| 11. |
- Isaksson, Karin, et al.
(författare)
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Bilateral risk-reducing mastectomies with implant-based reconstructions followed long term : a consecutive series of 185 patients
- 2019
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 0364-2313 .- 1432-2323. ; 43:9, s. 2262-2270
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bilateral risk-reducing mastectomy (BRRM) is the most effective method to prevent breast cancer in genetically predisposed women and is often performed concomitantly with breast reconstruction. The reconstruction time varies and corrective surgeries are common.METHODS: This study evaluated 185 consecutive cases of BRRM and immediate breast reconstruction with implants with regard to surgical outcome and resource consumption. With an 18-year observation period, it was possible to compare permanent expander implants (PEIs) with permanent fixed volume implants (PIs).RESULTS: A minimum follow-up of 2 years for all participants but one was achieved. Seventy-five percent (n = 138) of the women received PEI and 25% (n = 47) PI. In a multivariate analysis including age, BMI (<25, ≥25), smoking (yes, no), implant type (PEI, PI), incision technique, operation time and specimen weight <350 g, ≥350 g), only BMI ≥25 was associated with an increased risk of an early complication (OR 7.1, 95% CI 2.44-20.4). As expected, there was a significant difference in median reconstruction time between PEI and PI (12.4 vs. 1.0 months, p < 0.001). The cumulative reoperation-free 2-year survival was significantly higher in the PI than in the PEI group (81% vs. 26%, p < 0.001).CONCLUSION: Implant-based reconstruction remains a valid option after BRRM in high-risk women. Whenever possible (low BMI and small breast volume without severe ptosis), permanent fixed volume implants can be safely recommended and are resource saving in comparison with permanent expander implants.
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| 12. |
- Johansson, Unn-Britt, et al.
(författare)
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Mixed methods study on the feasibility of implementing periodic continuous glucose monitoring among individuals with type 2 diabetes mellitus in a primary care setting
- 2024
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Ingår i: Heliyon. - 2405-8440. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Health care professionals (HCPs) play a central role in leveraging technologies to support individuals with diabetes. This mixed-method study was completed to determine the feasibility of implementing periodic continuous glucose monitoring (CGM) in a primary care setting.AIM: This study aimed to evaluate and describe the experiences of using periodic CGM with data visualization tools in patients with type 2 diabetes to foster a person-centered approach in a primary care setting.METHODS: Fifty outpatients aged ≥18 years, diagnosed with type 2 diabetes, and with a disease duration of at least 2 years were included in this study. Data were collected from April 2021 to January 2022. Patients completed a single period of sensor measurements for 28 days and a diabetes questionnaire about feelings and experiences of health care. HbA1c was also measured. A focus group interview was conducted to evaluate and describe the HCPs experiences of using periodic CGM.RESULTS: Patients reported to HCPs that the CGM device was comfortable to wear and noted that LibreView was easy to use when scanning the sensor to obtain and visualize the glucose levels and trends. Data availability of CGM data was >70 %.Clinical observations revealed a mean reduction in HbA1c, mmol/mol from 60.06 [7.65 %] at baseline to 55.42 [7.20 %] after 4 weeks (p < 0.001). Two categories were identified: 1) Fostering dialogue on self-care and 2) Promoting understanding.CONCLUSIONS: The HCPs and participants in this study had a positive experience or viewed the implementation of periodic CGM with data visualization tools as a positive experience and appeared to be feasible for implementation in a primary care setting.
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| 13. |
- Lemonnier, Nathanaël, et al.
(författare)
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A novel whole blood gene expression signature for asthma, dermatitis, and rhinitis multimorbidity in children and adolescents
- 2020
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : WILEY. - 0105-4538 .- 1398-9995. ; 75:12, s. 3248-3260
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Tidskriftsartikel (refereegranskat)abstract
- Background: Allergic diseases often occur in combination (multimorbidity). Human blood transcriptome studies have not addressed multimorbidity. Large-scale gene expression data were combined to retrieve biomarkers and signaling pathways to disentangle allergic multimorbidity phenotypes.Methods: Integrated transcriptomic analysis was conducted in 1233 participants with a discovery phase using gene expression data (Human Transcriptome Array 2.0) from whole blood of 786 children from three European birth cohorts (MeDALL), and a replication phase using RNA Sequencing data from an independent cohort (EVA-PR, n = 447). Allergic diseases (asthma, atopic dermatitis, rhinitis) were considered as single disease or multimorbidity (at least two diseases), and compared with no disease.Results: Fifty genes were differentially expressed in allergic diseases. Thirty-two were not previously described in allergy. Eight genes were consistently overexpressed in all types of multimorbidity for asthma, dermatitis, and rhinitis (CLC, EMR4P, IL5RA, FRRS1, HRH4, SLC29A1, SIGLEC8, IL1RL1). All genes were replicated the in EVA-PR cohort. RT-qPCR validated the overexpression of selected genes. In MeDALL, 27 genes were differentially expressed in rhinitis alone, but none was significant for asthma or dermatitis alone. The multimorbidity signature was enriched in eosinophil-associated immune response and signal transduction. Protein-protein interaction network analysis identified IL5/JAK/STAT and IL33/ST2/IRAK/TRAF as key signaling pathways in multimorbid diseases. Synergistic effect of multimorbidity on gene expression levels was found.Conclusion: A signature of eight genes identifies multimorbidity for asthma, rhinitis, and dermatitis. Our results have clinical and mechanistic implications, and suggest that multimorbidity should be considered differently than allergic diseases occurring alone.
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| 14. |
- Lindegren, A, et al.
(författare)
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Autologous fat transplantation alters gene expression patterns related to inflammation and hypoxia in the irradiated human breast
- 2019
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:5, s. 563-573
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Radiation-induced fibrosis, an adverse effect of breast cancer treatment, is associated with functional and cosmetic impairment as well as surgical complications. Clinical reports suggest improvement following autologous fat transplantation, but the mechanisms underlying this effect are unknown. A global gene expression analysis was undertaken to identify genetic pathways dysregulated by radiation and evaluate the impact of autologous fat transplantation on gene expression.METHODS: Adipose tissue biopsies were taken synchronously from irradiated and contralateral non-irradiated breasts, before and 1 year after autologous fat transplantation. Whole-genome gene expression analyses were performed, and Hallmark gene set analysis used to explore the effect of radiotherapy and autologous fat transplantation on gene expression.RESULTS: Forty microarrays were analysed, using bilateral biopsies taken from ten patients before and after autologous fat transplantation. Forty-five pathways were identified among the 3000 most dysregulated transcripts after radiotherapy in irradiated compared with non-irradiated breast (P ≤ 0·023; false discovery rate (FDR) no higher than 0·026). After autologous fat transplantation, 575 of the 3000 genes were again altered. Thirteen pathways (P ≤ 0·013; FDR 0·050 or less) were identified; the top two canonical pathways were interferon-γ response and hypoxia. Correlative immunohistochemistry showed increased macrophage recruitment in irradiated tissues.CONCLUSION: The present findings contribute to understanding of how autologous fat transplantation can ameliorate radiation-induced fibrosis. This further supports the use of autologous fat transplantation in the treatment of radiation-induced fibrosis. Surgical relevance Clinical studies have indicated that autologous fat transplantation (AFT) stimulates regression of chronic inflammation and fibrosis caused by radiotherapy in skin and subcutaneous fat. However, there is a paucity of biological evidence and the underlying processes are poorly understood. Human data are scarce, whereas experimental studies have focused mainly either on the effect of irradiation or AFT alone. The present results indicate that radiotherapy causes dysregulated gene expression in fibrosis-related pathways in adipose tissues in humans. They also show that AFT can cause a reversal of this, with several dysregulated genes returning to nearly normal expression levels. The study provides biological evidence for the impact of AFT on radiation-induced dysregulated gene expression in humans. It supports the use of AFT in the treatment of radiation-induced fibrosis, associated with severe morbidity and surgical challenges.
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| 15. |
- Lindegren, Anna, et al.
(författare)
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Improved patient-reported outcomes after autologous fat transplantation and corrective surgery after breast surgery
- 2019
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 53:2, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Autologous fat transplantation (AFT) is being increasingly used to improve the results after breast-conserving surgery and breast reconstruction. However, studies on patient-reported outcomes (PROs) and health-related quality of life (HRQoL) after AFT are scarce. The aim of this prospective longitudinal case-series study was to assess PRO in women who had undergone AFT after surgery for breast cancer or risk-reducing mastectomy.METHODS: Fifty women, who had undergone breast-conserving surgery or breast reconstruction, needing corrective surgery, were consecutively included between 2008 and 2013. A 20-item study-specific questionnaire (SSQ) and the Short Form Health Survey (SF-36) were used pre-operatively and 6 months, 1 year and 2 years post-operatively, to evaluate PRO and HRQoL.RESULTS: The patients underwent three (1-4) AFT procedures, with the injection of 164 ml (median) (range 40-516) fat. Thirty-eight and 34 patients completed the study-specific questionnaire and the SF-36, respectively, both pre-operatively and after 2 years. Sixteen of the 20 items in the SSQ were improved after 2 years, including breast size (p < 0.0001), shape (p < 0.0001), appearance (p < 0.0001), softness of the breast (p = 0.001), pain in the region (p = 0.005), scarring from previous breast surgery (p < 0.001) and willingness to participate in public physical activities (p < 0.001). HRQoL did not largely differ before and after AFT, or between the study group and a reference population.CONCLUSIONS: AFT alone or in combination with other corrective surgical procedures, improved PRO after breast-conserving surgery and breast reconstruction in both irradiated and non-irradiated women.
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| 16. |
- Melén, Erik, et al.
(författare)
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Air pollution and IgE sensitization in 4 European birth cohorts : the MeDALL project
- 2021
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Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier. - 0091-6749 .- 1097-6825. ; 147:2, s. 713-722
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundWhether long-term exposure air to pollution has effects on allergic sensitization is controversial.ObjectiveOur aim was to investigate associations of air pollution exposure at birth and at the time of later biosampling with IgE sensitization against common food and inhalant allergens, or specific allergen molecules, in children aged up to 16 years.MethodsA total of 6163 children from 4 European birth cohorts participating in the Mechanisms of the Development of ALLergy [MeDALL] consortium were included in this meta-analysis of the following studies: Children, Allergy, Milieu, Stockholm, Epidemiology (BAMSE) (Sweden), Influences of Lifestyle-Related Factors on the Human Immune System and Development of Allergies in Childhood (LISA)/German Infant Study on the Influence of Nutrition Intervention PLUS Environmental and Genetic Influences on Allergy Development (GINIplus) (Germany), and Prevention and Incidence of Asthma and Mite Allergy (PIAMA) (The Netherlands). The following indicators were modeled by land use regression: individual residential outdoor levels of particulate matter with aerodynamic diameters less than 2.5 μm, less than 10 μm, and between 2.5 and 10 μm; PM2.5 absorbance (a measurement of the blackness of PM2.5 filters); and nitrogen oxides levels. Blood samples drawn at ages 4 to 6 (n = 5989), 8 to 10 (n = 6603), and 15 to 16 (n = 5825) years were analyzed for IgE sensitization to allergen extracts by ImmunoCAP. Additionally, IgE against 132 allergen molecules was measured by using the MedALL microarray chip (n = 1021).ResultsAir pollution was not consistently associated with IgE sensitization to any common allergen extract up to age 16 years. However, allergen-specific analyses suggested increased risks of sensitization to birch (odds ratio [OR] = 1.12 [95% CI = 1.01-1.25] per 10-μg/m3 increase in NO2 exposure). In a subpopulation with microarray data, IgE to the major timothy grass allergen Phleum pratense 1 (Phl p 1) and the cat allergen Felis domesticus 1 (Fel d 1) greater than 3.5 Immuno Solid-phase Allergen Chip standardized units for detection of IgE antibodies were related to PM2.5 exposure at birth (OR = 3.33 [95% CI = 1.40-7.94] and OR = 4.98 [95% CI = 1.59-15.60], respectively, per 5-μg/m3 increase in exposure).ConclusionAir pollution exposure does not seem to increase the overall risk of allergic sensitization; however, sensitization to birch as well as grass pollen Phl p 1 and cat Fel d 1 allergen molecules may be related to specific pollutants.
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| 17. |
- Silfver, Ann-Louise, et al.
(författare)
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Educating Parents : A critical encounter between Swedish government parent support and parent’s narratives
- 2011
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Ingår i: Changing the Future Educating about Gender. - Exeter : Exeter University.
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Konferensbidrag (refereegranskat)abstract
- The main purpose of this study is to explore constructions of family and parenthood in Swedish contemporary parent support initiatives. We focus on government policy; municipal support initiatives; media representations of parenthood; parents’ narratives, and online activities. A discourse analytical perspective will guide the study. We draw on notions of how discourses form actions and boundaries in government’s parent support initiatives and in narratives of parents. The governmentality concept will be used to analyse processes of governance at state and individual levels (Foucault 1991). For policy analysis a “What’s the problem represented to be” approach (2009) will be used addressing how problems are constructed in policy, and how representations of problems bring about effects. Since issues of parenthood are saturated by ideas of e.g. gender, sexual orientation and dis-/ability, the study will be informed by theories of social categorizations (Butler 1990/1999; Connell 2009; Young 1997) and how these categories intersect (Crenshaw 1994; Yuval-Davies 2006). Research states Swedish parent support mainly addresses women/mothers (Bremberg, 004). There also seems to be a bias where “parents” are mainly represented by ethnic Swedish, well educated, urban, heterosexual nuclear families (Sarkadi 2009). Since parent education primarily has been studied from a medical perspective, there certainly is a need for educational researchers to study these programs and those involved, from a pedagogical and psychological perspective.
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| 18. |
- Stjerna, Marie-Louise, et al.
(författare)
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The management of situated risk : A parental perspective on child food allergy
- 2014
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Ingår i: Health. - : SAGE Publications. - 1363-4593 .- 1461-7196. ; 18:2, s. 130-145
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Tidskriftsartikel (refereegranskat)abstract
- Food allergy is an illness that requires constant risk management in everyday life. To date, there is no cure or preventive treatment, and the only way to manage the condition is therefore careful avoidance of the offending foodstuff and treatment of reactions when they occur. This article draws on a socio-cultural approach to explore parents' understandings and management of child food allergy in the context of everyday life, as situated' risk. A focus group study was carried out with 31 parents of children diagnosed with food allergy at two children's hospitals. The analysis of the focus group material reveals how the management of allergy risk seems to permeate most aspects of everyday life as well as how the parents draw on a dominant norm of risk avoidance as well as a counter-discourse of calculated risk taking. The patterns of risk management found in this study are discussed in terms of how risk avoidance and risk taking are intertwined and balanced in the context of moral parenthood.
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| 19. |
- Tengvall, Oili, et al.
(författare)
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Memories of pain after burn injury : the patient's experience
- 2010
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Ingår i: Journal of Burn Care & Research. - 1559-047X .- 1559-0488. ; 31:2, s. 319-327
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Tidskriftsartikel (refereegranskat)abstract
- Pain after burns is a major clinical problem and researchers continue to report that burn pain remains undertreated. Adequate pain management could contribute to the prevention of post-traumatic stress disorder and can give a growing sense of patients' self-confidence and strength. Freedom from pain might be unrealistic, but the objective should be to reduce pain as much as possible. The purpose of this study was to describe burn patients' experiences and memories of pain during burn care and to acquire a deeper understanding of how patients cope with the experience. The study method was qualitative and interviews were conducted with 12 adult burn patients ( eight men and four women) 6 to 12 months postburn (mean = 7 months). The mean burn size for the group was 10.6% mean of TBSA and the mean stay in hospital was 16 days. The interviews were analyzed using Kvales' method for structuring analysis. The patients' experiences and memories of pain during the trajectory of care were clearly described by the informants during the interviews. Four themes were identified for pain: becoming aware of pain, allowing oneself to feel pain, different pain experiences, and fragile body surface. Four themes were identified for coping: pragmatic coping, allowing someone to care for you, carrying the pain, and perspectives on the trauma. Both good and bad memories were recorded during the care trajectory, and it is evident that the patient has to carry the pain experience by themselves to a large extent. (J Burn Care Res 2010;31:319-327)
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| 20. |
- Wickman, Marie
(författare)
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Surface chemical behaviour
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objective of the investigations included in this thesisis to show how the properties of alkyd resins, used as bindersin offset printing inks, affect the ink in terms of pigmentdispersion, emulsification of fountain solution, and inksetting.The interactions between alkyd resins and aqueous solutionshave been investigated by interfacial tension measurementsusing the pendant drop technique and by measurement of dropletsize using light diffraction. The interfacial tension dependsboth on the alkyd resin used and the surface active additivesin the fountain solution. Alkyd resins are surface active,acting as emulsifiers to stabilise the emulsion. Similar to oilsoluble surfactants, small amounts of alkyd resin are needed todecrease the interfacial tension substantially. The interfacialtension and droplet size show a strong dependence of hydroxylicand acidic value of the alkyd resins. Polar alkyd resins givelower interfacial tension and smaller droplets.Adsorption of alkyd resin onto pigment surfaces weredetermined by the solution depletion technique. The adsorptionof alkyd resins onto pigment surfaces must be discussed interms of adsorption of polydisperse polymers and the adsorbedamount depends on the total area available for adsorption. Theadsorbed amount increases with alkyd resin polydispersity andhydroxylic value but decreases with increasing oil length. Anempirical equation to determine adsorption of alkyd resins ontocalcium carbonate is presented. This equation may also beuseful to predict differences in adsorbed amount of alkyd resinon other surfaces.When adsorption of alkyd resins onto different pigmentsurfaces are compared, the porosity of the pigments must beconsidered. Larger molecules are unable to penetrate into thesmall pores. Alkyd resins with low molecular mass do notdiscriminate between different surface areas whereas with highmolecular mass alkyd resins the adsorbed amount decreases withincreasing surface area. It is also shown that the adsorbedamount decreases when coating pigments have been pre-treatedwith dispersants.It is believed that alkyd resinshaving strong interactionswith coating pigments would give printing inks with lessset-off and rub-off problems. A method for the directmeasurement of ink setting on coated papers is presented. Theresults show that alkyd resins with strong interactions give abetter phase separation during setting and remain on the papersurface, while alkyd resins with weaker interactions accompanythe oil into the paper.KEYWORDS:Adsorption, Alkyd resins, Binders, Calciumcarbonate, Carbon black, Droplet size, Emulsion, FTIR, Fountainsolution, Interfacial tension, Ink formulation, Ink properties,Ink setting, Offset, Printing ink, Surface tension
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