] weeks of gestation, 94% of neonatologists considered treatment futile. Nineteen percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, 99% reported that they would resuscitate when parents request it, 99% reported that they would resuscitate when parents are unsure, and 25% reported that they would follow parental requests to withhold treatment. CONCLUSION: Although neonatologists' attitudes and practices varied, respondents to our survey in general envisioned little parental role in delivery room decision-making for extremely preterm infants.
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| 45. |
|
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| 46. |
- Schollin, Jens, 1949-, et al.
(författare)
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Starten på det yrkeslivslånga lärandet som läkare : [A new internationally harmonized Swedish basic medical education]
- 2019
-
Ingår i: Läkartidningen. - : läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 116:35-36
-
Tidskriftsartikel (refereegranskat)abstract
- The Swedish Parliament and Government has recently sanctioned a new 6 year undergraduate medical degree leading directly to license, followed by a 12 month introduction to work as a certified doctor. The undergraduate education is internationally harmonized and the 23 learning outcomes address competence needs in future Swedish and international health-care. Particular attention is given to professional competence, critical thinking, team-work and health promotion. All 23 learning outcomes must be documented before the University can issue a MD degree. After license, the doctor applies for a 12 month introduction to employment as doctor in the Swedish health-care system. This introduction is mandatory for all, regardless of the country where the license was issued. The introduction comprises clinical service in general medicine, emergency medicine and elective disciplines. Assessment of 10 learning outcomes is carried out in a formative wav by experienced and trained clinicians during the clinical service. After the introduction, the doctor is duly qualified to apply for specialist training.
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| 47. |
- Schollin, Kristoffer, 1971, et al.
(författare)
-
Goda och onda medhjälpare — Är du socialt adekvat, lille vän? Om Pirate Bay-målets betydelse
- 2011
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Ingår i: Svensk Juristtidning. - 0039-6591. ; 2011:5-6
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Svea hovrätt dömde nyligen de ansvariga för webbsidan The Pirate Bay för medverkan till upphovsrättsintrång. Denna artikel behandlar två rättsfrågor som aktualiseras av hovrättens dom: 1. Hur ska den sociala adekvansen hos digitala mötes- och söktjänster av Pirate Bays slag bedömas? 2. Hur ska ansvarsfrihetsbestämmelserna i e-handelslagen tillämpas i förhållande till digitala tjänster av Pirate Bays slag? Mot bakgrund av hur hovrätten formulerar sina domskäl blir det mycket svårt för någon tillhandahållare av mötes- och söktjänster på Internet att undkomma subjektiv täckning för medhjälp till upphovsrättsintrång. Den avgörande prövningen av huruvida en tillhandahållare av sådana tjänster ska anses ansvarig som medhjälpare till upphovsrättsintrång förläggs i stället till den objektiva sidan av brottet. Frågan om ansvar för medhjälp till upphovsrättsintrång blir närmare bestämt en fråga om mötes- och söktjänsters sociala adekvans. I denna artikel framhålls ett antal aspekter av stor betydelse för bedömningen, som inte framkommer i hovrättsdomen. På motsvarande sätt framhålls i artikeln ett antal aspekter, inte minst av europarättslig karaktär, relevanta för tillämpningen av e-handelslagen vilka återstår att ta itu med.
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| 48. |
- Stenberg, Reidun, 1954-
(författare)
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Dietary antibodies and gluten related seromarkers in children and young adults with cerebral palsy
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background & Aims: Cerebral palsy (CP), the most common physical disorder in children that affect motor function, is associated with a low weight and height. Celiac disease (CD), an autoimmune disorder precipitated by ingestion of gluten, is another common chronic disease in children that has a negative impact on growth. Based on our findings in a small pilot study, antibodies against gluten, dietary antigens and antibodies against transglutaminase 6(TG6) a new possible gluten related neurological marker have been investigated in an extended group of children with CP. The main aim of this thesis was to find out if the children with elevated gluten related antibodies have enteropathy consistent with CD and if they have antibodies to other dietary antigens as well. We further wanted to study if elevated levels of antibodies were associated to their weight, subtypes of CP and also to investigate if there were an association between the brain damage seen in CP and antibodies against TG6.Methods: Ninety nine children with CP and matched (study4) controls (study3) were analysed for antibodies against gluten, TG6, egg white, lacto-globulin, casein and wheat. Small bowel biopsies were analysed in the majority of the children with antibody positivity, both by routine procedures and by extended analyse (study 2).Results: Significantly elevated levels of gluten related seromarkers and antibodies against casein, lacto globulin and egg white were found in the CP-group compared to matched controls. The overall elevated levels of antibodies were more frequent in the tetraplegic (TP) and dyskinetic (DK) CP -subtypes having the most severe neurologic handicap and undernourishment. Routine and extended small bowel biopsies analysis did not indicate an increased prevalence of CD. Elevated antibodies against TG6 were found in the CP-group and significantly in the tetraplegic CP-subgroup.Conclusion: Children with CP do not have increased prevalence of celiac disease but have elevated levels of gluten related seromarkers as well as antibodies against other dietary proteins compared to matched controls. There was a correlation between underweight, CP-subtypes (TP/DK) and occurrence of the tested antibodies suggesting disturbed intestinal permeability related to underweight. Compared to controls TG6 autoantibodies were found in the TP-subtype of CP that could be a result due to the brain damage.
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| 49. |
- Stenberg, Reidun, et al.
(författare)
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Increased Prevalence of Anti-gliadin Antibodies and Anti-tissue Transglutaminase Antibodies in Children With Cerebral Palsy
- 2009
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Ingår i: JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION. - : Lippincott Williams & Wilkins. - 0277-2116 .- 1536-4801. ; 49:4, s. 424-429
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Tidskriftsartikel (refereegranskat)abstract
- Aim and Objective: The aim of the study was to investigate whether there is any association between cerebral palsy (CP) and celiac disease(CD) in children. Patients and Methods: Ninety children between 18 months and 18 years of age (median 9 years) with CP were included. Antibodies (IgA and IgG) against gliadin (AGA), endomysium (EMA), and tissue transglutaminase (tTG) were measured. Children with elevated levels of these antibodies were offered a small-bowel biopsy. Results: Thirty-nine children showed an elevated level of 1 or more of the tested antibodies (43%). None had raised EMA antibodies. Presence of tetraplegia or dyskinesia was associated with increased antibody levels (P=0.045), as was a more severe functional type of CP (P=0.008). Children with elevated antibodies had a lower body weight (P=0.049), height (P=0.041), and body mass index (BMI) (P=0.014). Small-bowel biopsies were performed in 27 out of 39 children; 1 had CD and 2 had intraepithelial lymphocytosis. Conclusions: A large number of children with CP had elevated AGA and/or anti-tTG. Because these elevations were associated with lower weight, height, and BMI, it seemed of interest to speculate on how these findings correlated to CP and CD. However, we found no correlation between CP and CD.
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| 50. |
- Stenberg, Reidun, et al.
(författare)
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Is there a connection between severe cerebral palsy and increased gluten sensitivity?
- 2007
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Ingår i: Acta Paediatrica. - Oslo : Taylor & Francis. - 0803-5253 .- 1651-2227. ; 96:1, s. 132-134
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Tidskriftsartikel (refereegranskat)abstract
- In nine children with severe cerebral palsy (CP), feeding difficulties and poor development of weight and height, laboratory markers for metabolic and enteral dysfunction were studied. CONCLUSION: Four of the nine patients with CP had increased levels of antigliadin antibodies AGA (IgA), a finding which calls for further studies concerning the possible connection between increased celiac markers and CP.
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