| 1. |
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| 2. |
- Espinosa, Alexander, et al.
(författare)
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Loss of the lupus autoantigen Ro52/Trim21 induces tissue inflammation and systemic autoimmunity by disregulating the IL-23-Th17 pathway
- 2009
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Ingår i: Journal of Experimental Medicine. - : Rockefeller University Press. - 0022-1007 .- 1540-9538. ; 206:8, s. 1661-1671
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Tidskriftsartikel (refereegranskat)abstract
- Ro52/Trim21 is targeted as an autoantigen in systemic lupus erythematosus and Sjögren's syndrome. Polymorphisms in the Ro52 gene have been linked to these autoimmune conditions, but the molecular mechanism by which Ro52 may promote development of systemic autoimmune diseases has not been explored. To address this issue, we generated Ro52-null mice (Ro52(-/-)), which appear phenotypically normal if left unmanipulated. However, Ro52(-/-) mice develop severe dermatitis extending from the site of tissue injury induced by ear tags. The affected mice further develop several signs of systemic lupus with hypergammaglobulinemia, autoantibodies to DNA, proteinuria, and kidney pathology. Ro52, which was recently identified as an E3 ligase, mediates ubiquitination of several members of the interferon regulatory factor (IRF) family, and the Ro52-deficient mice have an enhanced production of proinflammatory cytokines that are regulated by the IRF transcription factors, including cytokines involved in the Th17 pathway (interleukin [IL] 6, IL-12/IL-23p40, and IL-17). Loss of IL-23/IL-17 by genetic deletion of IL-23/p19 in the Ro52(-/-) mice conferred protection from skin disease and systemic autoimmunity. These data reveal that the lupus-associated Ro52 protein is an important negative regulator of proinflammatory cytokine production, and they provide a mechanism by which a defective Ro52 function can lead to tissue inflammation and systemic autoimmunity through the IL-23-Th17 pathway.
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| 3. |
- Falkevall, Annelie, et al.
(författare)
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Reducing VEGF-B Signaling Ameliorates Renal Lipotoxicity and Protects against Diabetic Kidney Disease
- 2017
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Ingår i: Cell Metabolism. - : Elsevier BV. - 1550-4131 .- 1932-7420. ; 25:3, s. 713-726
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Tidskriftsartikel (refereegranskat)abstract
- Diabetic kidney disease (DKD) is the most common cause of severe renal disease, and few treatment options are available today that prevent the progressive loss of renal function. DKD is characterized by altered glomerular filtration and proteinuria. A common observation in DKD is the presence of renal steatosis, but the mechanism(s) underlying this observation and to what extent they contribute to disease progression are unknown. Vascular endothelial growth factor B (VEGF-B) controls muscle lipid accumulation through regulation of endothelial fatty acid transport. Here, we demonstrate in experimental mouse models of DKD that renal VEGF-B expression correlates with the severity of disease. Inhibiting VEGF-B signaling in DKD mouse models reduces renal lipotoxicity, re-sensitizes podocytes to insulin signaling, inhibits the development of DKD-associated pathologies, and prevents renal dysfunction. Further, we show that elevated VEGF-B levels are found in patients with DKD, suggesting that VEGF-B antagonism represents a novel approach to treat DKD.
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| 4. |
- Förlin, Lars, et al.
(författare)
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Effektscreening – Biologisk effektövervakning i förorenade områden längs Sveriges kust 2017–2018
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Undersökningarna visar att samtliga metoder inklusive undersökningar av hälsotillståndet hos fisk, fortplantning och biomarkörer hos vitmärla, lysosomal membranstabilitet hos mussla och imposex hos snäckor med få undantag visade på tydliga effekter i de åtta undersökta och förorenade områdena längs Sveriges kuster. En jämförelse mellan de olika metoderna visar, med undantag för området i Uddevalla/Byfjorden, en tydlig påverkan i resterande undersökta områdena. I Byfjorden noterades mindre stressade musslor och endast låga stadier av imposex hos snäckor medan fiskhälsan kunde konstateras vara påverkad. Utöver Byfjorden gjordes undersökningar med mer än en av metoderna även i Sundsvallsfjärden, Norrsundet, Bråviken, Ronnebyåns mynning och Landskrona. I dessa områden visar jämförelsen mellan metoderna att samtliga indikerar en tydlig påverkan. Att samtliga metoder ger utslag beror sannolikt på att alla valda undersökningsområden har en mycket komplex och ganska påtaglig föroreningsbelastning vilket innebär att det kan förväntas att de flesta organismer som lever i dessa områden kan uppvisa effekter som kan härledas till påverkan av miljöstörande ämnen.I Sverige är den nationella effektbaserade miljöövervakningen i marin miljö väsentligen inriktad på att undersöka effekter av miljögifter i referensområden. Sådana områden karakteriseras av att de ska ligga på stort avstånd från större befolkningscentra och industrier, eller till exempel inte ligga nära stora flodmynningar. Resultaten från denna studie kompletterar den ordinarie miljöövervakningen i referensområden och visar med stor tydlighet att de undersökta områdena är källor för miljöstörande ämnen till vattenmiljön. Undersökningarna visar också att det är önskvärt att kontinuerlig biologisk effektövervakning kommer igång i något eller några påverkade områden inom ramen för den nationella miljöövervakningen för att parallellt följa förändringar i miljön nära eller en bit från påtagliga, mer eller mindre kontinuerliga föroreningskällor i vårt samhälle. Detta skulle också komplettera Sveriges internationella rapportering av miljödata genom att förutom att rapportera effektdata från referensområden även kunna rapportera data från påverkade/förorenade områden.
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| 5. |
- Gunnarsson, Iva, et al.
(författare)
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Histopathologic and clinical outcome of rituximab treatment in patients with cyclophosphamide-resistant proliferative lupus nephritis
- 2007
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Ingår i: Arthritis and Rheumatism. - : John Wiley & Sons. - 0004-3591 .- 1529-0131. ; 56:4, s. 1263-1272
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Rituximab is a monoclonal antibody directed against the CD20 marker of B cells. Because of its ability to deplete B lymphocytes, it has been suggested that the drug could be of benefit in B cell-dependent diseases, including systemic lupus erythematosus (SLE). The purpose of this study was to investigate the histopathologic and clinical effects of combination treatment with rituximab and cyclophosphamide (CYC) in patients with CYC-resistant proliferative lupus nephritis.METHODS: Seven female patients with proliferative lupus nephritis were treated with rituximab in combination with CYC. Renal biopsies were performed before treatment and during followup. SLE activity was evaluated by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the British Isles Lupus Assessment Group index. In 6 of the 7 patients, immunostaining of lymphocyte subpopulations in the renal tissue was performed before treatment and during followup.RESULTS: At 6 months of followup, significant clinical improvement was noted, with a reduction in SLEDAI scores (from a mean of 15 to 3), anti-double-stranded DNA antibody levels (from a mean of 174 IU/ml to 56 IU/ml), and anti-C1q antibody levels (from a mean of 35 units/ml to 22 units/ml). On repeat renal biopsy, improvement in the histopathologic class of nephritis occurred in a majority of patients, and a decrease in the renal activity index was noted (from 6 to 3). A reduction in the number of CD3, CD4, and CD20 cells in the renal interstitium was noted in 50% of the patients on repeat biopsy.CONCLUSION: At 6 months of followup, all patients had responded both clinically and histopathologically to combination therapy. For patients with proliferative lupus nephritis who fail to respond to conventional immunosuppressive therapy including CYC, combined treatment with rituximab and CYC may constitute a new treatment option.
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| 6. |
- Johansson Niemelä, Birgitta, 1948-, et al.
(författare)
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A Clinical Report : Mental health, Self-esteem and Social Interaction in Adolescents with CL/P in the Context of Re-constructive Surgery
- 2011
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Ingår i: Depression and anxiety (Print). - 1091-4269 .- 1520-6394. ; 1:102
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Tidskriftsartikel (refereegranskat)abstract
- Background:Self-esteem in children and adolescents with deviances in function and appearance has been studied with diverse results. The effect of cleft lip/ and palate on mental health, self-esteem and social interaction were studied in the context of reconstructive surgery. Comparing parents’ and children’s’ self-esteem reports was also of interest. Exploring these differences could help the understanding of future mental health in patients with CL/P and their need for reconstructive surgery. Methods:A descriptive study within an in-patient setting, Plastic Surgery Clinic, Uppsala University Hospital. Twenty-six CL/P patients between 13 and 19 years of age and their parents answered a specific condition questionnaire specially adapted for this study and Beck’s Youth Inventories the day before reconstructive surgery. Results:Mental health was affected while self-esteem was on a median-high level for this CL/P group. Parents rated their children to have higher self-esteem as they grew older. However, females reported a diminished level from primary to secondary school age. Attention on CLP was high. Twenty-three adolescents, or 85 % of resondents, wanted to change their appearance, Conclusion:Mental health was affected by CL/P, especially for those children that had been bullied. Specifically, the wish to change appearance was associated with high level of anxiety and depression. The specific condition questionnaires proved to be more informative than the standardized measure regarding self-esteem under development for the sake of differentiating between parent-adolescent estimation of self-esteem.
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| 7. |
- Johansson Niemelä, Birgitta, et al.
(författare)
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Does Leg Lengthening Pose a Threat to a Child’s Mental Health? : An Interim Report one year after surgery
- 2007
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Ingår i: Journal of Pediatric Orthopaedics. - 0271-6798 .- 1539-2570. ; 27:6, s. 611-617
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies suggest that children react with functional and psychological disturbances after leg lengthening (LL). Long-term effects are not known, and there is a lack of prospective studies. The aim of this interim prospective study was to investigate the psychological impact of the Ilizarov technique on a sample of children 1 year after surgery. Methods: The subjects were 27 patients aged 6 to 16 years treated using the Ilizarov technique at the Pediatric Orthopaedic Department, Uppsala University Hospital, between 1997 and 2005. A control group of healthy children matched for age and sex were also included. Semistructured interviews and psychometric measures (anxiety, depression, self-esteem, behavior) were administered to patients and parents before surgery and 1 year after. Psychological measures were correlated with medical records (days of hospitalization, gained length, etc). The control group was examined at initial assessment only. Results: Before reconstructive surgery, the LL group had a significantly lower self-esteem compared with the control group. Aggressive behavior, attention and externalization problems, anxiety, and depression were significantly reduced after LL. Parents' state anxiety was also reduced. There were no differences in trait anxiety between the parents of patients and the parents of the control children. Conclusions: Patients reported pain, psychological discomfort, complications, and restrained function during LL. However, there were no adverse psychological effects at 1-year follow-up; rather, there were signs of improved mental health. No single psychological parameter could predict the outcome after LL.
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| 8. |
- Johansson Niemelä, Birgitta, 1948-
(författare)
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Mental Health in Children Undergoing Reconstructive Surgery : Studies on Self-Esteem and Social Interaction
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- While the functional and anatomical aspects of reconstructive surgery in children with leg length inequality (LLI), prominent ears (PE) and cleft lip and palate (CLP) have been studied in detail, the psychological aspects of surgery have been less explored. The benefit of a changed appearance and function on self-esteem and ability to social interaction are other areas where information is lacking. The aim of this thesis is to examine, during the process of reconstructive surgery, the mental health, self-esteem and social interaction of children with defects in appearance and function.Children, aged 6-16 years, with LLI (n=27) and PE (n=31) were invited to participate in interviews and psychological assessments by filling in a battery of questionnaires and tests (depression; anxiety; self-esteem; cognitive ability; and behaviour) before Ilizarov and otoplasty surgery and one year after. Parents filled in a child symptom check list and a state and trait anxiety questionnaire. Another six adolescents with CLP and their parents participated in interactive interviews with the aim of identifying relevant psychological issues for individuals with this condition. These issues were subsequently used to create new questionnaires. Being different, the development of self-esteem and social interaction were the central themes of the questionnaires designed after the interview study. The new questionnaires were explored in a retrospective study on other adolescents (n=26) with CL/P and their parents. Beck’s Youth Inventories (BYI) was used as comparative data.The LLI group had significantly lower mental health and self-esteem scores than the control group before surgery. The leisure activity level in both patient groups was low according to parents’ report before surgery. The mental health scores of both patient groups (LLI and PE) were improved after reconstructive surgery, but self-esteem was not affected. The questionnaires for CL/P patients proved to be useful in the exploration of self-esteem from a developmental perspective and in the search for strengthening factors of social interaction. Self-esteem was average or high on group level for adolescents with CL/P compared to BYI measure. Parents rated their adolescents to have higher self-esteem than the adolescents themselves. Females had a less positive development of self-esteem, there was an interaction effect between the female and male patients’ evaluation of self-esteem by higher age. Even a minor appearance defect like PE may affect mental health negatively. There were no adverse psychological effects one year after surgery in LLI and PE patients, rather, there were signs of improved mental health. Adolescents with CL/P have an anticipated risk of more mental health problems and especially those individuals who have been bullied. Cleft teams and Child and Adolescent Psychiatric Clinics should be attentive and offer psychological support to those individuals most affected by their conditions.
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| 9. |
- Johansson Niemelä, Birgitta, et al.
(författare)
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Prominent Ears : The Effect of Reconstructive Surgery on Self-Esteem and Social Interaction in Children with a Minor Defect Compared to Children with a Major Orthopedic Defect
- 2008
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Ingår i: Plastic and reconstructive surgery (1963). - 0032-1052 .- 1529-4242. ; 122:5, s. 1390-98
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Tidskriftsartikel (refereegranskat)abstract
- Background: In a prospective study of patients with prominent ears, the effect of reconstructive surgery on self-esteem and social interaction was examined 1 year after surgery.Methods: Of 42 patients with prominent ears aged 7 to 15 years, 21 were matched with a comparison group of orthopedic patients (leg lengthening) and a control group of schoolchildren. Psychological measures evaluated self-esteem, depression, anxiety, cognition, parents' ratings of child behavior and symptoms, and parent anxiety. Semistructured interviews with the child and parents were also conducted.Results: The motivation to be operated on was pain, teasing, and feelings of being different. The satisfaction rate with the result of reconstructive surgery was high. The psychological measures of the prominent ears group had results close to those of the control group, although the leg lengthening group had lower self-esteem and higher depression and anxiety scores. With few exceptions, all patients had scores within the normal range on self-rating scales. Parents reported less activity at leisure time in both patient groups than in the control group. After surgery, parents reported improved behavior on the Child Behavior Checklist total problem score.Conclusions: Patients with minor defects had fewer self-reported psychological and behavior problems than the major defect group. Interestingly, prominent ears patients also had low activity levels. Reconstructive surgery had no adverse effect on the prominent ears patients in this interim study but rather resulted in improved well-being. It is important to investigate further the effect of reconstructive surgery on children's self-esteem and social interaction.
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| 10. |
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| 11. |
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| 12. |
- Jónsdóttir, Thórunn, et al.
(författare)
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Long-term follow-up in lupus nephritis patients treated with rituximab : clinical and histopathological response
- 2013
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Ingår i: Rheumatology. - : Oxford University Press. - 1462-0324 .- 1462-0332. ; 52:5, s. 847-855
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the long-term clinical, histological and serological affects of B-cell-depleting therapy (BCDT) in patients with LN refractory to conventional treatment.METHODS: Twenty-five patients, followed for a mean time of 36 months (9-95 months), were included. Renal disease activity was evaluated with the BILAG index and renal response was determined according to the LN European consensus statement. Renal biopsies were performed for histological evaluation at baseline and follow-up.RESULTS: Partial response (PR) or complete renal response (CR) was observed in 22 of 25 after a median of 12 months. Sixteen patients achieved CR after a median of 24 months. Six patients experienced a renal relapse. Proteinuria decreased significantly (P = 0.0002) from baseline to 36 months. A noteworthy histological improvement was seen in nearly all patients with a significant reduction in activity index (P = 0.01). Longer depletion time and low baseline values of IgM were indicative of achieving clinical remission during the first year after treatment (P = 0.03 and P = 0.04, respectively).CONCLUSION: In therapy-resistant LN, BCDT induced clinical and histological improvements in the majority of patients. Transition from PR to CR was mainly seen during the second year of follow-up. Patients with longer depletion time and low baseline levels of IgM were more likely to gain a faster remission, suggesting that the clinical benefit may be linked to suppression of autoreactive plasmablasts. Although formal evidence of BCDT in LN is lacking, our data may provide guidance to clinicians considering therapeutic options in patients with refractory LN.
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| 13. |
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| 14. |
- Lasaitiene, Daina, 1970, et al.
(författare)
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Tubular mitochondrial alterations in neonatal rats subjected to RAS inhibition.
- 2006
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Ingår i: American journal of physiology. Renal physiology. - : American Physiological Society. - 0363-6127 .- 1931-857X .- 1522-1466. ; 290:5
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Tidskriftsartikel (refereegranskat)abstract
- Pharmacological interruption of the angiotensin II (ANG II) type 1 receptor signaling during nephrogenesis in rats perturbs renal tubular development. This study aimed to further investigate tubular developmental defects in neonatal rats subjected to ANG II inhibition with enalapril. We evaluated tubular ultrastructural changes using electron microscopy and estimated spectrophotometrically activity or concentrations of succinate dehydrogenase (SDH), cytochromes a and c, which are components of mitochondrial respiratory chain, on postnatal days 2 and 9 (PD2 and PD9). Renal expression of sodium-potassium adenosinetriphosphatase (Na(+)-K(+)-ATPase) and two reflectors of mitochondrial biogenesis [mitochondrial transcription factor A (TFAM) and translocase of outer mitochondrial membrane 20 (TOM20)] also were studied using Western immunoblotting and immunohistochemistry. Enalapril disrupted inner mitochondrial membranes of developing cortical and medullary tubular cells on PD2 and PD9. These findings were paralleled by impaired mitochondrial respiratory function, as revealed from the changes in components of the mitochondrial respiratory chain, such as decreased cytochrome c level in the cortex and medulla on PD2 and PD9, decreased cytochrome a level in the cortex and medulla on PD2, and diminished cortical SDH activity on PD2 and PD9. Moreover, tubular expression of the most active energy-consuming pump Na(+)-K(+)-ATPase was decreased by enalapril treatment. Renal expression of TFAM and TOM20 was not altered by neonatal enalapril treatment. Because nephrogenesis is a highly energy-demanding biological process, with the energy being utilized for renal growth and transport activities, the structural-functional alterations of the mitochondria induced by neonatal enalapril treatment may provide the propensity for the tubular developmental defect.
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| 15. |
- Lundberg, Ulf, et al.
(författare)
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Arbetsmiljöns betydelse för ryggproblem : En systematisk litteraturöversikt
- 2014
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Rapport (refereegranskat)abstract
- The Swedish Council on Health Technology Assessment (SBU) conducted a systematic literature review of research on the association between occupational exposures and back disorders. In this review, we use back disorders as an umbrella term to include the more specific terms back trouble (a subjective experience of pain, ache or discomfort in the back), symptoms of sciatica, intervertebral disc changes and diseases of the back. The report is focused on disorders of the thoracic and lumbar spine. A wide range of occupational exposures were investigated, including: physical work load, vibration, organizational and psychosocial factors, chemical and biological factors, noise, environmental factors and contagious substances.Background: Since 2011 SBU has had a mandate from the Swedish government to systematically assess the evidence associating occupational exposures to health issues. The objective of this review was to assess the scientific basis describing the influence of occupational exposures on back disorders. Back disorders are common. Between 60 and 70 percent of the general population world-wide suffer from back pain at least once in their life. For affected individuals, back disorders are the source of both suffering and decreased functioning. The costs to society are also considerable in terms of direct health care costs, financial support to individuals with work disability, as well as costs due to loss of production.Method: A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to an occupational context. A literature search covering years 1980 to January 2014 was conducted in international medical and occupational data bases. The review assessed almost 8 000 abstracts. Studies that fulfilled strict inclusion criteria were assessed for relevance and quality, using pre-set protocols. Relevance and quality assessments were conducted by two experts, working in an evaluation pair. After conducting independent assessments, the two experts had to agree on a mutual relevance and quality classification. Some articles required that all exporters participated in discussion and made a collective assessment. A total of 109 studies were classified as moderate or high quality, representing more than 150 000 study participants. The strength of the scientific evidence was assessed with the GRADE system.Results: There is an association between occupational exposure and back disorders. This result is based on investigations of a large variety of work environments, mainly in Europe and North America. In most studies passing the quality criteria, researchers investigated occupational exposure and back disorders in populations consisting of both women and men with at least one year of follow up.Conclusions: People in the following groups develop more back trouble over time than those who are not subjected to the specified exposure at work:– Those who work with manual handling (e.g. lift) or in a posture where the back is bent or rotated– Those who work in a kneeling or squatting posture, or have physically demanding work tasks– Those exposed to whole body vibration– Those who experience work as mentally stressful; or those who find their work demanding, but lack decision latitude (personal control of their own working situation); or those who have insufficient opportunities for personal development– Those who work outside standard office hours.In some work environments, people have less back trouble. Those who experience high influence over work-related decisions, those who get social support at work and those with high job satisfaction develop less back trouble than others.Women and men with similar occupational exposures develop back troubles to the same extent.Those who work in forward bent postures or are exposed to whole body vibration in their work develop more symptoms of sciatica than others, while those with high job satisfaction develop less such symptoms. Those whose work entails manual handling develop more intervertebral disc changes than others.This systematic literature review has uncovered a substantial body of knowledge concerning occupational exposures and back disorders. Future research should include intervention studies, i.e. studies that scientifically test the effect of well defined interventions on back disorders over extended periods of time in authentic work situations.Project groupExperts: Karin Harms-Ringdahl (Chair), Sven Ove Hanson (Ethics), Olle Hägg, Ulf Lundberg, Svend Erik Mathiasen, Gunnevi Sundelin, Magnus Svartengren, and Hans Tropp.SBU: Charlotte Hall (Project Director), Karin Stenström (Assistant Project Director), Agneta Brolund (Information Specialist), Therese Kedebring (Project Administrator), Laura Lintamo (Investigator), Maria Skogholm (Project Administrator), Lena Wallgren (Scientific Writer)Scientific reviewers: Eva Denison, Mats Hagberg, Gunnar Nemeth, Esa-Pekka Takala.
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| 16. |
- Löf, Marie, 1970-, et al.
(författare)
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Biomarker-enhanced assessment of reproductive disorders in Monoporeia affinis exposed to contaminated sediment in the Baltic Sea
- 2016
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Ingår i: Ecological Indicators. - : Elsevier BV. - 1470-160X .- 1872-7034. ; 63, s. 187-195
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Tidskriftsartikel (refereegranskat)abstract
- Introducing biomarkers into monitoring programs requires understanding of their responses in relation to higher-level biological effects as well as modulating effects of confounding environmental factors. We evaluated relationships between the general toxicity biomarkers (acetylcholinesterase [AChE], lysosomal membrane stability [LMS], oxygen radical absorbance capacity [ORAC]) and reproductive performance (fecundity and embryo aberrations) in the amphipod Monoporeia affinis in the Baltic Sea. To further link biomarker response to contaminant (PCBs, PAHs and metals) levels in the surrounding sediments as well as environmental factors (salinity, bottom depth and total organic carbon in sediments [TOC]), correlation and partial least square regression (PLSR) analyses were applied. The observed contaminants levels were frequently elevated for heavy metals and PAHs, but not PCBs. In the amphipod populations, female ORAC values were positively related to the occurrence of females carrying malformed or membrane-damaged embryos and to the percentage of such embryos in their broods, but also to the fecundity. Female AChE activity was negatively related to the frequency of the membrane-damaged embryos, and positively to the frequency of embryos with arrested development in the broods. Moreover, higher AChE activity and ORAC values in the females occurred at elevated concentrations of metals and PAHs, while there was a negative correlation between embryo ORAC and some PCB congeners. The PLSR models explained over 80% of the variation in the female ORAC and AChE values by variation in contaminant concentrations in combination with environmental variables. Specifically, CB180 and PAM4,9 were identified as negative predictors for ORAC, whereas many PAHs and some metals were positive predictors. The AChE activity was positively related to some metals and negatively to PCBs. In the PLSR models, environmental factors had significant modulating effects, with positive effect of salinity on female ORAC and AChE, and negative effect of TOC on the AChE. The LMS data were less informative, with no apparent relation to any of the contaminants. Linking subcellular responses to the reproduction effects facilitates environmental stress assessment and understanding of the response mechanisms, but also calls for more experimental and field data providing a mechanistic understanding to these linkages.
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| 17. |
- Oldfors Engström, Lena, 1948-
(författare)
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Att förstå patienters bristande deltagande i individualiserat rehabiliteringsprogram
- 2002
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this investigation was to elucidate and describe those patients who had discontinued their participation and/or paticipated infrequently in physiotherapy treatment based on their own activity and responsibility. The ambition was to understand the phenomenon of compliance/adherence from various perspectives in behavioural as well as social science.In study I the phenomenon compliance/adherence was studied in relation to Health Locus of Control and Health Belief variables. This study was based on a questionnaire that was answered by all patients before beginning of treatment. Questions concerning the patients´conceptions about both health locus of control and health beliefs were the focus.The definitions of compliance/adherence were completed treatment period and exercise frequency, respectively. Those patients who completed the treatment were also studied regarded exercise frequency.The results of study I showed that those who discontinued their treatment reported a higher perceived threat from their health condition (higher level of dysfunction (higher pain intensity) and a higher perceived severity of their health condition (higher level of dysfunction, worse general health) than those who completed treatment. The results also showed that those who exercised once a week or less often valued the significance of the caring situation as lower (HLC), perceived a higher threat from their health condition (higher pain intensity), a higher severity of their health condition (higher level of dysfunction, worse general health, greater distrution of impairment), more barriers to treatment (lower expectations), and had certain differences in demographic variables (younger individuals, more women) than those who exercised more often (HB).Study II investigated patients´descriptions of their reasons for discontinuing the treatment, whether those reasons varied, and if so how they varied. Sixteen patients who had discontinued their treatment were interviewed with open-ended questions. The inteviews began with a question about the background to the physiotherapy treatment. There were questions concerning carrying out the treatment as well as concerning what they thought about their impairment. The patients were also asked about their priotities in daily life, as these wre presumed to be anobstacle to the treatment over a shorter or longer period of time. The third domain concerned how they experiebced the patient/physiotherapist relationship. The interviews were anlysed qualitatively.Analysis of study II resulted in four different descriptions of reasons for treatment discontinuation. A) It was about time to end treatment and continue on alone. B) The treatment was not the most important activity to spend time on. C) An agreement with the physiothreapist to discontinue treatment due to lack of effect. D) No viewpoint as to why they discontinued the treatment. In further analysis of category D, this group appeared to experience varoius forms of powerlessness. They felt their trustworthiness was often questioned. They experienced frustration in their life situation as others made the important descisions and they themselves had little to say.They defended themselves by talking about their own conceptions of the reasons for their impairment and what should be done about them. In comparing category D with categories A, B, C it was found that those in the latter three categories experienced varying degrees of control in different situations, whereas those in category D did not experience a feeling of control.Conclusion: The concept of compliance in physiotherapy is ambiguous. The concept involves one part defining what will concern the other part. It is clear that the physiotherapist and the patient do not always agree about the aim of the treatment. Instead, we should develop the concept of concordance in encounters with the patients and abandon the reasoning of compliance.
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| 18. |
- Rydén-Lodi, Birgitta, 1944-
(författare)
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Lyckas mot alla odds : Protektiva faktorer i upphörandeprocessen vid brottslig verksamhet
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present study was to investigate the criminal career, focusing on factors of importance for quitting an ongoing severe criminal career. First a pilot study was performed on 15 young male criminals, for which an interview guide concerning life situation and background characteristics was applied and revised for further developing into a questionnaire (Study I). Further 100 male recidivists, aged 30-38 yrs and incarcerated in prisons in the region of Stockholm, Sweden, were studied. The subjects filled in a self-administered questionnaire on background factors, e.g., debut in crime and addiction, upbringing, values, and quality of social networks (Study II). The subjects were then interviewed according to the revised interview guide regarding life situation, e.g., criminality, addiction, quality of social networks, lodging situation, economic status, work and leisure-time (Study III). Self-reported personality traits were investigated using KSP, EPQ-I and SSS inventories (Study IV). Inclusion criteria were that the subject had at least three prior convictions to prison and at least a total of one year of prison served. At a follow-up three years after release from prison, registered criminal activity was assessed and subjects were grouped according to recidivism level. The subjects free of convictions displayed higher quality in upbringing conditions, relationships, and lodging situation; they also differed in self-reported evaluation of addiction and criminal life-style. Furthermore, they showed a later debut in addiction, and were less likely to live with addicted partners. Concerning personality, results indicated that individuals with higher extraversion and cognitive-psychic anxiety were less likely to be reconvicted, while individuals with higher irritability and sensation seeking traits were more likely to become reconvicted during the follow-up period. The results are discussed in terms of an interactional model of the crime quitting process
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| 19. |
- Sjödahl, Jenny, 1979-
(författare)
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Pregnancy-related pelvic girdle pain and its relation to muscle function
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Pregnancy-related lumbopelvic pain affects approximately 50% of all pregnant women. For the majority the pain disappears during the first months after delivery; however, for a significant number of women, the pain is persistent, with little improvement for more than three months after delivery. Moreover, women who experience persistent lumbopelvic pain three months postpartum are at substantial risk for new episodes or for chronic lumbopelvic pain later in life. Hence, pregnancy-related lumbopelvic pain should be considered a major public health issue. In order to develop and offer specific treatment strategies, it is important to identify different subgroups of lumbopelvic pain based on different clinical presentations. Pelvic girdle pain (PGP) is one of the major subgroups of pain related to pregnancy. There is no consensus regarding the underlying mechanisms although instability in the pelvis has been proposed as one of the possible mechanism; thus, further studies are necessary to determine how to treat these women. The local lumbopelvic muscle system, including the pelvic floor muscles (PFM) is thought to contribute to the stabilization of the pelvis and they are also the target for many treatment strategies for lumbopelvic pain.The overall aim of this thesis was to improve rehabilitation for women with persistent postpartum PGP by investigating three areas, including: 1) the postural response of the PFM, 2) the effect of home-based specific stabilizing exercises (SSE) that target the local lumbopelvic muscle system and, 3) predictors for disability at 15 months postpartum.The thesis comprises three studies: A) a methodological study, B) an experimental study, and C) a clinical randomized controlled trial (RCT). The data is mainly based on muscle function, including recordings of electromyographic (EMG) activation, muscle endurance, and muscle strength. We also collected subjective ratings of disability, healthrelated quality of life, and pain.The methodological study showed that the designed protocol, which included limb movements performed at a comfortable speed in both standing and supine positions, was useful for detecting a postural response in the PFM. The experimental study demonstrated that women with persistent postpartum PGP and those free of pain exhibited a feed-forward mechanism in the PFM that responded in anticipation to leg lifts performed in a supine position. However, we cannot rule out the possibility that women with difficulties in transferring load between the trunk and legs (i.e., those with functional pelvic instability) might have a different postural response in the PFM. In the present study, one woman with persistent postpartum PGP failed to present a feed-forward mechanism in the PFM, in agreement with previous studies on other parameters of the PFM from other similar groups.The clinical RCT demonstrated that the concept of home-based SSE with visits every second week with the treating physiotherapist was not more effective than the clinical natural course for improving subjective ratings or muscle function in women with persistent postpartum PGP.A linear regression analysis revealed a complex picture that suggests that disability 15 months postpartum in women with persistent PGP could be partially predicted by two interaction effects comprising factors from different dimensions: biological, physical functioning, and self-rated function. The proposed association between muscle function and PGP was strengthen. New approaches are most likely needed to further identify subgroups of patients with persistent postpartum PGP that can be considered homogeneous for treatment.
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| 20. |
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| 21. |
- Storm, Tina, et al.
(författare)
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Renal phenotypic investigations of megalin-deficient patients : novel insights into tubular proteinuria and albumin filtration
- 2013
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Ingår i: Nephrology, Dialysis and Transplantation. - : Oxford University Press (OUP). - 0931-0509 .- 1460-2385. ; 28:3, s. 585-591
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe reabsorption of filtered plasma proteins, hormones and vitamins by the renal proximal tubules is vital for body homeostasis. Studies of megalin-deficient mice suggest that the large multi-ligand endocytic receptor megalin plays an essential role in this process. In humans, dysfunctional megalin causes the extremely rare Donnai-Barrow/Facio-Oculo-Acustico-Renal (DB/FOAR) syndrome characterized by a characteristic and multifaceted phenotype including low-molecular-weight proteinuria. In this study, we examined the role of megalin for tubular protein reabsorption in humans through analysis of proximal tubular function in megalin-deficient patients.MethodsDirect sequencing of the megalin-encoding gene (LRP2) was performed in a family in which three children presented with classical DB/FOAR manifestations. Renal consequences of megalin deficiency were investigated through immunohistochemical analyses of renal biopsy material and immunoblotting of urine samples.ResultsIn the patients, a characteristic urinary protein profile with increased urinary excretion of vitamin D-binding protein, retinol-binding protein and albumin was associated with absence of, or reduced, proximal tubular endocytic uptake as shown by renal immunohistochemistry. In the absence of tubular uptake, urinary albumin excretion was in the micro-albuminuric range suggesting that limited amounts of albumin are filtered in human glomeruli.ConclusionsThis study demonstrated that megalin plays an essential role for human proximal tubular protein reabsorption and suggests that only limited amounts of albumin is normally filtered in the human glomeruli. Finally, we propose that the characteristic urinary protein profile of DB/FOAR patients may be utilized as a diagnostic marker of megalin dysfunction.
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| 22. |
- van Vollenhoven, Ronald F., et al.
(författare)
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Biopsy-verified response of severe lupus nephritis to treatment with rituximab (anti-CD20 monoclonal antibody) plus cyclophosphamide after biopsy-documented failure to respond to cyclophosphamide alone
- 2004
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Ingår i: Scandinavian Journal of Rheumatology. - : Taylor & Francis. - 0300-9742 .- 1502-7732. ; 33:6, s. 423-427
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The monoclonal anti-B cell antibody rituximab (Rituxin, Mabthera) may be of benefit in antibody-driven diseases, including systemic lupus erythematosus (SLE) nephritis.PATIENTS AND TREATMENT: Two female patients with biopsy-confirmed severe and active SLE nephritis despite treatment with cyclophosphamide (CyX) were given four rituximab infusions plus two additional CyX infusions.RESULTS: Both patients tolerated the treatment well and SLE activity improved. On repeat kidney biopsy after the combined treatment, Patient 1 showed a profound reduction of nephritis activity, and she was maintained on low-dose prednisolone only. A repeat biopsy after 1 year confirmed the sustained reduction of lupus nephritis activity. In Patient 2, rebiopsy after combined treatment also showed a significant reduction in disease activity.CONCLUSION: These cases provide histopathological documentation of a significant treatment benefit from rituximab plus CyX in two patients refractory to CyX alone. This combination is being explored further as salvage therapy for such CyX-resistant patients.
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| 23. |
- Welander, Adina, et al.
(författare)
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Increased Risk of IgA Nephropathy Among Individuals With Celiac Disease
- 2013
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Ingår i: Journal of Clinical Gastroenterology. - : Lippincott Williams & Wilkins. - 0192-0790 .- 1539-2031. ; 47:8, s. 678-683
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Tidskriftsartikel (refereegranskat)abstract
- Goal: To determine the risk of future biopsy-verified IgA nephropathy (IgAN) among individuals with biopsy-verified celiac disease (CD). Background: Individuals with CD suffer increased risk of end-stage renal disease. An association between CD and IgAN has been suggested; however, results have been inconclusive and no previous study has considered the risk of IgAN in biopsy-verified CD. Study: We performed a population-based prospective cohort study. We identified 27,160 individuals with CD (Marsh stage III) and no previous renal disease through small-intestinal biopsy reports obtained between July 1969 and February 2008 in all (n=28) Swedish pathology departments. Individuals with IgAN were identified by biopsy reports acquired at the 4 Swedish pathology departments specialized in renal pathology. Cox regression analysis was used to determine the risk of future IgAN among individuals with CD compared with 133,949 age-matched and sex-matched reference individuals. Results: Seven (0.026%) individuals with CD and 11 (0.008%) reference individuals developed IgAN. We found an increased risk of biopsy-verified IgAN among individuals with CD [hazard ratio, 3.03; 95% confidence interval, 1.22-7.56]. The risk increase remained statistically significant after adjustment for prior liver disease and country of birth. Conclusions: Individuals with CD suffer a 3-fold increased risk of future IgAN. Our findings warrant awareness of renal function in individuals with CD.
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