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| 2. |
- Wahlin, Sara, et al.
(författare)
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Clinical impact of T cells, B cells and the PD-1/PD-L1 pathway in muscle invasive bladder cancer : a comparative study of transurethral resection and cystectomy specimens
- 2019
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Ingår i: OncoImmunology. - 2162-4011. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- In patients with muscle invasive bladder cancer (MIBC), neoadjuvant chemotherapy (NAC) prior to radical cystectomy has improved survival but there is an urgent unmet need to identify prognostic and predictive biomarkers to stratify patients who will benefit from treatment. This study aimed to examine the composition of tumor-infiltrating immune cells in MIBC, with particular reference to the clinical outcome and the potential modifying effect of NAC. To this end, the expression of CD8+ and FoxP3+ T cells, CD20+ B cells, PD-1+ and PD-L1+ immune cells and PD-L1+ tumor cells was evaluated by immunohistochemistry on tissue microarrays with paired transurethral resection (TURB) specimens, cystectomy specimens and lymph node metastases from 145 patients, 65 of whom had received NAC. Kaplan–Meier and Cox regression analyses were applied to assess the impact of investigated cell subsets on time to recurrence (TTR). In cystectomy specimens, high infiltration of the investigated immune cell populations, but not PD-L1+ tumor cells, were independently associated with a prolonged TTR, whereas in TURB specimens, this association was only seen for CD8+ lymphocytes. An additive beneficial prognostic effect of NAC was seen for the majority of the cell subsets but there was no significant interaction between any immune marker and NAC in relation to TTR. Furthermore, no differences in cell densities prior to NAC treatment were observed between complete and non-complete responders, or pre- and posttreatment in non-complete responders. In conclusion, immune cell infiltration provides important prognostic information in both pre- and postsurgical samples of MIBC, independently of NAC.
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| 3. |
- Boman, Erika, 1975-
(författare)
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Inner strength as a health resource among older women
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Long life does not inevitably mean more healthy years; older women have an increased risk of disabilities, diseases and adverse life events. Nevertheless, many older women experience health. This may be explained by possessing resources that promote health, despite adversities. Inner strength is seen as a resource as such. In this thesis inner strength is interpreted according to a theoretical model where inner strength comprises four interrelated and interacting dimensions: connectedness, creativity, flexibility and firmness, and being rated by the Inner Strength Scale (ISS).Aim and methods The overall purpose of this thesis was to explore inner strength as a health resource among older women. In study I six focus group interviews were performed with older women (66-84 years; n = 29) and the interviews were analysed by a concept driven approach and by means of qualitative content analysis. Studies II–IV had a quantitative, cross-sectional design. A questionnaire was sent to all older women (65 years and older) living in Åland, an autonomous island community in the Baltic Sea, and 1555 (57%) women responded. The data was analysed using descriptive and inferential statistics.Results In study I, exploring how inner strength and its dimensions can be identified in narratives of older women, connectedness was interpreted as a striving to be in communion, creativity as the ability to make the best of the situation, firmness as having a spirit of determination – “it is all up to you”, and flexibility as a balancing act. The results of study II showed that strong inner strength was associated with better mental health, but not physical health. In exploring factors associated with health-related quality of life, fewer symptoms of depressive disorders was the strongest explanatory variable, and together with not feeling lonely associated with better both physical health and mental health. Better physical health was also explained by not having a diagnosed disease, being of lower age and the opportunity to engage in meaningful leisure activities. Better mental health was additionally explained by having enough money for personal needs. In study III the result showed that non-depressed women were likely to have a strong inner strength, as well as never or seldom feeling lonely, taking fewer prescribed drugs, feeling needed and having the opportunity to engage in meaningful leisure activities. In study IV poorer mental health was associated with weaker inner strength in total, and in all four dimensions of inner strength. Symptoms of depressive disorders and feeling lonely were related to lower scores in three of the dimensions (except firmness and creativity, respectively) and poorer physical health was associated with lower scores in two of the dimensions (firmness and flexibility). Some other health threats were significantly associated with only one of the dimensions (connectedness or creativity), and others were not significantly associated at all.Conclusion The results add nuance to the notion of inner strength and deepen empirical knowledge about the phenomenon. It is elucidated that the ISS can be used not only to rate inner strength but also to offer guidance as to the areas (i.e. dimensions) in which interventions may be profitable. It is further shown that inner strengths can be identified in narratives of older women. Mental ill health has shown to have overall the strongest association with weakened inner strength among community-dwelling older women. The causality can, though, not be studied due to the cross-sectional design; therefore, longitudinal studies are recommended. Notwithstanding that limitation, the findings can be used as a knowledge base in further research within this field.
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| 4. |
- Boman, Karolina, et al.
(författare)
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Podocalyxin-like and rna-binding motif protein 3 are prognostic biomarkers in urothelial bladder cancer : A validatory study
- 2017
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Ingår i: Biomarker research. - : Springer Science and Business Media LLC. - 2050-7771. ; 5:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Urothelial bladder cancer (UBC) is a disease that often is discovered when the tumour is non-muscle invasive, i.e. in Ta or T1 stage. Some patients will progress into muscle-invasive disease, a potentially deadly condition. Although there are some prognostic models, the need for prognostic and predictive biomarkers is considerate and urgent. Membranous expression of podocalyxin-like protein 1 (PODXL) and low expression of the RNA-binding motif 3 (RBM3) has previously been shown to be associated with an aggressive tumour phenotype and poor prognosis in several forms of cancer, including UBC. In this study, we sought to validate the prognostic impact of PODXL and RBM3 in an independent cohort of UBC. Methods: Using tissue microarrays and immunohistochemistry, PODXL and RBM3 expression was evaluated in 272 incident UBC cases from the prospective, population-based cohort study Malmö Diet and Cancer. Kaplan-Meier analysis and Cox proportional hazards modelling were used to evaluate the prognostic impact of these markers on 5-year overall survival (OS). Results: In line with previous studies, both membranous PODXL expression and low RBM3 expression was significantly associated with disadvantageous clinicopathological features. Membranous PODXL expression was significantly associated with a reduced 5-year overall survival in the entire cohort (univariable HR 3.28; 95% CI 1.89-5.69), but this association did not remain significant in multivariable analysis. In T1 tumours, PODXL was significantly associated with reduced survival in univariable analysis (HR = 2.83; 95% CI 1.04-7.72) and borderline significant in multivariable analysis (HR = 2.60; 95% CI 0.91-7.39). Low RBM3 expression was an independent predictor of a reduced survival in the entire cohort (univariable HR 3.19; 95% CI 2.02-5.04, and multivariable HR 1.85; 95% CI 1.11-3.09), and in T1 tumours (univariable HR 2.64; 95% CI 1.11-6.27, and multivariable HR 2.63; 95% CI 1.01-6.84). Conclusions: A link between membranous PODXL expression and clinically more aggressive tumours was further confirmed, but PODXL expression was not an independent prognostic biomarker in this study. Low RBM3 expression was validated as an independent factor of poor prognosis in UBC, including T1 disease. These findings suggest that these biomarkers could be useful in stratifying patients with non-muscle invasive disease for more aggressive first line treatment.
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| 5. |
- Hellström Ängerud, Karin, et al.
(författare)
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Areas for quality improvements in heart failure care : quality of care from the patient's perspective
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - Hoboken : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 31:4, s. 830-838
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Heart failure is a serious condition with high mortality and a high symptom burden. Most patients with heart failure will be taken care of in primary care but the knowledge of how the quality of care is perceived by patients with heart failure is limited.OBJECTIVE: The aim was to explore how patients with heart failure report quality of care, in an outpatient setting.METHODS: Seventy-one patients with a confirmed diagnosis of heart failure and who were cared for in an outpatient setting were included in this cross-sectional study. Quality of care was assessed with a short form of the Quality from the Patient's Perspective questionnaire. The items measured four dimensions, and each item consists of both perceived reality of the received care and its subjective importance.RESULTS: Inadequate quality was identified in three out of four dimensions and in items without dimension affiliation. In total, inadequate quality was identified in 19 out of 25 items. Patients reported the highest level of perceived reality in 'my family member was treated well' and the lowest perceived reality in 'effective treatment for loss of appetite'. Effective treatment for shortness of breath was of the highest subjective importance for the patients.CONCLUSION: Important areas for improvement in the quality of care for patients with heart failure in an outpatient setting were identified, such as symptom alleviation, information, participation and access to care.
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| 6. |
- Hellström Ängerud, Karin, et al.
(författare)
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Areas for quality improvements in heart failure care: quality of care from the family members' perspective
- 2018
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Ingår i: Scandinavian Journal of Caring Sciences. - Hoboken : Wiley. - 0283-9318 .- 1471-6712. ; 32:1, s. 346-353
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. ObjectiveTo describe family members' perceptions of quality of HF care in an outpatient setting. MethodsA cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. ResultsFamily members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. ConclusionFamily members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.
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| 7. |
- Sandström, Karin, et al.
(författare)
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Fluorides in Deposits
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 8. |
- Sandström, Karin, et al.
(författare)
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Fluorine reactions in MSW combustion
- 2019
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Ingår i: European Biomass Conference and Exhibition.
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Konferensbidrag (refereegranskat)abstract
- Fluorine is of increasing concern in waste combustion since fluorinated plastics constitute anincreasing share of waste fractions entering CHP plants. Alkali fluorides could potentially causesimilar problems as are well known for the corresponding chlorides. However, there are somefundamental differences in thermodynamic stabilities. Available literature essentially lacks theexperimental evidence needed to draw any further conclusions on the extent of any fluorine relatedproblems, but recently a MSW fired CHP reported alarming deposit growth rates, possibly relatedto a delivery of fluorine containing fuels. The objective of the present study was to experimentallyevaluate some of the thermodynamic considerations mentioned. Fuels were prepared by addingNaCl, NaF and S to softwood pellets. Deposit and aerosol samples were analyzed with SEM-EDSand XRD, and evaluated together with fundamental thermodynamic phase equilibriumconsiderations to provide new and important information on the ash forming reactions and theirimplications. The results from the combustion tests showed that the fluorine found on the depositprobe was in form of NaF and Na3F (SO4) in qualitative agreement with thermodynamicequilibrium calculations.
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| 9. |
- Tsigkourakos, Menelaos, et al.
(författare)
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Suppression of boron incorporation at the early growth phases of boron-doped diamond thin films
- 2015
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Ingår i: Physica Status Solidi (a) applications and materials science. - : Wiley. - 1862-6300 .- 1862-6319. ; 212:11, s. 2595-2599
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Tidskriftsartikel (refereegranskat)abstract
- The presence of O during the chemical vapour deposition (CVD) of B-doped diamond results in the suppression of B incorporation into the diamond film. In this study, we demonstrate that the amount of residual O within the chamber is higher at the beginning of the diamond growth due to the O-contaminated chamber walls, and is decreased after a certain time period. This leads to a gradual increase of the B incorporation by more than one order of magnitude during the early growth phases of nanocrystalline diamond (NCD). We further show that this suppression of B incorporation at the early growth phases of B-doped diamond is influenced by the growth rate of the film. This is attributed to the constant time period whereby most of the residual O interacts with the B-precursors in the gas phase by forming stable B-O species, which are flushed out from the chamber exhaust. Furthermore, the constant B profile of an NCD film grown in a loadlock hot-filament CVD (HFCVD) system reveals that the amount of residual O is constant and minimal during the growth process. Therefore, our work proves that the use of a loadlock overcomes the B-suppression problem at the early growth phases of diamond, making it the optimal solution for the growth of highly conductive thin diamond films.
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| 10. |
- Ulfsdotter Eriksson, Ylva, et al.
(författare)
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Contract care in dentistry : sense-making of the concept and in practice when multiple institutional logics are at play
- 2017
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Ingår i: Sociology of Health and Illness. - : John Wiley & Sons. - 0141-9889 .- 1467-9566. ; 39:7, s. 1035-1049
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Tidskriftsartikel (refereegranskat)abstract
- In 2009 contract dental care was introduced into Sweden's Public Dental Service under a programme called Dental Care for Health (DCH ). Previous research has revealed a possible dilemma whereby dental care professionals had the role of insurance agent foisted upon them, as they were assigned the task of ‘selling contracts’. Using qualitative interviews, this study explores how these professionals make sense of contract dental care today. Drawing on the concepts of occupational and organisational professionalism, in combination with the institutional logics perspective, we discern that dental care professionals are entangled in multiple rationalities when reasoning about and dealing with DCH . A professional logic comes into play over health issues and preventive care, while market and corporate logics are present in relation to selling contracts and taking responsibility for the financial aspects of DCH , all of which creates tensions in these professionals. Overall, dental care professionals in the welfare sector respond both to an organisational and an occupational professionalism.
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