| 1. |
- Sampson, Joshua N., et al.
(författare)
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Analysis of Heritability and Shared Heritability Based on Genome-Wide Association Studies for 13 Cancer Types
- 2015
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 107:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of related individuals have consistently demonstrated notable familial aggregation of cancer. We aim to estimate the heritability and genetic correlation attributable to the additive effects of common single-nucleotide polymorphisms (SNPs) for cancer at 13 anatomical sites. Methods: Between 2007 and 2014, the US National Cancer Institute has generated data from genome-wide association studies (GWAS) for 49 492 cancer case patients and 34 131 control patients. We apply novel mixed model methodology (GCTA) to this GWAS data to estimate the heritability of individual cancers, as well as the proportion of heritability attributable to cigarette smoking in smoking-related cancers, and the genetic correlation between pairs of cancers. Results: GWAS heritability was statistically significant at nearly all sites, with the estimates of array-based heritability, h(l)(2), on the liability threshold (LT) scale ranging from 0.05 to 0.38. Estimating the combined heritability of multiple smoking characteristics, we calculate that at least 24% (95% confidence interval [CI] = 14% to 37%) and 7% (95% CI = 4% to 11%) of the heritability for lung and bladder cancer, respectively, can be attributed to genetic determinants of smoking. Most pairs of cancers studied did not show evidence of strong genetic correlation. We found only four pairs of cancers with marginally statistically significant correlations, specifically kidney and testes (rho = 0.73, SE = 0.28), diffuse large B-cell lymphoma (DLBCL) and pediatric osteosarcoma (rho = 0.53, SE = 0.21), DLBCL and chronic lymphocytic leukemia (CLL) (rho = 0.51, SE = 0.18), and bladder and lung (rho = 0.35, SE = 0.14). Correlation analysis also indicates that the genetic architecture of lung cancer differs between a smoking population of European ancestry and a nonsmoking Asian population, allowing for the possibility that the genetic etiology for the same disease can vary by population and environmental exposures. Conclusion: Our results provide important insights into the genetic architecture of cancers and suggest new avenues for investigation.
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| 2. |
- Abelius, Martina, et al.
(författare)
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Pregnancy modulates the allergen-induced cytokine production differently in allergic and non-allergic women
- 2017
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Ingår i: Pediatric Allergy and Immunology. - : WILEY. - 0905-6157 .- 1399-3038. ; 28:8, s. 818-824
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Tidskriftsartikel (refereegranskat)abstract
- Background: The immunological environment during pregnancy may differ between allergic and non-allergic women. This study investigates the effect of maternal allergy on the allergen-induced cytokine and chemokine levels and whether pregnancy modulates these immune responses differently in allergic and non-allergic women. Methods: The birch-, cat-, phytohemagglutinin- and tetanus toxoid-induced interferon-gamma(IFN-gamma), interleukin (IL)-4, IL-5, IL-10, IL-13, the T-helper 1 (Th1)-associated chemokine CXCL10 and the Th2-associated chemokine CCL17 levels were quantified in 20 women with allergic symptoms (sensitized, n=13) and 36 women without allergic symptoms (non-sensitized, n=30) at gestational weeks 10-12, 15-16, 25, 35 and 2 and 12months post-partum. Results: Birch-, but not cat-induced, IL-5, IL-13 and CCL17 levels were increased during pregnancy as compared to post-partum in the sensitized women with allergic symptoms. In contrast, cat-, but not birch-induced, IL-5 and IL-13 levels were increased during pregnancy as compared to post-partum in the non-sensitized women without allergic symptoms. Furthermore, IFN-gamma secretion was increased in the first and decreased in the second and third trimesters in response to birch and decreased in the third trimester in response to cat as compared to post-partum in the non-sensitized women without allergic symptoms. Increased allergen-induced IL-4, IL-5 and IL-13 levels were associated with allergic symptoms and sensitization. Conclusions: Pregnancy had a clear effect on the allergen-induced IL-5, IL-13, CCL17, IFN-gamma and CXCL10 production, with distinct enhanced Th2-responses to birch in the allergic group and to cat in the non-allergic group.
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| 3. |
- Abelius, Martina S, et al.
(författare)
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The Placental Immune Milieu is Characterized by a Th2- and Anti-Inflammatory Transcription Profile, Regardless of Maternal Allergy, and Associates with Neonatal Immunity
- 2015
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Ingår i: American Journal of Reproductive Immunology. - : Wiley-Blackwell. - 1046-7408 .- 1600-0897. ; 73:5, s. 445-459
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Tidskriftsartikel (refereegranskat)abstract
- PROBLEM: How maternal allergy affects the systemic and local immunological environment during pregnancy and the immune development of the offspring is unclear.METHOD OF STUDY: Expression of 40 genes was quantified by PCR arrays in placenta, peripheral blood mononuclear cells (PBMC), and cord blood mononuclear cells (CBMC) from 7 allergic and 12 non-allergic women and their offspring.RESULTS: Placental gene expression was dominated by a Th2-/anti-inflammatory profile, irrespectively of maternal allergy, as compared to gene expression in PBMC. p35 expression in placenta correlated with fetal Tbx21 (ρ = -0.88, P < 0.001) and IL-5 expression in PBMC with fetal galectin1 (ρ = 0.91, P < 0.001). Increased expression of Th2-associated CCL22 in CBMC preceded allergy development.CONCLUSIONS: Gene expression locally and systemically during pregnancy was partly associated with the offspring's gene expression, possibly indicating that the immunological milieu is important for fetal immune development. Maternal allergy was not associated with an enhanced Th2 immunity in placenta or PBMC, while a marked prenatal Th2 skewing, shown as increased CCL22 mRNA expression, might contribute to postnatal allergy development.
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| 4. |
- Abrahamsson, Birgitta, et al.
(författare)
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To recommend the local primary health-care centre or not : What importance do patients attach to initial contact quality, staff continuity and responsive staff encounters?
- 2015
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1353-4505 .- 1464-3677. ; 27:3, s. 196-200
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: This study aims to examine the circumstances associated with patients’ tendencies to recommend a primary care centre, based on four hypotheses, the initial contact’s quality, care relationship continuity, treatment encounter responsiveness and whether the significance of encounter responsiveness differs depending on whether the patient has been seeing a nurse or physician. Design: The study is based on the patient’ self-reported responses, retrieved from the Swedish National Patient Survey. The design is cross-sectional, and data were analysed using a binary logistic regression. Setting: Data were collected from three primary healthcare centres in the region of Västra Götaland, Sweden. Participants: A total of 362 patients (62% females) having visited any of three publicly run healthcare centres in September 2010 constitute the analytical sample. Participants were fairly evenly distributed across all age groups. Main Outcome Measures: Recommendation was captured by patients’ binary responses to the question: Would you recommend the visited primary healthcare centre? Results: The hypotheses involving initial contact quality, care relationship continuity and treatment encounter responsiveness were supported by the analyses. The latter was strongly associated with patient tendency to recommend the primary healthcare centre. However, the profession (nurse or physician) involved in the treatment encounter made no difference for the predictive significance of encounter responsiveness for a patient’s tendency to recommend the healthcare centre. Conclusions: Striving for stable and responsive patient/staff relationships and an open approach towards patients are potentially successful strategies for primary healthcare centres seeking to attract new patients and maintain current ones. (PsycINFO Database Record (c) 2015 APA, all rights reserved)(journal abstract)
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| 5. |
- Adolfsson, Annsofie, 1960-, et al.
(författare)
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Miscarriage : Evidence Based Information for the Web and Its Development Procedure
- 2015
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Ingår i: Advances in Sexual Medicine. - Irvine, USA : Scientific Research Publishing. - 2164-5191 .- 2164-5205. ; 5:4, s. 89-110
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory design was used which included researchers, professional xperts and users. A participatory design was used involving researchers, professional experts and users. The information was developed in six stages: 1) identifying the needs of information; 2) identifying and constructing the main areas of information and its paths; 3) identifying and inviting experts for revision; 4) developing the text; 5) reviewing the text; 6) design and structuring for adaption to website. Results: The text of information developed gradually based on the seven steps. The final text comprised three parts: 1) what is miscarriage; 2) experiences of miscarriage; 3) processing and lanning for new pregnancy. Conclusion: Using participatory design was time and resource consuming, however it was functional for producing appropriate information for the target group. The developed evidence based facts text is assumed to be a complement to the information that is provided by the health care system.
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| 6. |
- Andolf, Ellika G., et al.
(författare)
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Hypertensive disorders in pregnancy and later dementia: a Swedish National Register Study
- 2017
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 96:4, s. 464-471
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Our aim was to investigate the rate of vascular dementia and dementia in women with previous hypertensive disorders in pregnancy, since white matter lesions of the brain and cardiovascular disease are linked both to dementia and hypertensive disorders in pregnancy. Material and methods. Prospective population-based registry study on all women giving birth in Sweden between 1973 and 1975 (284 598). Women with and without hypertensive disorders in pregnancy were identified by means of the Swedish Medical Birth Register and linked to the National Patient Register, where data on somatic disease later in life were obtained. International classification of disease was used. The Cox proportional hazard model was used to calculate hazard ratios for both groups and adjusted for possible confounders. Main outcome measures were in-hospital diagnosis of cardiovascular disease, vascular dementia and dementia. Results. No increased risks were seen for vascular dementia or dementia after any hypertensive disorders in pregnancy. If broken down in specific diagnoses for hypertensive disease in pregnancy, adjusted risks for vascular dementia after hypertension and proteinuria during pregnancy the hazard ratio was 6.27 (95% CI 1.65-27.44). Higher risks for cardiovascular disease were confirmed. Conclusions. Because of the very low absolute risk, the wide confidence interval and risk of misclassification, our results on vascular dementia could be questioned. Considering the pathophysiology of preeclampsia, the findings of brain lesions and the increased risk for cardiovascular disease, the possibly increased risk for all kinds of dementia must be investigated in larger and more well-defined cohorts.
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| 7. |
- Berg, Daniel, 1979-
(författare)
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Giftets värde : Apotekares förståelse av opium i Sverige, 1870-1925
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Before the regulation of opium as a “narcotic” in Sweden in 1923, opium was not regulated for its intoxicating properties and was freely available. But not in any kind of shop. Opium was legally available only through the pharmacies. This thesis explores how this free availability of a narcotic was understood by its traders, the pharmacists.The title of this thesis – The Value of Poison – indicates how opium could be conceptualized both as a safe, everyday remedy essential to keep freely available and as a drug of intoxication. As a poison it could be articulated as a matter of primarily pharmacological, not moral or medical, concern. This also gave the pharmacists, with their special knowledge of pharmaka (drugs, poisons), an autonomous space of knowledge free from the ever more intruding “medical gaze”. But, in order to articulate this kind of understanding of opium, another kind of knowledge was needed to be acknowledged: that of the user. In this articulation a “sensus communis” was tied in with a broader cultural knowledge of drugs. Problems with opium were focused on the danger of acute poisoning, not recreational intoxication. Concepts that could have problematized this kind of use were rearticulated as problems either of illegitimate trade, unregulated markets and advertising or of draconian regulation by greedy or sloppy doctors. These rather opposite elements were made equivalent through the articulation of ignorance in both cases, thus further emphasizing the special knowledge of the pharmacist.The thesis locates a process of contradiction that contributes to the eventual diminishing of the discourse of poison towards the end of the period. The pharmaceutical knowledge that guaranteed the discourse was based on a “pharmaceutical gaze” on pharmaka. It pierced through the drug to identify its constituent parts. In this process it was promised that the different effects of opium would be separated. “Narcotic” could be a by-product, to be discarded or controlled, without dispensing of other therapeutic effects. With this ever deeper knowledge of opium, knowledge in the pharmacies was made insufficient for the full understanding or opium, and so too was that of the traditional user. The era of opium as a poison was over.
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| 8. |
- Berg, Gunnar, et al.
(författare)
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Skolans kommunalisering och de professionellas frirum
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SammanfattningI enlighet med studiens uppdragsbeskrivning uppmärksammas följande frågeställningar i denna rapport: (1) Vilka konsekvenser i fråga om professionellt frirum har skolans kommunalisering öppnat för från 1990-talet och fram till dagsläget, och (2) har frirummet under denna tidsperiod använts av de professionella för självständiga handlingar, och i så fall hur? I rapporten behandlas lärares och skolledares yrkesutövande under tidsperioden från skolans kommunalisering i början av 1990-talet till dagsläget (2013) i ett institutionellt perspektiv. Frirum är alltså rapportens nyckelbegrepp, och givet detta tonar den s.k. frirumsteorin fram som en i sammanhanget adekvat analysram.Frågan om frirum och professionell frirumsanvändning behandlas under tre tidsperioder. Den skolinstitution som utvecklades under efterkrigstiden fram till 1980-talets slut benämns som i huvudsak centraliserad och regelstyrd, och medgav ett professionellt frirum som för lärares del i huvudsak var koncentrerat till klassrumsarbete. Den kommunaliserade skola som in-fördes i början av 1990-talet innebar en decentraliseringslinje som i sin tur öppnade för en marknadslinje. Med en samlingsbeteckning kan 1990-talets skolinstitution karaktäriseras som målstyrd och decentraliserad. Intentionerna bakom decentraliseringslinjen var bl.a. att fri-rummet för skolans professionella skulle vidgas till att i princip omfatta skolverksamhet i alla dess operativa aspekter. I marknadslinjen betonades värden som valfrihet och konkurrens, och en väsentlig vikt lades här vid föräldrars och elevers fria skolval. 2000-talets skolinstitution präglas av centraliserad resultatstyrning, vilket står för att inom kommunaliseringens, valfrihetens och det fria skolvalets ramar har staten infört en successivt alltmer finmaskig kontrollapparat. Skolinspektionen tonar fram som det främsta uttrycket för denna skolinstitutionella struktur, och inspektionens 2000-tals historia präglas av en gradvis skärpning av kontrollens utövande och möjliga sanktionsåtgärder för att korrigera skolverksamheter som inte bedöms hålla måttet. Ord som kvalitetsgranskning och kvalitetsarbete är nyckelbegrepp i detta sammanhang. Allmänt uttryckt innebär en mer utbyggd kontrollapparat att det formella frirummet för lärares och skolledares egna och självständiga handlingar minskar. De tre nämnda institutionella strukturerna vilar officiellt sett på begreppet likvärdighet, men detta begrepp har tillskrivits olika innebörder som kan förstås i ljuset av respektive institutionell struktur.Att frirummet formellt sett ökade under 1990-talets decentralisering, och minskade under 2000-talet till följd av utbyggnaden av den statliga kontrollapparaten, säger emellertid inte särskilt mycket om de professionellas faktiska frirumsanvändning. Att det över tid existerat – och fortfarande existerar – varierande art och grad av frirum för skolprofessionella handlingar innebär emellertid inte att det faktiskt används av skolans yrkesgrupper för egna och själv-ständiga handlingar. Med hänvisning till forskning, utvecklingsarbeten och annan empiri argumenteras i rapporten för att utvecklingsarbeten som syftat till utökad frirumsanvändning ofta utmynnat i intressemotsättningar mellan olika professionella aktörer snarare än kvalitetshöjande verksamhet. Rapporten visar även att 1990-talets decentralisering, som var tänkt att ge utrymme för en professionell frirumsanvändning som för lärares del sträckte sig utöver själva klassrumsarbetet, inte sällan stannade på kommunal skolpolitisk och förvaltningsnivå, och därmed i begränsad omfattning påverkade skolornas reella vardagsarbete. Rapporten visar vidare att även i dagens centraliserade och resultatstyrda skolinstitution existerar ett frirum som uppmärksammar lärares klassrumsarbete och rektorers resultat- och verksamhetsansvar, men som också lyfter fram skolors kollektiva professionella ansvar för vardagsarbetet.Rapporten har av avgränsningsskäl ett huvudsakligt fokus på grundskolan, men de principiella slutsatserna gäller även i allt väsentligt även för gymnasieskolan.
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| 9. |
- Berg, Marie, 1955, et al.
(författare)
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Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
- 2019
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Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215 .- 1745-6215. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. METHODS/DESIGN: Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman's wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7-10 on a scale of 1-10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women's self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. DISCUSSION: The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03948815. Registered 13 May 2019-retrospectively registered.
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| 10. |
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