| 1. |
- Bixo Ottosson, Anna, et al.
(author)
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Self-care management of type 1 diabetes has improved in Swedish schools according to children and adolescents
- 2017
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In: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 106:12, s. 1987-1993
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Journal article (peer-reviewed)abstract
- Aim: Age-appropriate support for diabetes self-care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.Methods: This national study was based on questionnaires answered by children and adolescents aged 6–15 years of age with type 1 diabetes attending schools or preschools in 2008 (n = 317) and 2015 (n = 570) and separate parental questionnaires. The subjects were recruited by Swedish paediatric diabetes units, with 41/44 taking part in 2008 and 41/42 in 2015.Results: Fewer participants said they were treated differently in school because of their diabetes in 2015 than 2008. The opportunity to perform insulin boluses and glucose monitoring in privacy increased (80% versus 88%; p < 0.05). Most (83%) adolescents aged 13–15 years were satisfied with the support they received, but levels were lower in girls (p < 0.05). More subjects had hypoglycaemia during school hours (84% versus 70%, p < 0.001), but hypoglycaemia support did not increase and was lower for adolescents than younger children (p < 0.001).Conclusion: Children and adolescents received more support for type 1 diabetes in Swedish schools in 2015 than 2008, but more support is needed by girls and during hypoglycaemia.
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| 6. |
- Karefylakis, Christos, et al.
(author)
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Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men : a randomized controlled trial
- 2018
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In: Endocrine. - : Humana Press. - 1355-008X .- 1559-0100. ; 61:3, s. 388-397
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Journal article (peer-reviewed)abstract
- Purpose: Several observational studies have shown an association between vitamin D deficiency and non-skeletal major health issues including impaired cardiorespiratory fitness and adiposity. Only a few studies have examined the impact of vitamin D supplementation on these conditions and the results are ambiguous. The aim of this study was to examine the effect of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight/obese men with vitamin D deficiency.Methods: This study was a prospective, placebo controlled, double blinded, randomized trial with a study period of 6 months. Forty overweight/obese men (BMI > 25 kg/m2) with vitamin D deficiency (25(OH)D ≤ 55 nmol/L) were randomized to receive either 2000 IU Cholecalciferol drops or the equivalent amount of drops of placebo. At baseline and follow up body composition and cardiorespiratory fitness were measured and blood samples were obtained. Body composition was measured using bioelectrical impedance analysis (BIA) and cardiorespiratory fitness using cardiopulmonary exercise test (CPET). The primary outcomes were changes in percentage body fat and in maximum oxygen uptake (VO2max).Results: No statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat (p = 0.54) and VO2max (p = 0.90) was observed. Moreover, there was no statistically significant difference between the groups concerning changes in BMI (p = 0.26), maximum load (p = 0.89) and oxygen uptake at anaerobic threshold (AT) (p = 0.14).Conclusions: We conclude that treatment with 2000 IU/d vitamin D for 6 months does not impact body composition or maximum oxygen uptake in overweight/obese men with vitamin D deficiency.
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| 8. |
- Karefylakis, Christos, 1982-
(author)
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Vitamin D and its role in obesity and other associated conditions
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Vitamin D has received much attention in recent years due to the re-emergence of vitamin D deficiency as a global health issue along with increasing evidence indicating that 1,25-dihydroxivitamin D, the hormonally active form of vita-min D, not only acts in calcium and bone metabolism but also generates ex-traskeletal biological responses.In this thesis, the role of vitamin D in obesity and other associated condi-tions has been studied.In paper 1, the prevalence of vitamin D deficiency and secondary hyperpara-thyroidism over the long term after Roux-en-Y gastric bypass (RYGB) were evaluated. We found a substantial prevalence of vitamin D deficiency and secondary hyperparathyroidism after RYGB, whereas calcium levels remained within normal range. An expected improvement in vitamin D status after weight loss could have been countered by the malabsorption induced by surgery.In paper 2, the prevalence of anemia and related deficiencies over the long term after RYGB were studied. We found that 27% of the patients had anemia postoperatively, 20% had iron deficiency, 12% had folate deficiency and 2% had vitamin B12 deficiency. Anemia was mainly due to iron deficiency, and its frequency did not seem to progress with time after surgery.In paper 3, the effects of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men with vitamin D deficiency at baseline were investigated. No statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat, maximum oxygen uptake, BMI and maximum load was found.In paper 4, the prevalence and determinants of 3-epi-25(OH)D3 were exam-ined. 3-epi-25(OH)D3 was detected in 7.7% of the study population and the mean concentration was 8.4 nmol/L. The quantification of 3-epi-25(OH)D3 would not significantly influence the clinical interpretation of vitamin D levels.In conclusion, new knowledge about vitamin D is continuously emerging but there is a discrepancy between cross-sectional studies associating low vitamin D levels to obesity and other related metabolic complications and the lack of effects of vitamin D supplementation in clinical trials. Large RCTs with longer duration in obese subjects with baseline vitamin D deficiency are warranted.
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| 9. |
- Karefylakis, Christos, 1982-, et al.
(author)
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Vitamin D C3 epimer in a mid-Swedish region : Analytical measurement and epidemiology
- 2018
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In: Clinica Chimica Acta. - Amsterdam, Netherlands : Elsevier. - 0009-8981 .- 1873-3492. ; 478, s. 182-187
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Journal article (peer-reviewed)abstract
- Background: The discovery of an epimeric form of 25(OH)D3 may complicate the interpretation of vitamin Dstatus. The aim of this study was to examine the prevalence and determinants of 25-hydroxy-3-epi-vitamin D3 (3- epi-25(OH)D3) in a mid-Swedish region and to investigate how the measurement of 3-epi-25(OH)D3 would affect the assessment of vitamin D status using current thresholds.Methods: We conducted a cross-sectional study of 8286 in- and outpatients in primary as well as secondary care settings. Plasma 25(OH)D, 25(OH)D2, 25(OH)D3 and 3-epi-25(OH)D3 were measured using High Pressure Liquid Chromatography – Tandem Mass Spectrometry (HPLC – MS/MS). The relative 3-epi-25(OH)D3 contribution was calculated as a percentage of the total 25(OH)D3. Blood samples were collected between March 2014 and July 2015 providing a seasonal aspect to the results.Results: 3-epi-25(OH)D3was detected in 635 cases (7.7% of all subjects), and the mean concentration was8.4 ± 3.5 nmol/L. 3-epi-25(OH)D3correlated significantly with 25(OH)D3(r =0.38, p < 0.001).A multivariateanalysis among the detected showed that male gender and winter season were independently associatedwith higher 3-epi-25(OH)D3/25(OH)D3percentage ratio (R2=0.044). Infants and children had a significantlyhigher detection rate compared to the reference age category (18–45 years) as well as those who were testedduring the summer season.Conclusions: We report findings from the first epidemiologic study of 3-epi-25(OH)D3 conducted in Sweden, based on a large population sample. 3-epi-25(OH)D3 was detected in 7.7% of the study population and the mean concentration was 8.4 nmol/L. The quantification of 3-epi-25(OH)D3 would not significantly influence the clinical interpretation of vitamin D levels. Additional studies are needed to understand the metabolic pathway and the possible physiological functions of this metabolite.
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| 10. |
- Lemonaki, Myrsini, et al.
(author)
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Paediatric education in the Curriculum of the School of Medicine in the University of Örebro in Sweden
- 2018
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Conference paper (peer-reviewed)abstract
- Background: In Sweden there are seven Medical Schools. Some of them have existed in more than 50 years whereas the School of Medicine at Örebro University was established in 2011. The education is built as 5,5 year studies (330 ECTS credits) and the Curriculum is integrated according to the PBL system. The aim is to present our approach to the training in paediatrics.Method: The poster presents the theoretical and clinical studies, as well as the examination and the assessment system concerning the paediatric education. The medical students in Örebro study paediatrics during the study of the theme of Reproduction and Growth. This is formed in three steps during their studies, particularly in terms 2, 6, 9. As an integrated medical curriculum students have both theoretical and practical studies during all the terms. The learning methods are base studies, seminars, lectures, simulation training, and clinic practice.In the second term, the medical students study embryology, genetics, anatomy and have some clinical practice in the paediatric primary health center. In the sixth term, they study about the healthy newborn, child and adolescent as well as normal and retarded growth and normal development and nutrition. Students also start their training in taking medical history and doing clinical examination. In the ninth term students have focus on the sick newborn, child and adolescent. Seminars on child abuse and neglect are given with a specialized pediatrician, a specialized lawyer and social worker as teachers.Conclusion: The theoretical aims of the paediatric curriculum are obtained through clinical practice, team base groups, case seminaria, other seminaria, lectures, and self studies. The clinical skills are obtained through clinical skills training in paediatric units and simulation training. The examination system includes a writing exam after each term as well as an examination of clinical skills and a OSCE examination after the ninth term. The assessment ofthe students in the end of each term is very good.Take-home message: The training in paediatrics in the Medical school of Örebro is formed in three steps in an integrated form.
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| 14. |
- Petersson, Jonathan, et al.
(author)
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Translating Glycated Hemoglobin A1c into Time Spent in Glucose Target Range : a Multicenter Study
- 2019
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In: Pediatric Diabetes. - : Blackwell Publishing. - 1399-543X .- 1399-5448. ; 20:3, s. 339-344
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Journal article (peer-reviewed)abstract
- Background: Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control.Objective: The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c).Subjects and Methods: Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70-140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70-180 mg/dL).Results: During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R 2 = 0.69.Conclusion: This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.
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| 15. |
- Philipsson, Anna, 1978-, et al.
(author)
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”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS
- 2019
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Conference paper (peer-reviewed)abstract
- Bakgrund och syfteFunktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.MetodEn randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.Resultat/(Planerade studier)Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. KonklusionStudien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.
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| 18. |
- Rosengren, Björn, et al.
(author)
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EPA - en modell för att träna och bedöma dagligt läkarjobb : [EPA (Entrustable professional activities) - an international approach to define key tasks that a doctor should be able to perform]
- 2019
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In: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 116:19-20, s. 872-874
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Journal article (peer-reviewed)abstract
- Entrustable Professional Activities (EPAs) define observable key tasks that a doctor should be able to do independently after having completed a certain level of education. Progression is facilitated by frequent assessments of the defined activities, with increased degree of independence. The observations should be supported by constructive feed-forward. EPA is currently used in several countries both in undergraduate and post graduate education. In the context of pending changes in Swedish legislation regarding undergraduate education qualifications ordinance and medical licensing, a Swedish national work group has begun to define Swedish EPA for the future undergraduate education.
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| 19. |
- Rosengren, Björn, et al.
(author)
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Tio »väsentliga aktiviteter« framtagna för läkarprogrammen
- 2019
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In: Läkartidningen. - 0023-7205. ; 47:19
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Journal article (other academic/artistic)abstract
- De 10 EPA som presenteras här (Fakta 1) har tagits fram av läkare och studenter som representerar läkarutbildningarna vid samtliga lärosäten. Utvecklingsarbetet baserades på internationell litteratur och förslagen har genomgått valideringsprocesser [2]. Samtliga avser aktiviteter som ingår i en läkares dagliga arbete och som läkaren ska klara självständigt (i förhållande till handledare) första dagen som legitimerad läkare. Det är samtidigt viktigt att poängtera att de bara täcker in en del av examensmålen för läkare.
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| 23. |
- Särnblad, Stefan, 1963-, et al.
(author)
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Body fat measurement in adolescent girls with type 1 diabetes : a comparison of skinfold equations against dual energy X-ray absorptiometry
- 2016
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In: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 105:10, s. 1211-1215
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Journal article (peer-reviewed)abstract
- Aim: Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual-energy X-ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age-matched controls.Methods: We included 49 healthy girls and 44 girls with diabetes aged 12 to 19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX-L scanner. The agreement between the methods was assessed by using an Bland-Altman plot.Results: The skinfold measurements were significantly higher in girls with diabetes (p=0.003) despite a non-significant difference in total %BF (p=0.1). A significant association between bias and %BF was found for all tested equations in the Bland-Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p=0.039) between the girls with diabetes and the healthy controls.Conclusion: The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criteron. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.
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| 25. |
- Särnblad, Stefan, 1963-, et al.
(author)
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Improved diabetes management in Swedish schools : results from two national surveys
- 2017
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In: Pediatric Diabetes. - Hoboken, USA : Wiley-Blackwell. - 1399-543X .- 1399-5448. ; 8:6, s. 463-469
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Journal article (peer-reviewed)abstract
- Background: Support in diabetes self-care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.Objective: To compare the results of a national survey conducted 2008 and 2015 measuring parents' and diabetes specialist teams' perceptions of support in school.Method: All pediatric diabetes centers in Sweden were invited to participate in the 2015 study. In each center, families with a child being treated for T1DM and attending preschool class or compulsory school were eligible. The parents' and the diabetes teams' opinions were collected in two separate questionnaires.Results: Forty-one out of 42 eligible diabetes centers participated and 568 parents answered the parental questionnaire in 2015. Metabolic control had improved since the 2008 survey (55.2 ± 10.6 mmol/mol, 7.2% ± 1.0%, in 2015 compared with 61.8 ± 12.4 mmol/mol, 7.8% ± 1.1% in 2008). The proportion of children with a designated staff member responsible for supporting the child's self-care increased from 43% to 59%, (P < .01). An action plan to treat hypoglycemia was present for 65% of the children in 2015 compared with 55% in 2008 (P < .01). More parents were satisfied with the support in 2015 (65% compared with 55%, P < .01).Conclusions: This study shows that staff support has increased and that more parents were satisfied with the support for self-care in school in 2015 compared with 2008. More efforts are needed to implement the national legislation to achieve equal support in all Swedish schools.
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| 26. |
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| 27. |
- Särnblad, Stefan, 1963-, et al.
(author)
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Will Early Clinical Training improve the professional skills? : Experience from a New Medical Education in Sweden
- 2018
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Conference paper (peer-reviewed)abstract
- Background: The undergraduate medical education in Sweden is 5½ years long (11 semesters), followed by an 18 months internship before license. The university curriculum used to be 6 theoretical semesters followed by 5 “clinical” semesters. Today it is common with integrated curricula with an early introduction of clinical training.Method: School of Medicine at Örebro University started in January 2011 and now admits 70 students every semester. The first students graduated in June 2016. The educational approach is problem-based learning and the curriculum is integrated with six themes based on physiological processes. Biomedicine, clinical medicine and professional development are integrated throughout the entire programme.Results: In total, clinical placement constitutes 74 weeks of which 16 weeks are spread through the first six semesters. The remaining 58 weeks (semester 7-11) are divided into six longer periods related to the themes. The objective of clinical placement during the first 6 semesters is to practice general clinical skills like communication, history-taking and clinical examination, but also to understand the health care system and the tasks of other health care personnel. The clinical placement in semester 6 ends with a seminar for reflection around the professional development and the value of early clinical placement. The students appreciate the early clinical placements. They manage to acquire general professional skills at this early stage and have the possibility to reflect upon their choice of profession. This stimulates theoretical studies and makes them more comfortable when entering the long clinical placements related to the themes. This is beneficial also for the clinical tutors. The first Örebro students that graduated were satisfied with the preparation given “to work as doctors” and gave the University the highest rank in a national survey.Conclusion: Early clinical training is beneficial for the development of professional skills; it motivates and gives the student an early understanding of their future professional role. A challenge may be to find enough placements and the need for coaching adjusted for different stages of professional development.Take-home message: Early clinical training is beneficial for the development of professional skills.
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