| 11. |
- Larsson, Christina R., et al.
(författare)
-
Suboptimal behaviour and knowledge regarding overnight glycaemia in adults with type 1 diabetes is common
- 2018
-
Ingår i: Internal medicine journal (Print). - : Wiley-Blackwell Publishing Inc.. - 1444-0903 .- 1445-5994. ; 48:9, s. 1080-1086
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn people with type 1 diabetes (T1D), nocturnal hypoglycaemia (NH) can be slept through and can cause seizures, arrhythmias and death. Hypoglycaemia avoidance can induce hyperglycaemia and ketosis. Patient behaviour impacts clinical outcomes and may be changed by education.AimTo develop and utilise a survey to evaluate patient self‐management of overnight glycaemia in adults with T1D.MethodsAdults with T1D attending two Australian tertiary referral diabetes clinics completed a survey about their diabetes self‐management and glycaemic control, including responses to hypothetical pre‐bed blood glucose (BG) levels (4–20 mmol/L). Statistical analyses included t‐tests, Chi square tests and ANOVA with significance considered at P < 0.05.ResultsThere were 205 participants (103 females), with a mean (SD) age of 41 (17) years, T1D duration of 20 (16) years, HbA1c of 7.8(1.4)%, (61.3(8.2) mmol/mol), 38% on insulin pump therapy (CSII) and 36% with impaired hypoglycaemia awareness (IHA). Mean (SD) number of BG tests/day was 5.4 (2.7). Patients set higher BG target levels at bedtime and overnight: 7.5(1.4) and 7.1(1.3) mmol/L, respectively, compared to daytime (6.9(1.0); P < 0.0001 and P = 0.002 respectively). Only 36% of participants reported treating nocturnal hypoglycaemia (NH) with the recommended refined, then complex, carbohydrate. Only 28% of patients made safe choices in all bedtime BG scenarios, with higher rates for CSII users, P = 0.0005. Further education was desired by 32% of respondents, with higher rates in those with (44%) versus without IHA (25%), P = 0.006.ConclusionsMany adults with T1D have suboptimal knowledge and behaviour regarding overnight BG self‐management. A survey, piloted herein, may facilitate the identification of patients who could benefit from further education.
|
|
| 12. |
- Åhrén, Christina, et al.
(författare)
-
Outbreak with ESBL (CTX-M)-producing Escherichia coli in a pediatric surgical ward
- 2009
-
Ingår i: Scandinavian Society for Antimicrobial Chemotherapy 2009, September 3, Tromsø, Norway.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Nosocomial outbreaks with ESBL-producing bacteria in Scandinavia are still rare. In a surgical ward carrying mainly for small children with congenital gastrointestinal disorders spread with ESBL-producing bacteria most likely had been ongoing for three months when we detected the outbreak in December 2008. Five children with ESBL-infections had been cared for since September. Four had septicaemia as compared to no E.coli isolated in blood the previous year. Materials and methods: ESBL-detection has been performed according to routine methods. Positive isolates from patients hospitalised in the ward since 2007 were typed with pulse field gel electrophoresis (PFGE) and the PhP-phenplate method. Results: Altogether 125/169 children hospitalised during September-December were screened and 23 were positive for ESBL-producing bacteria (~50 available isolates), of which15 were only positive in stool. They had been hospitalised for a few days to several months. Four children probably constituted the infection pool. Twenty children carried the likely outbreak strain, but ESBL-producing E coli with four additional PFGE-types as well as Klebsiella pneumonie of one type were identified. Each type demonstrated up to three different resistance-patterns against trimetoprim, ciprofloxacin and tobramycin. Six children had multiple types. Discussion and Conclusion: Spread of ESBL-producing bacteria may go undetected for a long time when only clinical isolates are available. By comparing resistance pattern we missed this outbreak by more than a month. PFGE has been an invaluable tool in the investigation. Through cohorting, enforced hygiene routines, including food handling, for personnel, parents and siblings no new child has been infected (uninfected children are screened twice weekly) since the outbreak was detected.
|
|
| 13. |
|
|
| 14. |
- Flentie, Kelly, et al.
(författare)
-
Chemical disarming of isoniazid resistance in Mycobacterium tuberculosis
- 2019
-
Ingår i: Proceedings of the National Academy of Sciences of the United States of America. - : The National Academy of Scionces of the United States of America. - 0027-8424 .- 1091-6490. ; 116:21, s. 10510-10517
-
Tidskriftsartikel (refereegranskat)abstract
- Mycobacterium tuberculosis (Mtb) killed more people in 2017 than any other single infectious agent. This dangerous pathogen is able to withstand stresses imposed by the immune system and tolerate exposure to antibiotics, resulting in persistent infection. The global tuberculosis (TB) epidemic has been exacerbated by the emergence of mutant strains of Mtb that are resistant to frontline antibiotics. Thus, both phenotypic drug tolerance and genetic drug resistance are major obstacles to successful TB therapy. Using a chemical approach to identify compounds that block stress and drug tolerance, as opposed to traditional screens for compounds that kill Mtb, we identified a small molecule, C10, that blocks tolerance to oxidative stress, acid stress, and the frontline antibiotic isoniazid (INH). In addition, we found that C10 prevents the selection for INH-resistant mutants and restores INH sensitivity in otherwise INH-resistant Mtb strains harboring mutations in the katG gene, which encodes the enzyme that converts the prodrug INH to its active form. Through mechanistic studies, we discovered that C10 inhibits Mtb respiration, revealing a link between respiration homeostasis and INH sensitivity. Therefore, by using C10 to dissect Mtb persistence, we discovered that INH resistance is not absolute and can be reversed.
|
|
| 15. |
|
|
| 16. |
- Holm, Göran, et al.
(författare)
-
Cross hole tomography of subsoil in transition zones at existing railway bridges : Sustainable Bridges Background document SB 3.14
- 2007
-
Rapport (refereegranskat)abstract
- The scope of the work described in this report includes 1) a description of problems in transitionzones at bridge abutments, 2) measurements with cross hole tomography, 3) a numberof field tests for verification of the cross hole tomography method and 4) applications and recommendation for use of the method.Recommendations and comments on the use of the method are presented, including applicable subsoil and geometrical conditions, required equipment and accuracy of evaluated parameters.
|
|
| 17. |
- Karami, Nahid, 1959, et al.
(författare)
-
Investigation of an outbreak of CTX-M-15-producing Escherichia coli of sequence types 131 and 1441 in a neonatal surgical ward: comparison of typing methods
- 2010
-
Ingår i: 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Vienna, Austria.
-
Konferensbidrag (refereegranskat)abstract
- Objectives: In a surgical ward caring mainly for newborns spread of CTX-M-15-producing E.coli had been ongoing at least since September 2008 when we finally recognized the outbreak in late December. We have compared various typing methods with pulsed-field gel electrophoresis (PFGE) to verify the actual outbreak and subsequently to determine number of affected children. Methods: In addition to clinical sampling 125 children hospitalized between Sept-Dec were screened for extended-spectrum beta-lactamase (ESBL)-producing bacteria in stool during Dec-Feb. From Jan-June 2009 newly admitted children were screened at admission and twice weekly. Fifty-one E coli isolates with ESBL from 27 children were found. These isolates have been typed with PFGE, multiple-locus-variable number tandem repeat analysis (MLVA), a mini multiple-locus-sequence typing (MLST) method (dnaJ, purA and fumC genes) as well as with the Phene Plate (PhP) biochemical fingerprinting system. Results: When the outbreak was revealed five children had developed infections with ESBL-producing E. coli that were of two PFGE-types (A and B) later considered to be the outbreak strains. One or both were spread to 21 children. Six children had multiple types. Altogether 38 isolates (20 children) were of type A (ST 131), 7 isolates (5 children) of type B (ST 1441). In addition E coli of six distinct PFGE-types (C-?) were found in one child each. MLVA gave identical discriminatory results as PFGE for all isolates tested. Mini-MLST could not differentiate ST 131 isolates of to distinct PFGE-types (type A and C) but accurately predicted the ST-types of each PFGE-type when confirmed with standard MLST according to http://mlst.ucc.ie/mlst/dbs/Ecoli. By comparing resistance pattern we thus missed the outbreak by a month. PhP indicated that all initial isolates were singletons and there was hardly any correlation with PFGE. Conclusion: If transmission has been ongoing for a long time several types of ESBL-producing bacteria may be found in an outbreak and all isolates including repeat and screening isolates need to be typed to identify affected patients. Only genetic typing, gave satisfactory results in this outbreak. MLVA gave identical results to PFGE and is thus attractive being faster, cheaper and easier to communicate. Our mini-MLST was somewhat less discriminatory but despite using only three house keeping genes accurately predicted the ST-types.
|
|
| 18. |
- Kyu, Hmwe H, et al.
(författare)
-
Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013 : Findings From the Global Burden of Disease 2013 Study.
- 2016
-
Ingår i: JAMA pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 170:3, s. 267-287
-
Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study.EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14 244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35 620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905 059 deaths; 95% UI, 810 304-998 125), diarrheal diseases among older children (38 325 deaths; 95% UI, 30 365-47 678), and road injuries among adolescents (115 186 deaths; 95% UI, 105 185-124 870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.
|
|
| 19. |
- McNabb, Sarah, et al.
(författare)
-
Meta-analysis of 16 studies of the association of alcohol with colorectal cancer
- 2020
-
Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 146:3, s. 861-873
-
Tidskriftsartikel (refereegranskat)abstract
- Alcohol consumption is an established risk factor for colorectal cancer (CRC). However, while studies have consistently reported elevated risk of CRC among heavy drinkers, associations at moderate levels of alcohol consumption are less clear. We conducted a combined analysis of 16 studies of CRC to examine the shape of the alcohol-CRC association, investigate potential effect modifiers of the association, and examine differential effects of alcohol consumption by cancer anatomic site and stage. We collected information on alcohol consumption for 14,276 CRC cases and 15,802 controls from 5 case-control and 11 nested case-control studies of CRC. We compared adjusted logistic regression models with linear and restricted cubic splines to select a model that best fit the association between alcohol consumption and CRC. Study-specific results were pooled using fixed-effects meta-analysis. Compared to non-/occasional drinking (<= 1 g/day), light/moderate drinking (up to 2 drinks/day) was associated with a decreased risk of CRC (odds ratio [OR]: 0.92, 95% confidence interval [CI]: 0.88-0.98, p = 0.005), heavy drinking (2-3 drinks/day) was not significantly associated with CRC risk (OR: 1.11, 95% CI: 0.99-1.24, p = 0.08) and very heavy drinking (more than 3 drinks/day) was associated with a significant increased risk (OR: 1.25, 95% CI: 1.11-1.40, p < 0.001). We observed no evidence of interactions with lifestyle risk factors or of differences by cancer site or stage. These results provide further evidence that there is a J-shaped association between alcohol consumption and CRC risk. This overall pattern was not significantly modified by other CRC risk factors and there was no effect heterogeneity by tumor site or stage.
|
|
| 20. |
|
|
