| 1. |
- Stocklassa, B, et al.
(författare)
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Evaluation of a new X-ray fluorescent analysis technique for the creation of a Nordic hair database : Elemental distributions within the root and the virgin segment of hair fibers
- 2001
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Ingår i: JOURNAL OF COSMETIC SCIENCE. - New York : Society of Cosmetic Chemists. - 0037-9832 .- 1525-7886. ; 117:3, s. 312-
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Tidskriftsartikel (refereegranskat)abstract
- A new, non-destructive X-ray fluorescence technique for quantitative estimation of elemental content in biological tissues has been developed. Technical and instrumental characteristics of the ITRAX X-ray spectrometer have been evaluated in relation to the properties of biological samples, i.e., human hair fibers. Thus, attenuation variations of the fluorescent X-rays in the hair bulk mass were demonstrated by analysis of sulfur, calcium, and zinc in a virgin part near the root of one hair fiber with elliptical cross section. By rotation of the hair fiber and successive analyses made of the same part of the hair fiber, the results showed that concentrations of elements varied as functions of the diameter of the analyzed hair volume. Other sources of errors are also discussed. The ITRAX instrument allows for precise, fast, non-destructive, simultaneous, quantitative recording of the detected elements and trace elements down to levels of 1 ppm (mug/g). It was used fur assessment of normal values of physiologically important elements present in hair in a cohort of normal, healthy Swedish, Caucasian individuals. The database constructed from data retrieved from a conceivably homogenous ethnic set of individuals represents, to our knowledge, the first of its kind.
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| 2. |
- Berg, Mats, et al.
(författare)
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Flashlamp pulsed dye laser (FPDL) did not cure papulopustular rosacea
- 2004
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Ingår i: Lasers in Surgery and Medicine. - : John Wiley & Sons. - 0196-8092 .- 1096-9101. ; 34:3, s. 266-268
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Pharmacological treatment has a fairly good effect on the papulopustular lesions in rosacea, but not as good an effect on the erythema and telangiectases. The aim was to treat rosacea patients with both erythematotelangiectatic and papulopustular lesions with flashlamp pulsed dye laser (FPDL) until telangiectases/erythema disappeared, and to evaluate whether the treatment might also be effective on papulopustular lesions.STUDY DESIGN/MATERIALS AND METHODS: Ten patients were treated on one side of the face with FPDL. The final examination was blinded and performed on the average 10 months after the last treatment.RESULTS: Two of the patients had more lesions after treatment, three were unchanged, three had only slightly less, and two had markedly less papulopustular lesions.CONCLUSION: Our conclusion from this small sample of patients is that FPDL probably has limited value on papulopustular lesions in rosacea. This indicates that the origin of rosacea may not be only vascular.
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| 3. |
- Edelbring, Samuel, 1969-, et al.
(författare)
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Characteristics of two questionnaires used to assess interprofessional learning : psychometrics and expert panel evaluations
- 2018
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Ingår i: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interprofessional learning activities are included in many curricula but are difficult to assess. For languages that are not widely spoken such as Swedish, few validated questionnaires exist that relate to interprofessional outcomes. Therefore, the aim was to examine two such questionnaires in relation to interprofessional competence domains.Methods: Psychometric characteristics, such as homogeneity of items and internal consistency, were assessed for the Swedish versions of the Jefferson Scale of Attitudes Towards Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS). The questionnaires were distributed directly following IPL activities. Mokken scale analysis based on Loevingers coefficient for homogeneity and Cronbachs alpha were used to evaluate the scales. Two expert panels performed a qualitative analysis of items in relation to four internationally defined interprofessional competences.Results: In total, 88 and 84 responded to the JSAPNC and RIPLS questionnaires, respectively. Estimates of homogeneity were low for both the JSAPNC (H = 0.16) and the RIPLS (H = 0.21). Reliabilities were weak (0.62 and 0.66, respectively) for the total scales. The expert panels categorised 68% of items into similar competence domains. However, their discussion revealed ambiguous wordings and imbalances in the two questionnaires in relation to domains.Conclusion: Interprofessional competence domains are defined but few validated tools exist to assess them. Examined tools relating to interprofessional learning in Swedish do not qualify for assessing overarching IPL outcomes, and summed scores from these tools should be used with caution.
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| 4. |
- Edelbring, Samuel, PhD, Docent, 1969-, et al.
(författare)
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Flexible interprofessional student encounters based on virtual patients : a contribution to an interprofessional strategy
- 2022
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 36:2, s. 310-317
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Tidskriftsartikel (refereegranskat)abstract
- It is challenging to organize interprofessional activities in terms of coordinating students' various schedules. These challenges can be overcome by providing flexible online opportunities based on virtual patients (VPs). This study set out to study feasibility of using a blended approach based on virtual patients and a flexible interprofessional student encounter. The encounter was arranged in pairs or triads between nursing and medical students from two separate courses. Data were gathered through a questionnaire and followed up with group interviews. Reflective texts from the interprofessional encounters were analyzed in relation to descriptions of interprofessional competence. The great majority (86%) chose to meet online due to its flexibility. The participants gained an understanding of the other profession's roles and competences and a holistic patient awareness. Given its flexible and scalable opportunities, the blended online virtual patient approach provides a valuable contribution to an interprofessional programme.
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| 5. |
- Elvén, Maria, 1973-, et al.
(författare)
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Clinical Reasoning Curricula in Health Professions Education : A Scoping Review
- 2023
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Ingår i: Journal of medical education and curricular development. - : Sage Publications. - 2382-1205. ; 10
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: This scoping review aimed to explore and synthesize current literature to advance the understanding of how to design clinical reasoning (CR) curricula for students in health professions education.METHODS: Arksey and O'Malley's 6-stage framework was applied. Peer-reviewed articles were searched in PubMed, Web of Science, CINAHL, and manual searches, resulting in the identification of 2932 studies.RESULTS: Twenty-six articles were included on CR in medical, nursing, physical therapy, occupational therapy, midwifery, dentistry, and speech language therapy education. The results describe: features of CR curriculum design; CR theories, models, and frameworks that inform curricula; and teaching content, methods, and assessments that inform CR curricula.CONCLUSIONS: Several CR theories, teaching, and assessment methods are integrated into CR curricula, reflecting the multidimensionality of CR among professions. Specific CR elements are addressed in several curricula; however, no all-encompassing CR curriculum design has been identified. These findings offer useful insights for educators into how CR can be taught and assessed, but they also suggest the need for further guidance on educational strategies and assessments while learners progress through an educational program.
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| 6. |
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| 7. |
- Forslind, B., et al.
(författare)
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Elemental content of anagen hairs in a normal Caucasian population studies with proton induced X-ray emission (PIXE)
- 1986
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Ingår i: Scanning electron microscopy. - Chicago : IIT research institute. - 0586-5581. ; :Pt 1, s. 237-241
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Tidskriftsartikel (refereegranskat)abstract
- The elemental content of anagen hair fibers in a Caucasian population of healthy females and males in the age range 10-69 years was performed to constitute a baseline for further studies of pathological conditions. Proton induced X-ray emission (PIXE) analyses were performed on single hair fibers in triplicate from 103 individuals in order to determine sulfur, zinc, calcium, and chlorine content. The hair fibers were all anagen hairs collected from a site little influenced by genetic and hormonal influences 1.5 cm above the right ear of the probands. An area 5-8 mm from the follicle bottom was chosen for the analysis in all cases to minimize effect of hair-do contamination. The average sulfur content was 0.049 g/g and the average zinc content 170 micrograms/g. These results were not significantly influenced by chloroform/ethanol rinsing before analysis. The calcium and chlorine contents were 330 micrograms/g and 0.0033 g/g respectively. The latter data are expected to be more seriously influenced by external factors (e.g., contamination) than sulfur and zinc. No correlation between elemental concentration and sex was found for sulfur and zinc in the present material. PIXE analysis of single hair fibers yields valuable information on the elemental composition of hair fibers and can be rapidly and efficiently performed after simple mounting procedures.
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| 8. |
- Friman, Anne, et al.
(författare)
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Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care
- 2017
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 31:5, s. 620-627
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Tidskriftsartikel (refereegranskat)abstract
- Lack of nurse‒physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician‒Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse‒physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.
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| 9. |
- Friman, Anne, et al.
(författare)
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General practitioners' knowledge of leg ulcer treatment in primary healthcare : an interview study
- 2020
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 21
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe general practitioners' (GPs') knowledge and the development of their knowledge regarding leg ulcer treatment when treating patients with leg ulceration at primary healthcare centers.BACKGROUND: Earlier research regarding GPs' knowledge of leg ulcer treatment in a primary healthcare context has focused primarily on the assessment of wounds and knowledge of wound care products. Less is known about GPs' understandings of their own knowledge and knowledge development regarding leg ulceration in the everyday clinical context. This study, therefore, sets out to highlight these aspects from the GPs' perspective.METHODS: Semi-structured interviews were conducted with 16 individual GPs working at both private and county council run healthcare centers. The data were analyzed inductively using a thematic analysis.RESULTS: Four themes were identified. 'Education and training' describe the GPs' views regarding their knowledge and knowledge development in relation to leg ulcer treatment. 'Experience' refers to GPs' thoughts about the importance of clinical experience when treating leg ulcers. 'Prioritization' describes the issues GPs raised around managing the different knowledge areas in their clinical work. 'Time constraints' explore the relationship between GPs' sense of time pressure and their opportunities to participate in professional development courses.CONCLUSIONS: The study shows that the GPs working in primary healthcare are aware of the need for ongoing competence development concerning leg ulceration. They describe their current knowledge of leg ulcer treatment as insufficient and point to the lack of relevant courses that are adapted for their level of knowledge and the limited opportunities for clinical training.
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| 10. |
- Friman, Anne, et al.
(författare)
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General practitioners’ perceptions of their role and their collaboration with district nurses in wound care
- 2019
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Ingår i: Primary Health Care Research and Development. - : Cambridge University Press. - 1463-4236 .- 1477-1128. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare.Background: Earlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs’ understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP’s perspective.Methods: Semi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data.Results: Four themes were identified. The first theme: ‘role as consultant and coordinator’ shows how the GPs perceived their role in wound care. In the second theme: ‘responsibility for diagnosis’ the GPs’ views on responsibility for wound diagnosis is presented. The third theme: ‘desire for continuity’ is based on the GPs’ desire for continuity concerning various aspects. In the fourth theme: ‘collaboration within the organisation’ the importance of the organisation for collaboration between GPs and DNs is presented.Conclusions: The GP’s often work on a consultation-like basis and feel that they become involved late in the patients’ wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.
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| 11. |
- Frohm Nilsson, M., et al.
(författare)
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Comparison of two dye lasers in the treatment of port-wine stains
- 2010
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Ingår i: Clincal and Experimental Dermatology. - : Blackwell Publishing. - 0307-6938 .- 1365-2230. ; 35:2, s. 126-130
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Port-wine stains (PWS) are congenital capillary malformations that persist throughout life. Laser therapy is a common treatment for PWS, and pulsed-dye laser is the current treatment of choice.AIM: To compare the clinical results on untreated PWS of two dye lasers with different wavelengths and pulse duration: a flashlamp-pumped dye laser (FPDL) and a long-pulse-duration dye laser (LPDL).METHODS: In total, 24 patients were treated on 4-6 test areas with both laser types using high-energy and low-energy fluences. An FPDL with 0.45 ms pulse duration tuned to 585 nm was compared with an LPDL with 1.5 or 3.0 ms pulse duration tuned to 595 nm. Twelve weeks later the degree of lightening was evaluated by a blinded assessor. Pain was assessed directly after treatment with both lasers, using a visual analogue scale.RESULT: There was no significant difference overall between the two systems in lightening of the lesion or in patient-reported pain.CONCLUSION: Both laser systems are equivalent in terms of efficacy and pain.
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| 12. |
- Hege, Inga, et al.
(författare)
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Developing a European longitudinal and interprofessional curriculum for clinical reasoning
- 2023
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Ingår i: Diagnosis. - : Walter de Gruyter GmbH. - 2194-8011 .- 2194-802X.
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Tidskriftsartikel (refereegranskat)abstract
- Clinical reasoning is a complex and crucial ability health professions students need to acquire during their education. Despite its importance, explicit clinical reasoning teaching is not yet implemented in most health professions educational programs. Therefore, we carried out an international and interprofessional project to plan and develop a clinical reasoning curriculum with a train-the-trainer course to support educators in teaching this curriculum to students. We developed a framework and curricular blueprint. Then we created 25 student and 7 train-the-trainer learning units and we piloted 11 of these learning units at our institutions. Learners and faculty reported high satisfaction and they also provided helpful suggestions for improvements. One of the main challenges we faced was the heterogeneous understanding of clinical reasoning within and across professions. However, we learned from each other while discussing these different views and perspectives on clinical reasoning and were able to come to a shared understanding as the basis for developing the curriculum. Our curriculum fills an important gap in the availability of explicit clinical reasoning educational materials both for students and faculty and is unique with having specialists from different countries, schools, and professions. Faculty time and time for teaching clinical reasoning in existing curricula remain important barriers for implementation of clinical reasoning teaching.
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| 13. |
- Hörfelt, Camilla, 1970, et al.
(författare)
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Topical methyl aminolaevulinate photodynamic therapy for treatment of facial acne vulgaris: results of a randomized, controlled study
- 2006
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Ingår i: Br J Dermatol. - : Blackwell Publishing. ; 155:3, s. 608-613
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a need for alternative treatments for moderate to severe acne vulgaris. Preliminary experience suggests that topical methyl aminolaevulinate photodynamic therapy (MAL-PDT) may have potential. OBJECTIVES: To investigate the efficacy and tolerability of MAL-PDT for treatment of moderate inflammatory facial acne. PATIENTS/METHODS: Thirty patients aged 15-28 years with moderate to severe acne were included in a blinded, prospective, randomized, placebo-controlled multicentre study. Each side of each patient's face was randomly assigned to treatment with MAL (160 mg g1) or placebo cream, applied for 3 h prior to illumination. A second treatment was given 2 weeks later. On each occasion, patients assessed the intensity of pain using a 10-cm visual analogue scale. Inflammatory and noninflammatory acne lesions were counted at baseline and 4 and 10 weeks after the last PDT treatment. The investigator assessed the global severity of acne at baseline (seven patients had severe acne on at least one side of the face) and each study visit using a six-point rating scale. Data were analysed on an intention-to-treat basis, including all 30 patients. RESULTS: There was a statistically significant greater reduction in the total inflammatory lesion count with MAL-PDT compared with placebo PDT at week 12; median reduction 54% [95% confidence interval (CI) 35-64%] vs. 20% (95% CI 8-50%), P = 0.0006. MAL-PDT was associated with more pain than placebo PDT, although intensity varied across centres and was reduced with repeated treatment. Local adverse events were consistent with this treatment modality. CONCLUSIONS: MAL-PDT is effective in the treatment of moderate to severe inflammatory facial acne. Further studies are warranted to optimize this promising procedure.
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| 14. |
- Lindelöf, Bernt, et al.
(författare)
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Previous extensive sun exposure and subsequent vitamin D production in patients with basal cell carcinoma of the skin, has no protective effect on internal cancers
- 2012
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Ingår i: European Journal of Cancer. - : Elsevier. - 0959-8049 .- 1879-0852. ; 48:8, s. 1154-1158
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It has been suggested that sunlight through production of vitamin D might have a protective effect on a number of internal cancers. Consequently, in spite of the well known skin cancer risks, some researchers advocate more exposure to ultraviolet radiation, supported by the solarium industry. We estimated the risk of internal cancer before the patient contracted a basal cell carcinoma (BCC) of the skin, the most common cancer in white populations and strongly associated with extensive sun exposure.METHODS: A nested case control study was undertaken in the whole Swedish population. 115,016 patients with BCC and 987,893 controls were linked to population based registers.FINDINGS: The cases had an increased risk of getting another form of cancer before the BCC diagnosis: odds ratio (OR)=1.84; 95% confidence interval (CI) 1.81-1.86. This risk was mainly due to skin cancer: OR=4.95; 95% CI 4.81-5.09 but also non-skin cancer risk was elevated: OR=1.37; 95% CI 1.35-1.39. We adjusted the estimates for age, level of income, occupational status in national censuses, place of living and sex, where appropriate. Of the cancers specifically suggested to be related to vitamin D status: colon, prostate, breast, and ovary cancer, all had slightly increased ORs whilst for pancreatic and gastric cancer no increased OR was found.INTERPRETATION: Patients with BCC, a proxy for extensive sun exposure, run an increased risk of other forms of cancer prior to the diagnosis of BCC. The findings in this study contradict that vitamin D production through extensive sun exposure has any protective effect on internal cancer but emphasise the increased risk for skin cancer.
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| 15. |
- Lodén, M., et al.
(författare)
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Sunscreen use : controversies, challenges and regulatory aspects
- 2011
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Ingår i: British Journal of Dermatology. - : Wiley-Blackwell Publishing Inc.. - 0007-0963 .- 1365-2133. ; 165:2, s. 255-262
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Tidskriftsartikel (refereegranskat)abstract
- Mismatches between skin pigmentation and modern lifestyle continue to challenge our naked skin. One of our responses to these challenges is the development and use of sunscreens. The management of sunscreens has to balance their protective effect against erythema, photocarcinogenesis and photoageing owing to the potential toxicity of the ultraviolet (UV) filters for humans and the environment. The protection against UV radiation offered by sunscreens was recently standardized in the European Union (EU) based on international harmonization of measurement techniques. Four different categories of sun protection have been implemented along with recommendations on how to use sunscreen products in order to obtain the labelled protection. The UV filters in sunscreens have long been authorized for use by the EU authority on the basis of data from studies on acute toxicity, subchronic and chronic toxicity, reproductive toxicity, genotoxicity, photogenotoxicity, carcinogenicity, irritation, sensitization, phototoxicity and photosensitization as well as on environmental aspects. New challenges with respect to the safety of UV filters have arisen from the banning of animal experiments for the development of cosmetics. Future debates on sunscreens are likely to focus on nanoparticles and environmental issues, along with motivation campaigns to persuade consumers to protect their skin. However, more efficient sunscreen use will also continue to raise questions on the benefit in preventing vitamin D synthesis in the skin induced by sunlight.
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| 16. |
- Lonne-Rahm, Solbritt, et al.
(författare)
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Laser treatment of rosacea : a pathoetiological study
- 2004
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Ingår i: Archives of Dermatology. - : American Medical Association. - 0003-987X. ; 140, s. 1345-1349
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the effect of laser treatment on rosacea, a common facial skin disease with symptoms of blushing, redness, telangiectasis, papules, pustules, and diffuse swelling of the skin, we focused on the stinging sensation and performed immunohistochemical evaluation of nerve density and neuropeptide expression.DESIGN: Clinical investigation as well as the lactic acid (stinger) test was performed before and 3 months after the treatment with flashlamp pulsed dye laser, when skin biopsy specimens were also taken.SETTING: University hospital.PATIENTS: Thirty-two patients with rosacea, all with positive results from the lactic acid "stinger" test, were treated by flashlamp pulsed dye laser.MAIN OUTCOME MEASURES: The biopsy specimens were taken from the stinger-positive areas in the nasolabial folds, fixed in Lanas fixative (10% formalin and 0.4% picric acid), and analyzed for the expression of protein gene product 9.5 (general nerve marker), substance P, calcitonin gene-related peptide, and vasoactive intestinal polypeptide, using a biotinylated streptavidin technique.RESULTS: Thirty-one patients who were stinger positive before treatment showed decreased scores after treatment, and 1 patient had the same stinger test score before and after treatment. The number of protein gene product 9.5-positive fibers in the epidermis (P< .05) as well as the papillary dermis (P< .01) was decreased. This was also the case for substance P in the papillary dermis (P< .001), whereas no evident difference was noted for vasoactive intestinal polypeptide and calcitonin gene-related peptide. No difference was found for contact between nerves and vessels (factor VIII positive).CONCLUSIONS: Laser treatment of rosacea that destroys small vessels has a good medical relevance because it reduces the unpleasant symptoms of the sensitive skin. A neurogenic etiology of stinging may be possible.
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| 17. |
- Lysell, Josefin, et al.
(författare)
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Antiviral therapy in children with hydroa vacciniforme
- 2009
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Ingår i: Acta Dermato-Venereologica. - : Society for Publication of Acta Dermato-Venereologica. - 0001-5555 .- 1651-2057. ; 89:4, s. 393-397
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Tidskriftsartikel (refereegranskat)abstract
- Hydroa vacciniforme is a rare, usually quite severe, photo-dermatosis. Association with Epstein-Barr virus infection and a possibly increased risk of lymphoproliferative malignancy have been demonstrated. We describe here four patients with Epstein-Barr virus-associated hydroa vacciniforme treated with acyclovir/valacyclovir therapy with a good clinical response. The children were reported to have less fatigue, fewer eruptions, less scarring, and increased ability to spend time outdoors without provoking new eruptions. This was also in agreement with clinical observations. However, one patient progressed into an anaplastic lymphoma kinase-1-negative anaplastic large-cell lymphoma in the upper jaw. This was preceded by an increase in EBV viral load. Acyclovir/valacyclovir therapy is a safe treatment. Further studies are required to confirm these results.
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| 18. |
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| 19. |
- Persson, Asa E, et al.
(författare)
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The mutagenic effect of ultraviolet-A1 on human skin demonstrated by sequencing the p53 gene in single keratinocytes.
- 2002
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Ingår i: Photodermatology, Photoimmunology & Photomedicine. - : Wiley. - 0905-4383 .- 1600-0781. ; 18:6, s. 287-293
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Sun exposure is accepted as the major risk factor for developing skin cancer, the most common cancer in the western world. Ultraviolet-B (UV-B) radiation is considered the causative agent, but recently several findings suggest a role also for ultraviolet-A (UV-A) radiation. Repeated suberythemal doses of ultraviolet-A1 (UV-A1) on healthy human skin induce an increase of p53 immunoreactive cells in epidermis, which may indicate cell cycle arrest and/or occurrence of p53 mutations.METHODS: We have investigated the possible mutagenic effect of UV-A1 on skin by sequencing exons 4-11 and adjacent intron sequence of the p53 gene in immunoreactive single cells from three healthy individuals. Previously unexposed buttock skin was irradiated three times a week for 2 weeks with physiological fluences (40 J/cm2) of UV-A1. Punch biopsies were taken before and at different time-points after the exposure, and from these single p53 immunoreactive cells were isolated by using laser-assisted microdissection.RESULTS: Three mutations--all being indicative of oxidative damage and most likely related to UV-A exposure--were found among the 37 single cells from exposed skin, whereas no mutations were found in the 22 single cells taken before exposure.CONCLUSIONS: The findings indicate a mutagenic effect of low-dose UV-A1 on healthy human skin, which further demonstrates the importance of considering UV-A when taking protective measures against skin cancer.
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| 20. |
- Sallander, Ellinor, et al.
(författare)
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Vitamin D levels after UVB radiation : effects by UVA additions in a randomized controlled trial
- 2013
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Ingår i: Photodermatology, Photoimmunology & Photomedicine. - : Wiley-Blackwell Publishing Inc.. - 0905-4383 .- 1600-0781. ; 29:6, s. 323-329
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ultraviolet B (UVB) radiation increases the serum level of 25-hydroxyvitamin D [25(OH)D]. However, the impact of UVA on vitamin D synthesis by UVB is poorly understood clinically.OBJECTIVE: To examine how different combinations of UVA and UVB radiation affect S-25(OH)D for the same vitamin D-weighted exposure.MATERIALS AND METHODS: Healthy participants were recruited and subsequently divided into four comparable groups regarding initial 25(OH)D value. The different radiations given were whole-body UVB (n = 23), UVAB (n = 23) and UVA (n = 10). The controls (n = 19) had no intervention. The exposure times were chosen to give the same calculated vitamin D effective dose (suberythemal exposures ≤1 standard erythema dose). Blood samples were collected before the first irradiation (t0), immediately after the last (fifth) irradiation (t1) and then after another 2 days after the last (fifth) irradiation (t2).RESULTS: UVB and UVAB radiation significantly increased 25(OH)D levels. In the UVA group the increase was less with the same vitamin D-weighted radiation dose.CONCLUSIONS: Short sessions of UVB or UVAB radiation with the same vitamin D-weighted exposure increased 25(OH)D levels. The UVA dose does not influence 25(OH)D levels under short exposure times. However, there was a significantly lower increase of 25(OH)D levels during longer UVA irradiation (≥9 min).
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| 21. |
- Wang, L, et al.
(författare)
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Protein gene product 9.5-immunoreactive nerve fibres and cells in human skin
- 1990
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Ingår i: Cell and Tissue Research. - : Springer. - 0302-766X .- 1432-0878. ; 261:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- Sections of human skin were processed according to the indirect immunofluorescence technique with a rabbit antiserum against human protein gene product 9.5 (PGP 9.5). Immunoreactivity was detected in intraepidermal and dermal nerve fibres and cells. The intraepidermal nerves were varicose or smooth with different diameters, running as single processes or branched, straight or bent, projecting in various directions and terminating in the stratum basale, spinosum or granulosum. The density of the intraepidermal nerves varied between the different skin areas investigated. PGP 9.5-containing axons of the lower dermis were found in large bundles. They separated into smaller axon bundles within the upper dermis, entering this portion of the skin perpendicular to the surface. Then they branched into fibres mainly arranged parallel to the epidermal-dermal junctional zone. However, the fibres en route to the epidermis traversed the upper dermis more or less perpendicularly. Furthermore, immunoreactive dermal nerve fibres were found in the Meissner corpuscles, the arrector pili muscles, hair follicles, around the eccrine and apocrine sweat glands and around certain blood vessels. Such fibres were also observed around most subcutaneous blood vessels, sometimes heavily innervating these structures. Numerous weakly-to-strongly PGP 9.5-immunoreactive cells were found both in the epidermis and in the dermis.
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| 22. |
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| 23. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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A phenomenographic study of students' conception of learning for a written examination
- 2015
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Ingår i: International Journal of Medical Education. - : University of Nottingham. - 2042-6372. ; 6, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We investigated students' conception of learning for an examination in internal medicine, infectious diseases and dermatology-venereology, in three separate examinations versus a single integrated one.METHODS: The study was carried out during a curricular change, with one cohort belonging to a new integrated examination and the other to the former non-integrated examination. Forty-eight interviews were carried out among medical undergraduates regarding the role of the examination in the learning process. The interviews were analyzed according to the phenomenographic approach to identify the students' conception of learning.RESULTS: The learning approaches could be categorized in 47 of the 48 students into 4 major groups: application directed, holistic, comprehensive and tactical memorizing learning. The result indicated that comprehensive learning was the most common approach among students following either examination-form; tactical memorizing learning was more prevalent among students following the non-integrated examination and holistic learning was applied more frequently among students following the integrated examination. Nine of the 47 students changed their approaches over time, the majority switching to a comprehensive approach. No significant gender difference was observed.CONCLUSIONS: Comprehensive learning was the most common strategy employed and students who changed during the course most often switched to this. However, only a minor change in approach was observed after a switching to an integrated examination, i.e. it takes more than just an integrated examination to change the student's conception of learning.
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| 24. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Cyclosporin A therapy for severe solar urticaria
- 1997
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Ingår i: Photodermatology, Photoimmunology & Photomedicine. - : Wiley-Blackwell Publishing Inc.. - 0905-4383 .- 1600-0781. ; 13:1-2, s. 61-63
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Tidskriftsartikel (refereegranskat)abstract
- Solar urticaria is characterized by itching weals that occur a few minutes after exposure to visible or ultraviolet light. The symptoms may sometimes restrict normal daily life. Treatment is difficult in more severe cases. We describe one patient with solar urticaria who was successfully treated with cyclosporin A. The patient had first been treated with antihistamine, PUVA and chloroquine phosphate without effect. Cyclosporin was given in a dose of 4.5 mg/kg body weight/day. Phototesting before, during and after treatment showed a decreased light sensitivity to UVA, UVB and visible light during cyclosporin treatment compared with phototesting before therapy. The patient could be out in the sun for at least 1 h with minimal urticaria during cyclosporin therapy compared with only a few minutes previously. However, 1-2 weeks after cyclosporin therapy was discontinued, skin symptoms returned. Cyclosporin therapy is a possible treatment in severe cases of solar urticaria where other treatments have failed, especially in countries where treatment is necessary only for a few months during summer.
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| 25. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Effects on human skin of repetitive ultraviolet-A1 (UVA1) irradiation and visible light.
- 2001
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Ingår i: Photodermatology, Photoimmunology & Photomedicine. - : Wiley-Blackwell Publishing Inc.. - 0905-4383 .- 1600-0781. ; 17:2, s. 66-70
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Ultraviolet radiation (UVR) has a variety of effects on human skin. Best known are the effects of UVB (290-320 nm) and UVA2 (320-340 nm), which cause DNA damage and increased risk of cancer. However, the effects of UVA1 (340-400 nm) have been not completely investigated.METHODS: The effects of repetitive low doses of UVA1 and visible light were studied in 12 healthy individuals. A part of the buttock was exposed to 20 J/cm2 UVA1 and another part of 126 J/cm2 of visible light three times a week for 4 weeks. Repeated punch biopsies were taken during the 4 weeks of treatment and also 2 weeks after the last irradiation. The avidin-biotin-immunoperoxidase technique was used to investigate the expression of p53, p21WAF, bcl-2, Ki67 and cyclin A.RESULTS: By comparison to untreated skin, an increased expression of p53 but not p21WAF in keratinocytes was seen. The bcl-2 protein expression increased slightly after both UVA1 and visible light. An increased staining with Ki67 and cyclin A after UVA1 but not after visible light was observed as a sign of increased proliferation.CONCLUSION: These results suggest that suberythemal doses of UVA1 and even visible light may cause DNA damage.
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| 26. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Flashlamp pulsed dye laser and argon-pumped dye laser in the treatment of port-wine stains a clinical and histological comparison
- 2002
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Ingår i: British Journal of Dermatology. - : Wiley-Blackwell Publishing Inc.. - 0007-0963 .- 1365-2133. ; 146:2, s. 285-289
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Port-wine stains (PWS) are congenital vascular malformations occurring in 0.3% of children. The pulsed dye laser is a well established treatment for PWS.OBJECTIVES: To compare, clinically and histologically, the effects of the flashlamp pulsed dye laser with the argon-pumped dye laser in the treatment of PWS.METHODS: Thirty patients were treated on two to four test areas with both laser types using different energy fluences. A flashlamp pulsed dye laser with 0.45 ms pulse duration and a spot size of 5 mm was compared with an argon-pumped dye laser, with a spot size of 1 mm delivered with a robotic scanning laser handpiece (Hexascan) and 70-190 ms pulse duration. Both were tuned to 585 nm. Twelve weeks later the degree of lightening was evaluated and biopsies were taken. To count the vessels the skin sections were stained with CD34 using an immunohistochemical technique. The vessels were divided into three groups by diameter (d): d < 10 microm, 10 < or = d < 20 microm, d > or = 20 microm.RESULTS: The clinical results showed a significantly better lightening using the flashlamp pulsed dye laser than with the argon-pumped dye laser. The histological results showed a significant decrease in the number of vessels of diameter larger than 20 microm in treated compared with untreated lesions. We found no histological difference in the number of vessels between the two laser treatments. However, there was a tendency towards more small vessels (diameter < 10 microm) after one treatment with the flashlamp pulsed dye laser compared with untreated PWS.CONCLUSIONS: The flashlamp pulsed dye laser is clinically superior to the argon-pumped dye laser in the treatment of PWS.
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| 27. |
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| 28. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Photodynamic therapy with topical 5-aminolevulinic acid for mycosis fungoides : clinical and histological response
- 2001
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Ingår i: Acta Dermato-Venereologica. - : Taylor & Francis. - 0001-5555 .- 1651-2057. ; 81:3, s. 184-188
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Tidskriftsartikel (refereegranskat)abstract
- There is no curative treatment for mycosis fungoides (MF), the most common primary cutaneous T-cell lymphoma. The aim of this study was to investigate the response of single lesions to photodynamic therapy (PDT). The study included 10 plaque MF lesions and 2 tumour MF lesions from 10 patients. First, 20% 5-aminolevulinic acid was applied topically to the lesion and adjacent skin for 5-6 h. The lesion was then exposed to red light at around 630nm. Skin biopsies were taken before treatment, after clinical improvement and after clinical remission. The expression of CD3, CD4, CD7, CD8, CD1a, CD34, CD68, CD71, Ki-67, bcl-2 and p53 was studied immunohistochemically. There was complete clinical clearance in seven of nine plaque lesions. Neither tumour lesion responded to PDT. The biopsies confirmed a regression of the infiltrate after treatment. In the sparse remaining infiltrate a few CD4+ and CD8+ cells were found, most of which showed normal bcl-2. There were also fewer proliferating cells, illustrated by a decrease in Ki-67 and CD71. In conclusion, PDT has good clinical and histological effects in treating local plaque MF lesions.
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| 29. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Phototherapy with ultraviolet radiation : a study of hormone parameters and psychological effects
- 2010
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Ingår i: Journal of the European Academy of Dermatology and Venereology. - : Blackwell Publishing. - 0926-9959 .- 1468-3083. ; 24:4, s. 403-409
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Patients report well-being as they are treated with phototherapy. We investigated hormone parameters and psychological well-being after phototherapy in a placebo-controlled study.METHODS: A total of 77 patients with dermatological conditions and 22 healthy volunteers were divided into four groups. The patients received phototherapy either on the whole body or only on hands and/or feet. The volunteers were given either whole-body phototherapy or placebo light. Serum or plasma samples were analysed for cortisol, calcium, magnesium, phosphate, TSH, T(4), T(3) and 25-hydroxyvitamin D, and urine samples for cortisol. Patients and volunteers answered a questionnaire before and 6 weeks after phototherapy/placebo light. Psychiatric ratings were performed according to the Comprehensive Psychopathological Self-rating Scale for Affective Syndromes, a self-report version of which has been transformed to correspond to the Montgomery-Asberg Depression Rating Scale (MADRS).RESULTS: In the patients who received whole-body irradiation, we observed a significant improvement in both MADRS score and cognitive-symptom score after the completion of phototherapy. We also observed a significantly higher level of 25-hydroxyvitamin D after phototherapy, but no difference in the other hormone parameters.CONCLUSION: Whole-body phototherapy of patients with dermatological conditions results in improved well-being and significantly higher levels of 25-hydroxyvitamin D in serum.
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| 30. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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The treatment of port-wine stains with the pulsed dye laser at 600 nm
- 1997
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Ingår i: British Journal of Dermatology. - : Blackwell Science Ltd. - 0007-0963 .- 1365-2133. ; 136:3, s. 360-363
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Tidskriftsartikel (refereegranskat)abstract
- The standard wavelength in the treatment of port-wine stains (PWS) with the pulsed dye laser is 585 nm. In many cases, the response to therapy is not adequate despite many treatments, depending partly on vessels out of reach of the laser. Longer wavelengths penetrate deeper into the dermis, but are absorbed less by oxyhaemoglobin, and require higher fluences. In this study, 22 patients with PWS were treated with the flashlamp-pumped pulsed dye laser using two different wavelengths, 585 and 600 nm. Four adjacent sites with PWS were treated on one occasion with 585 nm, 600 nm and equal fluence, and with 1.5 and 2 times the 585 nm fluence. The test areas were examined blindly, by four evaluators, an average of 12.5 weeks later. There was significantly less lightening with 600 nm than with 585 nm (P < or = 0.001) when equal fluences were used. When 1.5 and 2 times the 585 nm fluence were applied, with 600 nm the lightening was equal to that after 585 nm. However, in individual cases (11 of 22) 600 nm showed a superior lightening of at least 20% compared to 585 nm. There was slight hyperpigmentation and hypopigmentation, but no atrophy or scarring. In conclusion, 585 nm remains the wavelength of choice in treatment of PWS with the pulsed dye laser. However, in cases that do not respond satisfactorily with 585 nm, it may be worth trying 600 nm with a fluence that is at least 1.5-2 times the 585 nm fluence.
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| 31. |
- Wiegleb Edström, Desirée, 1959-, et al.
(författare)
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Using interviews and observations in clinical practice to enhance authenticity in virtual patients for interprofessional education
- 2020
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Ingår i: BMC Medical Education. - : BioMed Central. - 1472-6920. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Interprofessional collaboration is increasingly important in healthcare, but interprofessional education (IPE) faces challenges, such as different study programmes with varied schedules and campuses. These challenges can be met, in part, by using web-based virtual patients (VPs) as a tool in IPE. However, demands for relevant patient presentations and clinical practice increase when VPs are used by students from different programmes. The aim of this study was to improve the presentation of professional perspectives regarding nurses and physicians and their collaboration in order to increase the clinical authenticity of existing VPs.METHODS: Clinical observations were conducted to gain familiarity with the context. Semi-structured interviews were performed with individual nurses and physicians with experience of patients with leg ulcers. The interviews were recorded, transcribed and analysed using thematic analysis.RESULTS: The clinical observations exposed a lack of interprofessional collaboration in practice with regard to patients with leg ulcers. The interview analysis resulted in two themes: Clinical care and Organizational structure. The theme Clinical care included nursing with a holistic approach to the patient and awareness of the patient's well-being, including nutrition and home situation. The theme Organizational structure revealed a lack of teamwork in primary care. The interviewees stressed learning together and sharing responsibility, and they emphasised the importance of implementing interprofessional learning in the education of nurses and physicians in order to stimulate future teamwork. The VP should offer a broad medical history so that healthcare students are made aware of how a disease can affect the patient's social situation, and thereby illustrate the importance of interprofessional collaboration. The information should also be comprehensive and clear, leading to a diagnosis, so the student can gain clinical knowledge and build a foundation for discussion of treatment.CONCLUSIONS: Interviews and observations in clinical practice can be used to enhance authenticity in VPs for interprofessional learning. A thorough look at authentic clinical environments can enrich and improve educational settings using VPs, and it can highlight the challenges students can encounter in clinical care of the patient and in an organisation with regard to interprofessional collaboration.
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