| 1. |
- Skog, Malin
(författare)
-
Experiences of Screening for Postpartum Depression in Non-Native-Speaking Immigrant Mothers in the Swedish Child Health Services. Nurses’ and Mothers’ Perspectives.
- 2018
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postpartum depression (PPD) är ett globalt folkhälsoproblem. Mödrar som migrerar till ett annat land har en ökad risk att drabbas av PPD. Före-komsten av PPD bland utlandsfödda mödrar beräknas vara så hög som 20 procent, vilket nästan är dubbelt så hög som bland inhemsk västerländsk befolkning. Asylsökande och flyktingar är särskilt sårbara grupper som löper en ännu högre risk att drabbas, speciellt de som migrerat inom 10 år. Likaså de mödrar som inte talar språket i sitt nya hemland. PPD uppstår vanligtvis fyra till sex veckor efter förlossningen och kan ha långvariga traumatiska effekter inte bara på moderns egen hälsa utan även på hennes partners och framförallt på barnets hälsa och utveckling. Mot bakgrund av detta rekommenderar Socialstyrelsen att screening av nyblivna mödrar för PPD regelmässigt genomförs av sjuksköterskan i barnhälsovården (BHV) sex till åtta veckor efter förlossningen. Screeningen genomförs med hjälp av Edinburgh Postnatal Depression Scale (EPDS), som är en skala översatt och validerad till många olika språk. Skalan består av tio olika påståenden speciellt utvecklade för screening för PPD. Skalan används i kombination med ett samtal för att bedöma moderns psykiska mående. Vid screening av icke-svenskspråkiga mödrar instrueras sjuksköterskorna att använda ett översatt validerat formulär, ta hänsyn till moderns läs- och skrivkunnighet, tolkens arbete samt hur olika kulturella tolkningar av påståendena i skalan kan påverka resultatet. Screening av utlandsfödda mödrar har visat sig vara en utmanande arbetsuppgift för sjuksköterskorna. Tidigare forskning pekar på att dessa mödrar inte erbjuds delta i screening i samma omfattning som den inhemska befolkningen. Statistik visar också att invandrarmödrar i större utsträckning väljer att tacka nej till att delta i screening och likaså att bland de som deltar är det inte så många som förväntat som screenas ut i förhållande till den höga förekomsten av PPD i gruppen. Det övergripande syftet med studierna var att öka kunskapen om screening för PPD av icke-svenskspråkiga invandrarmödrar genom att belysa deras och BHV-sjuksköterskors erfarenheter. Ett ändamålsenligt urval användes vilket innebar att deltagare med erfaren¬¬heter av ämnet erbjöds delta i individuella intervjuer. Det insamlade text¬materialet analyserades med latent innehållsanalys med induktiv ansats. Det är en deskriptiv kvalitativ metod som syftar till att förutsättningslöst skapa kategorier och teman i avsikt att beskriva fenomenet för att öka förståelsen och kunskapen. Vid latent innehållsanalys tolkas även det underliggande budskapet i texten. Med syftet att belysa hur BHV-sjuksköterskor identifierar tecken på PPD hos icke-svenskspråkiga invandrarmödrar genomfördes 13 individuella inter-vjuer. Resultatet visade att en förutsättning för att kunna tolka den moderns sinnesstämning var etablerandet av en trans-kulturell vårdrelation som fördjupades. Sjuksköterskorna använde sig av kulturell kunskap för att uppfatta och tolka tecken på PPD i interaktionen med modern och i observationer av samspelet mellan mamma och barn, med tolken och anhöriga. Samtidigt orsakade bristande kulturell kompetens frustration hos sjuksköterskorna när de försökte anpassa screeningen efter de givna förutsättningarna och även när de försökte få mamman att öppna sig eller ta emot extern hjälp. Sjuksköterskorna förlitade sig även på sin intuition när de tolkade mammans sinnesstämning. För att få kunskap om hur icke-svenskspråkiga invandrarmödrar upplever att delta i screening för PPD i BHV intervjuades 13 med albanska, arabiska eller badinani som modersmål. Andra tolkar än de som användes i intervjusituationen lyssnade på ljudinspelningarna och validerade det utskrivna materialet. Resultatet visade att deltagandet i screeningen påminde mödrarna om deras brist på stöd i sin nuvarande livssituation, men sågs även som en möjlighet att erfara andra sätt att tänka kring psykisk ohälsa och nya källor till stöd. Kvalitén på relationen med sjuksköterskan var av betydelse för om modern valde att delta i screening och uppleva den som meningsfull. Innebörden av PPD var i allmänhet oklar, men möjligheten att delta i screening och därigenom bli behandlad som alla andra mödrar uppskattades. Kulturella föreställningar om psykisk ohälsa, negativa förväntningar kopplade till sitt upplevda värde som kvinna, skam över att inte vara tillräckligt tacksam för sitt nya liv och negativa upplevelser av interaktionen i samband med screeningen gjorde det utmanade för dem att tala om sitt mående. Studierna visar att screening för PPD av icke-svenskspråkiga invandrarmödrar kan underlättas av upprepad information om PPD både muntligt med hjälp av tolk, men även genom översatt material, ett förtroendefullt samtal med assistans av kvinnlig auktoriserad kontakttolk samt kunskap hos BHV-sjuksköterskor om olika utmaningar hos dessa mödrar för att kunna tala om psykiskt mående. Den förtrogenhetskunskap som erfarna BHV-sjuksköterskor besitter och använder sig av för att tolka icke-svenskspråkiga mödrars mående behöver ytterligare studeras. Det är också av intresse att undersöka om utbildning av BHV-sjuksköterskorna i kulturkänslig screening kan göra att screeningen av denna sårbara grupp av mödrar mer effektiv.
|
|
| 2. |
- Lamei, Sepideh
(författare)
-
The effect of honeybee-specific lactic acid bacteria on american foulbrood disease of honeybees
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The honeybee, Apis mellifera, is one of the most economically important pollinators and highly valued for its honey and wax production. Managed honeybees occupy an increasingly critical role in agricultural productivity and food security. American foulbrood (AFB) is a highly contagious and destructive bacterial honeybee brood disease caused by Paenibacillus larvae that affects beekeeping worldwide. However, only a minority of bacteria associated with honeybees are harmful. Honeybee-specific Lactic Acid Bacteria (hbs-LAB), a defined group of beneficial bacteria inhabiting the honey crop, have strong antimicrobial properties important for honey production and honeybee health that could be exploited for combating diseases such as AFB. The aim of this thesis was to investigate the effect of hbs-LAB on P. larvae and AFB, both in culture, in individual larval bioassays, and at colony level. First we showed that the laboratory cultivation of the 13 distinct hbs-LAB was significantly improved by the addition of L-cysteine and fructose to the medium and optimized a culture-independent molecular technique for the detection and identification of the individual hbs-LAB species. Secondly the effect of the cell free supernatant, the secretome, from a culture mix of the 13 hbs-LAB species was investigated on P. larvae growth and associated larval mortality. The results showed that this secretome strongly inhibited the multiplication of P. larvae vegetative cells but that spore germination appeared to be unaffected, and that it decreased the mortality of P. larvae infected larvae. Finally it was shown that oral administration of hbs-LAB supplement to honeybee colonies had no influence on colony-level P. larvae spore levels or colony strength. Furthermore, the results showed that although the antibiotic tylosin decreased AFB symptoms in colonies, it had no effect on P. larvae spore levels. In conclusion, the colony-level results do not contradict the antagonistic effects observed in individual larvae in laboratory studies, but rather suggest that supplementary administration of live bacteria may not be the most effective way to harness such effects in a useful application.
|
|
| 3. |
- Cociorva, Anamaria
(författare)
-
Essays on Credit Ratings
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of four self-contained articles, all of which contribute to the empirical research on credit ratings. Broadly speaking, the first two papers highlight two less ordinary “uses” of credit ratings, in the context of (1) measuring financial constraints and (2) bond market segmentation. The last two papers focus on a relatively new concept in the credit ratings’ literature, specifically the time variation in rating standards, by looking at the sovereign credit ratings, and at how the time variation in rating standards has been measured and interpreted in prior literature.By using an extensive set of tests and corporate investment decisions indicating various degrees of financial constraints, the first paper provides first-hand evidence of the ability of credit ratings to capture corporate responses consistent with various levels of financial constraints. We find that they outperform six common financial constraints proxies in each of our tests and shocks.In the second paper, I use an exogenous change in the index inclusion criteria for a large, widely followed bond index, to show that bonds also exhibit an “index” effect following either addition or deletion to the bond index. Furthermore, this exogenous change leads to different types of index effects, allowing me to compare, for the first time, the relative effect of positive (addition) and negative (deletion) changes in a bond index composition. In this comparison, I find that index addition triggers a market reaction twice as large as index deletion, suggesting that investor awareness may be an important channel for bond pricing.The third paper is the first to provide evidence of rating conservatism for sovereign (i.e. country) credit ratings. I find that a sovereign that received an AA rating in 1993 would only get an A+ twenty years later in spite of maintaining the same economic environment, and this change in conservatism is not justified by an increase in the default rates or by a riskier global environment.In the final paper, I revisit the method commonly used for measuring time variation (i.e. conservatism) of rating standards over time, and I find that the decrease in the year coefficients (i.e. the measure for conservatism according to prior research) is largely a result of common secular trends in the financial variables included in the model. While my findings do not disprove the existence of conservatism, they suggest that its true magnitude may be significantly lower, and that other empirical methods might be more suitable for its assessment.
|
|
| 4. |
- Khoshnood, Ardavan
(författare)
-
Prehospital Diagnosis and Oxygen Treatment in ST Elevation Myocardial Infarction
- 2017
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionPaper I: An Artificial Neural Network (ANN) was constructed to identify ST Elevation Myocardial Infarction (STEMI) and predict the need for Percutaneous Coronary Intervention (PCI). Paper II, III and IV: Studies suggest that O2 therapy may be harmful in STEMI patients. We therefore conducted the SOCCER study to evaluate the effects of O2 therapy in STEMI patients.MethodsPaper I: 560 ambulance ECGs sent to the Cardiac Care Unit (CCU), was together with the CCU physicians interpretation and decision of conducting an acute PCI or not collected, and compared with the interpretation and PCI decision of the ANN. Paper II, III, IV: Normoxic (≥94%) STEMI patients accepted for acute PCI were in the ambulance randomized to standard care with 10 L/min O2 or room air. A subset of the patients underwent echocardiography for determination of the Left Ventricular Ejection Fraction (LVEF) and the Wall Motion Score Index (WMSI). All patients had a Cardiac Magnetic Resonance Imaging (CMRI) to evaluate Myocardial area at Risk (MaR), Infarct Size (IS) and Myocardial Salvage Index (MSI).ResultsPaper I: The area under the ANN’s receiver operating characteristics curve for STEMI detection as well as predicting the need of acute PCI were very good.Paper II, III, IV: No significant differences could be shown in discussing MaR, MSI or IS between the O2 group (n=46) and the air group (n=49). Neither could any differences be shown for LVEF and WMSI at the index visit as well after six months between the O2 group (n=46) and the air group (n=41)ConclusionsPaper I: The results indicate that the number of ECGs sent to the CCU could be reduced with 2/3 as the ANN would safely identify ECGs not being STEMI.Paper II, III, IV: The results suggest that it is safe to withhold O2 therapy in normoxic, stable STEMI patients.
|
|
| 5. |
- Kjellström, Elisabeth
(författare)
-
Outsourcing of Organizational Routines : Knowledge, control, and learning aspects
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Organizational routines that are critical to learning, flexibility, and adaptation explain the behaviour of the business organization. When organizational routines cross the boundary of the organization, variability and stability are affected. This study emphasizes organizational routines committed in specific outsourcing or insourcing situations to clarify the dynamics of organizational routines that are cut off and put out of context.The theoretical analysis of organizational routines shows how three aspects of knowledge, control, and learning that are challenged by outsourcing or insourcing are able to explicate loss of organizational memory, loss of accountability, or loss of predictability over the business process. When organizational routines of an outsourced function are surgically removed, the organization is left with direct and indirect so called ‘phantom limbs pain’ that diminishes the effectiveness of the remaining activity system. Routines that are no longer in use result in reduced control and a weakened organizational memory, no longer updated for learning.Earlier research has shown the complexity of organizational routines. The interpretation of social phenomena is never a straightforward activity. The multifaceted patterns of the phenomenon of organizational routines are difficult to study, directly observe, and therefore well suited for a hermeneutical approach.The analysis emphasizes organizational boundaries and in particular control and accountability at lower organizational levels to present a new understanding of boundary management and the role of local knowledge as a link between internal and external systems in outsourcing processes. Knowledge does not necessarily erode when routines are outsourced if knowledgeable employees intervene and can regain knowledge. Concepts like tacit knowing, trading zone, and path dependency show how transfer of knowledge is possible when boundary spanning is organized in communities of practice.Three different conventional industry cases illustrate the theoretical analysis of how boundaries of time and space are challenged and broken down both within and between organizations. The study has resulted in contributions to thedifferent theoretical areas of organizational routines, knowledge management, control, organizational learning, and boundary management as well as some practical managerial advices.
|
|
| 6. |
- Wagner, Henrik
(författare)
-
Clinical and experimental insights into the use of mechanical chest compressions during prolonged resuscitation in the coronary catheterization laboratory
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION. Prolonged cardiopulmonary resuscitation (CPR) with manual chest compressions (CC) during simultaneous percutaneous coronary intervention (PCI) is exceedingly difficult, with high mortality rates. The use of a mechanical CC (MCC) device can overcome the ordeal of manual CC. The aims of this thesis were to investigate the impact of the introduction of the LUCAS™ MCC device in the cath-lab (Papers I and II); to develop a structured approach in advanced CPR during simultaneous PCI (Paper III); to study myocardial perfusion and blood flow during MCC with and without EPI (Papers IV and V). MATERIAL and METHODS. A retrospective analysis (5 years) and a prospective follow up study (4 years) with patients treated with MCC during simultaneous PCI were performed. Circumstances leading to the cardiac arrest, and patient and PCI outcomes were investigated (Papers I and II). A structured physiology-guided CPR approach during simultaneous PCI was developed (Paper III). In both animal studies (Papers IV and V) circulation was maintained with MCC during ventricular fibrillation. Coronary blood flow (APV) and coronary perfusion pressure (CPP) were analysed (Papers IV and V), with the addition of amplitude spectrum area (AMSA) in Paper V. The animals in Paper V were randomised to four injections of EPI or saline (control) during the MCC period. RESULTS. Forty-three patients were included in Paper I and 32 patients in Paper II. Twenty-five percent were discharged from hospital in good neurological condition in each study. Seventy-six percent (Paper I) and 81% (Paper II) were successfully treated with PCI. In Paper III, the development of a structured physiology-guided CPR approach in the cath-lab led to better CPR teamwork during the CPR effort. Coronary artery APV was good throughout the MCC period with a good correlation to CPP (Paper IV). In Paper V, epinephrine significantly increased CPP in 3/4 injections; APV was increased only after the first injection, and no increase was seen in AMSA. CONCLUSIONS. The use of MCC during prolonged CPR has been shown to be feasible, safe, with good PCI results, and can save lives. Mechanical chest compressions can maintain normal coronary blood flow in the experimental laboratory. Epinephrine decreases myocardial circulation despite increased CPP.
|
|
| 7. |
- Aardal Lönnerfors, Celine
(författare)
-
Robot-assisted laparoscopy for benign uterine disease. Feasibility, outcome and hospital cost.
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The introduction of the laparoscope was a milestone within gynecologic surgery. Despite evidence of better perioperative outcome compared to laparotomy, laparoscopy is mostly performed for less advanced surgical procedures and the uptake of laparoscopic hysterectomy has been slow. An effort to preserve the clinical benefits of laparoscopic surgery and facilitate the performance of more advanced surgery has led to the development of robot-assisted laparoscopic surgery. Technical progress has been advantageous for the patient from a historical point of view, but this cannot be assumed without proper evaluation. As for all surgical approaches, it is important to recognize the possible applications of robotic surgery as well as proper patient selection both from a clinical and economical point of view. The overall aim of this thesis was to investigate the possible applications, clinical outcome and hospital cost of robot-assisted laparoscopic surgery for benign uterine disease at a single institution following the introduction of robotic surgery. Study I: Evaluating the first 1000 robotic surgeries performed showed that a surgical robot provides the possibility to offer minimally invasive surgery to a larger patient population with low rates of conversions and intraoperative complications. Study II: 31 women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with a possible effect on conception had a pregnancy rate following robotic myomectomy of 68%. Study III: All women (n=114) with a BMI ≥ 30 kg/m2 who underwent a simple hysterectomy by robotics or laparotomy during the study period were included. Robot-assisted laparoscopic hysterectomy in obese women was associated with shorter hospital stay, less bleeding, and fewer complications and longer operative time compared to laparotomy although the operative times for morbidly obese women were similar between robotics and laparotomy. Study IV: 122 women planned for minimally invasive hysterectomy for benign disease were randomly allocated to either robot-assisted- or traditional, minimally invasive hysterectomy in a 1:1 proportion with vaginal hysterectomy as a primary choice in the latter. From the perspective of hospital costs, robotic-assisted hysterectomy is not advantageous for treating non-complex benign conditions when a vaginal approach is feasible in a high proportion of patients. A similar hospital cost is attainable for laparoscopy and robotics when the robot is a preexisting investment. Study V: Complication rates in 949 women planned for robotic hysterectomy for malignant (75%) and benign (25%) gynecological disease over an 8-year period with special awareness of complications possibly related to robot specific risk factors. Intraoperative- and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice. Study VI: All women (n=483) undergoing hysterectomy for benign disease during 2013 and 2014. Vaginal hysterectomy was associated with the lowest hospital cost and robotic hysterectomy with the lowest rate of perioperative complications. Procedure-specific proficiency influences outcome. Robotic hysterectomy for benign disease is clinically advantageous and economically feasible in complex cases, when performed by high volume surgeons.
|
|
| 8. |
- Abrahamsson, Tove
(författare)
-
Use and misuse of sedative drugs and related substances - Findings in the general population and in individuals with opioid dependence
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Prescription sedatives are efficient in the treatment of anxiety and sleeping disorders, but are associated with a risk of misuse and dependence, as well as an increased risk of accidents, injuries and overdoses, both in the general population and especially in individuals with other substance misuse. The present thesis aims to investigate prescription sedative use and misuse in two kinds of samples - in the general population, with focus on its association with subjective health and quality life, and in the subpopulation of individuals with opioid dependence, with focus on treatment outcome in opioid maintenance treatment and mortality. Materials and Methods: Prescription sedative misuse was studied in three Swedish datasets: 1) a general population survey (n =22,095), 2) a clinical pilot study for the treatment of opioid dependence (n =44 and 36, for the original study and the follow-up study, respectively), and 3) a national register-based study of individuals in opioid maintenance treatment ( n= 4,501). Results: In the general population, sedative misuse was found to be associated with poor self-assessed mental health and poor quality of life. In individuals with opioid dependence, benzodiazepine misuse was found to be negatively associated with retention in opioid maintenance treatment. Prescription of sedatives was associated with mortality in individuals with opioid dependence, including associations between prescriptions of ‘z-drug’ hypnotics and pregabalin and overdose death. Conclusions: It is important to be aware of the associations with mental health problems and quality of life in individuals with sedative misuse. In individuals with opioid dependence, clinicians also need to be aware of the increased risk of overdose and non-overdose death, as well as possible negative effects on treatment outcome, that come with sedative use and misuse.
|
|
| 9. |
- Abu-Humaidan, Anas Haider
(författare)
-
Rules of engagement - Regulation of complement response in tissue
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Always in motion and probing for danger, complement proteins are found in every space and notch of the body. Their omnipresence combined with an ability to wreak havoc when activated, mandates a strong leash! The how, when, and where to unleash or constrain the complement response remain partly answered questions, despite the significant progress made in the field in the past 100 years.The work in this thesis aims to answer some of these questions with models that compare healthy and disease states, using methods that investigate complement response in each. The investigation often followed the lines ofqueries like: Is complement relevant to this disease state? Is complement activated or its expression induced? If so, through what mechanisms? And what local effect could the activation or induced expression have?Chapter 1 provides an introduction to the complement system that tackles specific topics like complement’s discovery, evolution, function and role in disease. As well as challenges and progress made in complement targeted therapies. Chapter 2 discusses methods and models used in this thesis and in complement research in general. While chapter 3 focuses on the present investigation and where it falls within current knowledge about the local regulation of complement.
|
|
| 10. |
- Adamsson Eryd, Samuel
(författare)
-
Novel risk factors for atrial fibrillation in an urban population
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the general population, and a major cause of morbidity and mortality. Low-grade inflammation, erythrocyte volume variation, and subclinical atherosclerosis have repeatedly been associated with cardiovascular disease, but it remains unclear whether these risk factors are also associated with incident AF. This thesis is based on four epidemiological papers. Paper I-II included subjects from the Malmö Preventive Project (n=22 444, aged 26-61 years), followed during a mean follow-up time of 25 years. Paper III-IV included subjects from the Malmö Diet and Cancer Study (n=30 477, aged 44-74 years), followed during mean follow-up of 13.6 and 15.3 years respectively. Cases of incident AF were retrieved by linkage with the Swedish Hospital Discharge Register and the Swedish Cause of Death Register. Participants in Paper I-II underwent measurements of inflammation-sensitive proteins (ISPs) and genotyping of polymorphisms in the ceruloplasmin gene (CP). Red blood cells distribution width (RDW) was measured in participants of Paper III. Carotid intima-media thickness (IMT) was measured in participants of Paper IV. All subjects were without history of AF, myocardial infarction and heart failure at study entry. A score of five ISPs (ceruloplasmin, fibrinogen, haptoglobin, orosomucoid and α1-antitrypsin) were significantly associated with incidence of AF. Plasma levels of ceruloplasmin were associated with incidence of AF. Genetic polymorphisms in the promoter of the ceruloplasmin gene were associated with elevated plasma levels of ceruloplasmin. One of these polymorphisms was also associated with incidence of AF, suggesting a causal relationship between ceruloplasmin and AF. RDW and carotid IMT were both independently associated with incidence of AF. In conclusion, this thesis shows that ceruloplasmin, RDW and carotid IMT are all factors that may predict future events of AF in the general population. Further studies are needed to elucidate the causal pathway between ceruloplasmin and AF.
|
|
| 11. |
- Agyemang, Alex Adusei
(författare)
-
Preterm intraventricular cerebral hemorrhage: role of cell-free hemoglobin
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cerebral intraventricular hemorrhage in preterm infants continues to be a major clinical problem associated with neurodevelopmental abnormalities manifested by cognitive, behavioral, attentional, social and motor deficits. Hypothesis and aims: The central thesis is that the cytotoxicity of extravasated blood and of consequently released cell-free hemoglobin(Hb) is pivotal for the pathophysiological events causally involved in brain injury. The general aim focuses on the development and implementation of novel neuroprotective strategies with the aim of promoting brain development in preterm infants with high risk for neurodevelopmental impairment.Methods: Paper I. The presence and distribution of cell-free Hb in the periventricular white matter was evaluated in preterm rabbit pups with intraventricular hemorrhage(IVH). Paper II. The distribution, deposition and effect of cell-free Hb on cerebellar development was investigated following IVH in preterm rabbit pups. The protective effect of the cell-free Hb scavenger haptoglobin (Hp) was evaluated. Paper III. The relative cytotoxicity of the different cell-free Hb metabolites was evaluated in mixed glial cell culture. Paper IV. The biodistribution and functional protection of intraventricularly administered recombinant ( alpha 1 microglobulin (rA1M), a heme and radical scavenger was investigated following IVH in preterm rabbit pups.Results: Paper I. IVH was associated with extensive amounts of cell-free Hb in the periventricular white matter, with a wide distribution throughout the brain. Paper II. IVH was followed by a decreased proliferation in the external granular layer (EGL), delayed Purkinje cell maturation and activated microglia in the cerebellum. Cell-free Hb was present in all cerebellar layers, with a gradient towards the molecular and white matter layers. Intraventricular administration of Hp resulted in a partial reversion of the damaging effects following IVH. Paper III. Met/oxidized Hb and not oxyHb was found to initiate a proinflammatory and oxidative response with cytoskeletal disintegration in mixed glial cell cultures. Paper IV. Administered rA1M following IVH was widely distributed in periventricular white matter tissue and present throughout the fore- and mid brain extending to the cerebellum,with a high coexistence of cell-free Hb. Administration of r A1M resulted in an attenuation of proinflammatory and oxidative damage.Conclusions: IVH is characterized by the penetration of cell-free Hb into periventricular brain tissue and cerebellum resulting in a proinflammatory and oxidative damage to the brain. Hp and A1M, scavengers of cell-free Hb and Hbmetabolites respectively, attenuate the damage sustained by the periventricular white matter and cerebellum, affirming cell-free Hb to be causally involved in the brain damage resulting from IVH. Hp and A1M hence appear potential candidates for neuroprotective strategies against brain damage following IVH
|
|
| 12. |
- Ahmad, Abrar
(författare)
-
Identification of genetic biomarkers for the risk prediction of recurrent venous thromboembolism. Risk prediction of recurrent VTE.
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Venous thromboembolism (VTE) is the third most frequent life-threatening cardiovascular disease with an annual incidence rate of 1-2 per 1000 person-years. After the diagnosis for primary VTE, about 20-30% patients develop a recurrence within 5-years. VTE recurrence can be prevented by anticoagulants, albeit at the risk of severe bleeding. Heritability of VTE is high and hereditary factors lead to a lifelong risk of recurrence. Moreover, a single biomarker is not enough to precisely predict the risk of VTE recurrence. Therefore, there is a need for the development of genetic risk scores (GRSs) based on multiple genetic risk factors to identify patients at high and low risk of VTE recurrence.Aims: The overall objective of this thesis was the identification of novel genetic variants and to develop a GRS for risk prediction of VTE recurrence.Material and methods: The studies included in this thesis were performed on Malmö thrombophilia study (MATS) cohort (n= 1465, follow up=~10 years), which includes objectively diagnosed DVT and or PE patients. In Paper I and II, we selected age and sex matched VTE patients (n= 95) to sequence the whole genes (apolipoprotein M [ApoM] and thrombomodulin [THBD] respectively) by Sanger sequencing for identification of novel genetic variants. In addition,validation of identified polymorphisms (with minor allele frequency [MAF] ≥5%) was performed in the whole MATS by TaqMan polymerase chain reaction (PCR). In papers III and IV, we genotyped genetic variants from several genes(including established and putative genetic variants associated with VTE risk) in MATS samples by TaqMan PCR.Results: Among 1465 VTE patients, we excluded (n= 415) before inclusion into the final analyses those who previously had one or more episodes of recurrence, who had VTE recurrence or died during anticoagulant treatment or for whomcomplete information was missing. In paper I, we identified six single nucleotide polymorphisms (SNPs) in ApoM; among them, rs805297 polymorphism was significantly associated with an increased risk of VTE recurrence in male patients. In paper II, we sequenced the whole THBD gene, which is previously known to be associated with risk of primary VTE. We found eight SNPs in THBD. However, the results showed that genetic variants in THBD had no role in the risk assessment of VTE recurrence, which suggests that genetic risk factors for primary and recurrent VTE may differ. In paper III, we analyzed genetic variants in the fat mass and obesity-associated (FTO) gene (rs9939609) and found asex-specific association of FTO polymorphism with the risk of VTE recurrence. In paper IV, we genotyped 22-SNPs to develop a GRS for VTE recurrence as well as validated a previously described 5-SNP GRS in our cohort. The results showed that a GRS consisting of 8-SNPs could stratify patients into low and high risk groups of VTE recurrence and its discriminating power was better than previously described 5-SNP GRS in terms of higher post-test probabilities. Therisk prediction by 8-SNP GRS was further improved when we stratified according to sex (in male patients) and into patients with first unprovoked VTE (patients with no acquired risk factors).Conclusion: The findings in this thesis have demonstrated that genetic variants have a sex specific role in recurrent VTE and that a GRS consisting of multiple genetic variants can predict the risk of VTE recurrence. These findings havelaid a foundation towards understanding the role of genetics in the VTE recurrence and highlighted the need for identification of additional genetic risk factors to further optimize the risk prediction of VTE recurrence.
|
|
| 13. |
- Ahmadi, Zainab
(författare)
-
Prevalence and Pharmacologic Treatment of Breathlessness in Severe Chronic Obstructive Pulmonary Disease
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Chronic breathlessness is a feared and distressing symptom with significant impact on daily life. Little is known of the prevalence of breathlessness at the end of life in severe COPD. International guidelines support the use of opioids to treat breathlessness, but it is unknown how commonly opioids are prescribed for the indication of breathlessness. Supplemental oxygen therapy is commonly prescribed, but data is conflicting on its efficacy in treating breathlessness. Knowledge of physician ability to identify chronic breathlessness and readiness to treat breathlessness with opioids is limited.Aims•To evaluate the prevalence of symptoms and their management at the end of life in patients with oxygen-dependent COPD in Sweden, compared to those with cancer (Study I).•To quantify the reported indications for opioid prescriptions in oxygen-dependent COPD in Sweden (Study II).•To investigate the efficacy of supplemental oxygen therapy for breathlessness in COPD patients with no or mild hypoxemia (Study III).•To assess potential recognition and treatment of chronic breathlessness as compared to chronic pain by physicians in Sweden, using a case-based survey (Study IV).Study DesignNationwide register-based cohort study of patients with oxygen-dependent COPD recorded in the Swedevox register linked with the Swedish Register of Palliative Care (Study I) and with the Swedish Prescribed Drug Register (Study II). Cochrane systematic review and meta-analysis of the efficacy of supplemental oxygen therapy for breathlessness (Study III). Randomized, controlled, double-blind, parallel-group, web-based trial of Swedish physicians treating a hypothetical patient with COPD and severe breathlessness versus a patient with severe pain (Study IV).Results and conclusionsAt the end of life, breathlessness was three times more common in patients with COPD than in those with cancer (Study I). Opioids were commonly prescribed for pain in oxygen-dependent COPD patients but rarely to treat breathlessness, which represented 2% of the stated indications (Study II). Supplemental oxygen therapy modestly reduced breathlessness during exercise in COPD with no or mild hypoxemia, but there was no evidence of an effect in daily life or on quality of life (Study III). In a case presentation of a COPD patient, severe chronic breathlessness was less likely to be identified by physicians as requiring symptomatic treatment and also less likely to be treated with opioids as compared to a patient with chronic pain (Study IV).
|
|
| 14. |
- Ahnlide, Ingela
(författare)
-
Aspects of skin cancer diagnosis in clinical practice
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Skin cancer incidence is increasing in fair-skinned populations. The three most common skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). A correct diagnosis is crucial for an efficient and tailored treatment for the skin cancer patient. The purpose of this thesis was to evaluate different aspects of the preoperative diagnosis of skin cancer. The studies making up this thesis were based on analysis of data from a register including all skin tumour excisions at the Department of Dermatology in Helsingborg, Sweden, from March 2008 to January 2015. The registered data included e.g. sex and age of the patient, tumour site and size, dermoscopic features of the tumour, the preliminary preoperative and final postoperative (histopathological) diagnosis as well as tumour cells at surgical margins. The preliminary preoperative clinical diagnosis was compared with the final histopathological diagnosis in 2,953 excised tumours, whereof 1,626 (55.1%) were malignant, showing high diagnostic accuracy for the diagnosis of malignant tumour and for the diagnosis of basal cell carcinoma (BCC). A total of 96.0% of all excisions had tumour-free margins. The number needed to excise (NNE) for melanoma (the number of pigmented lesions excised to find one melanoma) was calculated for 1,717 cases of excised skin tumours (252 melanomas, 1,395 naevi and 70 seborrhoeic keratoses (SK)). The overall NNE value during the study period was 6.5 (SKs not included). When SKs were included in the calculations the NNE was 6.8. The NNE value decreased with increasing age of the patient and varied for different body locations, with the highest values found for the trunk and the lowest for the arms. When the ABCD rule of dermoscopy was used preoperatively at the bedside in 309 cases (46 melanomas and 263 naevi), use of the algorithm achieved 83% sensitivity and 45% specificity for melanoma diagnosis. A sensitivity of 74% and specificity of 91% were seen for the clinical diagnosis. A considerable percentage (19.6%) of very early melanomas were preoperatively not expected to be melanomas by the dermatologist. The prediction of histopathological subtype of BCC is important for choosing optimal treatment in BCC patients and was assessed in 1,501 cases with pre- or postoperative diagnosis of BCC. The prediction of superficial BCC (sBCC) significantly improved after an educational update on dermoscopic criteria for sBCC in cases assessed by dermoscopy. In conclusion, these studies have shown high accuracy of the preoperative diagnosis of malignant tumour and BCC. With increasing age of the patient, a higher rate of excised pigmented skin lesions was melanomas. Bedside use of the ABCD rule of dermoscopy achieved high sensitivity but low specificity for melanoma diagnosis; however, clinical information seemed to add to specificity. Prediction of sBCC was enhanced after a dermoscopy training session and when dermoscopy was mandatory.
|
|
| 15. |
- Akrawi, Delshad
(författare)
-
Epidemiology of kidney failure and glomerulonephritis in Sweden. Hereditary and non-hereditary factors.
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Kidney disease is recognised as an important worldwide health burden. Kidney failure is the result of acute and chronic kidney disease and is associated with morbidity and mortality. Chronic kidney failure is associated with high-costs for society and low quality of life. Kidney failure may progress to end-stage renal disease (ESRD) that requires dialysis or kidney transplantation with associated high costs for society and low quality of life for the patient. Both genetic and socioeconomic factors are increasingly recognised as important for the development of kidney disease. However, the importance of hereditary and socioeconomic factors has not been studied nationwide in a whole country for kidney failure or glomerulonephritis. Aims: The overall aim was to study the association between familial and non-hereditary factors and kidney failure and glomerulonephritis in Sweden. In the first paper, neighbourhood deprivation and ESRD was studied. In the second paper, familial risks of renal failure was determined. In the third paper, familial risks of glomerulonephritis was studied. In the fourth paper, heritability of ESRD was determined among Swedish adoptees.Methods: The thesis is based on nationwide retrospective cohort studies using Swedish registers such as the Multi-generation register and the National patient register (NPR). In the first paper, data were analysed by multilevel logistic regression, with individual-level sociodemographic factors and comorbidities at the first level and neighbourhood deprivation at the second level. In the second and third papers familial relative risks (FRRs) of kidney failure and glomerulonephritis were determined using standardized incidence ratio (SIR). In study IV logistic regression (OR=odds ratio) and tetrachoric correlation and also Falconers regression were used to determine heritability of ESRD among adoptees in Sweden.Results: In paper I, neighbourhood deprivation was modestly associated with ESRD in the full model after adjusting for individual-level sociodemographic factors and comorbidities in men OR=1.17 (95% confidence interval [CI] 1.07–1.27) and in women OR=1.18 (95% CI 1.06–1.31). In paper II the FRR was significantly increased for chronic kidney failure (SIR= 2.02, 95% CI 1.90-2.14) but not for acute kidney failure (SIR=1.08 (95% CI 0.94-1.22) and for unspecified kidney failure, i.e. not specified as acute or chronic (SIR=1.25 (95% CI 0.94–1.63). Males and females had similar FRR for chronic kidney failure, (males SIR=2.04 [95% CI 1.90-2.20] versus females SIR=1.97 [95% CI 1.78-2.17]). The highest FRR was observed for chronic kidney failure among individuals aged 10-19 years (SIR=6.33 [95% CI 4.16-9.22]). In paper III FRR for acute glomerulonephritis was 3.57 (95% CI 2.77-4.53), for chronic glomerulonephritis 3.75 (95% CI 2.85-4.83), and 3.75 (95% CI 2.85-4.83) for unspecified glomerulonephritis, i.e. not specified as acute or chronic. An especially high FRR was observed if two or more relatives were affected (SIR=209.83, 95% 150.51-284.87). In paper IV odds ratio (OR) for ESRD was 6.41 (95% CI 2.96-13.89) in adoptees with a biological parent diagnosed with ESRD. The odds ratio for ESRD was not significantly increased in adoptees with an adoptive parent diagnosed with ESRD (OR=2.40, 95% CI 0.76-7.60). The heritability of ESRD was 59.5 ± 18.2 %.Conclusion: Family history of chronic kidney failure and glomerulonephritis are important risk factors for kidney diseases. Heritability of ESRD is high. Familial factors were not associated with acute kidney failure to any major degree. Genetic factors are indicated to be of importance for the burden of glomerulonephritis and chronic kidney failure and in the Swedish population. In contrast, neighbourhood deprivation is only associated with a modestly increased risk of ESRD.
|
|
| 16. |
|
|
| 17. |
- Alajbegovic, Azra
(författare)
-
Transcriptional and post-transcriptional regulation of vascular smooth muscle cell phenotype - Implications for vascular disease states
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- As the world population is pushing toward 8 billion, cardiovascular diseases (CVD) remain the leading cause of death worldwide, representing 30% of all global deaths. A large body of work has recognized that smooth muscle cells (SMCs) surrounding the blood vessels play a prominent role in the development and progression of cardiovascular diseases. SMCs are highly specialized cells with the main function to maintain vascular tension and thereby regulate blood pressure and blood flow. SMCs retain remarkable plasticity. In response to changes in external cues, SMCs can modulate their phenotype from a highly mature contractile phenotype to a synthetic, proliferative phenotype. Although beneficial during key physiological processes such as wound healing, phenotypic modulation can contribute to the development and progression of several vascular disease states. Despite extensive studies on the transcriptional programs that define smooth muscle phenotype, the endogenous regulators that control smooth muscle specificity are still far from understood. The aim of this thesis was to gain further insight into the transcriptional and post-transcriptional regulation of gene expression that occurs during disease development and how these changes affect the function of the vascular wall.The work in the following papers has identified previously unknown mechanisms by which small non-coding RNAs (miRNAs), actin polymerization and transcriptional regulators MRTFA and GATA6 can contribute to the changes in vascular smooth muscle observed in vascular disease states. In summary, we show that actin polymerization and MRTFA regulate a profile of miRNAs that are downregulated in patients with mildly dilated aorta. Moreover, we demonstrate a novel role for MRTFA in lipid accumulation and foam cell formation. We further demonstrate the importance of miRNA-143 and miRNA-145 for vascular function and for adaptation to hypertension. Lastly, we show that GATA6 regulates migration of SMCs. A deeper understanding into the underlying molecular mechanisms is crucial in order to develop new efficient therapeutic approaches against cardiovascular disease states.
|
|
| 18. |
|
|
| 19. |
- Ambite, Ines
(författare)
-
Molecular determinants of disease severity in urinary tract infection
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In the urinary tract, Escherichia coli infection may result in life-threatening disease, or asymptomatic bacterial carriage, comparable to bacterial commensalism in the gut. Pathogenic strains trigger a disease provoking host response which differs depending on the infected organ. The diversity of the response reflects the virulence repertoire of the infecting strain and by the susceptibility of the host. During asymptomatic bacteriuria (ABU), the lack of clinical symptoms has been attributed to the loss of virulence by the strains. ABU strains have a reduced genome size and carry point mutations or deletions in virulence genes. In the prototype strain E. coli 83972 fimbrial gene clusters are affected by multiple point mutations (the papG adhesin gene) or large deletions (the fim gene cluster). As a result, the innate immune response to ABU strains is reduced. In addition, we made the discovery that asymptomatic carrier strains actively inhibit RNA Polymerase II (Pol II) Ser2 phosphorylation. Pol II is the enzyme required for the transcription of all mRNA in eukaryotes and its function is tightly regulated. E. coli 83972 suppresses Pol II-dependent host gene expression, including genes involved in immune activation. Compared to a broad chemical inhibitor, DRB, inhibition was more limited, suggesting a degree of specificity for a certain repertoire of host genes. Through this suppression of transcription, ABU strains may promote tissue integrity while inhibiting potentially destructive immune activation. NlpD was identified as a protein released by asymptomatic carrier strains with potent host gene expression inhibitory capacity. NlpD targeted the Pol II phosphorylation machinery by interacting with the biggest Pol II subunit, RPB1, and PAF1C in host cells. In treated mice, NlpD inhibited the destructive arm of innate immune activation and reduced bacterial loads. Our findings suggest that molecules of bacterial origin may be explored as therapies to reproduce the beneficial effects associated with ABU.The symptoms of acute cystitis, in contrast, are caused by an exaggerated inflammatory response triggered by infection. We now define acute cystitis as an IL-1β-driven, hyper-inflammatory disorder with atypical IL-1β processing through MMP-7. The results also suggest a genetic susceptibility factor in patients with severe and chronic cystitis, through mutations affecting ASC or NLRP3 expression. ASC and NLRP-3 were identified as negative regulators of MMP-7 expression and the identified molecular determinants and IL-1β and MMP-7 as novel targets for immunomodulatory therapy with potent effects in vivo as well as biomarkers for acute cystitis.In contrast to acute cystitis, acute pyelonephritis is a severe, sometimes life-threatening kidney infection with systemic involvement and risk of developing bacteremia. Uropathogenic E. coli strains initiate tissue attack of the renal pelvis thus starting disease pathogenesis. A normally protective innate immune signalling cascade, controlled by toll like receptor (TLR)4, is exaggerated explaining the acute disease and sometimes destructive, long-term effects. The response is determined, in part, by bacterial P fimbriae, their receptors and the quality of the signalling cascade that they activate, including several transcription factors. The transcription factor IRF-3 controls the protective arm of the innate immune response to kidney infection, and as a result, mice lacking Irf3 develop severe infection accompanied by urosepsis and renal abscess formation. We identify IRF-7 as a driving force for the disease response in Irf3-/- mice and development of renal pathology. We also define Irf7 as an immuno-therapeutic target that can be controlled with small interfering RNA (siRNA) to restore the balance of resistance versus pathology and prevent kidney damage.Finally, we show that P fimbriae influence the IRF-7 expression and the repertoire of downstream genes associated with acute pyelonephritis (APN). Specifically, P fimbriae were shown to act as IRF-7 agonists. The expression of functional P fimbriae was sufficient to reprogram host gene expression, through effects of PapG on the transcriptional machinery of the host. Paradoxically, the results suggest that a single “super virulence” factor may be sufficient to tilt the balance from peaceful coexistence to disease and for the host to recognize and respond to a strain that lacks most other virulence factors.
|
|
| 20. |
- Andersson, Ewa
(författare)
-
The experience of younger adults and their next of kin following a myocardial infarction and registered nurses' conceptions of caring in a coronary care context
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite the fact that caring has been regarded as the core of nursing for decades, our knowledge about caring is still mainly on a philosophical level. The problem with these philosophical descriptions is that they do not serve as explicit guides for today's nurses, particularly in the light of the considerable changes that have taken place in the healthcare sector. One of the aims of this thesis was therefore to describe registered nurses' conceptions of caring. Another aim was to extend, and understand the nurses' descriptions by analysing their views of caring through a hierarchical outcome space (findings from Paper III), and in relation to a patient case reflecting the meaning of the experience after a myocardial infarction (findings from Paper I). Even if there is a growing knowledge base within healthcare, with a firm focus on medicine and technology, knowledge about the patients' and their next of kin' experiences is sparse by comparison. Such knowledge is needed to understand what to be prioritised in the development of nursing interventions directed at younger people and their next of kin after a myocardial infarction. A further aim of this thesis was to elucidate the meaning of the experience of younger people and their next of kin following a myocardial infarction. This thesis is based on a naturalistic inquiry. For Paper I, the sample consisted of younger people (55 years and younger) who had suffered a myocardial infarction (n = 17). For Paper II, the sample comprised their next of kin (n = 13). Data was collected by means of narrative interviews and the analysis was conducted by the phenomenological-hermeneutic method (Papers I-II). In Papers III and IV, the sample consisted of registered nurses (n = 21). The data for Paper III was collected by means of interviews and the analysis of the transcribed texts was inspired by phenomenography. In Paper IV, a stimulated recall interview technique was used. The transcribed texts were analysed in two distinct phases inspired by the descriptions of deductive and inductive content analysis. The findings in Paper I reflected how the experience of younger people after a myocardial infarction could be interpreted as an everyday fight to redress the balance in life. In Paper II, the experience of being a midlife next of kin of a relative who had suffered a myocardial infarction could be interpreted as standing alone when life took an unexpected turn. In Paper III, the findings mirrored four qualitatively different ways of understanding caring from the nurses' perspective but with a hierarchical relationship: Caring as person-centredness, Caring as safeguarding the patient's best interests, Caring as nursing interventions and Caring as contextually intertwined. The most comprehensive feature of their collective understanding of caring was their acknowledgment of the person behind the patient, i.e. person-centredness. In Paper IV the findings from the first phase, the deductive analysis reflected the main content of how nurses could understand caring, the hierarchical outcome space from Paper III, but the analysis indicated that the hierarchical outcome space broke up i.e. flipped. The findings from the second phase, the inductive analysis showed that the nurses' views of caring fell into four generic categories; Person-centredness 'lurking' in the shadows, Limited 'potential' for safeguarding the patient's best interests, Counselling as virtually the 'only' nursing intervention and Caring preceded by the 'almighty' context. The findings from both phases of content analysis were interpreted to offer extended understandings and perspectives of how the nurses' could understand caring. The findings indicated that there is a need to reform the overall contextual conditions surrounding caring. Such reformation should facilitate caring signified by safe clinical judgements, nurses standing by their patients, care based on the individual patient and deliverance and development of relevant nursing interventions. Nurses' conception of caring as person-centredness seems to be a prerequisite for practising caring in a person-centred fashion, however, this needs to be cultivated on a daily basis. This approach could innovate care and cardiac rehabilitation. Therefore there must be a greater awareness in the in-hospital care that caring is contextually intertwined. Managers as well as leaders need to investigate how the context is organised and structured to provide contextual improvements. In order to ensure that the essentials of caring are met at all times, nurses need to plan and deliver caring in a structured and systematic way. Using nursing models for care including the nursing process can facilitate this. Using systematic structures in caring, as the nursing process, will supply nurse with relevant problem-solving models and simultaneously support them to work in a person-centred way, where the patients' objective and subjective symptoms and experiences are taken into account in caring.
|
|
| 21. |
|
|
| 22. |
- Anesäter, Erik
(författare)
-
Negative Pressure Wound Therapy - Mechanisms of Action and Protecting Exposed Blood Vessels in the Wound Bed
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- NPWT has recently been associated with severe complications and bleeding when used in wounds with exposed blood vessels. The aims of this work were to investigate the mechanisms of action of NPWT and to explore the possibility of using thin plastic discs to protect exposed blood vessels in the wound bed during NPWT. Three different kinds of wounds were created in pigs: 6 cm and 10 cm diameter circular defect wounds on the back and 6 cm incision wounds in the groin, exposing the femoral artery. Microvascular blood flow was studied with transcutaneous laser Doppler flowmetry (LDF), invasive LDF, and thermodiffusion. Femoral artery blood flow was studied with invasive LDF. Pressure in the wound edge tissue, in the wound cavity and periarterial pressure was measured with pressure transducers. Wound contraction and wound fluid removal were also studied. Tissue pressure 0.1 cm from the wound edge decreased while an increase was found further (0.5 cm) from the wound edge. Increased tissue pressure is believed to be the result of wound contraction and wound edge tissue deformation. The use of a small foam wound filler allowed significant wound contraction, which may result in considerable mechanical stress. In contrast, gauze or a large foam filler led to less wound contraction, which may be more appropriate when NPWT causes pain. Furthermore, NPWT induced a decrease in blood flow 0.5 cm, and an increase 2.5 cm from the wound edge, with a transition zone at 1 cm. This combination of hypo- and hyperperfusion may facilitate both oxygenation and stimulate angiogenesis. However, NPWT should be used with caution in tissues with compromised vascularity due to the risk of ischemia. Thin plastic discs of different designs were placed in the wound bed during NPWT. Femoral artery blood flow and wound bed tissue blood flow decreased when NPWT was applied, but was restored when a disc was inserted. The key mechanisms of NPWT – i.e., pressure transmission to the wound cavity, wound contraction, and wound fluid removal – were not impaired by the discs. Further development and studies on the possible protective effects of thin plastic discs used during NPWT are needed before these can be implemented in clinical practice.
|
|
| 23. |
|
|
| 24. |
- Appelquist, Malin
(författare)
-
Insania Simplex. Empiriska studier av psykisk sjukdom vid förra sekelskiftet.
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Målsättning: Sveriges första sinnessjukstadga utfärdades 1858. Vi ville studera patienter med psykisk sjukdom och den vård de fick vid förra sekelskiftet.Patienter och metod: Patienter med psykisk sjukdom (n=503) som vårdades på Kristianstads lasarett 1896-1905 studerades, för att få en bild av diagnoser/diagnostik, behandling och förlopp. För 92 patienter återfanns även journaler vid Lunds hospital, vilka också studerades. Patienter med sinnessjukintyg kunde transkriberas till en ICD-10 diagnos. Patienternas livslängd och dödsorsak återfanns initialt i kyrkoböcker och senare hos Socialstyrelsen. Resultat: Neurasteni vad den vanligaste diagnosen, följd av affektiva sjukdomar och sedan alkoholism. 36 % fick ett sinnessjukintyg för att kunna ansöka om vård på hospital. Dessa patienter var svårt sjuka (GAF 29) och 17% av hade även en hög alkoholkonsumtion. Beskrivningarna av patienterna och deras symtom verkar inte ha ändrat sig, även om vissa diagnosnamn har ändrats över tid. Behandlingarna följde dåtidens rekommendationer och tvångsbehandlingar var sällsynta. 65 % skrevs ut friska eller förbättrade från lasarettet. Det fanns inga belägg för att fattiga oftare fick vård, samtliga samhällsklasser fanns representerade. Livstidsrisken för självmord var 5,5%. En högre självmordsrisk fanns för diagnoserna melankolia, mania, paranoia, alkoholism och för manliga patienter med neurasteni. Av de patienter som fått ett intyg för att ansöka om hospitalsvård kom färre än hälften dit till slut. Det rådde platsbrist på hospitalen. Patienterna fick istället vårdas inom fattigvården eller hemma. På hospitalet blev 64% friska eller förbättrade och medianvårdtiden för de som utskrevs som friska var 158 dagar. Tvångsvård var sällsynt. 58% av patienterna hade varit våldsamma före eller under vårdtiden.Slutsats: Lasarettet i Kristianstad och Hospitalet i Lund erbjöd enligt dåtidens riktlinjer och möjligheter en god och adekvat vård för sinnessjuka och de flesta patienter utskrevs som friska eller förbättrade. Livstidsrisken för självmord var låg (5,5%).
|
|
| 25. |
- Arvidsson, Ida
(författare)
-
Studies of the pathogenesis of Shiga toxin-producing Escherichia coli-induced hemolytic uremic syndrome
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hemolytic uremic syndrome (HUS) is characterized by non-immune hemolytic anemia, thrombocytopenia and acute kidney failure. The most common form of HUS is associated with gastrointestinal Shiga toxin-producing enterohemorrhagic Escherichia coli (EHEC) infection. EHEC are non-invasive strains with Shiga toxin as the unique virulence factor. The aim of this study was to describe host-pathogen interactions during EHEC infection using patient samples, an established mouse model and blood cells in vitro. In the first study the mechanism by which hemolysis is induced was investigated. Red blood cells from HUS patients and from controls were utilized to demonstrate complement activation on red blood cells in patients and show that Shiga toxin could induce hemolysis mediated by complement activation. Shiga toxin also induced the release of complement-coated red blood cell-derived microvesicles. The toxin may thus contribute to the induction of hemolysis. After intestinal colonization Shiga toxin is released into the circulation but does not circulate in free form. In the second study the means by which toxin reaches the kidney was investigated showing that the toxin circulated within blood cell-derived microvesicles (in patients and in the mouse model). These toxin-containing microvesicles were internalized in renal endothelial and epithelial cells where they emptied their cargo. The study thereby identified a novel mechanism of bacterial virulence by which virulence factors evade the host response. In the third study the importance of the antimicrobial peptide cathelicidin in EHEC infection was investigated using cathelicidin-deficient mice. These mice exhibited a thinner colonic mucosa layer, increased intestinal colonization, severe symptoms accompanied by intestinal and renal damage, in comparison to the wild-type cathelicidin-producing mice, which remained asymptomatic. Thus cathelicidin was found to be protective in murine EHEC infection. In the fourth study the protective effect of complement blockade during murine EHEC infection was determined, showing that early blockade, or inherent deficiency, of the terminal complement complex was protective whereas late blockade was not. In summary, this thesis unraveled mechanisms of induction of hemolysis and of toxin transfer and as well as the protective role of the anti-microbial cathelicidin and the terminal complement cascade in EHEC-HUS.
|
|
