| 1. |
- Dahlberg, Anton, et al.
(författare)
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Successful implementation of parenting support at preschool : An evaluation of Triple P in Sweden
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:4
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Tidskriftsartikel (refereegranskat)abstract
- Although emotional and behavioural problems among young children are common and, if unaddressed, can lead to multi-facetted problems later in life, there is little research investigating the implementation of parenting programs that target these problems. In this study, the RE-AIM framework was used to evaluate the implementation of the Triple P parenting program in a preschool setting at a medium-sized municipality in Sweden. Reach increased over time, showing an overall increase in participating fathers and parents with lower education. Effectiveness outcomes showed an improvement in emotional and behavioural problems in children and less mental health-related symptoms and higher self-efficacy in parents. Adoption rate was 93.3%. To ensure staff "buy-in", designated coordinators made changes in recruitment procedures, and provided supervision and training to all Triple P practitioners. Implementation adaptations were made, such as minor revisions of parenting strategies and other program content, as well as providing child care during seminars and groups, and setting up weekend-groups. Maintenance assessed through 12 month follow-up data suggested that several child and parent outcomes were maintained over time. Uppsala municipality continues to offer Triple P to parents. The reach, effectiveness, adoption, implementation and maintenance of the program were all satisfactory and demonstrated the suitability of delivering evidence-based parenting support using preschools as an arena.
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| 2. |
- Docherty, Anna R, et al.
(författare)
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GWAS Meta-Analysis of Suicide Attempt: Identification of 12 Genome-Wide Significant Loci and Implication of Genetic Risks for Specific Health Factors.
- 2023
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Ingår i: The American journal of psychiatry. - : American Psychiatric Association Publishing. - 1535-7228 .- 0002-953X. ; 180:10, s. 723-738
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Tidskriftsartikel (refereegranskat)abstract
- Suicidal behavior is heritable and is a major cause of death worldwide. Two large-scale genome-wide association studies (GWASs) recently discovered and cross-validated genome-wide significant (GWS) loci for suicide attempt (SA). The present study leveraged the genetic cohorts from both studies to conduct the largest GWAS meta-analysis of SA to date. Multi-ancestry and admixture-specific meta-analyses were conducted within groups of significant African, East Asian, and European ancestry admixtures.This study comprised 22 cohorts, including 43,871 SA cases and 915,025 ancestry-matched controls. Analytical methods across multi-ancestry and individual ancestry admixtures included inverse variance-weighted fixed-effects meta-analyses, followed by gene, gene-set, tissue-set, and drug-target enrichment, as well as summary-data-based Mendelian randomization with brain expression quantitative trait loci data, phenome-wide genetic correlation, and genetic causal proportion analyses.Multi-ancestry and European ancestry admixture GWAS meta-analyses identified 12 risk loci at p values <5×10-8. These loci were mostly intergenic and implicated DRD2, SLC6A9, FURIN, NLGN1, SOX5, PDE4B, and CACNG2. The multi-ancestry SNP-based heritability estimate of SA was 5.7% on the liability scale (SE=0.003, p=5.7×10-80). Significant brain tissue gene expression and drug set enrichment were observed. There was shared genetic variation of SA with attention deficit hyperactivity disorder, smoking, and risk tolerance after conditioning SA on both major depressive disorder and posttraumatic stress disorder. Genetic causal proportion analyses implicated shared genetic risk for specific health factors.This multi-ancestry analysis of suicide attempt identified several loci contributing to risk and establishes significant shared genetic covariation with clinical phenotypes. These findings provide insight into genetic factors associated with suicide attempt across ancestry admixture populations, in veteran and civilian populations, and in attempt versus death.
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| 3. |
- Edvinsson Sollander, Sofia, et al.
(författare)
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Asthma and allergies correlate to mental health problems in preschool children
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:5, s. 1601-1609
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To explore the relations between asthma, allergies and mental health problems in preschool children, aged 3-5-years.METHODS: In this cross-sectional Swedish study, we used data on 4649 children in Uppsala municipality whose parents and preschool teachers had responded to questions measuring asthma and allergies, and the Strengths and Difficulties Questionnaire (SDQ) for assessment of mental health problems. Logistic regression models were used to explore the relations between asthma and allergies and mental health problems.RESULTS: Children with asthma (8.5%) had elevated odds of having emotional symptoms as rated by parents (OR: 1.34; 1.02-1.76) and teachers (OR: 1.44; 1.09-1.91). According to parents' ratings, these children also had elevated odds of showing mental health problems in general according to the SDQ total score (OR: 1.42; 1.05-1.94). Children with food allergies or intolerance (4.4%) only had elevated odds of having emotional symptoms (OR: 1.64; 1.16-2.33), as reported by parents. These results remained significant after adjustment for parental background factors.CONCLUSION: Preschool children with asthma and food allergies or intolerance are at risk of having concurrent mental health problems. Mental health problems should be assessed in children with these disorders. Adequate support and/or referral to specialised services should be offered when needed.
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| 4. |
- Fäldt, Anna, et al.
(författare)
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"All of a sudden we noticed a difference at home too" : Parents' perception of a parent-focused early communication and AAC intervention for toddlers.
- 2020
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Ingår i: Augmentative and Alternative Communication. - : Informa UK Limited. - 0743-4618 .- 1477-3848. ; 36:3, s. 143-154
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Tidskriftsartikel (refereegranskat)abstract
- Augmentative and alternative communication (AAC) can enhance children's communication and is recommended to be introduced as soon as problems are identified. The aim of this interview study was to investigate how parents perceive the ComAlong Toddler intervention offered to parents of children with communication difficulties early in the diagnostic process. ComAlong Toddler consists of a 5-session, group-based, parental course, and two home visits that focus on responsive communication, enhanced milieu teaching, and multimodal AAC. Interviews were conducted 1 year after the intervention with 16 parents who had attended ComAlong Toddler. The data were analyzed through qualitative content analysis, resulting in four categories: (a) Development for us and the child, (b) acquiring useful tools, (c) useful learning strategies, and (d) benefits and challenges regarding intervention structure. Findings suggest that parents of toddlers with language or communication disorders learned and appreciated responsive communication and enhanced milieu teaching. All had used multimodal AAC and described its benefits. Parents emphasized the value of learning from other parents as well as from a speech-language pathologist who engaged with their child in the home environment. Parents suggest an enhanced family focus as a potential improvement.
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| 5. |
- Fäldt, Anna, 1975-, et al.
(författare)
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Family and child health centre characteristics associated with exposure to universal language and literacy promotion
- 2023
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Ingår i: Child Language Teaching and Therapy. - : Sage Publications. - 0265-6590 .- 1477-0865. ; 39:1, s. 5-15
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study investigated which specific socio-demographic characteristics of the family and child health service centre are associated with parents receiving a video guide. The video guide, intended to be offered universally, aimed at promoting language and literacy development.Methods: The video guide included language and literacy activities and was offered through child healthcare centres to all visiting families. Cross-sectional data were collected during three years through parental self-reported questionnaires when the children were three years old, and families of 2512 children were included.Results: In 60% of the families, none of the parents reported receiving the video guide, and in 84%, none of the parents reported that they had watched the video guide. Most of the parents who watched the video guide reported having tried the presented activities. Socio-demographic characteristics associated with parents having received the video guide were: being married or cohabiting, having a university education, or if the mother was native-born. The child's age when the video guide was initially offered and the child's birth order were also factors associated with parents having received the video guide.Conclusions: The results indicate that few parents overall received the video guide. Socio-economically advantaged parents seemed to have received the video guide to a higher extent.
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| 6. |
- Fäldt, Anna, et al.
(författare)
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Infant-Toddler Checklist identifies 18-month-old children with communication difficulties in the Swedish child healthcare setting
- 2021
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:5, s. 1505-1512
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Tidskriftsartikel (refereegranskat)abstract
- Aim: At present there is no reliable method to screen for communication difficulties at age 18-months in the Swedish child health care. This study examined the psychometric properties of the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (ITC) when used at the 18-month visit in the child health care setting.Method: Children aged 16 to 20 months (n=679) were screened. Children were referred for an assessment if they screened positive screen or if the parent or nurse was concerned about the child’s communicative development. Two groups of positive screens were used in the analysis (n=78 children), one based on the ITC result, and one combining the ITC with contradicting information from the nurses’ informal clinical assessment.Result: The AUC ranged from 0.68 to 0.84. The sensitivity was 0.85, and the specificity was 0.59. When the ITC result was combined with the nurses’ information, sensitivity increased to 0.88 and specificity to 0.63. The internal consistency was moderate to high, and fit indices were satisfactory.Conclusion: The results suggest that the ITC can be used to identify children in need of interventions to enhance communication at 18 months of age, especially in combination with the nurse’s assessment.
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| 7. |
- Fäldt, Anna
(författare)
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Targeting toddlers’ communication difficulties at the Swedish child health services – a public health perspective
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Communication is fundamental for human interaction. Communication difficulties have a negative impact on children’s learning, relations, and quality of life and are regarded as a public health problem. The Swedish child health services have a possibility to prevent communication difficulties and their consequences for the individual through universal interventions and identification of affected children. This thesis investigates interventions at the levels of universal prevention, identification, and indicated intervention for children with communication difficulties.Study I explored associations between family and child health centre characteristics and exposure to a universal preventive communication intervention. Questionnaires answered by 2326 mothers and 2077 fathers were analysed. Few parents reported that they had been exposed to the intervention. Positive associations were seen to high socioeconomic status and if the child was of low age at the start of the intervention or was oldest among siblings. Study II described the study design employed to investigate the identification and effects of an indicated intervention. Study III used a mixed-methods design to explore child health service nurses’ experiences and sense of competence when using the Infant-Toddler Checklist (ITC) at the 18-month health visit. The nurses considered the ITC to be a beneficial tool both in communicating with families and in identifying children with communication difficulties. The ITC seemed to enhance nurses’ and parents’ awareness of the child’s communication.In study IV, the psychometric properties of the ITC were analysed using data on 679 children. A sensitivity of 86% and specificity of 59% were found. These measures improved when combining the ITC with the child health service nurses’ informal developmental surveillance. Study V explored parents’ perceptions of the intervention ComAlong Toddler, consisting of five group sessions and two individual home visits. The parental intervention focused on responsive communication, enhanced milieu teaching and augmentative and alternative communication. Qualitative content analysis showed that parents appreciated the intervention and used the strategies taught. Parents described benefits of the combination of home visits and group sessions with peer learning through video recorded home assignments.In conclusion, the thesis shows that the ITC can be implemented in the child health services as the method identifies children with communication difficulties and seems to have preventive capabilities. ComAlong Toddler may help parents to implement communication-enhancing strategies with their children. When universal interventions are delivered through the child health services, implementation and distribution need to be carefully planned and carried out so that they reach all children.
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| 8. |
- Fäldt, Anna, et al.
(författare)
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The study design of ComAlong Toddler : a randomised controlled trial of an early communication intervention
- 2020
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 48:4, s. 391-399
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: This study design article aims to describe a research study focused on evaluating the use of the Infant-Toddler Checklist to identify children at 18 months with early communication difficulties, and to study the ComAlong Toddler intervention for parents to support their child's communication development.BACKGROUND: Communication disorders are a common public health problem affecting up to 20% of children. Evidence points to the importance of early detection and intervention to improve young children's communicative abilities and decrease developmental delay. Early identification of communication difficulties is possible with instruments such as Infant-Toddler Checklist. The ComAlong Toddler intervention is tailored to the needs of parents of young children with communication delay before definitive diagnosis. The parents are provided with guidance in communication enhancing strategies during home visit and five group sessions.METHODS: The study uses a prospective cohort design. Children were consecutively recruited during 2015-2017, and data will be collected 2015-2023. The screening was performed at the child health centre through use of the Infant-Toddler Checklist. An assessment and first consultation were then performed by a speech and language therapist for children with suspected communication delay according to the screen as well as for children referred for other reasons before the age of 2.5 years. Children with confirmed communication delay were randomised between two interventions: the ComAlong Toddler parental course or a telephone follow-up. Outcome measures include child communication and language skills and use of augmentative and alternative communication. To gain insight into the participants' perspectives, surveys have been collected from parents.CONCLUSION: The study will provide information regarding identification and intervention for 18-month old children with communication delay.TRIAL REGISTRATION: ISRCTN13330627.
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| 9. |
- Fält, Elisabet, et al.
(författare)
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Facilitating implementation of an evidence-based method to assess the mental health of 3–5-year-old children at Child Health Clinics: a mixed-methods process evaluation
- 2020
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; :6
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. Methods: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Results: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. Conclusion: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.
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| 10. |
- Fält, Elisabet, et al.
(författare)
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Parental sociodemographic characteristics and mental health referrals by nurses in Swedish child health centres
- 2022
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 111:9, s. 1743-1751
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Tidskriftsartikel (refereegranskat)abstract
- AimTo explore the influence of parents' socio-economic characteristics on child healthcare nurses' mental health referrals of 3- to 5-year-olds and also to test the association between mental health problems and referrals.MethodsRepeated cross-sectional data including parents' Strengths and Difficulties Questionnaire (SDQ) assessments and referral data (psychologist and speech and language pathologist). Hierarchical regression was used to analyse whether parents' country of birth, education level, marital status and mental health problem scores (SDQ; total difficulties and impact scores) were associated with nurses' referrals.ResultsAbout 9% of mothers and 12% of fathers rated high SDQ scores (total difficulties) in their children. Approximately, 1% of the children were referred. The influence of parents' socio-economic characteristics on referral rates was not observed. However, for children with Swedish-born mothers, referral rates were significantly lower. Scores for SDQ total difficulties and impact were associated with the child's referral to specialists.ConclusionIn general, parental sociodemographic characteristics do not influence Swedish child healthcare nurses' mental health referrals. Although there was a significant association between problem behaviour and referral, a disproportion between children rated with high SDQ scores (9% and 12%) and children referred to specialists (1%) should be addressed.
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| 11. |
- Greijer, Helena, et al.
(författare)
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Tuneable conductivity at extreme electric fields in ZnO tetrapod-silicone composites for high-voltage power cable insulation
- 2022
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322 .- 2045-2322. ; 12:1, s. 6035-
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Tidskriftsartikel (refereegranskat)abstract
- Resistive Field Grading Materials (RFGM) are used in critical regions in the electrical insulation system of high-voltage direct-current cable systems. Here, we describe a novel type of RFGM, based on a percolated network of zinc oxide (ZnO) tetrapods in a rubber matrix. The electrical conductivity of the composite increases by a factor of 108 for electric fields > 1 kV mm-1, as a result of the highly anisotropic shape of the tetrapods and their significant bandgap (3.37 eV). We demonstrate that charge transport at fields < 1 kV mm-1 is dominated by thermally activated hopping of charge carriers across spatially, as well as energetically, localized states at the ZnO-polymer interface. At higher electric fields (> 1 kV mm-1) band transport in the semiconductive tetrapods triggers a large increase in conductivity. These geometrically enhanced ZnO semiconductors outperform standard additives such as SiC particles and ZnO micro varistors, providing a new class of additives to achieve variable conductivity in high-voltage cable system applications.
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| 12. |
- Liang, Frank, et al.
(författare)
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A Fraction of CD8+T Cells from Colorectal Liver Metastases Preferentially Repopulate Autologous Patient-Derived Xenograft Tumors as Tissue-Resident Memory T Cells
- 2022
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Ingår i: Cancers. - : MDPI AG. - 2072-6694. ; 14:12
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Tidskriftsartikel (refereegranskat)abstract
- Simple Summary Treatment options for colorectal cancer (CRC) patients with liver metastases are often limited to liver surgery with or without chemotherapy. However, not all patients present operable colorectal liver metastases (CRLMs). Thus, alternative therapies that exploit the anti-tumor potential of tumor-infiltrating lymphocytes (TILs) are being evaluated. The establishment of markers connecting the phenotype to the function of tumor-reactive CD8+ TILs could aid diagnostic and therapeutic advances. In this regard, tissue-resident memory T cells (T-RM cells) could be a potential candidate for therapies targeting TILs. Putative tumor-reactive T-RM cells among CD8+ TILs likely co-express CD103 and CD39, since these markers indicate stable tumor residency and repeated response to antigens from the tumor environment, respectively. Our phenotypic and functional analyses of TILs in CRLM, with a specific focus on CD103+CD8+ T-RM cells, may guide the improvement of TIL-mediated CRC treatments. The diversity of T cells in the human liver may reflect the composition of TILs in CRLM. Our ex vivo characterization of CRLM vs. adjacent liver tissue detected CD103+CD39+CD8+ T-RM cells predominantly in CRLM, which prompted further assessments. These T-RM cells responded to cognate antigens in vitro. As functional activities of autologous TILs are central to the implementation of personalized cancer treatments, we applied a patient-derived xenograft (PDX) model to monitor TILs' capacity to control CRLM-derived tumors in vivo. We established PDX mice with CRLMs from two patients, and in vitro expansion of their respective TILs resulted in opposing CD4+ vs. CD8+ TIL ratios. These CRLMs also displayed mutated KRAS, which enabled trametinib-mediated inhibition of MEK. Regardless of the TIL subset ratio, persistent or transient control of CRLM-derived tumors of limited size by the transferred TILs was observed only after trametinib treatment. Of note, a portion of transferred TILs was observed as CD103+CD8+ T-RM cells that strictly accumulated within the autologous CRLM-derived tumor rather than in the spleen or blood. Thus, the predominance of CD103+CD39+CD8+ T-RM cells in CRLM relative to the adjacent liver and the propensity of CD103+CD8+ T-RM cells to repopulate the autologous tumor may identify these TILs as strategic targets for therapies against advanced CRC.
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| 13. |
- Mullins, Niamh, et al.
(författare)
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Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors
- 2022
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Ingår i: Biological Psychiatry. - : Elsevier. - 0006-3223 .- 1873-2402. ; 91:3, s. 313-327
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders.METHODS: We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors.RESULTS: Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged.CONCLUSIONS: Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.
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| 14. |
- Persson, Jan, et al.
(författare)
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Efterfrågestyrd kollektivtrafik : Systemeffekter och acceptans
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Efterfrågestyrd kollektivtrafik (DRT) är en transporttjänst där fordonet anpassar sin rutt baserat på resenärernas särskilda transportbehov. I denna rapport presenteras resultat som pekar på väsentliga möjligheter för DRT att kunna öka tillgänglighet för människor utanför städer till systemkostnader som kan vara likvärdiga med relativt gles linjelagd busstrafik.Resultaten pekar vidare på att energi-/miljöeffekterna kan bli likvärdiga om linjelagd kollektivtrafik ersätts med DRT, åtminstone vid relativt gles trafik. Om DRT ersätter privata bilresor kan det totala antalet fordonskilometrar gå upp eller ned beroende på uppnådd samåkningsgrad i förhållande till tomkörning. Väsentlig reduktion av det totala antalet fordonskilometrar kan typiskt bara uppnås om en privat bilresa ersätts med en kombinationsresa med DRT och tidtabellstyrd kollektivtrafik. En möjlighet med DRT är att tjänsten kan bidra till att minska det totala antalet fordon i samhället. Simuleringsresultat pekar på att ett DRT-fordon kan ha potential att ersätta upp till 30 privata fordon (under relativt gynnsamma antagande).Noterbart är att DRT kan utformas på många sätt avseende till exempel var, när och hur den erbjuds, vilket har stor påverkan på både systemeffekter och attraktivitet för potentiella resenärer.Resultaten från användarundersökningar pekar på att DRT kan vara intressant för många resenärer i olika åldrar. Det som resenärer ser som mest attraktivt är möjligheter till resor dörr-till-dörr, ökad tillgång till kollektivtrafik, flexibilitet i förhållande till rutt och tidtabell, och att DRT kan bidra till ökad säkerhet. Resultaten indikerar att DRT ses av unga och äldre som en möjlighet till ökad tillgänglighet i miljöer utanför städerna, där kollektivtrafikens utbud idag uppfattas som relativt begränsat.Vad gäller äldre resenärer är majoriteten positiv till att använda DRT, även om de troligen skulle använda tjänsten relativt sällan. Dessutom skulle äldre resenärer acceptera en viss grad av ändrade reseförhållanden, som till exempel försenad upphämtningstid. Det här innebär att det finns utrymme för effektivitetsvinster på så vis att resans förutsättningar kan förändras, till exempel vad gäller resrutten, samtidigt som majoriteten av de äldre resenärerna skulle fortsätta att använda tjänsten.
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| 15. |
- Ramiro, Sofia, et al.
(författare)
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ASAS-EULAR recommendations for the management of axial spondyloarthritis : 2022 update
- 2022
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 82:1, s. 19-34
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA.
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