| 1. |
- Ejhed, Helene, et al.
(författare)
-
Enskilda avlopp som källa till läkemedelsrester och andra kemikalier
- 2012
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I Sverige finns cirka 700 000 fastigheter med enskilda avlopp, varav cirka 75 % utgörs av markbaserade anläggningar där det renade avloppsvattnet direkt eller via grundvattnet når ytvattenrecipienter. Syftet med detta projekt har varit: att undersöka om halter av läkemedel och andra kemikalier från enskilda avlopp är detekterbara i en recipient med känd påverkan av enskilda avlopp, att kvantifiera spridning av ett antal substanser av läkemedel från enskilda avlopp samt att undersöka reningseffektivitet i enskilda avlopp avseende läkemedel och andra kemikalier. Projektet har genomförts i samarbete med Södertälje kommun. Provtagning genomfördes i Lillsjön med tillflöden, i Hölö inom Södertälje kommun. Analyser genomfördes av vatten, sediment och biota av ett urval läkemedel- och andra hushållrelaterade kemikalier som perfluoroktansulfonsyra (PFOS) och etylendiamintetraättiksyra (EDTA). Provtagning genomfördes även av läkemedelsubstanser i inkommande och utgående vatten i två markbäddar. I den ena anläggningen tillsattes manuellt (spikades) en känd mängd läkemedelssubstanser och bromid som spårämne. I den andra anläggningen analyserades läkemedelsubstanser som användes av brukarna. Analyser genomfördes även av pH, total fosfor, "biochemical oxygen demand" (BOD) och totalt organiskt kol (TOC) för att kontrollera markbäddarnas funktion. Analyserna av vatten och sediment i Lillsjön uppvisade endast små mängder läkemedelsrester, PFOS och EDTA. Läkemedelsrester påvisades dock i det tillflöde som sammantaget är mest befolkat med enskilda avlopp samt i ett utlopp med utsläpp från Hölö församlingshem, vilket visar att enskilda avlopp bidrar till spridning av läkemedelsrester till miljön. Markbäddarna uppvisade en god reduktion av de femton analyserade läkemedlen och låg generellt sett över den genomsnittliga reduceringsgraden avseende dessa ämnen i fyra stora svenska reningsverk. Undantagen var diklofenak och ketoprofen där reduceringsgraden var betydligt lägre än för de fyra svenska reningsverken. Orsaken tros vara problem att detektera substanserna i ingående avloppsvatten och att reduktionen därmed inte kunde bestämmas på ett rättvisande sätt. Beräkning av total mängd som passerade användare med enskilda avlopp har beräknats baserat på nationell statistik om permanentboende med enskilda avlopp, statistik från Apotekens service avseende försåld mängd och uppmätt reduktion i markbäddarna. Enskilda avlopp står för en betydande del av avloppsflödet i Sverige. Cirka tio gånger större mängder av karbamazepin och diklofenak sprids från enskilda avlopp avseende hela Sverige än från Henriksdals reningsverk i Stockholm. Paracetamol är den substans som står för störst utsläpp enligt beräkningarna, cirka 12 ton år 2010. Reduktion av läkemedelsubstanser i markbaserade anläggningar beror på utformning och skötsel av avloppsanläggningen. God syresättning och lång uppehållstid i markbaserade anläggningar är gynnsamma förutsättningar. Reduktionen sker dock inte i lika hög grad för samtliga substanser och anläggningar som brister i utformningen kan ge utsläpp till vattenmiljön och grundvatten, vilket har noterats i både denna studie och i internationell litteratur. Ytterligare studier behövs för att bestämma om substanserna bryts ner och hur de bryts ner i de enskilda avloppen. Risker med avseende på spridning av läkemedelsrester och andra kemikalier från enskilda avlopp bör undersökas vidare.
|
|
| 2. |
- von Tottleben, Malte, et al.
(författare)
-
An Integrated Care Platform System (C3-Cloud) for Care Planning, Decision Support, and Empowerment of Patients With Multimorbidity: Protocol for a Technology Trial
- 2022
-
Ingår i: JMIR Research Protocols. - : JMIR Publications. - 1929-0748. ; 11:7
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support.Objective: The Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems.Methods: This paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 “testing and evaluation” phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening.Results: The technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product.Conclusions: Patients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic.
|
|
| 3. |
- Adler, Sara, et al.
(författare)
-
Symptoms and risk factors of Cryptosporidium hominis infection in children : data from a large waterborne outbreak in Sweden
- 2017
-
Ingår i: Parasitology Research. - : Springer Berlin/Heidelberg. - 0932-0113 .- 1432-1955. ; 116:10, s. 2613-2618
-
Tidskriftsartikel (refereegranskat)abstract
- Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1-80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.
|
|
| 4. |
|
|
| 5. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Borders in the mind and on the ground - (Re)categorization as “peace-building resistance”in the Preah Vihear Temple conflict
- 2019
-
Ingår i: Heritage and borders. Editor: Anna Källén.. - Stockholm : Kungliga Vitterhets historie och antikvitets akademien. - 0348-1433. - 9789188763143 ; , s. 83-104
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Borders now seem to be everywhere, just like it is often said in heritage studies that the past is everywhere. In this edited volume a multidisciplinary group of scholars explore what happens, philosophically and in practice, when these two concepts and phenomena, heritage and borders, are combined. The findings show that heritage, as well as borders, exist just as much in the mind as on the ground. Heritage and borders can be understood both in terms of roots and routes. They are matters of administration, but they are also matters of consideration, matters of competition, and matters of contention. They are defended in the name of security and protection, longing for belonging, and good will. And they are contested in the name of philosophical critique, or political and artistic activism. In six articles and a joint conversation, the volume addresses key issues and entangled complexities in discussions on heritage and borders that take place in and across academic disciplines today.
|
|
| 6. |
|
|
| 7. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Defining and Analyzing “Resistance”: Possible Entrances to the Study of Subversive Practices
- 2016
-
Ingår i: Alternatives: Global, Local, Political. - THOUSAND OAKS, CA 91320 USA : SAGE Publications. - 0304-3754 .- 2163-3150. ; 41:3, s. 137-153
-
Tidskriftsartikel (refereegranskat)abstract
- This article explores the meaning of “resistance” and suggests a new path for “resistance studies,” which is an emerging and interdisciplinary field of the social sciences that is still relatively fragmented and heterogeneous. Resistance has often been connected with antisocial attitudes, destructiveness, reactionary or revolutionary ideologies, unusual and sudden explosions of violence, and emotional outbursts. However, we wish to add to this conceptualization by arguing that resistance also has the potential to be productive, plural and fluid, and integrated into everyday social life. The first major part of the article is devoted to discuss existing understandings of resistance with the aim of seeking to capture distinctive features and boundaries of this social phenomenon. Among other things, we will explore resistance in relation to other key concepts and related research fields. We then, in the article’s second major part, propose a number of analytical categories and possible entrances aiming at inspire more in-depth studies of resistance.
|
|
| 8. |
|
|
| 9. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Emotions and resistance: An introduction
- 2018
-
Ingår i: Resistance and Emotions: interrogating Crossroads and Social change. - Abingdon, Oxon : Routledge. - 9781138482531
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 10. |
- Baaz, Mikael, 1966, et al.
(författare)
-
I Felt a Little Homosexual Today, So I Called in Sick: The Formation of “Reverse Discourse” by Swedish Gay Activists in the 1970s
- 2022
-
Ingår i: Global Society. - : Informa UK Limited. - 1360-0826 .- 1469-798X. ; 36:3, s. 330-346
-
Tidskriftsartikel (refereegranskat)abstract
- This article revolves around the legal and epistemic battles around “homosexuality” in Sweden in 1979, which led to the abolition of homosexuality being classified as a “disease”. Among other things, gay activists “called in sick” to the Social Insurance Agency (SIA) and claimed that they were unable to work because they were homosexuals (read as mentally disordered). The phone calls can be understood as a formation of “reverse” discourse; that is, gay people starting to speak on their own behalf, while using the same categories by which they were labelled. By analysing this resistance and a sit-in that was organised at the Swedish National Board of Health and Welfare (NBHW), we conclude that reverse discourse, as a productive yet rupturing practice, is not a single- handed and unaccompanied resistance strategy but materialises as one practice among many in a complex web of resistance and power.
|
|
| 11. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Involuntary Resistance
- 2024
-
Ingår i: International Journal of Politics, Culture, and Society. - : Springer Science and Business Media LLC. - 0891-4486 .- 1573-3416. ; 37:1, s. 77-97
-
Tidskriftsartikel (refereegranskat)abstract
- This paper problematizes the notion of “intent” through the concept of “involuntary resistance”. Departing from the narratives of employees in nursing homes in Sweden during the Covid-19 pandemic in 2020 and 2021, we suggest that neoliberal norms and a local management that capitalizes on social hierarchies (sex, age, class, etc.) were the context of the strong biopolitical state management that occurred due to the Covid-19 pandemic. The friction between different forms of governing became a seedbed for an involuntary resistance with an unclear intent against the state recommendations. This sheds light upon the need to (re)frame the current dominance of specific types of knowledge that are constructed in the field of resistance. We suggest that new paths of thought are needed—within social sciences—that work towards a wider conceptualizing of resistance, which embraces practices that lie outside the common thought of dissent.
|
|
| 12. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Involuntary Resistance
- 2023
-
Ingår i: International Journal of Politics Culture and Society. - : Springer Science and Business Media LLC. - 0891-4486 .- 1573-3416.
-
Tidskriftsartikel (refereegranskat)abstract
- This paper problematizes the notion of "intent" through the concept of "involuntary resistance". Departing from the narratives of employees in nursing homes in Sweden during the Covid-19 pandemic in 2020 and 2021, we suggest that neoliberal norms and a local management that capitalizes on social hierarchies (sex, age, class, etc.) were the context of the strong biopolitical state management that occurred due to the Covid-19 pandemic. The friction between different forms of governing became a seedbed for an involuntary resistance with an unclear intent against the state recommendations. This sheds light upon the need to (re)frame the current dominance of specific types of knowledge that are constructed in the field of resistance. We suggest that new paths of thought are needed-within social sciences-that work towards a wider conceptualizing of resistance, which embraces practices that lie outside the common thought of dissent.
|
|
| 13. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Legal Pluralism, Gendered Discourses and Hybridity in Land-Titling Practices in Cambodia
- 2017
-
Ingår i: Journal of law and society (Print). - : Wiley-Blackwell. - 0263-323X .- 1467-6478. ; 44:2, s. 220-227
-
Tidskriftsartikel (refereegranskat)abstract
- This article describes and analyses the tensions, ambivalence, and hybridity that prevail in the nexus between discourses of gender and the legal pluralism of the new, formalized, and customary ways of handling land titles. Based on empirical research in Cambodia, it reveals a number of mechanisms, challenges, and inconsistencies in the practice of land-titling. Foremost, the practice of titling seems to be highly informed by local discourses of marriage, family, gender, and age, which all affect to whom land is assigned; this leaves a hybrid construction in the nexus between statutory law and customary practices. The article departs from this observation and adds three contributions on a theoretical level to existing research: by incorporating the dimensions of discourse analysis and legal hybridity, by linking the concept of legal pluralism to the process of hybridization, and by introducing the notion of hybridity of implementation as a supplement to hybridity of law.
|
|
| 14. |
- Baaz, Mikael, 1966, et al.
(författare)
-
(Re)categorization as Resistance: Civil Society Mobilizations Around the Preah Vihear Temple
- 2017
-
Ingår i: International Journal of Politics, Culture, and Society. - New York, NY, USA : Springer Science and Business Media LLC. - 0891-4486 .- 1573-3416. ; 30:3, s. 295-310
-
Tidskriftsartikel (refereegranskat)abstract
- This paper deals with civil society mobilizations and resistance in relation toaworld heritage site—the ninth-century Khmer temple Preah Vihear, which is located in the northern province of Cambodia and borders eastern Thailand. In particular, the paper explores resis- tance in terms of (re)categorizations from a historical and discursive–materialistic perspective. The field of resistance studies has mainly been preoccupied with entities such as texts, signs, symbols, identity, and language. In this article, however, we bring in physical and material entities in order to display the ways in which matter is of importance in the (re)construction of discourses and thereby for resistance.
|
|
| 15. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Researching Resistance and Social Change: A Critical Approach to Theory and Practice
- 2017
-
Bok (övrigt vetenskapligt/konstnärligt)abstract
- Resistance has often been connected with anti-social attitudes, destructiveness, reactionary or revolutionary ideologies, unusual and sudden explosions of violence and emotional outbursts. This book goes beyond these conventions. Exploring various key questions, ranging from concept definitions of affect and temporality, to complex entanglements of various social dimensions and ethical questions, this accessible guide provides a robust theoretical and methodological framework for researching of resistance and social change. By drawing connections between resistance and politics, between performance and everyday strategies, and between the juridical and its counter-strategies, this book provides students with a transdisciplinary understanding of contemporary debates in this emerging field.
|
|
| 16. |
|
|
| 17. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Resistance Studies as an Academic Pursuit
- 2017
-
Ingår i: Journal of Resistance Studies. - 2001-9947. ; 3:1
-
Tidskriftsartikel (refereegranskat)abstract
- Journal of Resistance Studies Number 1 - Volume 3 - 2017 10 Resistance Studies as an Academic Pursuit Baaz 1 , Lilja 2 & Vinthagen 3 ABSTRACT Resistance is both a common and somewhat unusual concept. It appears often in political debates and the media. Members of various non-govern-mental organizations and social movements also frequently use resistance when they refer to their various activities. In spite of the significant growth regarding the use of resistance during recent years, the discussion about the meaning and content of the concept, the ways resistance activities can be understood, as well as their potential impact, et cetera, is still rather divided and under-developed within academia. Hence, in spite of offer-ing a necessary addition to the earlier focus on ‘power’ within the social sciences, the rapidly growing field of resistance studies is still very much in its infancy. This article is an attempt to introduce some of our main ideas on researching resistance in a systematized and structured fashion. One of the main arguments put forward in the article is that what qualifies as resistance is very much dependent on context, as the aim of various resistance practices also varies very much; so, does its different articula-tions as well as the ability of various activities to challenge political, legal, economic, social and cultural structures in society—ultimately to achieve ‘social change’
|
|
| 18. |
|
|
| 19. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Some concluding reflections
- 2018
-
Ingår i: Resistance and Emotions: Interrogating Crossroads and social change. - Abingdon, Oxon ; Routledge : Routledge. - 9781138482531
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 20. |
- Baaz, Mikael, 1966, et al.
(författare)
-
The ABC of resistance: towards a new analytical framework
- 2023
-
Ingår i: Journal of Political Power. - 2158-379X .- 2158-3803. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- Two significant developments – (1) the rapidly changing world order, and (2) significant gaps in current social science scholarship – call for a further exploration of resistance theories. In this paper, we identify some of the gaps and inconsistencies within the current bulk of research, and seek to contribute to the understanding of resistance, its applications and complexity. In short, this paper discusses three interacting and supporting forms of resistance, including various overlaps and interlinkages between them, which together constitute what we would like to call the ABC of resistance; that is, avoidance resistance, breaking resistance, and constructive resistance.
|
|
| 21. |
|
|
| 22. |
|
|
| 23. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Understanding Hybrid Democracy in Cambodia: The Nexus Between Liberal Democracy, the State, Civil Society, and a “Politics of Presence”
- 2014
-
Ingår i: Asian Politics & Policy. - : Wiley. - 1943-0779 .- 1943-0787. ; 6:1
-
Tidskriftsartikel (refereegranskat)abstract
- Abstract This article analyzes the gap between globally promoted definitions of liberal democracy and the different ways in which the concept is interpreted by individual politicians and civil society representatives in Cambodia. By taking as our point of departure the gap between “hegemonic” views of democracy and locally lived democracy experiences and strategies, we argue that one of the basic concepts of liberal democracy—the concept of the “politics of ideas”—does not easily match local facets of democracy. Followers of liberal democracy give priority to the representation of ideas and ideologies over the question of who represents them. This priority, however, seems to correspond poorly to the situation in present-day Cambodia. Based on extensive field material, the article demonstrates how Cambodian interpretations of the Western understanding of “liberal democracy” try to bridge the gap between the praxis of the “politics of ideas” and the “politics of presence.”
|
|
| 24. |
- Baaz, Mikael, 1966, et al.
(författare)
-
Using International Criminal Law to Resist Transitional Justice : Legal Rupture in the Extraordinary Chambers in the Courts of Cambodia
- 2016
-
Ingår i: Conflict and Society. - : Berghahn Books. - 2164-4543 .- 2164-4551. ; 2:1, s. 142-159
-
Tidskriftsartikel (refereegranskat)abstract
- An increasing body of literature focuses on negotiations of transitional justice, but not much has been written so far regarding contestations over its practices and the refusal of states and individuals to participate. Given the remaining legalistic dominance, this is particularly true regarding the field of international criminal law. Very little, if any, work in international criminal law engages with the topic of “resistance.” Departing from this gap in research, focusing on Cambodia and the Extraordinary Chambers in the Courts of Cambodia (ECCC), the objective of this article is to introduce, discuss, and analyze the “strategy of rupture”—as developed by the late French lawyer Jacques Vergès—and the ways in which this legal defense has been applied in practice at the ECCC in order to resist not only the Tribunal per se, but also the entire Cambodian transitional justice process and, by extension, the post–Cold War global liberal project.
|
|
| 25. |
|
|
| 26. |
- Benckert, Martin, et al.
(författare)
-
Improved metabolic health among the obesein six population surveys 1986 to 2009 : the Northern Sweden MONICA study
- 2015
-
Ingår i: BMC Obesity. - : BioMed Central. - 2052-9538. ; 2:7
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe incidence of CVD is decreasing in spite of increasing BMI in the population. We examined trends in metabolic health among overweight and obese individuals and the influence of lifestyle and socioeconomic status. Six cross sectional population surveys in the Northern Sweden MONICA Study between 1986 and 2009. 8 874 subjects 25 to 64 years participated (74% participation rate). Metabolic health was defined as a total cholesterol level below 5.0 mmol/l, blood pressure below 140/90 mmHg and not having diabetes. In 2009 the age span 25 to 74 years was studied.ResultsThe prevalence of metabolic health among obese subjects increased by 7.9 % per year (95% confidence interval 5.4; 10.5), reaching 21.0% in 2009. The corresponding figures for overweight subjects were 5.9% per year (4.6; 7.3), reaching 18% in 2009, whereas for the normal-weight subjects, the increase was 6.2% per year (5.3; 7.2), reaching 39% in 2009. The prevalence of metabolic health among subjects with abdominal obesity increased by 5.8% (4.6; 7.0) per year, reaching 17.3% in 2009. Among those with no abdominal obesity the increase was 6.2% (5.2; 7.1), reaching 38% in 2009 (p = <0.001 for all groups). Only among non-obese men and obese women did the increase continue between 2004 and 2009. In the other groups a slight decline or levelling off was noted.In 2009 women had a 27% higher prevalence of metabolic health than men. The prevalence of metabolic health among the obese was 19.8% which declined to 15.8% if subjects treated for hypertension or hypercholesterolemia were classified as not healthy. Overweight and obese subjects were less often metabolically healthy (odds ratio 0.54 and 0.59 respectively) compared with normal-weight subjects, independent of sex and age as were subjects with abdominal obesity (odds ratio 0.52). Adjustments for smoking, physical activity and education level did not influence any estimates.ConclusionsThis report shows a large increase in prevalence of metabolic health from 1986 to 2009 for all anthropometric categories. Metabolic health remains considerably less prevalent among overweight and obese subjects than among those with normal weight.
|
|
| 27. |
- Bergström, Göran, 1964, et al.
(författare)
-
Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS.
- 2023
-
Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 373, s. 46-54
-
Tidskriftsartikel (refereegranskat)abstract
- Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p<0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
|
|
| 28. |
- Björnsson, Bergthor, et al.
(författare)
-
Digital twins to personalize medicine
- 2020
-
Ingår i: Genome Medicine. - : Springer Science and Business Media LLC. - 1756-994X. ; 12:1
-
Forskningsöversikt (refereegranskat)abstract
- Personalized medicine requires the integration and processing of vast amounts of data. Here, we propose a solution to this challenge that is based on constructing Digital Twins. These are high-resolution models of individual patients that are computationally treated with thousands of drugs to find the drug that is optimal for the patient.
|
|
| 29. |
- Boks, Marije, et al.
(författare)
-
Increased incidence of late-onset inflammatory bowel disease and microscopic colitis after a Cryptosporidium hominis outbreak
- 2022
-
Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis Group. - 0036-5521 .- 1502-7708. ; 57:12, s. 1443-1449
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In 2010, 27,000 inhabitants (45% of the population) of Östersund, Sweden, contracted clinical cryptosporidiosis after drinking water contaminated with Cryptosporidium hominis. After the outbreak, local physicians perceived that the incidence of inflammatory bowel disease (IBD), including ulcerative colitis (UC), Crohn's disease (CD), and IBD-unclassified, and microscopic colitis (MC) increased. This study assessed whether this perception was correct.MATERIALS AND METHODS: This observational study included adult patients (≥18 years old) from the local health care region who were diagnosed with pathology-confirmed IBD or MC during 2006-2019. We collected and validated the diagnosis, date of diagnosis, age at diagnosis, and sex from the Swedish quality register SWIBREG and electronic patient records. Population data were collected from Statistics Sweden. The incidences for 2006-2010 (pre-outbreak) and 2011-2019 (post-outbreak) were evaluated by negative binomial regression analysis and presented as incidence rate ratios (IRRs). Data were analyzed for IBD, for UC and CD separately, and MC.RESULTS: During the study period, we identified 410 patients with new onset IBD and 155 new cases of MC. Overall, we found a trend toward an increased incidence of IBD post-outbreak (IRR 1.39, confidence interval (CI) 0.99-1.94). In individuals ≥40 years old, the post-outbreak incidence significantly increased for IBD (IRR 1.69, CI 1.13-2.51) and CD (IRR 2.23, CI 1.08-4.62). Post-outbreak incidence of MC increased 6-fold in all age groups (IRR 6.43, CI 2.78-14.87).CONCLUSIONS: The incidence of late-onset IBD and MC increased after the Cryptosporidium outbreak. Cryptosporidiosis may be an environmental risk factor for IBD and MC.
|
|
| 30. |
- Boks, Marije, et al.
(författare)
-
Persisting symptoms after Cryptosporidium hominis outbreak : a 10-year follow-up from Östersund, Sweden
- 2023
-
Ingår i: Parasitology Research. - : Springer Nature. - 0932-0113 .- 1432-1955. ; 122:7, s. 1631-1639
-
Tidskriftsartikel (refereegranskat)abstract
- In late 2010, an outbreak of Cryptosporidium hominis affected 27,000 inhabitants (45%) of Östersund, Sweden. Previous research shows that abdomen and joint symptoms commonly persist up to 5 years post-infection. It is unknown whether Cryptosporidium is associated with sequelae for a longer duration, how persisting symptoms present over time, and whether sequelae are associated with prolonged infection. In this prospective cohort study, a randomly selected cohort in Östersund was surveyed about cryptosporidiosis symptoms in 2011 (response rate 69.2%). A case was defined as a respondent reporting new diarrhoea episodes during the outbreak. Follow-up questionnaires were sent after 5 and 10 years. Logistic regressions were used to examine associations between case status and symptoms reported after 10 years, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals. Consistency of symptoms and associations with case status and number of days with symptoms during outbreak were analysed using X 2 and Mann–Whitney U tests. The response rate after 10 years was 74% (n = 538). Case status was associated with reporting symptoms, with aOR of ~3 for abdominal symptoms and ~2 for joint symptoms. Cases were more likely to report consistent symptoms. Cases with consistent abdominal symptoms at follow-up reported 9.2 days with symptoms during the outbreak (SD 8.1), compared to 6.6 days (SD 6.1) for cases reporting varying or no symptoms (p = 0.003). We conclude that cryptosporidiosis was associated with an up to threefold risk for reporting symptoms 10 years post-infection. Consistent symptoms were associated with prolonged infection.
|
|
| 31. |
- Bratt, Ola, 1963, et al.
(författare)
-
Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps
- 2023
-
Ingår i: BMJ Oncology. ; 2:1, s. 1-9
-
Forskningsöversikt (refereegranskat)abstract
- Long-term screening with serum prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to unacceptable overdiagnosis. Over the past decade, diagnostic methods have improved and the indolent nature of low-grade prostate cancer has been established. These advances now enable more selective detection of potentially lethal prostate cancer. This non-systematic review summarises relevant diagnostic advances, previous and ongoing screening trials, healthcare policies and important remaining knowledge gaps. Evidence synthesis and conclusions: The strong association between low serum PSA values and minimal long-term risk of prostate cancer death allows for adjusting screening intervals. Use of risk calculators, biomarkers and MRI to select men with a raised PSA value for biopsy and lesion-targeting rather than systematic prostate biopsies reduce the detection of low-grade cancer and thereby overdiagnosis. These improvements recently led the European Union to recommend its member states to evaluate the feasibility and effectiveness of organised screening programmes for prostate cancer. Nonetheless, important knowledge gaps remain such as the performance of modern diagnostic methods in long-term screening programmes and their impact on mortality. The knowledge gaps are currently being addressed in three large randomised screening trials. Population-based pilot programmes will contribute critical practical experience.
|
|
| 32. |
|
|
| 33. |
|
|
| 34. |
- De Luca, Vincenzo, et al.
(författare)
-
Digitally enabled health service for the integrated management of hypertension : A participatory user-centred design process
- 2021
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 18:23
-
Tidskriftsartikel (refereegranskat)abstract
- This article describes a user-centred approach taken by a group of five procurers to set specifications for the procurement of value-based research and development services for IT-sup-ported integrated hypertension management. The approach considered the unmet needs of patients and health systems of the involved regions. The procurers established a framework for requirements and a solution design consisting of nine building blocks, divided into three domains: service delivery, devices and integration, and health care organisation. The approach included the development of questionnaires, capturing patients’ and professionals’ views on possible system functionalities, and a template collecting information about the organisation of healthcare, professionals involved and existing IT systems at the procurers’ premises. A total of 28 patients diagnosed with hypertension and 26 professionals were interviewed. The interviewees identified 98 functional requirements, grouped in the nine building blocks. A total of nine use cases and their corresponding process models were defined by the procurers’ working group. As result, a digitally enabled integrated approach to hypertension has been designed to allow citizens to learn how to prevent the development of hypertension and lead a healthy lifestyle, and to receive comprehensive, individualised treatment in close collaboration with healthcare professionals.
|
|
| 35. |
- Despotou, George, et al.
(författare)
-
Localisation, Personalisation and Delivery of Best Practice Guidelines on an Integrated Care and Cure Cloud Architecture : The C3-Cloud Approach to Managing Multimorbidity
- 2020
-
Ingår i: Digital Personalized Health and Medicine. - : IOS Press. - 9781643680835 - 9781643680828 ; , s. 623-627
-
Konferensbidrag (refereegranskat)abstract
- BACKGROUND: C3-Cloud is an integrated care ICT infrastructure offering seamless patient-centered approach to managing multimorbidity, deployed in three European pilot sites. Challenge: The digital delivery of best practice guidelines unified for multimorbidity, customized to local practice, offering the capability to improve patient personalization and benefit.METHOD: C3-Cloud has adopted a co-production approach to developing unified multimorbidity guidelines, by collating and reconciling best practice guidelines for each condition. Clinical and technical teams at pilot sites and the C3-Cloud consortium worked in tandem to create the specification and technical implementation.RESULTS: C3-Cloud offers CDSS for diabetes, renal failure, depression and congenital heart failure, with over 300 rules and checks that deliver four best practice guidelines in parallel, customized for each pilot site.CONCLUSIONS: The process provided a traceable, maintainable and audited digitally delivered collated and reconciled guidelines.
|
|
| 36. |
|
|
| 37. |
- Eriksson, Mikael, et al.
(författare)
-
MAX-IV Design: Pushing the Envelope
- 2007
-
Ingår i: 2007 IEEE Particle Accelerator Conference, vols 1-11. - 9781424409167 ; , s. 1277-1279
-
Konferensbidrag (refereegranskat)abstract
- The proposed MAX IV facility is meant as a successor to the existing MAX-lab. The accelerator part will consist of three storage rings, two new ones operated at 3 and 1.5 GeV respectively and the existing 700 MeV MAX III ring. The two new rings have identical lattices and are placed on top of each other. Both these rings have a very small emittance, 0.86 and 0.4 nm rad respectively, and offer synchrotron radiation of very high mean brilliance. As an injector, a 3 GeV linear accelerator is planned. The design philosophy and the special technical solutions called for are presented in this paper.
|
|
| 38. |
- Eriksson, Mikael, et al.
(författare)
-
The MAX IV Facility
- 2013
-
Ingår i: 11th International Conference on Synchrotron Radiation Instrumentation (SRI 2012). - : IOP Publishing. - 1742-6588 .- 1742-6596. ; 425
-
Konferensbidrag (refereegranskat)abstract
- The MAX IV synchrotron radiation facility is currently being constructed in Lund, Sweden. The accelerator park consists of a 3 GeV linac injector and 2 storage rings operated at 1.5 and 3 GeV respectively. The linac injector will also be used for the generation of short Xray pulses. Close to 30 straight sections will be available for IDs at the rings. The three machines mentioned above are described below with some emphasis on the effort to create a very small emittance in the 3 GeV ring. Some unconventional technical solutions imposed by the emittance minimisation are discussed.
|
|
| 39. |
- Eriksson, Mikael, et al.
(författare)
-
The MAX IV Synchrotron Light Source
- 2011
-
Ingår i: [Host publication title missing]. - 9789290833666 ; , s. 3026-3028
-
Konferensbidrag (refereegranskat)abstract
- The MAX IV synchrotron radiation facility is currently being constructed in Lund, Sweden. It consists of a 3 GeV linac injector and 2 storage rings operated at 1.5 and 3 GeV respectively. The linac injector will also be used for the generation of short X-ray pulses. The three machines mentioned above are described with some emphasis on the effort to create a very small emittance in the 3 GeV ring. Some unconventional technical solutions will also be presented.
|
|
| 40. |
- Erturkmen, Gokce B. Laleci, et al.
(författare)
-
A Collaborative Platform for Management of Chronic Diseases via Guideline-Driven Individualized Care Plans
- 2019
-
Ingår i: Computational and Structural Biotechnology Journal. - : Elsevier. - 2001-0370. ; 17, s. 869-885
-
Tidskriftsartikel (refereegranskat)abstract
- Older center dot age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by dearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans. We also report the results of usability studies carried out in four pilot sites by patients and clinicians.
|
|
| 41. |
- Fjällström, Petter, et al.
(författare)
-
Adopting standardized cancer patient pathways as a policy at different organizational levels in the Swedish health system
- 2023
-
Ingår i: Health Research Policy and Systems. - : BioMed Central (BMC). - 1478-4505. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Standardized cancer patient pathways as a new policy has been adopted in healthcare to improve the quality of cancer care. Within the health systems, actors at different levels manage the adoption of new policies to develop healthcare. The various actors on different levels play an important role and influence the policy adoption process. Thus, knowledge about how these actors use strategies when adopting cancer patient pathways as a policy in the health system becomes central.Method: The study's aim was to explore how actors at different organizational levels in the health system adopted cancer patient pathways. Our overarching case was the Swedish health system at the national, regional, and local levels. Constructivist Grounded Theory Method was used to collect and analyze qualitative interviews with persons working in organizations directly involved in adopting cancer patient pathways at each level. Twelve individual and nine group interviews were conducted including 53 participants.Results: Organizational actors at three different levels used distinct strategies during the adoption of cancer patient pathways: acting as-missionaries, fixers, and doers. Acting as missionaries consisted of preaching the idea of cancer patient pathways and framing it with a common purpose to agree upon. Acting as fixers entailed creating a space to put cancer patient pathways into practice and overcome challenges to this. Acting as doers comprised balancing breadth and speed in healthcare provision with not being involved in the development of cancer patient pathways for the local context. These strategies were not developed in isolation from the other organizational levels but rather, each level interacted with one another.Conclusions: When adopting new policies, it is important to be aware of the different strategies and actors at various organizational levels in health systems. Even when actors on different levels developed separate strategies, if these contribute to fulfilling the four domains of inter-organizational collaboration, they can work well together to adopt new policies. Our study highlighted that the application of two domains was lacking, which meant that local actors were not sufficiently involved in collaboration, thus constricting the local use and optimization of cancer patient pathways in practice.
|
|
| 42. |
- Fjällström, Petter, et al.
(författare)
-
CN59 A meeting between existing practices and new ones in primary healthcare : How nurses adjust work routines to using cancer patient pathways
- 2021
-
Ingår i: Annals of Oncology. - : Elsevier. - 0923-7534 .- 1569-8041. ; 32:Supplement 5, s. S1277-S1277
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The aim was to explore how nurses in primary healthcare (PHC) adjust routines using Cancer Patient Pathways (CPP). CPPs are intended to shorten time to diagnosis but unintended consequences can occur for organizations that utilizes them. Furthermore, in Sweden, PHC is the main entrance into healthcare and nursesas first contact, together with physicians’ are important actors for timely diagnosis.Hence, to explore the unintended consequences when using CPPs in PHC is important since it may impact the process of adaption to CPP.Methods: Grounded Theory method was used to collect and analyse qualitative data. Six PHC units were included with a variation in size, staff and location. Data was collected through focus groups with nurses and physicians at each PHC unit, for a total of 41 participants in nine interviews.Results: When previous practices meet new ones, three distinct but connected work routines emerged in PHC and encompassed a dimension ranging from continuing working with existing practice to adapting CPPs in their work. However, two of the work routines were mainly related to nurses and depicted how they continued working broadly with patient needs in the population while adapting CPP to speed up patient flows. Additionally, nurses continued to draw upon their longstanding know-how of prioritizing with alarm symptoms while adapting to work with routines in new ways, while physicians were the ones reorganizing adjusted routines in their units. Lastly, the third work routine generally illustrated physicians dealing with unequal relations in communication with secondary care regarding referral criteria and nurses were not involved in these referrals.Conclusions: PHC units in our study had not been involved in planning the introduction of CPPs, with nurses excluded in particular. Instead, as our results show, nurses developed their own process to manage using CPPs as a way to adjust to the new procedures, with the unintended consequences influencing their process of adaption. Our study suggests that decision-makers in healthcare could make better use of the know-how within PHC, especially nurses expertise, when developing and introducing new tools such as CPPs.
|
|
| 43. |
- Fjällström, Petter, et al.
(författare)
-
Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare
- 2022
-
Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The introduction of new tools can bring unintended consequences for organizational routines. Cancer Patient Pathways (CPP) were introduced into the Swedish healthcare system in 2015 to shorten time to diagnosis and treatment. Primary healthcare (PHC) plays a central role since cancer diagnosis often begins in PHC units. Our study aimed to understand how PHC units adjusted organizational routines to utilizing CPPs.Method: Six PHC units of varied size from both urban and rural areas in northern Sweden were included. Grounded theory method was used to collect and analyse group interviews at each unit. Nine group interviews with nurses and physicians, for a total of 41 participants, were performed between March and November 2019. The interviews focused on CPPs as tools, the PHC units’ routines and providers’ experiences with using CPPs in their daily work.Results: Our analysis captured how PHC units adjusted organizational routines to utilizing CPPs by fusing existing practices with new practices to offer better quality of care. Specifically, three overarching organizational routines within the PHC units were identified. First, Manoeuvring diverse patient needs with easier patient flow, the PHC units handled the diverse needs of the population while simultaneously drawing upon CPPs to ease the patient flow within the healthcare system. Second, (Dis) integrating internal know-how, the PHC units drew upon internal competence even when PHC know-how was not taken into account by those driving the CPP initiative. Third, Coping with unequal relationships toward secondary care, the PHC units dealt with being in an unequal position while adopting CPPs instead further decreased possibilities to influence decision-making between care-levels.Conclusion: Adopting CPPs as a tool within PHC units brought various unintended consequences in organizational routines. Our study from northern Sweden illustrates that the PHC know-how needs to be integrated into the healthcare system to improve the use of new tools as CPP. Further, the relationships between different levels of care should be taken in account when introducing new tools for healthcare. Also, when adopting innovations, unintended consequences need to be further explored empirically in diverse healthcare contexts internationally in order to generate deeper knowledge in the research area.
|
|
| 44. |
- Fjällström, Petter, et al.
(författare)
-
Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden
- 2023
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 41:3, s. 287-296
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden.Design: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016.Setting: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2).Subjects: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden.Main outcome measures: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department.Results: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18–99) to 29 days (IQI 9–74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department.Conclusion: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon.Implication: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.
|
|
| 45. |
- Fjällström, Petter, et al.
(författare)
-
Reworking routines in primary healthcare : Adapting standarized cancer patient pathways while continuing practice
- 2021
-
Ingår i: Ca-PRI Online Conference 2021. ; , s. 55-55
-
Konferensbidrag (refereegranskat)abstract
- Background: The aim was to explore how primary healthcare centers (PHC) had adjusted working routines using Cancer Patient Pathways (CPP). CPPs are intended to shorten time to diagnosis, improve access to care and reduce inequality in cancer care. In addition to these intended changes, CPPs have unintended consequences for organizations that utilizes them. In Sweden, PHCs are particularly affected because they are the first and main entrance into healthcare and also important actors of CPP for timely diagnosis. When Sweden in 2015 introduced CPPs, there was an opportunity to explore unintended consequences of using CPPs in PHCs.Method: Grounded Theory method was used to collect and analyze qualitative data. Six PHCs were included with a variation in size and location. Data was collected through group interviews with nurses and physicians at each PHC, for a total of 41 participants in nine interviews.Results: Our analysis resulted in a process consisting of three distinct but connected work routines. Each routine encompassed a dimension ranging from continuing working as usual to adapting CPPs in their work. The PHCs continued working broadly with patient needs while adapting to speeding up patient flows. Additionally, the PHCs continued to be in a position of dependency on secondary care while adapting to “easier” referral of patients. Lastly, the PHCs continued to draw upon their longstanding know-how while adapting to work with alarm symptoms in new ways.Conclusion: PHCs in our study had not been involved in planning the introduction of CPPs. Instead, as our results show, the PHCs developed their own process to manage using CPPs as a tool. The process illuminated their adeptness to deal with new tools and procedures. Our study suggests that decision-makers in healthcare could make better use of the know-how within PHCs when developing and introducing new tools such as CPPs.
|
|
| 46. |
|
|
| 47. |
- Fureman, Anna-Lena, et al.
(författare)
-
Comparing Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections in children with type 1 diabetes in Sweden from 2011 to 2016 : a longitudinal study from the Swedish National Quality Register (SWEDIABKIDS)
- 2021
-
Ingår i: Pediatric Diabetes. - : Blackwell Publishing. - 1399-543X .- 1399-5448. ; 22:5, s. 766-775
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as BMI-SDS in a nationwide sample of children and adolescents with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively.METHODS: Longitudinal data from 2011-2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia.RESULTS: <0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016.CONCLUSION: There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
|
|
| 48. |
- Fureman, Anna-Lena, et al.
(författare)
-
Partial clinical remission of Type 1 diabetes in Swedish children : A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS) and the Better Diabetes Diagnosis (BDD) study
- 2024
-
Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1520-9156 .- 1557-8593.
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether insulin delivery method, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) affect incidence and duration of this period 2007-2011. Factors that increase the proportion of subjects that enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life and in the long run reduce late complications.METHODS: Longitudinal data from 2007-2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study (BDD) from 2007-2010 were used. The definition of partial remission was Insulin Dose Adjusted HbA1c (IDAA1c): HbA1c (%)+(4 x total daily insulin dose (U/kg/day)) ≤9.RESULTS: Of the 3,887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared to older age groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared to those with MDI (37% vs 33%, p=0.02 and 31% vs 27%, p<0.01 respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower, both p<0.001. Partial remission at 12 months after diabetes onset was associated with CSII (OR:1.39 CI:1.13, 1.71), shorter diabetes duration (OR:0.80 CI:0.76, 0.84) and male sex (OR:1.23 CI:1.04, 1.46)Conclusions/interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seem to contribute to longer partial remission among Swedish children with type 1 diabetes.
|
|
| 49. |
- García-Lorenzo, Borja, et al.
(författare)
-
Assessment of the effectiveness, socio-economic impact and implementation of a digital solution for patients with advanced chronic diseases : the ADLIFE study protocol
- 2023
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:4
-
Tidskriftsartikel (refereegranskat)abstract
- Due to population ageing and medical advances, people with advanced chronic diseases (ACD) live longer. Such patients are even more likely to face either temporary or permanent reduced functional reserve, which typically further increases their healthcare resource use and the burden of care on their caregiver(s). Accordingly, these patients and their caregiver(s) may benefit from integrated supportive care provided via digitally supported interventions. This approach may either maintain or improve their quality of life, increase their independence, and optimize the healthcare resource use from early stages. ADLIFE is an EU-funded project, aiming to improve the quality of life of older people with ACD by providing integrated personalized care via a digitally enabled toolbox. Indeed, the ADLIFE toolbox is a digital solution which provides patients, caregivers, and health professionals with digitally enabled, integrated, and personalized care, supporting clinical decisions, and encouraging independence and self-management. Here we present the protocol of the ADLIFE study, which is designed to provide robust scientific evidence on the assessment of the effectiveness, socio-economic, implementation, and technology acceptance aspects of the ADLIFE intervention compared to the current standard of care (SoC) when applied in real-life settings of seven different pilot sites across six countries. A quasi-experimental trial following a multicenter, non-randomized, non-concurrent, unblinded, and controlled design will be implemented. Patients in the intervention group will receive the ADLIFE intervention, while patients in the control group will receive SoC. The assessment of the ADLIFE intervention will be conducted using a mixed-methods approach.
|
|
| 50. |
- Gawel, Danuta, et al.
(författare)
-
A validated single-cell-based strategy to identify diagnostic and therapeutic targets in complex diseases
- 2019
-
Ingår i: Genome Medicine. - : Springer Science and Business Media LLC. - 1756-994X. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Genomic medicine has paved the way for identifying biomarkers and therapeutically actionable targets for complex diseases, but is complicated by the involvement of thousands of variably expressed genes across multiple cell types. Single-cell RNA-sequencing study (scRNA-seq) allows the characterization of such complex changes in whole organs. Methods: The study is based on applying network tools to organize and analyze scRNA-seq data from a mouse model of arthritis and human rheumatoid arthritis, in order to find diagnostic biomarkers and therapeutic targets. Diagnostic validation studies were performed using expression profiling data and potential protein biomarkers from prospective clinical studies of 13 diseases. A candidate drug was examined by a treatment study of a mouse model of arthritis, using phenotypic, immunohistochemical, and cellular analyses as read-outs. Results: We performed the first systematic analysis of pathways, potential biomarkers, and drug targets in scRNA-seq data from a complex disease, starting with inflamed joints and lymph nodes from a mouse model of arthritis. We found the involvement of hundreds of pathways, biomarkers, and drug targets that differed greatly between cell types. Analyses of scRNA-seq and GWAS data from human rheumatoid arthritis (RA) supported a similar dispersion of pathogenic mechanisms in different cell types. Thus, systems-level approaches to prioritize biomarkers and drugs are needed. Here, we present a prioritization strategy that is based on constructing network models of disease-associated cell types and interactions using scRNA-seq data from our mouse model of arthritis, as well as human RA, which we term multicellular disease models (MCDMs). We find that the network centrality of MCDM cell types correlates with the enrichment of genes harboring genetic variants associated with RA and thus could potentially be used to prioritize cell types and genes for diagnostics and therapeutics. We validated this hypothesis in a large-scale study of patients with 13 different autoimmune, allergic, infectious, malignant, endocrine, metabolic, and cardiovascular diseases, as well as a therapeutic study of the mouse arthritis model. Conclusions: Overall, our results support that our strategy has the potential to help prioritize diagnostic and therapeutic targets in human disease.
|
|
