| 1. |
- Åberg, Anna, et al.
(författare)
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Helicobacter pylori adapts to chronic infection and gastric disease via ph-responsive baba-mediated adherence
- 2017
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Ingår i: Cell Host and Microbe. - : Elsevier BV. - 1931-3128 .- 1934-6069. ; 21:3, s. 376-389
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Tidskriftsartikel (refereegranskat)abstract
- The BabA adhesin mediates high-affinity binding of Helicobacter pylori to the ABO blood group antigen-glycosylated gastric mucosa. Here we show that BabA is acid responsive-binding is reduced at low pH and restored by acid neutralization. Acid responsiveness differs among strains; often correlates with different intragastric regions and evolves during chronic infection and disease progression; and depends on pH sensor sequences in BabA and on pH reversible formation of high-affinity binding BabA multimers. We propose that BabA's extraordinary reversible acid responsiveness enables tight mucosal bacterial adherence while also allowing an effective escape from epithelial cells and mucus that are shed into the acidic bactericidal lumen and that bio-selection and changes in BabA binding properties through mutation and recombination with babA-related genes are selected by differences among individuals and by changes in gastric acidity over time. These processes generate diverse H. pylori subpopulations, in which BabA's adaptive evolution contributes to H. pylori persistence and overt gastric disease.
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| 2. |
- Johansson Wensman, Jonas, et al.
(författare)
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Visualization of Borna Disease Virus Protein Interactions with Host Proteins using in situ Proximity Ligation Assay
- 2016
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Ingår i: British journal of virology. - : ResearchersLinks Ltd. - 2055-6128. ; 3:1, s. 11-23
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Tidskriftsartikel (refereegranskat)abstract
- Borna disease virus type 1 (BDV) comprises highly conserved neurotropic non-segmented negative strand RNA-virus variants causing neurological and behavioral disorders in a wide range of mammalian animals, possibly including humans. Viral persistence in the brain has been frequently observed, however, the exact mechanisms behind BDV’s ability to establish persistence despite a prominent immune response are not known. Here we have used in situ proximity ligation assay (in situ PLA), a selective tool for studying virus-host protein-protein interactions. BDV P (phosphoprotein) and N (nucleoprotein) have previously been reported to interact with several host proteins, thereby interfering with various signaling pathways. In this study, we focused on some of these interactions (BDV P-HMGB1, BDV N/P-Cdc2). First, we used rat glioma cell cultures persistently infected with a laboratory strain of BDV (C6BV) to establish the assay. Next, in situ PLA was applied to detect BDV P in brain tissues of infected animals. Finally, protein-protein interactions were visualized in both C6BV and brain tissues of experimentally as well as naturally infected animals (rat and horse, respectively). BDV proteins and their interactions with host proteins could be shown in cell cultures (HMGB1, Cdc2) and in brain tissues of rat (HMGB1, Cdc2) and horse (Cdc2 only) infected with BDV. In this study, we have for the first time directly visualized protein-protein interactions between BDV and its host, and thereby confirmed previous data to demonstrate findings in cell cultures to be applicable also in experimentally and naturally infected animals.
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| 3. |
- Moonens, Kristof, et al.
(författare)
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Structural Insights into Polymorphic ABO Glycan Binding by Helicobacter pylori
- 2016
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Ingår i: Cell Host and Microbe. - : Elsevier BV. - 1931-3128 .- 1934-6069. ; 19:1, s. 55-66
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Tidskriftsartikel (refereegranskat)abstract
- The Helicobacter pylori adhesin BabA binds mucosal ABO/Le b blood group (bg) carbohydrates. BabA facilitates bacterial attachment to gastric surfaces, increasing strain virulence and forming a recognized risk factor for peptic ulcers and gastric cancer. High sequence variation causes BabA functional diversity, but the underlying structural-molecular determinants are unknown. We generated X-ray structures of representative BabA isoforms that reveal a polymorphic, three-pronged Le(b) binding site. Two diversity loops, DL1 and DL2, provide adaptive control to binding affinity, notably ABO versus O bg preference. H. pylori strains can switch bg preference with single DL1 amino acid substitutions, and can coexpress functionally divergent BabA isoforms. The anchor point for receptor binding is the embrace of an ABO fucose residue by a disulfide-clasped loop, which is inactivated by reduction. Treatment with the redox-active pharmaceutic N-acetylcysteine lowers gastric mucosal neutrophil infiltration in H. pylori-infected Le(b)-expressing mice, providing perspectives on possible H. pylori eradication therapies.
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| 4. |
- Arveklev Höglund, Susanna
(författare)
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Drama and Learning in Nursing Education : A study in first and second cycle
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to explore and describe the nature of students learning through drama in nursing education, in first and second cycle. Methods: Study I was conducted as an integrative review of the literature. Study II was performed as a qualitative phenomenographic study were 16 nursing students was interviewed. In study III 43 group assignment by nursing students in first cycle were analyzed using Qualitative content Analysis. Study IV was conducted as a qualitative phenomenographic study where 15 nursing students in second cycle was individually interviewed. Results: The findings in study I showed that drama can be used effectively in nursing education to enhance students' learning. The summarized results of the empirical studies (II–IV) showed that drama enabled the students to learn about themselves and develop a higher self-awareness. Learning through drama also gave the students opportunities to learn about others by exploring the perspectives of colleagues, patients, and patients' next of kin in fictive nursing situations. The findings showed in addition that drama could make the theoretical course content more concrete and easier to grasp. Learning through drama activated the students' learning by offering them the possibility to be active and explore various roles and scenarios, and by promoting reflection in which they could share experiences with their peers. By participating in drama, the students reached an evolving identification with the profession of a nurse (II–III) and of a specialist nurse in paediatric care (IV). Conclusion: Drama in nursing education has the unique potential to prepare nursing students in both first and second cycle for their future nursing role. Through drama, students are given the opportunity to explore and gain knowledge about how to use theoretical knowledge in practice, about their inner selves, and about other person's perspectives.
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| 5. |
- Balk, Lennart, et al.
(författare)
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Widespread episodic thiamine deficiency in Northern Hemisphere wildlife
- 2016
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Many wildlife populations are declining at rates higher than can be explained by known threats to biodiversity. Recently, thiamine (vitamin B-1) deficiency has emerged as a possible contributing cause. Here, thiamine status was systematically investigated in three animal classes: bivalves, ray-finned fishes, and birds. Thiamine diphosphate is required as a cofactor in at least five life-sustaining enzymes that are required for basic cellular metabolism. Analysis of different phosphorylated forms of thiamine, as well as of activities and amount of holoenzyme and apoenzyme forms of thiaminedependent enzymes, revealed episodically occurring thiamine deficiency in all three animal classes. These biochemical effects were also linked to secondary effects on growth, condition, liver size, blood chemistry and composition, histopathology, swimming behaviour and endurance, parasite infestation, and reproduction. It is unlikely that the thiamine deficiency is caused by impaired phosphorylation within the cells. Rather, the results point towards insufficient amounts of thiamine in the food. By investigating a large geographic area, by extending the focus from lethal to sublethal thiamine deficiency, and by linking biochemical alterations to secondary effects, we demonstrate that the problem of thiamine deficiency is considerably more widespread and severe than previously reported.
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| 6. |
- Berg, Lena M, et al.
(författare)
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Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department
- 2019
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Ingår i: Annals of Emergency Medicine. - : Elsevier BV. - 0196-0644 .- 1097-6760. ; 74:3, s. 345-356
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Tidskriftsartikel (refereegranskat)abstract
- STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.
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| 7. |
- Berg, Lena M, et al.
(författare)
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Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing : a qualitative study
- 2016
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 27, s. 11-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.
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| 8. |
- Berg, Lena M
(författare)
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Patient safety at emergency departments : challenges with crowding, multitasking and interruptions
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Several challenges with patient safety in the emergency department (ED) context have beenpreviously identified, and some commonly mentioned are crowding, multitasking, andinterruptions. The ED is a complex, high-risk work environment where multiple clinicians(physicians, registered nurses [RNs], and licensed practical nurses [LPNs]) are constantlyworking in parallel work processes, in an often crowded ED, while conducting tasksinvolving cognitively demanding decision-making processes. ED crowding has for the past20 years been identified as a problem internationally, resulting in extended ED length of stay(LOS) and increased morbidity and mortality for patients. ED crowding is also considered tohave negative effects on the clinicians' workload and work satisfaction.Both multitasking and interruptions have been identified as risk factors for patient safety byhaving negative effects on a clinician's decision-making processes and thus increasing therisk of forgetting important details and events because of memory overload. However,information has been lacking about what specific work assignments ED clinicians conduct,and thus there is little information about the types of assignments they perform whilemultitasking and being exposed to interruptions. Further, because not all interruptions lead toerrors and because they are not all preventable, a more refined account of interruptions iscalled for. Moreover, it seems that previous studies have not identified which specific factorsinfluence the ED clinicians' perceptions of interruptions. The work environment has beenreferred to as a possible influencing factor, but specific details on the relationship between thework environment and negative effects from interruptions are pending.The overall aim of the thesis was to describe ED crowding, and its influence on EDclinicians' work processes (activities, multitasking, and interruptions) and patient outcomes,from a patient safety perspective. The thesis addressed six research questions: 1) How has EDcharacteristics, patient case mix and occurrence of ED crowding changed over time? 2) Whatwork activities are performed by ED clinicians? 3) What kind of multitasking situations areclinicians exposed to during ED work? 4) What kind of interruptions are clinicians exposedto during ED work? 5) How do ED clinicians perceive interruptions? 6) Is there anassociation between ED crowding and mortality for stable patients without the need for acutehospital care upon departure from the ED?The data in the thesis were generated from two data collections: 1) registry data containingpatient characteristics and measures of ED crowding (ED occupancy ratio [EDOR], ED LOS,and patient/clinician ratios) extracted from the patients' electronic health records (paper I andIV) and 2) observations and interviews with ED clinicians (physicians, RNs, and LPNs)(paper II and III). Nonparametric statistics were used in paper I and III, quantitative and qualitative content analysis were used in paper II and III, and multivariate logistic regressionanalysis was used in paper IV.The main results in the thesis are presented based on Asplin's conceptual model of EDcrowding, from the aspect of input-throughput-output, and how parts of a sub-optimalthroughput influence patient safety through ED clinicians' work processes and patientoutcomes. During 2009 – 2016 there has been a change in patient case mix at the EDs at thestudy hospital, primarily with an increase in unstable patients (input) and a decrease in thenumber of patients admitted to in-hospital care (output). The median for ED LOS over thestudy period increased, and the largest increases occurred among the subgroups of unstablepatients, patients ≥80 years of age, and those admitted to in-hospital care (throughput).Further, an increase in crowding, in terms of median EDOR and median patients per RNratios, was identified, with an increase in EDOR from 0.8 in 2009 to 1.1 in 2016 and anaverage increase of 0.164 patients/RN/year (throughput). The ED clinicians' workassignments consisted of 15 categories of activities, and information exchange was found tobe the most common activity (42.1%). In contrast, the clinicians only spent 9.4% of theiractivities on direct interaction with patients and their families (ED clinicians' workprocesses). The clinicians multitasked during 23% of their total number of performedactivities, and there was an overall interruption rate of 5.1 interruptions per hour. Themajority of the observed multitasking situations and interruptions in the ED clinicians' workoccurred during demanding activities that required focus or concentration (ED clinicians'work processes). Finally, an association was identified between an increase in ED LOS andEDOR and 10-day mortality for stable patients without the need for acute hospital care upondeparture from the ED (patient outcomes).This thesis illustrates how a sub-optimal throughput, affected by conditions in both the inputand output components, negatively influence the ED clinicians' work processes as well aspatient outcomes.
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| 9. |
- Berg, Lena M, et al.
(författare)
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Reasons for interrupting colleagues during emergency department work : A qualitative study
- 2016
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 29, s. 21-26
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.Method: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.Results: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.Conclusion: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.
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| 10. |
- Berg, Lena M, et al.
(författare)
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Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital
- 2019
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Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 43, s. 50-55
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.
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| 11. |
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| 12. |
- Cadrin-Tourigny, Julia, et al.
(författare)
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A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy
- 2019
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 40:23, s. 1850-1858
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients. METHODS AND RESULTS: Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 ± 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.6% reduction of ICD placements with the same proportion of protected patients (P < 0.001). CONCLUSION: Using the largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).
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| 13. |
- Lundblad, Barbro, 1947, et al.
(författare)
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Teacher’s Attitudes and Strategies when Schoolchildren Need to Go to the Toilet
- 2016
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Ingår i: Journal of Health Science. - : David Publishing Company. - 2328-7136. ; 4, s. 99-104
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: It is well known that a lot of children avoid going to the toilet during school. This is mainly due to poor hygienic standards in the toilets but also due to fear and insecurity when visiting the toilet during recess. Studies show that children are not always allowed to go to the toilet during class and that many teachers decide when the children may satisfy their toilet needs. The purpose of this study was to describe teacher’s attitudes and strategies when schoolchildren need to go to the toilet. Interviews with 17 teachers working in five Swedish compulsory schools. The teacher’s attitudes were that the physiological need or children’s will should determine when they could go to the toilet and that children have different toilet needs. All teachers used rules to regulate toilet visits during class. The rules were not communicated and required the interpretation of the children. The teachers demanded openness and information about the toilet needs of the children. Suspected misuse of toilet visits led the teacher to make their own assessment of the children’s toilet needs, as a sanction toilet visits could be prohibited. The strategies used during class did not reflect the health-promoting attitude the teachers told about. In reality, the task of maintaining order and control was prioritised. The strategies used were not adapted to children’s needs, which could have significance for maintaining toilet habits consistent with health and well-being.
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| 14. |
- Mehlig, Kirsten, 1964, et al.
(författare)
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Cohort Profile: The INTERGENE Study.
- 2017
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Ingår i: International journal of epidemiology. - : Oxford University Press (OUP). - 1464-3685 .- 1464-3685 .- 0300-5771. ; 46:6
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Tidskriftsartikel (refereegranskat)abstract
- In 2001, the INTERGENE research programme established a population-based cohort of 3614 adults living in south-western Sweden. The aim was to assess environmental, lifestyle and hereditary risk factors for cardio-metabolic and respiratory diseases, and to document secular changes in many of these characteristics. Because the focus is on coronary heart disease (CHD), the population cohort was complemented with 618 patients with acute or chronic CHD who were sampled during the examination period for the cohort (2001–04), following the same protocol. More than 800 variables describe lifestyle and socio-demographic characteristics from questionnaires, anthropometric characteristics from physical examinations, and biomarkers from blood sampled during the examination. Additional blood samples and extracted DNA are stored in biobanks. Data from the case-control study of CHD were used to investigate associations between common risk factors (overweight, smoking, alcohol consumption, sedentary behaviour) and different candidate genes with respect to CHD, and explore interactions. In addition, a biomarker for airway inflammation (Fraction of Exhaled Nitric Oxide, FENO) was investigated as a risk factor for respiratory disease, and collaboration was established with international consortia to identify genes related to respiratory and cardiovascular diseases. An update of registry information on cohort members from hospitals, general practitioners and pharmacies provides a wide spectrum of incident diagnoses and treatments between 2001 and 2014. A recently completed longitudinal follow-up of the baseline cohort will provide a further measurement point to describe changing cardiovascular risk factors in south-west Sweden. Participation at baseline was 42%, and 61% of these participated at the follow-up.
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| 15. |
- Mörner, Torsten, et al.
(författare)
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Thiamine deficiency impairs common eider (Somateria mollissima) reproduction in the field
- 2017
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- The Baltic Sea population of the common eider (Somateria mollissima) has declined dramatically during the last two decades. Recently, widespread episodic thiamine (vitamin B1) deficiency has been demonstrated in feral birds and suggested to contribute significantly to declining populations. Here we show that the decline of the common eider population in the Baltic Sea is paralleled by high mortality of the pulli a few days after hatch, owing to thiamine deficiency and probably also thereby associated abnormal behaviour resulting in high gull predation. An experiment with artificially incubated common eider eggs collected in the field revealed that thiamine treatment of pulli had a therapeutic effect on the thiamine status of the brain and prevented death. The mortality was 53% in untreated specimens, whereas it was only 7% in thiamine treated specimens. Inability to dive was also linked to brain damage typical for thiamine deficiency. Our results demonstrate how thiamine deficiency causes a range of symptoms in the common eider pulli, as well as massive die-offs a few days after hatch, which probably are the major explanation of the recent dramatic population declines.
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| 16. |
- Qiao, Yingjin, et al.
(författare)
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MC1R is dispensable for the proteinuria reducing and glomerular protective effect of melanocortin therapy
- 2016
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Melanocortin therapy by using adrenocorticotropic hormone (ACTH) or non-steroidogenic melanocortin peptides attenuates proteinuria and glomerular injury in experimental glomerular diseases and induces remission of nephrotic syndrome in patients with diverse glomerulopathies, even those resistant to steroids. The underlying mechanism remains elusive, but the role of melanocortin 1 receptor (MC1R) has been implicated and was examined here. Four patients with congenital red hair color and nephrotic syndrome caused by idiopathic membranous nephropathy or focal segmental glomerulosclerosis were confirmed by gene sequencing to bear dominant-negative MC1R mutations. Despite prior corticosteroid resistance, all patients responded to ACTH monotherapy and ultimately achieved clinical remission, inferring a steroidogenic-independent and MC1R-dispensable anti-proteinuric effect of melanocortin signaling. In confirmatory animal studies, the protective effect of [Nle4, D-Phe7 ]-α-melanocyte stimulating hormone (NDP-MSH), a potent non-steroidogenic pan-melanocortin receptor agonist, on the lipopolysaccharide elicited podocytopathy was completely preserved in MC1R-null mice, marked by reduced albuminuria and diminished histologic signs of podocyte injury. Moreover, in complementary in vitro studies, NDP-MSH attenuated the lipopolysaccharide elicited apoptosis, hypermotility and impairment of filtration barrier function equally in primary podocytes derived from MC1R-null and wild-type mice. Collectively, our findings suggest that melanocortin therapy confers a proteinuria reducing and podoprotective effect in proteinuric glomerulopathies via MC1R-independent mechanisms.
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| 17. |
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| 18. |
- Sparud Lundin, Carina, 1964, et al.
(författare)
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Use of participatory design in the development of person-centred web-based support for persons with long-term illness
- 2015
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Ingår i: Abstracts: 19th International Philosophy of Nursing Society (IPONS) conference August 24-26, 2015 Karolinska Institutet, Stockholm, Sweden. - Stockholm : Karolinska Institutet. ; , s. 43-43
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Konferensbidrag (refereegranskat)abstract
- Background: E-health solutions are increasingly developed to meet patients’ preferences and promote their participation in their health care. This has led to increased interest in person-centred technology developed by means of participatory approaches. However, few studies explore the participatory design process from the perspective of person-centeredness including how it becomes materialized in the informational technology. This paper explores how applied participatory approaches and the design of four web based supports correspond to key areas of person-centeredness.Aim and method: The purpose was to create shared knowledge and understanding of each separate case and to generate relevant categories. Data was collected from four Swedish research projects. The analysis followed an inductive approach involving a step-wise cross-case analysis.Results: A number of question areas describe the dialogue with the participants in the cases. The areas cover individual, social, and practical issues. The results of the dialogue are categorized into four support areas; psychological/emotional, personal, information, technical. By means of common as well as specifically developed technical solutions the support areas becomes visible in the design. Person-centredness will appear in the participatory design (PD) process as the approach promotes the development of a holistic view of the person and the illness and a partnership between patients and carers.Conclusions: Our results contribute to a central development area within eHealth involving greater opportunities for the patient to actively contribute in real time, getting access to and add information, and sometimes interact directly with carers. However, it is concluded that neither participatory approaches nor technology for online information and communication can guarantee personcenteredness by itself. Instead, it is the design of the PD process and the forming of the actual use of technology together with the particular purpose of the web based support that shape person-centred online support.
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| 19. |
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