| 1. |
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| 2. |
- Dahlberg, Helena, 1980, et al.
(författare)
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Den fenomenologiska forskningens evidensanspråk
- 2019
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Ingår i: Fenomenologi i praktiken. fenomenologisk forskning i ett skandinaviskt perspektiv / Helena Dahlberg, Sidsel Ellingsen, Bente Martinsen, Susanne Rosberg (red.). - Stockholm : Liber. - 9789147113453 ; , s. 155-189
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Bokkapitel (refereegranskat)
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| 3. |
- Dahlberg, Helena, 1980, et al.
(författare)
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Ecological caring-Revisiting the original ideas of caring science
- 2016
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 11, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this empirically grounded philosophical paper is to explore the notion of holistic care with the intention to expand it into a notion of ecological care and in such a way revisit the original ideas of caring science. The philosophical analysis, driven by lifeworld theory and especially Merleau-Ponty's philosophy, is firmly rooted in contemporary clinical care. We used interview data from patients in a study at an anthroposophic clinic in Sweden, which forms part of an ecological community with, for example, ecological agriculture. The empirical study is analysed according to reflective lifeworld research. Starting from the fact that illness can be defined as a loss of homelikeness in the body and in the familiar world, our findings illustrate how ecological care helps the patient to once again find one's place in a world that is characterized by interconnectedness. The task of ecological care is thus not only to see the patient within a world of relationships but to help the patient find his/her place again, to understand himself/herself and the world anew. Ecological care is not only about fighting an illness, but also recognizes a patient from inside a world that s/he is affected by and affects, that s/he is understood and understands from. Such care tries to restore this connection by making possible the rhythmical movement as well as the space in-between activity and rest, between being cared for and actively involving oneself in one's recovery and between closing oneself off from the world and once again going out into it.
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| 4. |
- Dahlberg, Helena, 1980, et al.
(författare)
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The question of meaning — a momentous issue for qualitative research
- 2019
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 14:1, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- In this article, we identify some worrying problems in the contemporary practice of qualitative research, such as the confusion regarding content and meaning in content analysis, the frequent use of standardized methods that avoids philosophy, as well as the description/interpretation dichotomy in empirical research. Since they all arise from a failure to understand the concept of meaning, we return to the question of meaning as the axis that qualitative research pivots around. We examine the meaning of meaning, and how meaning differs from content, and we then ask what consequences this has for research. Even though our analysis is rooted in phenomenological philosophy, we argue that that the ideas that we present are valid for any qualitative research approach. The question of understanding and relating to meaning, we argue, is a momentous issue for qualitative research, where we either continue safeguarding the very essence of qualitative research as dealing with human phenomena, or give it up in favor of more pragmatic and clear-cut methods that seemingly does away with the question of meaning.
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| 5. |
- Dahlberg, Helena, 1980, et al.
(författare)
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Vårdande mellanrum och sammanhang
- 2016
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Ingår i: Teoretiska grunder för vårdande. Maria Arman, Karin Dahlberg, Margaretha Ekebergh (red.). - : Liber. - 9789147114115 ; , s. 145-168
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Bokkapitel (refereegranskat)
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| 6. |
- Dahlberg, Josef, et al.
(författare)
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Microbiota data from low biomass milk samples is markedly affected by laboratory and reagent contamination
- 2019
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Discoveries of bacterial communities in environments that previously have been described as sterile have in recent years radically challenged the view of these environments. In this study we aimed to use 16S rRNA sequencing to describe the composition and temporal stability of the bacterial microbiota in bovine milk from healthy udder quarters, an environment previously believed to be sterile. Sequencing of the 16S rRNA gene is a technique commonly used to describe bacterial composition and diversity in various environments. With the increased use of 16S rRNA gene sequencing, awareness of methodological pitfalls such as biases and contamination has increased although not in equal amount. Evaluation of the composition and temporal stability of the microbiota in 288 milk samples was largely hampered by background contamination, despite careful and aseptic sample processing. Sequencing of no template control samples, positive control samples, with defined levels of bacteria, and 288 milk samples with various levels of bacterial growth, revealed that the data was influenced by contaminating taxa, primarily Methylobacterium. We observed an increasing impact of contamination with decreasing microbial biomass where the contaminating taxa became dominant in samples with less than 10 4 bacterial cells per mL. By applying a contamination filtration on the sequence data, the amount of sequences was substantially reduced but only a minor impact on number of identified taxa and by culture known endogenous taxa was observed. This suggests that data filtration can be useful for identifying biologically relevant associations in milk microbiota data.
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| 7. |
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| 8. |
- Dahlberg, Karin, et al.
(författare)
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Ensamheter
- 2015
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Bok (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
- Sha, Bo, et al.
(författare)
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Fluorotelomer alcohols (FTOHs), brominated flame retardants (BFRs), organophosphorus flame retardants (OPFRs) and cyclic volatile methylsiloxanes (cVMSs) in indoor air from occupational and home environments
- 2018
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Ingår i: Environmental Pollution. - : Elsevier BV. - 0269-7491 .- 1873-6424. ; 241, s. 319-330
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Tidskriftsartikel (refereegranskat)abstract
- Indoor air samples were collected from private homes and various occupational indoor environments using passive air sampler and analysed for fluorotelomer alcohols (FTOHs), brominated flame retardants (BFRs), organophosphorus flame retardants (OPFRs) and cyclic volatile methyl siloxanes (cVMSs). The aim was to investigate their occurrence in indoor air, factors that may affect their presence and human daily exposure dose (DED) via inhalation. In general, levels of cVMSs were 3-4 orders of magnitude greater than the other compound classes. OPFRs concentration was found significantly higher than BFRs in indoor air. The most abundant compounds in each chemical class were 8:2 FTOH, 2,4,6-TBP, TNBP and TCEP and decamethylcyclopentasiloxane (D5). Home samples contained higher level of FTOHs, BFRs and cVMSs than occupational environments, whereas concentration of OPFRs in office samples were higher. BFRs concentrations were significantly correlated with building age and with the number of electronic/ electrical devices at the sampling sites. Moreover, significantly lower levels of FTOHs and cVMSs were observed in rooms with forced-ventilation system. Estimated DED via inhalation was significantly higher at home than in office and the total DED was on average 3-5 orders of magnitude lower than the reference value. (C) 2018 Elsevier Ltd. All rights reserved.
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| 11. |
- Ahrné, Karin, et al.
(författare)
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Tillstånd och trender för arter och deras livsmiljöer – rödlistade arter i Sverige 2015
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- 2015 års upplaga av den svenska rödlistan är den fjärde i ordningen. Den är baserad på IUCN:s rödlistningskriterier och revideras vart femte år. I rödlistan bedöms risken som enskilda arter av djur, växter och svampar löper att försvinna från Sverige. Bedömningen utförs av ArtDatabankens medarbetare i samverkan med över 100 externa experter, indelade i 14 expertkommittéer för olika organismgrupper. Under arbetet med 2015 års rödlista har tillstånd och trender bedömts för 21 600 arter och 1 318 lägre taxa (apomiktiska arter, underarter och varieteter), sammanlagt ca 22 900 taxa. Av de bedömda arterna klassificerades 2 029 som hotade (kategorierna CR, EN och VU) och 4 273 som rödlistade (inkluderar även kategorierna NT, RE och DD). Förhållandet mellan antalet rödlistade och antalet bedömda arter ar 19,8 %, vilket är ungefär samma värde som 2010 och 2005. I denna rapport jämförs antalet och andelen rödlistade arter mellan olika organismgrupper, biotoper, substrat och påverkansfaktorer. Texten ar indelad i en allmän del och åtta kapitel inriktade på olika landskapstyper. Landskapstyperna utgör en grov indelning av landets miljöer enligt följande kategorier: Skog, Jordbrukslandskap, Urbana miljöer, Fjäll, Våtmarker, Sötvatten, Havsstränder och Havsmiljöer. Skogen och jordbrukslandskapet är de artrikaste landskapstyperna med 1 800 respektive 1 400 arter som har en stark anknytning dit, och ytterligare flera hundra arter som förekommer där mer sporadiskt. De faktorer som påverkar flest rödlistade arter i Sverige är skogsavverkning och igenväxning, som båda utgör ett hot mot vardera ca 30 % av de rödlistade arterna. Avverkning minskar arealen av skog där naturliga strukturer och naturlig dynamik upprätthålls, och den orsakar därmed förlust av livsmiljöer. Igenväxning orsakas av ett antal faktorer, bland annat upphörande hävd (bete och slåtter), gödsling, trädplantering och brist på naturliga störningsregimer som t.ex. regelbundna översvämningar kring vattendrag och sjöar. Andra viktiga påverkansfaktorer är fiske, torrläggning av våtmarker, tillbakagång hos värdarter (främst alm och ask som drabbats av invasiva svampsjukdomar), klimatförändringar och konkurrens från invasiva arter. IUCN:s rödlisteindex beräknas för ett urval av de bedömda organismgrupperna. Rödlisteindex visar att skillnaderna mellan rödlistorna från 2000, 2005, 2010 och 2015 är små. Ett par undantag finns dock. Groddjur och stora däggdjur har fått en något förbättrad situation sedan 2000. Totalt förefaller det ändå som att trycket mot Sveriges artstock har förblivit relativt konstant under de senaste 15 åren.
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| 12. |
- Anderberg, Mats, 1961-, et al.
(författare)
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Mer än varannan ungdom med alkohol- och narkotikaproblem i öppenvården har erfarenhet av utsatthet i barndomen
- 2019
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Ingår i: Socialmedicinsk Tidskrift. - Stockholm : Karolinska Institutet. - 0037-833X. ; 96:6, s. 786-799
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Tidskriftsartikel (refereegranskat)abstract
- Det finns idag få svenska studier som undersöker erfarenheter av utsattheti barndom hos ungdomar med drogproblem, särskilt inom öppenvården.Den här studien analyserade erfarenheter av försummelse och övergreppunder barndomen hos ungdomar (medelålder 18 år) som påbörjat öppenvårdsbehandlingför drogproblem. Resultaten visade att många ungdomarhade erfarenheter av försummelse och övergrepp i barndomen. Erfarenhetav utsatthet i barndomen var också relaterat till upplevda problem i uppväxtfamiljen,t.ex. ekonomiska svårigheter, missbruk, psykisk ohälsa och våld ifamiljen. Resultaten pekar på att det är angeläget att även utreda utsattheti barndomen bland ungdomar i behandling för drogproblem, särskilt då det idag finns god evidens för att psykiatrisk samsjuklighet (t.ex. traumareaktionoch drogproblem) bör behandlads samtidigt för att uppnå bäst effekt.
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| 13. |
- Anderberg, Mats, et al.
(författare)
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Mer än varannan ungdom med alkohol- och narkotikaproblem i öppenvården har erfarenhet av utsatthet i barndomen
- 2019
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Ingår i: Socialmedicinsk Tidskrift. - 0037-833X. ; 96:6, s. 786-799
-
Tidskriftsartikel (refereegranskat)abstract
- Few Swedish studies investigated experiences of childhood maltreatment in adolescents with substance use problems, especially in outpatient care. This study analyzed experiences of neglect and abuse during childhood in adol- escents (mean age 18 years) who started outpatient treatment for substance use problems. The results showed that several of them had experience of child maltreatment. Child maltreatment was also related to perceived pro- blems in the upbringing family, e.g. financial difficulties, substance use pro- blems, mental illness and violence in the family. This indicate the importance to investigate experiences of child maltreatment among adolescents in tre- atment for substance use problems, especially since there is evidence to- day that psychiatric co-morbidity (e.g. trauma reaction and drug problems) should be treated simultaneously to achieve the best effect.
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| 14. |
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| 15. |
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| 16. |
- Dahlberg, Anna-Karin, et al.
(författare)
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Anthropogenic and naturally produced brominated substances in Baltic herring (Clupea harengus membras) from two sites in the Baltic Sea
- 2016
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Ingår i: Chemosphere. - : Elsevier BV. - 0045-6535 .- 1879-1298. ; 144, s. 2408-2414
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Tidskriftsartikel (refereegranskat)abstract
- In the eutrophicated Baltic Sea, several naturally produced hydroxylated polybrominated diphenyl ethers (OH-PBDEs) have been found in marine biota. OH-PBDEs are toxic to adult and developing zebrafish and shown to be potent disruptors of oxidative phosphorylation (OXPHOS). Disturbed OXPHOS can result in altered energy metabolism and weight loss. In herring, the concentration of OH-PBDEs (i.e. 2'-OH-BDE68 and 6-OH-BDE47) has increased during the period 1980-2010 in the Baltic Proper. Over the same time period, the condition and fat content in Baltic herring have decreased. Given the toxicity and increasing trends of OH-PBDEs in Baltic herring it is important to further assess the exposure to OH-PBDEs in Baltic herring. In this study, the concentrations of OH-PBDEs and related brominated substances i.e. polybrominated phenols (PBPs), polybrominated anisoles (PBAs), methoxylated polybrominated diphenyl ethers (MeO-PBDEs) and polybrominated diphenyl ethers (PBDEs) were measured in herring sampled in the northern Baltic Proper (Asko, n = 12) and the southern Bothnian Sea (Angskarsklubb, n = 12). The geometric mean (GM) concentrations (ng/g l.w.) at Asko and Angskarsklubb were; Sigma(2)PBPs: 4.3 and 9.6, Sigma 2PBAs: 34 and 20, Sigma 6OH-PBDEs: 9.4 and 10, Sigma 7MeO-PBDEs: 42 and 150, Sigma 6PBDEs: 54 and 27, respectively. 6-OH-BDE47 dominated the OH-PBDE profile and comprised 87% (Asko) and 91% (Angskarsklubb) of the Sigma OH-PBDEs. At Angskarsklubb the mean concentration of Sigma MeO-PBDEs (150 ng/g l.w.) was 15 times higher than Sigma OH-PBDEs. As other fish species are known to metabolically transform MeO-PBDEs to OH-PBDEs, high levels of MeO-PBDEs can be of concern as a precursor for more toxic OH-PBDEs in herring and their roe.
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| 17. |
- Dahlberg, Anna-Karin, 1985-
(författare)
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Environmentally relevant chemical disruptors of oxidative phosphorylation in Baltic Sea biota : Exposure and toxic potentials
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses on toxicity and occurrence of hydroxylated polybrominated diphenyl ethers (OH-PBDEs) in Baltic Sea biota. The aims were to assess OH-PBDEs potency for disruption of oxidative phosphorylation (OXPHOS) and determine their and related compounds exposure in Baltic blue mussel, herring and long-tailed duck. A method for analysis of OH-PBDEs in herring and long-tailed duck plasma was also evaluated.Relevant OH-PBDEs were tested in vitro for OXPHOS disruption, using a classic rat mitochondrial respiration assay and a cell mitochondrial membrane potential assay. All compounds were found to disrupt OXPHOS either by protonophoric uncoupling and/or via inhibition of the electron transport chain. 6-OH-BDE47 and 6-OH-BDE85, were identified as particularly potent OXPHOS disruptors. Strong synergism was observed when OH-PBDEs were tested as a mixture corresponding to what is present in Baltic blue mussels.Baltic blue mussel is main feed for several species of mussel feeding sea ducks which have decreased dramatically in numbers. To assess long-tailed ducks exposure to brominated substances, liver tissue from long-tailed ducks wintering in the Baltic Sea and blue mussels were analysed. The result confirms that long-tailed duck are exposed to OH-PBDEs via their diet. However, low concentrations were found in the duck livers, which suggest low retention of these compounds despite daily intake. How the nutritional value of blue mussels as feed for sea ducks are affected by OH-PBDE exposure still needs further studies. Other species of sea ducks foraging on Baltic blue mussels during summer months can also be more exposed due to seasonal variation in primary production.Herring sampled in the Baltic Proper and Bothnian Sea, were found to contain OH-PBDEs and high levels of their methylated counterpart, MeO-PBDEs. As demethylation of MeO-PBDEs is known to occur in fish, MeO-PBDEs may pose as additional source for more toxic OH-PBDEs in herring and their roe.
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| 18. |
- Dahlberg, Anna-Karin, et al.
(författare)
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Hydroxylated and methoxylated polybrominated diphenyl ethers in long-tailed ducks (Clangula hyemalis) and their main food, Baltic blue mussels (Mytilus trossulus x Mytilus edulis)
- 2016
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Ingår i: Chemosphere. - : Elsevier BV. - 0045-6535 .- 1879-1298. ; 144, s. 1475-1483
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Tidskriftsartikel (refereegranskat)abstract
- Long-tailed ducks (Clangula hyemalis) that breed in northern Europe and western Siberia and commonly winter in the Baltic Sea, are threatened by a significant population decrease. The ducks are, by primarily feeding on Baltic blue mussels (Mytilus trossulus x Mytilus edulis) while wintering in the Baltic Sea, potentially subjected to high levels of toxic hydroxylated polybrominated diphenyl ethers (OH-PBDEs). To assess long-tailed ducks exposure to polybrominated phenols (PBPs), polybrominated anisoles (PBAs), hydroxylated polybrominated diphenyl ethers (OH-PBDEs), their methylated counterparts (MeO-PBDEs) and polybrominated diphenyl ethers (PBDEs), livers of ten long-tailed ducks wintering in the Baltic Sea were analysed. Pattern and levels of analytes in long-tailed ducks (liver) and blue mussels sampled in March and May at nine sites in the Baltic Sea were compared. The geometric mean concentration (ng/g l.w.) in livers of long-tailed ducks and Baltic blue mussels were: ∑2PBPs: 0.57 and 48; ∑2PBAs: 0.83 and 11; ∑7OH-PBDEs: 6.1 and 45; ∑7MeO-PBDEs: 3.8 and 69; ∑7PBDEs: 8.0 and 7.2, respectively. Based on an estimated daily intake of 450 g fresh blue mussel meat, long-tailed ducks daily dietary intake of brominated substances while foraging in the Baltic Sea in March-May was estimated to; 390 ng ∑2PBPs, 90 ng ∑2PBAs, 370 ng ∑7OH-PBDEs, 590 ng ∑7MeO-PBDEs and 59 ng ∑7PBDEs. The low levels of PBPs, PBAs, OH-PBDEs and MeO-PBDEs in the long-tailed duck livers compared to blue mussel, despite a continuous daily intake, suggest that these compounds are poorly retained in long-tailed ducks.
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| 19. |
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| 20. |
- Dahlberg, Jenny, et al.
(författare)
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Ten years transmission of the new variant of Chlamydia trachomatis in Sweden : prevalence of infections and associated complications
- 2018
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Ingår i: Sexually Transmitted Infections. - : BMJ Publishing Group Ltd. - 1368-4973 .- 1472-3263. ; 94:2, s. 100-104
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In 2006, a new variant of Chlamydia trachomatis (nvCT) was discovered in Sweden. It has a deletion in the plasmid resulting in failed detection by the single target systems from Abbott and Roche used at that time, whereas the third system used, from Becton Dickinson (BD), detects nvCT. The proportion of nvCT was initially up to 65% in counties using Abbott/Roche systems. This study analysed the proportion of nvCT from 2007 to 2015 in four selected counties and its impact on chlamydia-associated complications.METHODS: C. trachomatis-positive specimens collected from 2007 to 2015 were analysed by a specific PCR to identify nvCT cases. Genotyping was performed by multilocus sequence typing (MLST) and ompA sequencing. Ectopic pregnancy and pelvic inflammatory disease records were extracted from the national registers.RESULTS: In total, 5101 C. trachomatis-positive samples were analysed. The nvCT proportion significantly decreased in the two counties using Roche systems, from 56% in 2007 to 6.5% in 2015 (p<0.001). In the two counties using BD systems, a decrease was also seen, from 19% in 2007 to 5.2% in 2015 (p<0.001). Fifteen nvCT cases from 2015 and 102 cases from 2006 to 2009 had identical MLST profiles. Counties using Roche/Abbott systems showed higher mean rates of ectopic pregnancy and pelvic inflammatory disease compared with counties using BD systems.CONCLUSIONS: The nvCT proportion has decreased in all counties and converged to a low prevalence irrespective of previous rates. Genotyping showed that nvCT is clonal and genetically stable. Failing detection only marginally affected complication rates.
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| 21. |
- Dahlberg, Karin, 1952-
(författare)
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The Art of Understanding
- 2018
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Ingår i: Evaluation for a Caring Society. - : Information Age Publishing. - 9781641131636 - 9781641131643 - 9781641131650 ; , s. 51-79
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Bokkapitel (refereegranskat)
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| 22. |
- Dahlberg, Matz, 1966-, et al.
(författare)
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Ethnic Diversity and Preferencesfor Redistribution : Reply
- 2017
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Ingår i: Scandinavian Journal of Economics. - : John Wiley & Sons. - 0347-0520 .- 1467-9442. ; 119:2, s. 288-294
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Tidskriftsartikel (refereegranskat)abstract
- In this reply, we briefly respond to three of the issues raised: possible measures of preferences for redistribution, sample selection bias, and the use of the refugee placement policy as an instrument for immigration.
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| 23. |
- Dahlberg, Matz, et al.
(författare)
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Revisiting the Relationship between Ethnic Diversity and Preferences for Redistribution : Reply
- 2017
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Ingår i: Scandinavian Journal of Economics. - : Wiley. - 0347-0520 .- 1467-9442. ; 119:2, s. 288-294
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Tidskriftsartikel (refereegranskat)abstract
- Here, we respond to the comments raised by Nekby and Pettersson-Lidbom on our paper Dahlberg et al. (2012, Journal of Political Economy 120, 41-76). We argue that our estimates are internally valid, but we acknowledge that the external validity could have been discussed more thoroughly.
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| 24. |
- Fängström, Karin, et al.
(författare)
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In My Shoes - Validation of a computer assisted approach for interviewing children
- 2016
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Ingår i: Child Abuse & Neglect: The International Journal. - : Elsevier BV. - 0145-2134. ; 58, s. 160-172
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Tidskriftsartikel (refereegranskat)abstract
- Interviewing young children presents a challenge because they tend to provide incomplete accounts and are easily misled. Therefore there is a need for techniques to improve young children's recall, while maintaining accuracy and increasing completeness. The computer-assisted interview In My Shoes (IMS) is an aid that potentially offers a way for young children to provide accounts of their experiences. This study examined the validity of IMS, by comparing it with a forensic best practice interview approach using a real life clinical situation to ensure high ecological validity. Children were randomly assigned to either method and both accuracy and completeness of statements made by 4- and 5-year-olds (N = 54) regarding a video-documented health check-up were assessed. The In My Shoes interviews were as good as best practice interviews on all accuracy measures for both age groups, except for object accuracy that was better in the forensic interview condition. Events description completeness was similar in both interview conditions; however, IMS interviews generated more complete statements about people present at the visit. The findings suggest that the IMS approach yields comparable results to a best practice interview, and it can be used as an alternative aid in child interviews.
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| 25. |
- Fängström, Karin, et al.
(författare)
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Is the Strengths and Difficulties Questionnaire with a Trauma Supplement a Valuable Tool in Screening Refugee Children for Mental Health Problems?
- 2019
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Ingår i: The Journal of Refugee Studies. - : Oxford University Press (OUP). - 0951-6328 .- 1471-6925. ; 32:Special issue 1, s. 122-140
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Tidskriftsartikel (refereegranskat)abstract
- The high number of asylum seekers in Sweden has highlighted the need to develop and evaluate structured assessment tools for children. In this study, we aimed to explore the utility of the Strengths and Difficulties Questionnaire (SDQ) with a trauma supplement of six items for preschool children in routine care. Parents of two- to six-year-olds (N = 61) were asked to complete the questionnaire during the routine health check-up offered to all refugees upon their arrival to Sweden. Focus-group interviews were conducted with the nurses who used the SDQ. The nurses found the SDQ valuable once they established a routine and felt that the SDQ contributed to a more structured and informative conversation about the child’s mental health. The SDQ total difficulties showed good internal consistency (alpha = 0.82). A significant proportion of children scored above the clinical cut-off and SDQ scores correlated significantly with the number of post-traumatic stress disorder symptoms measured using the supplement (rho = 0.29). The findings suggest that the SDQ with the trauma supplement is a useful tool in this clinical setting.
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| 26. |
- Hamberg, Anna-Karin, et al.
(författare)
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A Bayesian decision support tool for efficient dose individualization of warfarin in adults and children
- 2015
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 15:7
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Tidskriftsartikel (refereegranskat)abstract
- Warfarin is the most widely prescribed anticoagulant for prevention and treatment of thromboembolic events. Although highly effective, the use of warfarin is limited by a narrow therapeutic range combined with a more than ten-fold difference in the dose required for adequate anticoagulation in adults. For each patient, an optimal dose that leads to a favourable balance between the wanted antithrombotic effect and the risk of bleeding, measured as the prothrombin time International Normalised Ratio (INR), must be found. A model capable of describing the time-course of the INR response to warfarin therapy can be used to aid dose selection, both before starting therapy (a priori dose prediction) and after therapy has been initiated (a posteriori dose revision). In this paper we describe the transfer of a population PKPD-model for warfarin developed in NONMEM to a platform independent decision support tool written in Java. The tool proved capable of solving a system of differential equations representing the pharmacokinetics and pharmacodynamics of warfarin, with a performance comparable to NONMEM. To estimate an a priori dose the user provides information on body weight, age, CYP2C9 and VKORC1 genotype, baseline and target INR. With addition of information about previous doses and INR observations, the tool will use a Bayesian forecasting method to suggest an a posteriori dose, i.e. the dose with the highest probability to result in the desired INR. Results are displayed as the predicted dose per day and per week, and graphically as the predicted INR curve. The tool can also be used to predict INR following any given dose regimen, e.g. a loading-dose regimen. We believe it will provide a clinically useful tool for initiating and maintaining warfarin therapy in the clinic. It will ensure consistent dose adjustment practices between prescribers, and provide more efficient individualization of warfarin dosing in both children and adults.
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| 27. |
- Hörberg, Ulrica, 1968-, et al.
(författare)
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Caring potentials in the shadows of power, correction, and discipline : Forensic psychiatric care in the light of the work of Michel Foucault
- 2015
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : CoAction Publishing. - 1748-2623 .- 1748-2631. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this article is to shed light on contemporary forensic psychiatric care through a philosophical examination of the empirical results from two lifeworld phenomenological studies from the perspective of patients and carers, by using the French philosopher Michel Foucault’s historical-philosophical work. Both empirical studies were conducted in a forensic psychiatric setting. The essential results of the two empirical studies were reexamined in a phenomenological meaning analysis to form a new general structure in accordance with the methodological principles of Reflective Lifeworld Research. This general structure shows how the caring on the forensic psychiatric wards appears to be contradictory, in that it is characterized by an unreflective (non-)caring attitude and contributes to an inconsistent and insecure existence. The caring appears to have a corrective approach and thus lacks a clear caring structure, a basic caring approach that patients in forensic psychiatric services have a great need of. To gain a greater understanding of forensic psychiatric caring, the new empirical results were further examined in the light of Foucault’s historical-philosophical work. The philosophical examination presented in terms of the three meaning constituents: Caring as correction and discipline, The existence of power, and Structures and culture in care. The philosophical examination illustrates new meaning nuances of the corrective and disciplinary nature of forensic psychiatric care, its power, and how this is materialized in caring, and what this does to the patients. The examination reveals embedded difficulties in forensic psychiatric care and highlights a need to revisit the aim of such care.
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| 28. |
- Johnzon, Carl-Fredrik, et al.
(författare)
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The Effect of Lipopolysaccharide-Induced Experimental Bovine Mastitis on Clinical Parameters, Inflammatory Markers, and the Metabolome : A Kinetic Approach
- 2018
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Ingår i: Frontiers in Immunology. - : FRONTIERS MEDIA SA. - 1664-3224. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Mastitis is an inflammatory condition of the mammary tissue and represents a major problem for the dairy industry worldwide. The present study was undertaken to study how experimentally induced acute bovine mastitis affects inflammatory parameters and changes in the metabolome. To this end, we induced experimental mastitis in nine cows by intramammary infusion of 100 pg purified Escherichia call lipopolysaccharide (LPS) followed by kinetic assessments of cytokine responses (by enzyme-linked immunosorbent assay), changes in the metabolome (assessed by nuclear magnetic resonance), clinical parameters (heat, local pain perception, redness, swelling, rectal temperature, clot formation, and color changes in the milk), and milk somatic cell counts, at several time points post LPS infusion. Intramammary LPS infusion induced clinical signs of mastitis, which started from 2 h post infusion and had returned to normal levels within 24-72 h. Milk changes were seen with a delay compared with the clinical signs and persisted for a longer time. In parallel, induction of IL-6 and TNF-alpha were seen in milk, and there was also a transient elevation of plasma IL-6 whereas plasma TNF-alpha was not significantly elevated. In addition, a robust increase in CCL2 was seen in the milk of LPS-infused cows, whereas G-CSF, CXCL1, and histamine in milk were unaffected. By using a metabolomics approach, a transient increase of plasma lactose was seen in LPS-induced cows. In plasma, significant reductions in ketone bodies (3-hydroxybutyrate and acetoacetate) and decreased levels of short-chain fatty acids, known to be major products released from the gut microbiota, were observed after LPS infusion; a profound reduction of plasma citrate was also seen. Intramammary LPS infusion also caused major changes in the milk metabolome, although with a delay in comparison with plasma, including a reduction of lactose. We conclude that the LPS-induced acute mastitis rapidly affects the plasma metabolome and cytokine induction with similar kinetics as the development of the clinical signs, whereas the corresponding effects in milk occurred with a delay.
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| 29. |
- Legradi, Jessica, et al.
(författare)
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Effects of Hydroxylated Polybrominated Diphenyl Ethers in Developing Zebrafish Are Indicative of Disruption of Oxidative Phosphorylation
- 2017
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Ingår i: International Journal of Molecular Sciences. - : MDPI AG. - 1661-6596 .- 1422-0067. ; 18:5
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Tidskriftsartikel (refereegranskat)abstract
- Hydroxylated polybrominated diphenyl ethers (OH-PBDEs) have been detected in humans and wildlife. Using in vitro models, we recently showed that OH-PBDEs disrupt oxidative phosphorylation (OXPHOS), an essential process in energy metabolism. The goal of the current study was to determine the in vivo effects of OH-PBDE reported in marine wildlife. To this end, we exposed zebrafish larvae to 17 OH-PBDEs from fertilisation to 6 days of age, and determined developmental toxicity as well as OXPHOS disruption potential with a newly developed assay of oxygen consumption in living embryos. We show here that all OH-PBDEs tested, both individually and as mixtures, resulted in a concentration-dependant delay in development in zebrafish embryos. The most potent substances were 6'-OH-BDE47 and 6-OH-BDE49 (No-Effect-Concentration: 0.1 and 0.05 mu M). The first 24 h of development were the most sensitive, resulting in significant and irreversible developmental delay. All substances increased oxygen consumption, an effect indicative of OXPHOS disruption. Our results suggest that the induced developmental delay may be caused by disruption of OXPHOS. Though further studies are needed, our findings suggest that the environmental concentrations of some OH-PBDEs found in Baltic Sea wildlife in the Baltic Sea may be of toxicological concern.
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| 30. |
- Nilsson, Ulrica, 1960-, et al.
(författare)
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Postoperative recovery after general and regional anesthesia in patients undergoing day surgery : A mixed methods study
- 2019
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Ingår i: Journal of Perianesthesia Nursing. - : Elsevier. - 1089-9472 .- 1532-8473. ; 34:3, s. 517-528
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate differences and describe experiences of postoperative recovery after day surgery between patients undergoing general anesthesia (GA) versus regional anesthesia (RA).Design: A mixed methods design.Methods: Day surgery patients (N = 401) were included. Postoperative recovery was assessed daily for 14 days using the Swedish Web Version of the Quality of Recovery questionnaire included in a mobile application. In addition, qualitative interviews were completed with 20 day surgery patients. Quantitative and qualitative data were first analyzed separately and then merged.Findings: There were significant differences in Swedish Web Version of the Quality of Recovery between GA and RA on days 1 to 13 (P < .05). These findings could not be confirmed in the qualitative findings, except for psychological issues as well as tiredness and fatigue. Unexpected issues contributed to a greater extent to the theme not feeling well Pain in the surgical wound was overall the biggest problem.Conclusions: There seems to be a poorer recovery after GA compared with RA. Tiredness or fatigue is present also after minor surgery in RA. Unexpected issues affect recovery negatively, and therefore should be addressed by health care.
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| 31. |
- Näsvall, Pia, 1967-
(författare)
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Parastomal hernia : investigation and treatment
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundParastomal hernia is a common stoma complication causing the patient considerable inconvenience. The patient becomes aware of a bulge around the stoma, but a bulge is not always a parastomal hernia and diagnostics must be performed to enable differential treatment. It is difficult to distinguish between a bulge and a hernia. Results based on clinical examination and computerised tomography (CT) in the supine position, have not been convincing. Three-dimensional intrastomal ultrasonography (3D US) is a novel technique shown to be promising in the assessment of stoma complaints. Two studies were performed to determine inter- and intra-observer reliability as well as the validity of 3D US as an alternative to CT when assessing stoma complaints.There are numerous options for the treatment of parastomal hernia, but none has been shown superior. In the recent decades the use of mesh in the repair of incisional and inguinal hernia has become routine. New materials must be evaluated as there are potential morbidity and even mortality risks with mesh repair. As recurrence of a parastomal hernia is an even greater challenge, the method of choice should have a low risk for recurrence. A prospective multicenter study was performed to evaluate safety and recurrence rate when using Parastomal Hernia Patch BARDTM (PHP), a mesh specially designed for parastomal hernia repair.A stoma has a profound impact on the patient´s daily life, both physical and psychological. A parastomal hernia with its associated risk for leakage and incarceration worsens the situation. Patient driven assessment of healthcare outcome is important if we are to improve medical care. A quality of life (QoL) survey was performed to assess the impact of parastomal bulging and hernia on the patient´s daily life.MethodsForty patients were investigated and the 3D US images were twice evaluated by two or three physicians to assess inter- and intra-observer reliability. Totally 20 patients with stoma complaints requiring surgery were examined with CT and 3D US prior to surgery. The findings were compared with the intraoperative findings – regarded as the true outcome.Fifty patients with parastomal hernia requiring surgery were enrolled from three hospitals. Patients were followed up one month and one year after repair using PHP.Patients still alive in 2008 who had been operated between1996 and 2004 for rectal cancer in Uppsala/Örebro-, Stockholm/Gotland-, and Northern Regions (986 patients) and registered in the Swedish Rectal Cancer Registry (SRCR) were invited to fill in four QoL questionnaires.ResultsInter-observer agreement using 3D US reached 80% for the last 10 patients examined, with a kappa value of 0.70. Intra-observer agreement for two examiners was 80% and 95%. The learning curve levelled out at 30 patients. Both CT and 3D US showed high sensitivity and specificity when compared with intraoperative findings.After surgery for parastomal hernia with a PHP, the complication rate at one month was 30% and recurrence rate at one year was 22%. Twelve patients were reoperated within one year.In the QoL study, 31.5% of the patients with a stoma reported a bulging or a hernia. 11.7% had been operated for parastomal hernia. A hernia or a bulge gave rise to significantly more pain and impaired stoma function. Overall QoL was inferior in patients with a permanent stoma compared to a group without a stoma.
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| 32. |
- Näsvall, Pia, 1967-, et al.
(författare)
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Parastomal hernia repair with intraperitoneal mesh
- 2017
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Ingår i: Surgery Research and Practice. - : Hindawi Publishing Corporation. - 2356-7759 .- 2356-6124. - 9789176012413 ; 2017
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. Parastomal hernia is a common complication following a stoma and may cause leakage or incarceration. No optimal treatment has been established, and existing methods using mesh repair are associated with high recurrence rates and a considerable risk for short- and long-term complications including death. A double-layer intraperitoneal on-lay mesh (IPOM), the Parastomal Hernia Patch (BARD™), consisting of ePTFE and polypropylene, has been developed and tailored to avoid recurrence. To evaluate the safety of and recurrence rate using this mesh, a nonrandomised prospective multicentre study was performed. Method. Fifty patients requiring surgery for parastomal hernia were enrolled. Clinical examination and CT scan prior to surgery were performed. All patients were operated on using the Parastomal Hernia Patch (BARD). Postoperative follow-up at one month and one year was scheduled to detect complications and hernia recurrence. Results. The postoperative complication rate at one month was 15/50 (30%). The parastomal hernia recurrence rate at one year was 11/50 (22%). The reoperation rate at one month was 7/50 (14%), and further 5/50 (10%) patients were reoperated on during the following eleven months.
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| 33. |
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| 34. |
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| 35. |
- Odensten, Christoffer, et al.
(författare)
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Use of prophylactic mesh when creating a colostomy does not prevent parastomal hernia : a randomized controlled trial—STOMAMESH
- 2019
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Ingår i: Annals of Surgery. - : Wolters Kluwer. - 0003-4932 .- 1528-1140. ; 269:3, s. 427-431
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.Background: Prevention of PSH is important as it often causes discomfort and leakage from stoma dressing. Different methods of prevention have been tried, including several mesh techniques. The incidence of PSH is high; up to 78%.Methods: Randomized controlled double-blinded multicenter trial. Patients undergoing open colorectal surgery, including creation of a permanent end colostomy, were randomized into 2 groups, with and without mesh. A lightweight polypropylene mesh was placed around the colostomy in the sublay position. Follow up after 1 month and 1 year. Computerized tomography and clinical examination were used to detect PSH at the 1-year follow up. Data were analyzed on an intention-to-treat basis.Results: After 1 year, 211 of 232 patients underwent clinical examination and 198 radiologic assessments. Operation time was 36 minutes longer in the mesh arm. No difference in rate of PSH was revealed in the analyses of clinical (P = 0.866) and radiologic (P = 0.748) data. There was no significant difference in perioperative complications.Conclusions: The use of reinforcing mesh does not alter the rate of PSH. No difference in complication rate was seen between the 2 arms. Based on these results, the prophylactic use of mesh to prevent PSH cannot be recommended.
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| 36. |
- Ozolins, Lise-Lotte, et al.
(författare)
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Caring touch : patients' experiences in an anthroposophic clinical context
- 2015
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 29:4, s. 834-842
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Tidskriftsartikel (refereegranskat)abstract
- This study describes the phenomenon of caring touch from the patients' perspective in an anthroposophic clinical context where caring touch is often used to promote health and alleviate suffering. The aim of the study was to explore and phenomenologically describe the phenomenon of caring touch from the patients' perspectives. The study has been carried out with a Reflective Lifeworld Research approach in order to understand and describe human existential phenomena. Ten female patients were interviewed in an anthroposophic clinic in Sweden. The findings show how caring touch has multifaceted meanings and makes the patients' feel present and anchored in a meaningful context. The patients' feel that they are seen, accepted and confirmed. Furthermore, touch creates a caring space where the patients become receptive for care and has the power to alleviate the patients' suffering, as well as to frighten and cause or worsen the suffering. In order to take advantage of the caring potential, the patient needs to be invited to a respectful and sensitive form of touch. An interpersonal flexible space is necessary where the touch can be effective, and where a dynamic interplay can develop. In conclusion, caring touch is an opportunity for carers to support well-being and health. The carers need to approach their patients in both a sensitive and reflective way. A caring science perspective can serve as a help to further understand touch as a unique caring act.
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| 37. |
- Stridsman, Caroline, et al.
(författare)
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Asthma in adolescence affects daily life and school attendance : two cross-sectional population-based studies 10 years apart
- 2017
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 4:3, s. 143-148
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study was to study the impact of asthma on daily life, school absenteeism and physical education. In addition, to describe asthma triggers at school.DESIGN: Two cross-sectional population-based studies ten years apart.METHOD: Within the OLIN-studies, in 2003 (n = 3,327) and in 2013 (n = 2,345) adolescents (14-15 years) answered an expanded ISAAC questionnaire. Of these, 8% and 11%, respectively with current asthma participated in this study.RESULTS: Between the years 2003-2013, the proportion of adolescents reporting that asthma interfered with daily life had increased, in 2013, girls were significantly more affected than boys. The proportion reporting a worsening of asthma at school had decreased, but it was still over a quarter. The proportion of absenteeism from school and from physical education was at the same level both years. Asthma triggers were described to be poor air quality, poorly cleaned environment, allergens, strong fragrance, rebuilding projects, physical education and stress.
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| 38. |
- van Wijngaarden, Els, et al.
(författare)
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Researching Health Care as a Meaningful Practice : Toward a Nondualistic View on Evidence for Qualitative Research
- 2017
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Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 27:11, s. 1738-1747
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Tidskriftsartikel (refereegranskat)abstract
- Being able to describe how research findings become evidence is crucial in providing a justification for all kinds of research findings. However, qualitative researchers in health care, including those who conduct phenomenological research, are usually fairly modest when it comes qualifying their research findings as such. We advocate a view of evidence for phenomenological research, an approach that is rooted in philosophy of science, including perspectives of ontology, epistemology, and methodology. We suggest that phenomenology can become an exemplar for how qualitative research can make convincing arguments and thus can be better appreciated. In this article, we present a philosophical foundation for phenomenological evidence by exploring the notions of objectivity, validity, and generalizability in terms of openness, meaning, and essence.
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| 39. |
- Yin, Ge, et al.
(författare)
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Sampling designs for contaminant temporal trend analyses using sedentary species exemplified by the snails Bellamya aeruginosa and Viviparus viviparus
- 2017
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Ingår i: Chemosphere. - : Elsevier BV. - 0045-6535 .- 1879-1298. ; 185, s. 431-438
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Tidskriftsartikel (refereegranskat)abstract
- Environmental monitoring typically assumes samples and sampling activities to be representative of the population being studied. Given a limited budget, an appropriate sampling strategy is essential to support detecting temporal trends of contaminants. In the present study, based on real chemical analysis data on polybrominated diphenyl ethers in snails collected from five subsites in Tianmu Lake, computer simulation is performed to evaluate three sampling strategies by the estimation of required sample size, to reach a detection of an annual change of 5% with a statistical power of 80% and 90% with a significant level of 5%. The results showed that sampling from an arbitrarily selected sampling spot is the worst strategy, requiring much more individual analyses to achieve the above mentioned criteria compared with the other two approaches. A fixed sampling site requires the lowest sample size but may not be representative for the intended study object e.g. a lake and is also sensitive to changes of that particular sampling site. In contrast, sampling at multiple sites along the shore each year, and using pooled samples when the cost to collect and prepare individual specimens are much lower than the cost for chemical analysis, would be the most robust and cost efficient strategy in the long run. Using statistical power as criterion, the results demonstrated quantitatively the consequences of various sampling strategies, and could guide users with respect of required sample sizes depending on sampling design for long term monitoring programs.
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