| 1. |
- Dalin, Frida, 1984-, et al.
(författare)
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Clinical and immunological characteristics of Autoimmune Addison's disease : a nationwide Swedish multicenter study
- 2017
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 102:2, s. 379-389
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Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Studies on clinical and immunological features of Autoimmune Addison's disease (AAD) are needed to understand the disease burden and increased mortality.OBJECTIVE: To provide upgraded data on autoimmune comorbidities, replacement therapy, autoantibody profiles and cardiovascular risk factors.DESIGN, SETTING AND PARTICIPANTS: Cross sectional, population-based study. 660 AAD patients were included utilizing the Swedish Addison Registry (SAR) 2008-2014. When analyzing cardiovascular risk factors, 3,594 individuals from the population-based survey in Northern Sweden, MONICA (MONItoring of Trends and Determinants of CArdiovascular Disease), served as controls.MAIN OUTCOME MEASURE: Prevalence of autoimmune comorbidities and cardiovascular risk factors. Autoantibodies against 13 autoantigens were determined.RESULTS: Sixty percent of the SAR cohort consisted of females. Mean age at diagnosis was significantly higher for females than for males (36.8 vs. 31.1 years). The proportion of 21-hydroxylase autoantibody positive patients was 83% and 62% of patients had one or more associated autoimmune diseases, more frequently coexisting in females (p<0.0001). AAD patients had lower BMI (p<0.0001) and prevalence of hypertension (p=0.027) compared with controls. Conventional hydrocortisone tablets were used by 89% of patients; with the mean dose 28.1±8.5 mg/day. The mean hydrocortisone equivalent dose normalized to body surface was 14.8±4.4 mg/m(2)/day. Higher hydrocortisone equivalent dose was associated with higher incidence of hypertension (p=0.046).CONCLUSIONS: Careful monitoring of AAD patients is warranted to detect associated autoimmune diseases. Contemporary Swedish AAD patients do not have increased prevalence of overweight, hypertension, T2DM or hyperlipidemia. However, high glucocorticoid replacement doses may be a risk factor for hypertension.
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| 2. |
- Eriksson, D, et al.
(författare)
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Extended exome sequencing identifies BACH2 as a novel major risk locus for Addison's disease
- 2016
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 286:6, s. 595-608
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Autoimmune disease is one of the leading causes of morbidity and mortality worldwide. In Addison's disease, the adrenal glands are targeted by destructive autoimmunity. Despite being the most common cause of primary adrenal failure, little is known about its aetiology.METHODS: To understand the genetic background of Addison's disease, we utilized the extensively characterized patients of the Swedish Addison Registry. We developed an extended exome capture array comprising a selected set of 1853 genes and their potential regulatory elements, for the purpose of sequencing 479 patients with Addison's disease and 1394 controls.RESULTS: We identified BACH2 (rs62408233-A, OR = 2.01 (1.71-2.37), P = 1.66 × 10(-15) , MAF 0.46/0.29 in cases/controls) as a novel gene associated with Addison's disease development. We also confirmed the previously known associations with the HLA complex.CONCLUSION: Whilst BACH2 has been previously reported to associate with organ-specific autoimmune diseases co-inherited with Addison's disease, we have identified BACH2 as a major risk locus in Addison's disease, independent of concomitant autoimmune diseases. Our results may enable future research towards preventive disease treatment.
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| 3. |
- Saevik, Ase Bjorvatn, et al.
(författare)
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Altered biomarkers for cardiovascular disease and inflammation in autoimmune Addison's disease - a cross-sectional study
- 2023
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Ingår i: European Journal of Endocrinology. - : Bioscientifica. - 0804-4643 .- 1479-683X. ; 189:4, s. 438-447
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Increased prevalence of cardiovascular disease has been reported in autoimmune Addisons disease (AAD), but pathomechanisms are poorly understood.Design: Cross-sectional study.Methods: We compared serum levels of 177 cardiovascular and inflammatory biomarkers in 43 patients with AAD at >18-h glucocorticoid withdrawal and 43 matched controls, overall and stratified for sex. Biomarker levels were correlated with the frequency of adrenal crises and quality of life (QoL) by AddiQoL-30. Finally, we investigated changes in biomarker levels following 250 mu g tetracosactide injection in patients without residual adrenocortical function (RAF) to explore glucocorticoid-independent effects of high ACTH.Results: Nineteen biomarkers significantly differed between patients with AAD and controls; all but 1 (ST1A1) were higher in AAD. Eight biomarkers were significantly higher in female patients compared with controls (IL6, MCP1, GAL9, SPON2, DR4, RAGE, TNFRSF9, and PGF), but none differed between male patients and controls. Levels of RAGE correlated with the frequency of adrenal crises (r = 0.415, P = .006) and AddiQoL-30 scores (r = -0.347, P = .028) but not after correction for multiple testing. PDL2 and leptin significantly declined 60 min after injection of ACTH in AAD without RAF (-0.15 normalized protein expression [NPX], P = .0001, and -0.25 NPX, P = .0003, respectively).Conclusions: We show that cardiovascular and inflammatory biomarkers are altered in AAD compared with controls, particularly in women. RAGE might be a marker of disease severity in AAD, associated with more adrenal crises and reduced QoL. High ACTH reduced PDL2 and leptin levels in a glucocorticoid-independent manner but the overall effect on biomarker profiles was small.
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| 4. |
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| 12. |
- Ahola, Virpi, et al.
(författare)
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The Glanville fritillary genome retains an ancient karyotype and reveals selective chromosomal fusions in Lepidoptera
- 2014
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 5, s. 4737-
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have reported that chromosome synteny in Lepidoptera has been well conserved, yet the number of haploid chromosomes varies widely from 5 to 223. Here we report the genome (393 Mb) of the Glanville fritillary butterfly (Melitaea cinxia; Nymphalidae), a widely recognized model species in metapopulation biology and eco-evolutionary research, which has the putative ancestral karyotype of n = 31. Using a phylogenetic analyses of Nymphalidae and of other Lepidoptera, combined with orthologue-level comparisons of chromosomes, we conclude that the ancestral lepidopteran karyotype has been n = 31 for at least 140 My. We show that fusion chromosomes have retained the ancestral chromosome segments and very few rearrangements have occurred across the fusion sites. The same, shortest ancestral chromosomes have independently participated in fusion events in species with smaller karyotypes. The short chromosomes have higher rearrangement rate than long ones. These characteristics highlight distinctive features of the evolutionary dynamics of butterflies and moths.
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| 13. |
- Andersson, Olov, 1979-, et al.
(författare)
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WARA-PS : a research arena for public safety demonstrations and autonomous collaborative rescue robotics experimentation
- 2021
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Ingår i: Autonomous Intelligent Systems. - : Springer Nature. - 2730-616X. ; 1:1
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Tidskriftsartikel (refereegranskat)abstract
- A research arena (WARA-PS) for sensing, data fusion, user interaction, planning and control of collaborative autonomous aerial and surface vehicles in public safety applications is presented. The objective is to demonstrate scientific discoveries and to generate new directions for future research on autonomous systems for societal challenges. The enabler is a computational infrastructure with a core system architecture for industrial and academic collaboration. This includes a control and command system together with a framework for planning and executing tasks for unmanned surface vehicles and aerial vehicles. The motivating application for the demonstration is marine search and rescue operations. A state-of-art delegation framework for the mission planning together with three specific applications is also presented. The first one concerns model predictive control for cooperative rendezvous of autonomous unmanned aerial and surface vehicles. The second project is about learning to make safe real-time decisions under uncertainty for autonomous vehicles, and the third one is on robust terrain-aided navigation through sensor fusion and virtual reality tele-operation to support a GPS-free positioning system in marine environments. The research results have been experimentally evaluated and demonstrated to industry and public sector audiences at a marine test facility. It would be most difficult to do experiments on this large scale without the WARA-PS research arena. Furthermore, these demonstrator activities have resulted in effective research dissemination with high public visibility, business impact and new research collaborations between academia and industry.
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| 14. |
- Arlien-Soborg, Mai C., et al.
(författare)
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Acromegaly management in the Nordic countries: A Delphi consensus survey
- 2024
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Ingår i: CLINICAL ENDOCRINOLOGY. - : WILEY. - 0300-0664 .- 1365-2265.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveAcromegaly is associated with increased morbidity and mortality if left untreated. The therapeutic options include surgery, medical treatment, and radiotherapy. Several guidelines and recommendations on treatment algorithms and follow-up exist. However, not all recommendations are strictly evidence-based. To evaluate consensus on the treatment and follow-up of patients with acromegaly in the Nordic countries.MethodsA Delphi process was used to map the landscape of acromegaly management in Denmark, Sweden, Norway, Finland, and Iceland. An expert panel developed 37 statements on the treatment and follow-up of patients with acromegaly. Dedicated endocrinologists (n = 47) from the Nordic countries were invited to rate their extent of agreement with the statements, using a Likert-type scale (1-7). Consensus was defined as >= 80% of panelists rating their agreement as >= 5 or <= 3 on the Likert-type scale.ResultsConsensus was reached in 41% (15/37) of the statements. Panelists agreed that pituitary surgery remains first line treatment. There was general agreement to recommend first-generation somatostatin analog (SSA) treatment after failed surgery and to consider repeat surgery. In addition, there was agreement to recommend combination therapy with first-generation SSA and pegvisomant as second- or third-line treatment. In more than 50% of the statements, consensus was not achieved. Considerable disagreement existed regarding pegvisomant monotherapy, and treatment with pasireotide and dopamine agonists.ConclusionThis consensus exploration study on the management of patients with acromegaly in the Nordic countries revealed a relatively large degree of disagreement among experts, which mirrors the complexity of the disease and the shortage of evidence-based data.
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| 15. |
- Arnadottir, Anna, et al.
(författare)
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Från Jorden mot Universum
- 2016
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Konstnärligt arbete (övrigt vetenskapligt/konstnärligt)abstract
- The night sky, both beautiful and mysterious, has been the subject of campfire stories, ancient myths and awe for as long as there have been people. A desire to comprehend the Universe may well be humanity’s oldest shared intellectual experience. Yet only recently have we truly begun to grasp our place in the vast cosmos. To learn about this journey of celestial discovery, from the theories of the ancient Greek astronomers to today’s grandest telescopes.
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| 16. |
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| 17. |
- Baresel, Christian, et al.
(författare)
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Läkemedelsrester och andra skadliga ämnen i avloppsreningsverk - koncentrationer, kvantifiering, beteende och reningsalternativ
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Många läkemedelsrester och andra prioriterade substanser passerar igenom dagens avloppsreningsverk (ARV) och hamnar antingen i slammet eller i recipienten, ibland i nivåer som kan påverka vattenlevande organismer. Substanser som släpps ut via avlopps-reningsverk kan också anrikas i den akvatiska näringskedjan och orsaka effekter i högre organismer såsom fiskätande fåglar eller däggdjur, inklusive människor. Studier har också visat att antibiotika som hamnar i miljön kan bidra till uppkomsten av antibiotikaresistenta gener i bakterier, vilket är ett allvarligt globalt hot mot möjligheten att bota livshotande sjukdomar. Eftersom nuvarande vattenreningstekniker har utvecklats främst för att avlägsna partikulärt material samt kväve och fosfor är de oftast inte anpassade för att rena bort mikrobiellt stabila kemiska föroreningar. Utvärderingar av effektiviteten hos olika behandlingstekniker för avlägsnande av sådana ämnen baseras vanligtvis på analyser av förekomst av ett ämne i inkommande och utgående vatten från reningsverket. Det finns dock problem med detta tillvägagångssätt eftersom vissa ämnen metaboliseras till potentiellt mer skadliga substanser, som då inte automatiskt fångas i analysen. Dessutom kan vissa ämnen spontant bildas i reningsverken, vilket kan resultera i högre nivåer i utgående än i inkommande vatten. Ett ytterligare problem är att de utgående koncentrationerna ibland kan vara lägre än detektions-gränserna, men trots det ändå vara högre än eller nära etablerade risknivåer. This report is only available in Swedish.
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| 18. |
- Baresel, Christian, et al.
(författare)
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Pharmaceutical residues and other emerging substances in the effluent of sewage treatment plants
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Pharmaceutical residues and other emerging substances pass through modern sewage treatment plants (STPs) and end up in the receiving waters and sludge. In several studies, recipient concentrations have been detected with expected effects on aquatic organisms. Chemicals released via STPs may also enter the aquatic food-web and cause effects in higher organisms such as fish-eating birds or mammals including humans. Studies have also shown that antibiotics in the environment may contribute to the increase of antibiotic resistant genes in bacteria, which is a serious threat to our possibility to cure life-threatening diseases on the global scale. Current STP treatment technologies are usually not fit to remove microbial stable chemical pollutants and the evaluation of the removal efficiency of the STP systems applied today, is not complete. The evaluation of the removal efficiency of the substances in the STP systems is usually based on chemical analysis of the presence of certain substances in influent and effluent waters. However, there are difficulties associated with this approach, e.g. since some substances are metabolized into potentially more harmful substances which are not captured in the analysis unless they are actively sought for. Furthermore, some substances are formed in the STPs, resulting in higher levels in effluents than in influents. In addition, effluent concentrations may sometimes be lower than the analytical detection limits, yet still higher than or close to established risk concentrations emphasizing the need for developments of the analytical methods.
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| 19. |
- Björkman, Annica, et al.
(författare)
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Identified obstacles and prerequisites in telenurses’ work environment : a modified Delphi study
- 2017
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Telenursing is an expanding part of healthcare, staffed with registered nurses whose work environment is typical of a call centre. Work-related stress has been shown to be a major problem in nurses’ work environments and of importance to the outcome of care, patient safety, nurse job satisfaction and burnout. Today, however, we have a limited understanding of and knowledge about the work environment for telenurses. The aim of the present study is to explore and reach consensus on perceived important obstacles and prerequisites in telenurses’ work environment.Methods: A modified Delphi design, using qualitative as well as quantitative data sequentially through three phases, was taken. Data were initially collected via semi-structured interviews (Phase I) and later using a web survey (Phase II-III) between March 2015 and March 2016.Results: The findings present a consensus view of telenurses’ experiences of important obstacles and prerequisites in their work environment. Central to the findings are the aspects of telenurses having a demanding work, cognitive fatigue and having no opportunity for recovery during the work shift was ranked as important obstacles. Highly ranked prerequisites for managing were being able to focus on one caller at a time, working in a calm and pleasant environment and having technical support 24/7.Conclusions: Managers need to enable telenurses to experience control in their work, provided with possibilities to control their work and to recover during work; shortening work time could improve their work environment. Limited possibilities to perform work might contribute to feelings of stress and inability to perform work.
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| 20. |
- Bohlin, I, et al.
(författare)
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Mapping potential location for bilberry picking with remote sensing, local field data andphone application
- 2023
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the study was to create a practical method for identifying potential locations for bilberry picking with help of remote sensing, local field data and phone application to support the development of the local berry value chain. Local field data w as collected 2021 and 2022 and consisted 503 and 525 plots from a study area of circa 25x45km in Västerbotten, Sweden. The potential for bilberry production was evaluated by measuring the shrub cover and amount of raw berries. Wall to wall remote sensing d ata included a Sentinel 2 image from same summer, airborne laser scanning data from 2020 and other map products. We created classification models for bilberry shrub and yield using both logistic regression (2 classes) and ordinal regression (3 classes) mod els using 2021 data, and validated and calibrated models with 2022 data. Predictor variables consisted of spectral metrics from satellite data; structural metrics from laser data; existing raster maps of tree species, stand attributes, site index, soil moi sture and land use classes. The 2 class models performed better than three class models, delivering the AUC 0.73, overall accuracy 0.83 and kappa value 0.51 for best bilberry shrub model and 0.75, 0.77 and 0.50 respectively for best bilberry yield model. T he best models included both laser based structural metrics describing e.g canopy closure and spectral metrics, but also e.g. volume of pine, soil moisture and site index were found significant predictor variables. Calibration of the models improved annual predictions and the validation of the 2021 raster maps with 2022 data produced similar AUC, OA, and kappa values for bilberry yield (0.73, 0.74 and 0.46), but lower for bilberry shrub (0.61, 0.68 and 0.24). A dedicated phone application was developed duri ng the project, which was used both for collecting the field data and for presenting the potential locations of berry yields. Local berry maps can help berry pickers easier to find the berries in forest landscape and therefore support local berry value cha in. This study is part of the FAIRCHAIN project, which has received funding from the European Union’s funding programme H2020 research and innovation programme under grand agreement 101000723.
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| 21. |
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| 22. |
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| 23. |
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| 24. |
- Boisen, Cecilia, et al.
(författare)
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'Some women are proud of their experience and I have to respect that' : an interview-study about midwives' experiences in caring for infibulated women during childbirth in Sweden
- 2021
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Ingår i: JOURNAL OF PRIMARY HEALTH CARE. - : CSIRO Publishing. - 1172-6164 .- 1172-6156. ; 13:4, s. 334-339
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: As the immigrant communities in high-income countries become larger and increasingly multicultural and ethnically diverse, health professionals are more likely to see girls and women with, or at risk of, female genital mutilation or 'cutting' (FGM/C) in clinical practice. To provide good care and support, other health-care professionals may learn from the experiences of midwifes caring for infibulated women during labour in Sweden. AIM: To describe Swedish midwives' experiences in caring for infibulated women during labour. METHODS: This is a qualitative study. Semi-structured interviews with six midwives working at obstetric clinics in Sweden used open-ended questions. The interviews were recorded, transcribed verbatim and analysed by using thematic analysis. RESULTS: Two main themes were identified: experienced challenges during the process of labour; and midwives' emotional experiences. Midwives experienced challenges during their professional encounters with infibulated women and a variety of emotions were evoked when caring for these women during labour. Lack of general guidelines and standardised routines complicated their work. DISCUSSION: The midwives' experiences were negatively affected by organisational factors and being emotionally affected by the fact that these women were not perceived to be given appropriate care because of their FGM/C. Policymakers in Sweden should consider implementing national guidelines for how to care for women exposed to FGM/C, ideally at an early stage in their reproductive life.
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| 25. |
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| 26. |
- Brink, Anna, 1971, et al.
(författare)
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Maximum fee vs child benefit: A welfare analysis of Swedish child-care fee reform
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The effects of a recent Swedish child-care fee reform are compared with those of an alternative reform, increased child benefits. The fee reform implied considerably decreased fees and was intended to increase both labor supply among parents and their economic well-being. We estimate labor supply effects using a discrete choice labor supply model, and simulate behavioral responses to the changes. We find positive, but small, effects on labor supply from reduced fees, while increased child benefits would make single mothers decrease their labor supply. On the other hand, increased child benefits would make income distribution more equal. We make a social welfare comparison and conclude that for plausible values of inequality aversion, the alternative reform would have been preferable to the implemented fee reform.
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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Cassel-Lundhagen, Anna, et al.
(författare)
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Wing morphology of the butterfly Coenonympha arcania in Europe: Traces of both historical isolation in glacial refugia and current adaptation
- 2020
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Ingår i: Journal of Zoological Systematics and Evolutionary Research. - : Wiley. - 0947-5745 .- 1439-0469. ; 58:4, s. 929-943
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Tidskriftsartikel (refereegranskat)abstract
- In this study, we examined the evolutionary outcome of and interplay between historic isolation and current selection pressures on traits more or less closely connected to fitness in the Pearly Heath butterfly (Coenonympha arcania) across its range in Europe. We hypothesized that a trait mean is more related to historic events if it has low connection to fitness, while a trait more closely connected with fitness is expected to have a mean that relates more to current selection pressures. In order to test this, we collected 322 butterflies from across the species range in Europe and measured five wing traits relating to size and color patterns. To infer a phylogeographic history for each individual, we sequenced a 594 bp fragment of the COI gene. The morphological data were then analyzed in relation to selected climatic variables and the history of individuals to disentangle which factors best correlated with morphological variation. The results supported our hypothesis in that wing sizes correlated with summer precipitation but not with its inferred location during the last glaciation. Eyespot position, on the other hand, correlated with the history of individuals but not with the analyzed climatic indicators. The sizes of the black spot and the white band, two traits that were expected to have intermediate selection pressure, were associated with both history and current conditions. Thus, this study illustrates the fascinating interplay between events and processes that lead to a specific evolutionary outcome.
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| 31. |
- Chazot, Nicolas, et al.
(författare)
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Conserved ancestral tropical niche but different continental histories explain the latitudinal diversity gradient in brush-footed butterflies
- 2021
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- The global increase in species richness toward the tropics across continents and taxonomic groups, referred to as the latitudinal diversity gradient, stimulated the formulation of many hypotheses to explain the underlying mechanisms of this pattern. We evaluate several of these hypotheses to explain spatial diversity patterns in a butterfly family, the Nymphalidae, by assessing the contributions of speciation, extinction, and dispersal, and also the extent to which these processes differ among regions at the same latitude. We generate a time-calibrated phylogeny containing 2,866 nymphalid species (~45% of extant diversity). Neither speciation nor extinction rate variations consistently explain the latitudinal diversity gradient among regions because temporal diversification dynamics differ greatly across longitude. The Neotropical diversity results from low extinction rates, not high speciation rates, and biotic interchanges with other regions are rare. Southeast Asia is also characterized by a low speciation rate but, unlike the Neotropics, is the main source of dispersal events through time. Our results suggest that global climate change throughout the Cenozoic, combined with tropical niche conservatism, played a major role in generating the modern latitudinal diversity gradient of nymphalid butterflies.
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| 32. |
- Consiglio, Camila, et al.
(författare)
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Immune system adaptation during gender-affirming testosterone treatment
- 2023
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Ingår i: Journal of Reproductive Immunology. - : Elsevier. - 0165-0378 .- 1872-7603. ; 159, s. 29-30
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Biological sex impacts human immune responses, modulating susceptibility and severity to immune-related diseases. Female generally mount more robust immune responses than males, resulting in lower infection severity and greater autoimmunity incidence. Here, we addressed the contribution of testosterone to human immune function by analyzing a cohort of subjects undergoing gender-affirming testosterone treatment. We performed systems-level immunomonitoring through mass cytometry, scRNA and scA-TAC-Sequencing, and proteome profiling of blood samples at baseline and following 3 and 12 months of treatment. Testosterone treatment was associated with a low-grade inflammatory profile, evidenced by upregulation of proinflammatory plasma proteome (e.g., EN-RAGE, OSM, TNF), and induction of an inflammatory transcriptional program associated with NFkB signaling, and TNF signaling. Following testosterone treatment, higher NFkB activity was revealed in CD4 T, CD8 T, and NK cells in scATACseq analyses. Further, testosterone increased monocytic inflammatory responses upon bacterial stimulation in vitro. Although testosterone was associated with this inflammatory profile, it also exerted negative effects on antiviral immunity. Firstly, the percentage of plasmacytoid dendritic cells (pDC) decreased over transition, with pDC also displaying phenotypic changes associated with lower IFN responses. Secondly, bulk transcriptomics analyses show an overall reduction of IFNa responses. Thirdly, testosterone treatment led to reduced IFNa production upon PBMCs stimulation with a viral agonist. Our results show that testosterone has broad effects on the human immune system, and significantly modulates important players in antiviral immunity and inflammatory response. Identifying pathways involved in immune sexual dimorphism will help define novel targets for effective prevention and treatment of immune-mediated diseases.
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| 33. |
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| 34. |
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| 35. |
- Dahlqvist, Per, et al.
(författare)
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Nationellt kort vid binjurbarksvikt : nytt varningskort kan leda till bättre handläggning och ökad patientsäkerhet
- 2011
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:44, s. 2226-2227
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Tidskriftsartikel (refereegranskat)abstract
- Akut binjurebarkssvikt (akut kortisolbrist/Addisonkris) är en ovanlig men viktig differentialdiagnos vid akut cirkulationssvikt. De flesta fall av Addisonkris drabbar patienter med känd binjurebarkssvikt, oftast i samband med gastroenterit eller annan infektion. Noggrann och tydlig information och utbildning av patienter, anhöriga och sjukvårdspersonal behövs för att undvika sjuklighet och dödsfall i akut binjurebarkssvikt. Ett nationellt varningskort i kreditkortsformat har tagits fram till patienter med binjurebarkssvikt för att uppmärksamma och förbättra handläggningen av detta potentiellt livshotande tillstånd
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| 36. |
- Dahlqvist, Per, et al.
(författare)
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Nationellt kort vid binjurebarkssvikt : Nytt varningskort kan leda till bättre handläggning och ökad patientsäkerhet
- 2012
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:44, s. 2226-2227
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Tidskriftsartikel (refereegranskat)abstract
- Akut binjurebarkssvikt (akut kortisolbrist/Addisonkris) är en ovanlig men viktig differentialdiagnos vid akut cirkulationssvikt.De flesta fall av Addisonkris drabbar patienter med känd binjurebarkssvikt, oftast i samband med gastroenterit eller annan infektion.Noggrann och tydlig information och utbildning av patienter, anhöriga och sjukvårdspersonal behövs för att undvika sjuklighet och dödsfall i akut binjurebarkssvikt.Ett nationellt varningskort i kreditkortsformat har tagits fram till patienter med binjurebarkssvikt för att uppmärksamma och förbättra handläggningen av detta potentiellt livshotande tillstånd.
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| 37. |
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| 38. |
- Eriksson, Daniel, et al.
(författare)
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Common genetic variation in the autoimmune regulator (AIRE) locus is associated with autoimmune Addison’s disease in Sweden
- 2018
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Autoimmune Addison's disease (AAD) is the predominating cause of primary adrenal failure. Despite its high heritability, the rarity of disease has long made candidate-gene studies the only feasible methodology for genetic studies. Here we conducted a comprehensive reinvestigation of suggested AAD risk loci and more than 1800 candidate genes with associated regulatory elements in 479 patients with AAD and 2394 controls. Our analysis enabled us to replicate many risk variants, but several other previously suggested risk variants failed confirmation. By exploring the full set of 1800 candidate genes, we further identified common variation in the autoimmune regulator (AIRE) as a novel risk locus associated to sporadic AAD in our study. Our findings not only confirm that multiple loci are associated with disease risk, but also show to what extent the multiple risk loci jointly associate to AAD. In total, risk loci discovered to date only explain about 7% of variance in liability to AAD in our study population.
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| 39. |
- Eriksson, Daniel, et al.
(författare)
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Cytokine Autoantibody Screening in the Swedish Addison Registry Identifies Patients With Undiagnosed APS1
- 2018
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Ingår i: The Journal of clinical endocrinology and metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; 103:1, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- Context: Autoimmune polyendocrine syndrome type 1 (APS1) is a monogenic disorder that features autoimmune Addison disease as a major component. Although APS1 accounts for only a small fraction of all patients with Addison disease, early identification of these individuals is vital to prevent the potentially lethal complications of APS1.Objective: To determine whether available serological and genetic markers are valuable screening tools for the identification of APS1 among patients diagnosed with Addison disease.Design: We systematically screened 677 patients with Addison disease enrolled in the Swedish Addison Registry for autoantibodies against interleukin-22 and interferon-α4. Autoantibody-positive patients were investigated for clinical manifestations of APS1, additional APS1-specific autoantibodies, and DNA sequence and copy number variations of AIRE.Results: In total, 17 patients (2.5%) displayed autoantibodies against interleukin-22 and/or interferon-α4, of which nine were known APS1 cases. Four patients previously undiagnosed with APS1 fulfilled clinical, genetic, and serological criteria. Hence, we identified four patients with undiagnosed APS1 with this screening procedure.Conclusion: We propose that patients with Addison disease should be routinely screened for cytokine autoantibodies. Clinical or serological support for APS1 should warrant DNA sequencing and copy number analysis of AIRE to enable early diagnosis and prevention of lethal complications.
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| 40. |
- Eriksson, Daniel, et al.
(författare)
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GWAS for autoimmune Addison’s disease identifies multiple risk loci and highlights AIRE in disease susceptibility
- 2021
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Ingår i: Nature Communications. - : Nature Publishing Group. - 2041-1723. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Autoimmune Addison's disease (AAD) is characterized by the autoimmune destruction of the adrenal cortex. Low prevalence and complex inheritance have long hindered successful genetic studies. We here report the first genome-wide association study on AAD, which identifies nine independent risk loci (P < 5 × 10-8). In addition to loci implicated in lymphocyte function and development shared with other autoimmune diseases such as HLA, BACH2, PTPN22 and CTLA4, we associate two protein-coding alterations in Autoimmune Regulator (AIRE) with AAD. The strongest, p.R471C (rs74203920, OR = 3.4 (2.7-4.3), P = 9.0 × 10-25) introduces an additional cysteine residue in the zinc-finger motif of the second PHD domain of the AIRE protein. This unbiased elucidation of the genetic contribution to development of AAD points to the importance of central immunological tolerance, and explains 35-41% of heritability (h2).
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| 41. |
- Ewerman, Lea, et al.
(författare)
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Immunomodulating Effects Depend on Prolactin Levels in Patients with Hyperprolactinemia
- 2020
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Ingår i: Hormone and Metabolic Research. - Stuttgart : Thieme Medical Publishers. - 0018-5043 .- 1439-4286. ; 52:04, s. 228-235
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Tidskriftsartikel (refereegranskat)abstract
- Prolactin is known to have immune modulatory effects acting through the prolactin receptor, which is present on a variety of immune cells. Certain chemokines contribute to form the type of T helper (Th) preponderance in the immune response. The objective of this work was to assess if hyperprolactinemia not related to pregnancy is associated with changes in circulating levels of chemokines and other immunological markers. In this cross sectional study, 35 patients with hyperprolactinemia (5 men), and 102 healthy blood donors (19 men) were included. Serum levels of Th1- Th2- and Th17-associated chemokines, C-reactive protein, immunoglobulins, and the B cell attracting chemokine CXCL13 were assessed. The hyperprolactinemic group had significantly higher levels of Th2 associated CCL22 (p=0.022), Th17 associated CXCL1 (p=0.001), B cell attracting CXCL13 (p=0.003), and C-reactive protein (p<0.001) compared to controls, and these proteins were also positively correlated with prolactin levels. While differences in CCL22, CXCL1, CXCL13, and C-reactive protein were present in patients with low or moderate hyperprolactinemia, no differences were observed at high (>3600 mU/l) prolactin levels. To evaluate a possible dose-associated response to prolactin, an in vitro model was used, showing prolactin-induced increase in T-helper cell activation at moderate levels, while activation decreased at higher levels. Hyperprolactinemia seems to have several immunomodulatory effects and was associated with increased levels of chemokines associated with Th2 and Th17 responses and B cell attraction. However, patients with greatly increased prolactin had normal levels of chemokines, and in vitro, high levels of prolactin decreased T-helper cell activation.
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| 42. |
- Foka, Anna, 1981-, et al.
(författare)
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Women’s Metadata, Semantic Web, Ontologies and AI : Potentials in Critically Enriching Carl Sahlin’s Industrial History Collection
- 2022
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Ingår i: Emerging Technologies, Museums. - London and New York : Berghahn Books. - 9781800733749 - 9781800733756 ; , s. 65-88
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Bokkapitel (refereegranskat)abstract
- This chapter moves beyond claims of digital technology as a means for democratisation of knowledge and focus on archival online repositories of women’s history, concentrating on a Swedish case study: the collection of industry leader Carl Sahlin (1861–1943) at the Swedish National Museum of Science and Technology. The chapter contributes a detailed methodology for collection enrichment, including the possibilities and pitfalls of using emerging technologies, specifically AI, for classification and enrichment so as to open up new critical questions about historical women.
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| 43. |
- Friman, Anne, et al.
(författare)
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District nurses' knowledge development in wound management : ongoing learning without organizational support
- 2014
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Ingår i: Primary Health Care Research and Development. - 1463-4236 .- 1477-1128. ; 15:4, s. 386-95
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to describe district nurses' (DNs') experiences of their knowledge development in wound management when treating patients with different types of wounds at healthcare centers.BACKGROUND: In primary healthcare, DNs are mainly responsible for wound management. Previous research has focused on DNs' level of expertise regarding wound management, mostly based on quantitative studies. An unanswered question concerns DNs' knowledge development in wound management. The present study therefore intends to broaden understanding and to provide deeper knowledge in regard to the DNs' experiences of their knowledge development when treating patients with wounds.METHODS: A qualitative descriptive design was used. Subjects were a purposeful sample of 16 DNs from eight healthcare centers in a metropolitan area in Stockholm, Sweden. The study was conducted with qualitative interviews and qualitative content analysis was used to analyze the data.RESULTS: The content analysis resulted in three categories and 11 sub-categories. The first category, 'ongoing learning by experience,' was based on experiences of learning alongside clinical practice. The second category 'searching for information,' consisted of various channels for obtaining information. The third category, 'lacking organizational support,' consisted of experiences related to the DNs' work organization, which hindered their development in wound care knowledge.CONCLUSIONS: The DNs experienced that they were in a constant state of learning and obtained their wound care knowledge to a great extent through practical work, from their colleagues as well as from various companies. A lack of organizational structures and support from staff management made it difficult for DNs to develop their knowledge and skills in wound management, which can lead to inadequate wound management.
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| 44. |
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| 45. |
- Fägerskiöld, Astrid M., et al.
(författare)
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Maternal expectations of the child health nurse
- 2001
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 3:3, s. 139-147
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Tidskriftsartikel (refereegranskat)abstract
- The main aim of this study was to identify what first-time mothers in Sweden expected of Child Health Nurses. A further aim was to investigate what help and support was received by the new mothers and whether they felt that anything was missing. Twenty new mothers were interviewed according to grounded theory and the data were analyzed by the constant comparative method. It was found that first-time mothers expected Child Health Nurses to have faith in a new mother's own strength and to be accessible, approachable and knowledgeable, providing advice and support. New mothers indicated that they had experienced most of these characteristics, especially accessibility and approachability, but some felt that there were deficiencies (e.g. a lack of continued interest in their own bodies and health, as well as a lack of support when they ceased to breast-feed). The Child Health Service was taken for granted by new mothers. First-time mothers indicated that they appreciated the service, particularly those mothers who did not have a good social network. However, some of the new mothers expressed negative feelings regarding the Child Health Service provided.
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| 46. |
- Fägerskiöld, Astrid M., et al.
(författare)
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What child health nurses believe mothers with infants expect of them
- 2000
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Ingår i: Nursing and Health Sciences. - : Wiley. - 1441-0745 .- 1442-2018. ; 2:2, s. 83-91
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Tidskriftsartikel (refereegranskat)abstract
- The aims were to identify what the child health nurse believed was expected of her by women who had recently become mothers, primipara and multipara, to investigate which problems the nurse found most difficult to deal with and to analyse why they were difficult. The grounded theory method was employed for conducting interviews with 15 nurses. The data analysis showed that the nurses thought mothers expected care of the infant and the family from the nurse, comprising support, advice and child health assessments. What the nurses found most difficult to deal with were obstacles to interaction with mothers such as motherhood problems, hidden, social and organisational problems. They wanted to have a positive interaction with mothers to be able to fulfil the task of supporting parents and identifying risks to the child's healthy upbringing. This task places great demands on nurses' competence and knowledge about the child and family.
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| 47. |
- Hafström, Anna, et al.
(författare)
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Predictors of survival in advanced oral cancers after salvage surgery with free tissue flap reconstruction
- 2023
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer Science and Business Media LLC. - 0937-4477 .- 1434-4726. ; 280:6, s. 2953-2964
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To identify prognostic factors for patients with advanced persistent, recurrent, or 2nd primary oral cavity squamous cell carcinoma (OCSCC) potentially unsuitable for salvage surgery with free tissue flap (FTF) reconstruction. Materials and methods: A population-based cohort of 83 consecutive patients with advanced OCSCC who underwent salvage surgery with FTF reconstruction at a tertiary referral centre between 1990 and 2017. Retrospective uni- and multivariable analyses were performed to identify factors affecting all-cause mortality (ACM), i.e., overall survival (OS), as well as disease-specific mortality (DSM), i.e., disease-specific survival (DSS) after salvage surgery. Results: Median disease-free interval until recurrence was 15 months with recurrent stage I/II in 31% and III/IV in 69%. Median age at salvage surgery was 67 years (range 31–87) and the median follow-up (alive patients) 126 months. At 2, 5, and 10 years after salvage surgery, respectively, DSS rates were 61%, 44%, and 37% and OS rates 52%, 30%, and 22%. Median DSS was 26 and OS 43 months. Multivariable analysis identified recurrent clinical regional (cN-plus) disease [HR 3.57; p <.001] and elevated gamma-glutamyl transferase (GGT) [HR 3.30; p =.003] as independent pre-salvage predictors for poor OS after salvage, whereas initial cN-plus [HR 2.07; p =.039] and recurrent cN-plus disease [HR 5.14; p <.001] predicted poor DSS. Among post-salvage factors, extranodal extension according to histopathology [HR ACM 6.11; HR DSM 9.99; p <.001] as well as positive [HR ACM 4.98; DSM 7.51; p < 0.001] and narrow surgical margins [HR ACM 2.12; DSM HR 2.80; p < 0.01] emerged as independent factors for poor survival. Conclusion: While salvage surgery with FTF reconstruction is the primary curative option for patients with advanced recurrent OCSCC, the present findings may help guide discussions with patients who have advanced recurrent regional disease and high GGT preoperatively, especially if there is a small chance of reaching surgical radicality.
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| 48. |
- Hafström, Anna, et al.
(författare)
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Sentinel lymph node biopsy staging for cutaneous malignant melanoma of the head and neck.
- 2016
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 1651-2251 .- 0001-6489. ; 136:3
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Tidskriftsartikel (refereegranskat)abstract
- Conclusion Sentinel lymph node biopsies (SLNBs) can be performed safely and with reasonable accuracy in HNM patients. The outcome provides important prognostic information concerning DFS and further treatment. However, one must recognize that SLNB is a multidisciplinary procedure with a learning curve for all. Objectives To evaluate efficacy of performing SLNBs in a series of consecutive patients with cutaneous head and neck melanoma (HNM) ≥ T1b from introduction of the procedure and 10 years onward. Method End-points comprised of SLNB outcome, disease-free survival (DFS), and overall survival (OS). Results SNs were harvested in 128 of 160 patients (median Breslow = 2.0 mm, 29% ulcerated); success rate = 80.0%, or 92.1% if excluding patients where SLNBs were omitted due to non-localization on pre-operative imaging or because of SN-location in the parotid basin. Ten patients (7.8%) had positive SLNBs and were offered early completion neck dissections. Of the 146 patients available for follow-up (median = 27 months), 15.8% had recurrent disease. The risk of a regional nodal recurrence after a negative SLNB was 7.5%. SN-negative patients had improved DFS c.f. SN-positive patients (p < 0.001). A positive SLNB was the most important prognostic predictor of decreased DFS (hazard ratio = 5.70; p < 0.005), but had no significant impact on OS.
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| 49. |
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| 50. |
- Hanberger, Adam, et al.
(författare)
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Attitudes towards comparison of male and female genital cutting in a Swedish Somali population
- 2021
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 100:4, s. 604-613
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Tidskriftsartikel (refereegranskat)abstract
- Introduction In Sweden, the law treats female genital cutting (FGC) differently from male genital cutting (MGC). However, the comparability of the medical, ethical, and legal aspects of genital cutting of girls and boys are increasingly discussed by scholars, although little is known about how practicing communities view these aspects. This study aimed to explore attitudes towards comparison of genital cutting of girls and boys among Swedish Somalis, and to investigate factors associated with considering the two practices to be comparable. Material and methods In a cross-sectional questionnaire with 648 Swedish Somali men and women from four Swedish cities, descriptive statistics and logistic regression were used for the analysis. Results Among the Swedish Somalis, 10% considered FGC and MGC to be comparable practices. A majority (98%) of the participants thought FGC could cause long-term health complications, but only 1% considered the physical health disadvantage of MGC would outweigh the physical health benefits. FGC was perceived to be a violation of children's rights by 60%, whereas this proportion for MGC was 3%. Individuals who had a dominant bridging social capital and those who expressed that performing FGC follows religion were more likely to think that FGC and MGC were comparable practices. Conclusions The increased global attention and emphasis on the comparability of genital cutting of boys and girls was not reflected in this study among Swedish Somalis. Rather, attitudes reflected the common description of the two practices in global public health campaigns, portraying FGC as a harmful practice violating children's rights, while describing MGC as a public health measure. Social interactions and separation of FGC from religion could explain why FGC and MGC were not considered comparable.
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