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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Eckeryd, Robert, 1972-
(författare)
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Acceptans eller utstötning? : ogifta mödrar i Ångermanland 1860–1940
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation has investigated the social vulnerability of unmarried mothers in three rural court districts in the province of Ångermanland in northern Sweden during the period 1860–1940. The main focus is on the consequences that the birth of one or more illegitimate children had on the women’s lives as regards to how they were treated in the local community, including by both neighbours and formal institutions. It was pre-supposed that the social vulnerability of unmarried mothers can vary considerably between geographically close areas and that such variations are likely linked to the frequency of illegitimate births, which in turn should be dependent on unrelated variables such as diverging socio-economic structures and the importance of Christianity. Two periods have been chosen for in-depth analysis: the 1860s and a number of years before and after 1918, when the first specific law regarding illegitimate children was put into practice. This enables both a comparison of areas with diverging illegitimate fertility rates and a comparison of the unmarried mothers’ social vulnerability in a community still largely based on farming in the 19th century, with that of a more industrialised and modernised society in the early 20th century. Theories of social stigma and the concept of deviancy have been applied for the purposes of interpretation. Social vulnerability has been assumed to be linked to perceptions regarding how deviant the unmarried mothers were considered to be in the local community. To investigate this Church records have been used for life course analyses covering the women’s fertile ages, with a primary focus on the unmarried mothers’ marriage patterns. Court protocols have also been studied for an analysis of how paternity suits were handled by district courts, as regards what evidence was required for different outcomes and what that can tell us about the women’s social vulnerability. Based on the frequency of illegitimate births, two main hypotheses were formulated: first, that the unmarried mothers were least socially vulnerable in one particular area during both periods, and secondly that they during the 1860s were most vulnerable in a court district with an unusually low rate of illegitimate births. The first main hypothesis was confirmed regarding the 1860s. The second main hypothesis was however disproven by several factors. In the early 20th century, modernisation and the growing working class seem to have eased attitudes towards unmarried mothers in the two court districts with the lowest illegitimate fertility frequences, leading to a similar social vulnerability in all three areas. However an illegitimate birth could still be seen as deviant behavior and women who had been abandoned with two illegitimate children seems to have been stigmatised in all areas during both periods of investigation.
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| 3. |
- Fresard, Laure, et al.
(författare)
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Identification of rare-disease genes using blood transcriptome sequencing and large control cohorts
- 2019
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Ingår i: Nature Medicine. - : NATURE PUBLISHING GROUP. - 1078-8956 .- 1546-170X. ; 25:6, s. 911-919
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Tidskriftsartikel (refereegranskat)abstract
- It is estimated that 350 million individuals worldwide suffer from rare diseases, which are predominantly caused by mutation in a single gene(1). The current molecular diagnostic rate is estimated at 50%, with whole-exome sequencing (WES) among the most successful approaches(2-5). For patients in whom WES is uninformative, RNA sequencing (RNA-seq) has shown diagnostic utility in specific tissues and diseases(6-8). This includes muscle biopsies from patients with undiagnosed rare muscle disorders(6,9), and cultured fibroblasts from patients with mitochondrial disorders(7). However, for many individuals, biopsies are not performed for clinical care, and tissues are difficult to access. We sought to assess the utility of RNA-seq from blood as a diagnostic tool for rare diseases of different pathophysiologies. We generated whole-blood RNA-seq from 94 individuals with undiagnosed rare diseases spanning 16 diverse disease categories. We developed a robust approach to compare data from these individuals with large sets of RNA-seq data for controls (n = 1,594 unrelated controls and n = 49 family members) and demonstrated the impacts of expression, splicing, gene and variant filtering strategies on disease gene identification. Across our cohort, we observed that RNA-seq yields a 7.5% diagnostic rate, and an additional 16.7% with improved candidate gene resolution.
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| 4. |
- Svedin, Glenn
(författare)
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"En ohyra på samhällskroppen" : Kriminalitet, kontroll och modernisering i Sverige och Sundsvallsdistriktet under 1800- och det tidiga 1900-talet
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis presents an analysis of crime trends and social control during the dramatic transformation of Sweden's social landscape in the nineteenth and early twentieth centuries, set against the background of the modernization process in the country as a whole and the city of Sundsvall and environs in particular. What assumptions about crime were evident in public debate? How did crime levels vary from region to region, and what were the changes over time? What strategies did government and local authorities try for combating crime? Did the joint efforts by government, local communities, and the voluntary sector actually solve the problems that social change was believed to have caused?When it comes to theory, the interpretative framework is based on Anthony Giddens's argument about modernity and modernization, making particular use of a few central points about what the changes meant for the structuration of society. Giddens's ideas about changes in social control are refined with Michel Foucault's and David Garland's work on the increasingly disciplinary trend seen in the exercise of the law and public control. The analysis of modernity's ramifications for the transformation of both social structures and crime alike has also benefitted from Robert Putnam's and Travis Hirschi's insights into the importance of social capital and social bonds for a well-functioning, low-crime society.The process by which Sweden was transformed from an overwhelmingly agrarian country to an urban, industrial society left its mark on crime patterns. To the contemporary mind, industrialization, migration, and urbanization were the underlying causes of the high levels of serious crime in the society. The start of the nineteenth century had seen a rise in criminality, with both petty crime and lethal violence becoming more common. At the same time, there was a heated debate about the socio-economic problems that were such a strain on the structure of society. The analysis finds that there were large differences in prosecutions in the country and between cities. The Sundsvall area was among those that saw a dramatic change in crime in the course of becoming a major industrial region. At the same time, the thesis shows that there were plenty of cities in Sweden, however rapidly they grew, that had low crime rates. However, the widespread fear of industrialization, migration, and urbanization was often unfounded. For example, both lethal violence and public order offences reached their lowest recorded levels in the interwar period. By then, new cures were sought for the social and moral ills of society. The state's sphere of influence had expanded. New social reforms, including a modified crime policy, were launched. The state became even more assertive, and the same was true of civil society. Society would attend to the moral education of a number of different groups. Moral virtues were to be instilled in the workshy, alcoholic, or criminal, in order to produce disciplined and cultured citizens. The attention of social activists, the scientific community, civil servants, and local and national politicians shifted from crime per se to the far broader issue of asociality. Modernization gave the voluntary sector a significant role in the social organization of the day, shaping new forums for interpersonal relationships and strengthening social ties. The thesis makes the case that two distinct periods, each with its specific social structures and crime patterns, can be observed; one belonging to the nineteenth century, the other to the first four decades of the twentieth century.Finally, the similarities between the history of crime in Sweden and, for example, the US or the UK are highlighted. As in Britain and North America, the early industrialization period saw weakened social bonds, and a time of greater violence and disorder ensued. After a while however, the situation stabilized, and crime rates began to drop again. When industrial societies ceased to be 'frontier communities' at the forefront of modernization, and instead became more mature communities, crime levels fell as people's commitment to their communities was renewed.
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