| 1. |
- Arver, Brita, et al.
(författare)
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Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey.
- 2011
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Ingår i: Annals of surgery. - : Lippincott Williams and Wilkins; 1999. - 1528-1140 .- 0003-4932. ; 253:6, s. 1147-1154
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVE:: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. METHODS:: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. RESULTS:: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. CONCLUSIONS:: Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.
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| 2. |
- Owe-Larsson, Björn, et al.
(författare)
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Increased plasma levels of thioredoxin-1 in patients with first episode psychosis and long-term schizophrenia.
- 2011
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Ingår i: Progress in neuro-psychopharmacology & biological psychiatry. - : Elsevier BV. - 1878-4216 .- 0278-5846. ; 35:4, s. 1117-21
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Tidskriftsartikel (refereegranskat)abstract
- Excessive level of radicals and/or dysfunctional antioxidant response, oxidative stress, is implicated in the pathogenesis of schizophrenia. A condition of oxidative stress has been detected in the brain, peripheral tissues and fluids including plasma. Plasma thioredoxin-1 (Trx1) is well characterized and a putative marker for oxidative stress and recently shown to be increased in plasma at the onset of schizophrenia. The present study aimed to explore whether Trx1 can be used as a marker to identify schizophrenic patients at the time-point when patients have their first episode of psychosis as compared to patients with long-term schizophrenia and mentally healthy patients, respectively. Plasma samples obtained from 18 patients at first episode of psychosis, from 49 long-term schizophrenic patients and from 20 mentally healthy controls (admitted with minor physical injury to the general ward) where analyzed by ELISA for Trx1. The patients with first episode of psychosis were diagnosed at least 6months later and shown to constitute various psychotic syndromes, including schizophrenia, or affective disorder. The concentration of Trx1 in the patients with first episode of psychosis was 1.5±1.0ng/ml and 0.8±0.6ng/ml in controls. In the long-term schizophrenic patients the plasma concentration was 1.5±0.7. The differences between the groups of acute psychotic or long-term schizophrenia patients to controls were significant (p<0.016 and p<0.001, respectively). Our data indicate that Trx1 may not be used as an early marker to identify schizophrenic patients in a mixed population of first episode psychotic patients. Further, Trx1 did not discriminate with reliable accuracy patients with psychotic disorder from mentally healthy controls on an individual basis due to overlap in levels of Trx1. However, our observations show that psychotic patients in general are in a significant long-term condition of oxidative stress, with possible implications for the profound morbidity and mortality found in this patient population.
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| 3. |
- Bergström, Ida, et al.
(författare)
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Persistent accumulation of interferon-gamma-producing CD8(+)CD56(+) T cells in blood from patients with coronary artery disease
- 2012
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Ingår i: Atherosclerosis. - : Elsevier. - 0021-9150 .- 1879-1484. ; 224:2, s. 515-520
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There is emerging evidence for CD8(+) T cell alterations in blood from patients with coronary artery disease (CAD). We examined whether the distribution and phenotype of CD8(+)CD56(+) T cells differed according to the clinical manifestation of CAD. less thanbrgreater than less thanbrgreater thanMethods: Patients with acute coronary syndrome (ACS, n = 30), stable angina (SA, n = 34) and controls (n = 36) were included. Blood was collected before and up to 12 months after referral for coronary investigation. CD8(+)CD56(+) T cells were assessed by flow cytometry for expression of surface markers, apoptosis, and intracellular expression of cytokines. less thanbrgreater than less thanbrgreater thanResults: The proportions of CD8(+)CD56(+) T cells were significantly higher in both ACS and SA patients compared with controls, and remained so after 3 and 12 months. This was independent of age, sex, systemic inflammation and cytomegalovirus seropositivity. CD8(+)CD56(+) T cells differed from CD8(+)CD56(-) T cells in terms of lower CD28 expression and fewer apoptotic cells. Both CD8(+) T cell subsets were positive for interferon (IFN)-gamma and tumor necrosis factor, although IFN-gamma was significantly more confined to the CD8(+)CD56(+) T cells. less thanbrgreater than less thanbrgreater thanConclusion: The persistent accumulation of CD8(+)CD56(+) T cells in ACS and SA patients share several features with immunological aging. It also contributes to a larger IFN-gamma(+) pool in blood, and may thereby hypothetically drive the atherosclerotic process in a less favorable direction.
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| 4. |
- Björklund, Johanna, 1961-, et al.
(författare)
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Ecosystem-based agriculture combining production and conservation : a viable way to feed the world in the long term?
- 2012
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Ingår i: Journal of Sustainable Agriculture. - : Taylor & Francis. - 1044-0046 .- 1540-7578. ; 36:7, s. 824-855
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Tidskriftsartikel (refereegranskat)abstract
- This study analyzed examples of sustainable ecosystem-based agriculture where management methods supported livelihoods of smallholders while at the same time local ecosystem services were enhanced in Ethiopia, Brazil, and the Philippines. Participation by farmers and collective actions were found to be a crucial driving force, as local specific knowledge and “learning by doing” were main components of the development. Social cohesion, particularly through associations and cooperatives, and improved marketing opportunities were also important drivers. Furthermore, recognition by authorities at all levels was perceived as crucial. Effects of climate change, insecure property rights, and political instability were potential threats. The possibilities of such systems to be scaled up beyond self-sufficiency raised further questions.
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| 5. |
- Björkman Björkelund, Karin, et al.
(författare)
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Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study.
- 2010
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; Apr 7, s. 678-688
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (>/=65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%.
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| 6. |
- Björkman Björkelund, Karin, et al.
(författare)
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The influence of perioperative care and treatment on the 4-month outcome in elderly patients with hip fracture.
- 2011
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Ingår i: AANA Journal. - 0094-6354. ; 79:1, s. 51-61
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this descriptive cohort study was to identify perioperative risk factors associated with postoperative outcome up to 4 months after surgery in elderly patients with hip fracture. Data were collected prospectively through the Swedish National Hip Fracture, the local Acute and Emergency, and Anesthesia registers, and retrospectively from medical and nursing records. The 428 patients (aged > or = 65 years) with hip fracture were consecutively included. Multiple logistic regression analyses were used to identify factors predicting each of 4 outcomes. Perioperative risk factors predicting death within 4 months after surgery were fasting time of 12 or more hours and blood transfusion of 1 U or more. Risk factors predicting postoperative confusion were postoperative oxygen saturation less than 90% and fasting time 12 hours or longer. Risk factors predicting in-hospital complications were transfusion of 1 or more units of blood, preoperative oxygen saturation less than 90%, and fasting time 12 hours or more. Risk factor predicting length of stay longer than 10 days was blood transfusion of 1 U or more. To minimize morbidity and mortality, providers should increase efforts to optimize the patients' oxygen saturation and hemoglobin level and reduce fasting time and waiting time for surgery.
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| 7. |
- Borell, Lena, et al.
(författare)
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Kognitiva köket - framtidens kök
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Äldre personer som har en demenssjukdom eller andra medicinska diagnoser som kan leda till kognitiva problem och som bor i egna hem är en växande grupp. Samtidigt så förväntas alla oavsett funktionsnedsättning kunna hantera matlagning och andra köksrelaterade aktiviteter på egen hand. Personer med kognitiva problem, och personer som arbetar med denna grupp definierar problem relaterade till matlagning och att hålla ordning i köket som några av de viktigaste att lösa (Wherton and Monk 2008). Att kunna utföra köksrelaterade aktiviteter betraktas som något som höjer livskvaliteten. Trots det växande behovet av att kunna skapa köksmiljöer och köksprodukter, både generellt och med individuella anpassningar, finns det i dag ingen samlad kunskap om hur sådana miljöer och produkter bäst kan utformas. I det här projektet ses köket som en plats där flera dimensioner av livet pågår. Förutom matlagning och förvaring av mat så är köket även en plats för socialt umgänge, och utgör vardagens nav. Kökets roll i hemmet är alltså central. Projektet utgår från att det är möjligt att skapa inkluderande köksmiljöer som tar hänsyn till personer med nedsatt kognition, men som samtidigt förenklar för alla. Modern design av kök handlar idag mycket om eleganta ytor och dolda, och därmed svårdefinierade, funktioner vilket skapar problem för personer med kognitiva funktionsnedsättningar. Dessa problem måste lyftas fram och diskuteras för att kunna utforma framtida inkluderande köksmiljöer. Syftet med projektet är att, i dialog med intressenter och experter inom området, sammanställa och generera kunskap om hur kök och köksprodukter kan designas för att underlätta för äldre människor med kognitiva nedsättningar att kunna använda sina kök utan problem.
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| 8. |
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| 9. |
- Eliason, Gabriella
(författare)
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Sceletal muscle characteristics and physical activity patterns in COPD
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Besides abnormities within the respiratory system COPD is also associated with effects outside the lungs, so called systemic effects. One systemic effect that has been highlighted is skeletal muscle dysfunction which has also been associated with reduced exercise capacity. Apart from changes in muscle morphology, low levels of physical activity have also been suggested as a plausible mediator of reduced exercise capacity in COPD. The aim of this thesis was to study muscle morphology and physical activity patterns in patients with different degrees of COPD and to examine the associations between muscle morphology, physical activity and exercise capacity in these patients. Skeletal muscle morphology was found to shift towards a more glycolytic muscle profile in COPD patients and changes in muscle morphology were found to be correlated to disease severity and to exercise capacity. Muscle capillarization was also found to be lower in COPD compared with healthy subjects and to be correlated to disease severity and exercise capacity. When studying signalling pathways involved in muscle capillarization, an overexpression of VHL was found in patients with mild and moderate COPD compared with healthy subjects. Furthermore, COPD patients were found to be less physically active compared with healthy subjects and the level of physical activity was associated with exercise capacity.In conclusion, changes in skeletal muscle morphology and low levels of physical activity are present in COPD patients and may partly explain the lower exercise capacity observed in these patients. The more glycolytic muscle profile in COPD is suggested to be mediated by hypoxia and low levels of physical activity in this patient group. Furthermore, increased levels of VHL may lead to impaired transduction of the hypoxic signalling pathway, which may contribute to the decreased muscle capillarization observed in COPD.
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| 10. |
- Erixson, Lea, et al.
(författare)
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Att se det som inte syns – om talföljder i årskurs 3 och 4
- 2013
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Ingår i: Forskning om undervisning och lärande. - : Stiftelsen SAF i samverkan med Lärarförbundet. - 2000-9674 .- 2001-6131. - 9789198112405 ; :10, s. 64-81
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Tidskriftsartikel (refereegranskat)abstract
- Internationell forskning och undersökningar visar att elever har svårt att lära sig algebra i allmänhet samt att konstruera och beskriva talföljder i synnerhet. Undervisningen, som fokuserar på olika undervisningsmetoder i stället för på det som krävs för att lära, anses vara en av de viktigaste orsakerna till detta.Studiens syfte är att, utifrån ett variationsteoretiskt perspektiv, studera det som är kritiskt för elever i årskurs 3 och 4 när de ska lära sig att konstruera och beskriva vad som kännetecknar olika talföljder. I artikeln beskrivs de identifierade kritiska aspekterna och hur dessa gjordes synliga i undervisningen genom variation. Learning study användes som metod.Resultatet visar att eleverna utvecklade förmågan att beskriva talföljder när det i undervisningen gavs möjlighet för dem att urskilja sambandet mellan talen och talens inbördes förhållande till varandra, urskilja helheten, förstå att det finns ett system mellan talen som kan varieras i oändlighet och upptäcka att talföljder kan byggas upp på olika sätt. Detta benämns i studien som kritiska aspekter.
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