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- Axelsson, C, et al.
(författare)
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Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system
- 2013
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 31:8, s. 1196-1200
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.
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- Buhrman, Monica, 1974-, et al.
(författare)
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Guided Internet-delivered cognitive behavioural therapy for chronic pain patients who have residual symptoms after rehabilitation treatment: Randomized controlled trial
- 2013
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Ingår i: European Journal of Pain. - : Elsevier. - 1090-3801 .- 1532-2149. ; 17:5, s. 753-765
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Tidskriftsartikel (refereegranskat)abstract
- Background Chronic pain can be treated with cognitive behavioural therapy delivered in multidisciplinary settings. However, relapse is likely, and there is a need for cost-effective secondary interventions for persons with residual problems after rehabilitation. The aim of the present study was to investigate the effects of a guided Internet-delivered cognitive behavioural intervention for patients who had completed multidisciplinary treatment at a pain management unit. Methods A total of 72 persons with residual pain problems were included in the study and were randomized to either treatment for 8 weeks or to a control group who were invited to participate in a moderated online discussion forum. The participants had different chronic pain conditions, and a majority were women (72%). Twenty-two percent of the participants dropped out of the study before the post-treatment assessment. Results Intent-to-treat analyses demonstrated differences on the catastrophizing subscale of the Coping Strategies Questionnaire (Cohens d=0.70), in favour of the treatment group but a small within-group effect. Differences were also found on other measures of pain-related distress, anxiety and depressive symptoms. A 6-month follow-up exhibited maintenance of improvements. Conclusions We conclude that Internet-delivered treatment can be partly effective for persons with residual problems after completed pain rehabilitation.
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- Caruso, Vanni, et al.
(författare)
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Synaptic changes induced by melanocortin signalling
- 2014
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Ingår i: Nature Reviews Neuroscience. - : Springer Science and Business Media LLC. - 1471-003X .- 1471-0048. ; 15:2, s. 98-110
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Forskningsöversikt (refereegranskat)abstract
- The melanocortin system has a well-established role in the regulation of energy homeostasis, but there is growing evidence of its involvement in memory, nociception, mood disorders and addiction. In this Review, we focus on the role of the melanocortin 4 receptor and provide an integrative view of the molecular mechanisms that lead to melanocortin-induced changes in synaptic plasticity within these diverse physiological systems. We also highlight the importance of melanocortin peptides and receptors in chronic pain syndromes, memory impairments, depression and drug abuse, and the possibility of targeting them for therapeutic purposes.
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- Drgonova, Jana, et al.
(författare)
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Involvement of the Neutral Amino Acid Transporter SLC6A15 and Leucine in Obesity-Related Phenotypes
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:9, s. e68245-
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Tidskriftsartikel (refereegranskat)abstract
- Brain pathways, including those in hypothalamus and nucleus of the solitary tract, influence food intake, nutrient preferences, metabolism and development of obesity in ways that often differ between males and females. Branched chain amino acids, including leucine, can suppress food intake, alter metabolism and change vulnerability to obesity. The SLC6A15 (v7-3) gene encodes a sodium-dependent transporter of leucine and other branched chain amino acids that is expressed by neurons in hypothalamus and nucleus of the solitary tract. We now report that SLC6A15 knockout attenuates leucine's abilities to reduce both: a) intake of normal chow and b) weight gain produced by access to a high fat diet in gender-selective fashions. We identify SNPs in the human SLC6A15 that are associated with body mass index and insulin resistance in males. These observations in mice and humans support a novel, gender-selective role for brain amino acid compartmentalization mediated by SLC6A15 in diet and obesity-associated phenotypes.
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- Eriksson, Charli C-G, 1948-, et al.
(författare)
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Academic practice-policy partnerships for health promotion research : experiences from three research programs
- 2014
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 42:15 Suppl, s. 88-95
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The development of knowledge for health promotion requires an effective mechanism for collaboration between academics, practitioners, and policymakers. The challenge is better to understand the dynamic and ever-changing context of the researcher-practitioner-policymaker-community relationship.AIMS: The aims were to explore the factors that foster Academic Practice Policy (APP) partnerships, and to systematically and transparently to review three cases.METHODS: Three partnerships were included: Power and Commitment-Alcohol and Drug Prevention by Non-Governmental Organizations in Sweden; Healthy City-Social Inclusion, Urban Governance, and Sustainable Welfare Development; and Empowering Families with Teenagers-Ideals and Reality in Karlskoga and Degerfors. The analysis includes searching for evidence for three hypotheses concerning contextual factors in multi-stakeholder collaboration, and the cumulative effects of partnership synergy.RESULTS: APP partnerships emerge during different phases of research and development. Contextual factors are important; researchers need to be trusted by practitioners and politicians. During planning, it is important to involve the relevant partners. During the implementation phase, time is important. During data collection and capacity building, it is important to have shared objectives for and dialogues about research. Finally, dissemination needs to be integrated into any partnership. The links between process and outcomes in participatory research (PR) can be described by the theory of partnership synergy, which includes consideration of how PR can ensure culturally and logistically appropriate research, enhance recruitment capacity, and generate professional capacity and competence in stakeholder groups. Moreover, there are PR synergies over time.CONCLUSIONS: The fundamentals of a genuine partnership are communication, collaboration, shared visions, and willingness of all stakeholders to learn from one another
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- Fredriksson, Albin, 1984-
(författare)
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Robust optimization of radiation therapy accounting for geometric uncertainty
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Geometric errors may compromise the quality of radiation therapy treatments. Optimization methods that account for errors can reduce their effects.The first paper of this thesis introduces minimax optimization to account for systematic range and setup errors in intensity-modulated proton therapy. The minimax method optimizes the worst case outcome of the errors within a given set. It is applied to three patient cases and shown to yield improved target coverage robustness and healthy structure sparing compared to conventional methods using margins, uniform beam doses, and density override. Information about the uncertainties enables the optimization to counterbalance the effects of errors.In the second paper, random setup errors of uncertain distribution---in addition to the systematic range and setup errors---are considered in a framework that enables scaling between expected value and minimax optimization. Experiments on a phantom show that the best and mean case tradeoffs between target coverage and critical structure sparing are similar between the methods of the framework, but that the worst case tradeoff improves with conservativeness.Minimax optimization only considers the worst case errors. When the planning criteria cannot be fulfilled for all errors, this may have an adverse effect on the plan quality. The third paper introduces a method for such cases that modifies the set of considered errors to maximize the probability of satisfying the planning criteria. For two cases treated with intensity-modulated photon and proton therapy, the method increased the number of satisfied criteria substantially. Grasping for a little less sometimes yields better plans.In the fourth paper, the theory for multicriteria optimization is extended to incorporate minimax optimization. Minimax optimization is shown to better exploit spatial information than objective-wise worst case optimization, which has previously been used for robust multicriteria optimization.The fifth and sixth papers introduce methods for improving treatment plans: one for deliverable Pareto surface navigation, which improves upon the Pareto set representations of previous methods; and one that minimizes healthy structure doses while constraining the doses of all structures not to deteriorate compared to a reference plan, thereby improving upon plans that have been reached with too weak planning goals.
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