| 1. |
- Ekelöf, Katarina, et al.
(author)
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A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates : a study protocol
- 2022
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In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 22, s. 1-13
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Journal article (peer-reviewed)abstract
- BACKGROUND: An intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice.METHODS: The Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach.DISCUSSION: The SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping.TRIAL REGISTRATION: Clinicaltrials.gov, NCT04070560 . Registered 28 August 2019.
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| 2. |
- Jokinen, Jussi, et al.
(author)
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Suicide attempt and future risk of cancer : a nationwide cohort study in Sweden
- 2015
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In: Cancer Causes and Control. - : Springer Nature. - 0957-5243 .- 1573-7225. ; 44, s. 11-12
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Journal article (peer-reviewed)abstract
- Purpose: Little is known about cancer incidence among patients with a history of suicide attempt. Suicide attempters have lower levels of oxytocin, a hormone related to lactation, stress, social functioning, and well-being, and recent research indicates influence on carcinogenesis. We hypothesized that the low oxytocin levels among suicide attempters results in an increased risk of cancer in general and in organs with oxytocin receptors in particular.Methods: A nationwide cohort study of patients aged 15 years or older with hospitalization for self-inflicted injury or attempted suicide was identified from the Swedish patient register in 1968–2011. The cancer outcomes were identified from the Swedish cancer register. Cancer risk in suicide attempters was compared with the risk in the background population of the corresponding age, sex, and calendar period by calculating standardized incidence ratios (SIRs) with 95 % confidence intervals (95 % CI).Results: The 186,627 patients (83,637 men and 102,990 women) hospitalized for self-inflicted injury or attempted suicide contributed with 2.6 million person-years at risk. The SIR for all cancer was 1.3 (95 % CI 1.27–1.33) in men and 1.25 (1.22–1.28) in women. For cancers in organs rich in oxytocin receptors (uterus, breast, and brain), the corresponding SIRs were 1.02 (0.87–1.19) and 1.13 (1.09–1.17), respectively. There was a particularly increased risk of cancers related to alcohol and tobacco in both sexes.Conclusion: Patients attempting suicide have an increased risk of cancer. However, this increase does not seem to be associated with low oxytocin levels, but rather to exposures like tobacco smoking and alcohol consumption.
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| 3. |
- Lagergren, Katarina, et al.
(author)
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Abdominal fat and male excess of esophageal adenocarcinoma
- 2013
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In: Epidemiology. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 1531-5487.
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Journal article (peer-reviewed)abstract
- The 7-to-1 male-to-female ratio in esophageal and gastroesophageal junctional adenocarcinoma (EAC) might be explained by abdominal adiposity, typical for males. If true, a stronger male predominance in higher BMI categories is expected. We conducted a nationwide Swedish population-based case-control study in 1995-1997 and collected data on BMI and other variables at face-to-face interviews. Age-adjusted relative risk (RR) and 95% confidence intervals (CI) levels were calculated using Poisson regression. Among 451 EAC cases and 820 controls, RR of EAC in males compared to females did not increase with higher BMI as assessed 20 years before interview, at 20 years of age, or at maximum or minimum adult BMI. For BMI 20 years before interview, RR in males compared to females were 7.4 (95%CI:3.9-14.1), 5.3 (95%CI:3.5-8.1), and 5.8 (95%CI:3.9-8.8) in the BMI categories <22, 22-<25, and ≥25, respectively. Conclusions: Abdominal adiposity might not explain the male predominance in esophageal adenocarcinoma.
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| 4. |
- Edfeldt, Katarina, 1979-, et al.
(author)
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Improved health‐related quality of life during peptide receptor radionuclide therapy in patients with neuroendocrine tumours
- 2023
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In: Journal of neuroendocrinology. - : John Wiley & Sons. - 0953-8194 .- 1365-2826. ; 35:10
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Journal article (peer-reviewed)abstract
- Neuroendocrine tumours (NETs) can arise in different locations in the body, and may give rise to hormonal symptoms, which amongst other factors may affect patients' health-related quality of life (HRQoL). Up to four cycles of peptide receptor radionuclide therapy (PRRT) have been shown effective for symptom alleviation and prolonging progression-free survival. The aim of this study was to assess the patient's perspective regarding changes in their HRQoL during PRRT. HRQoL was assessed using the questionnaires for cancer in general, EORTC QLQ-C30, and the gastrointestinal NET-specifically EORTC QLQ-GINET21. Patients with NET (n = 204) rated their HRQoL before PRRT cycles one and four. The medical records of patients were reviewed and their HRQoL was compared to a matched reference population (n = 4910). HRQoL was found to improve during PRRT in aspects of global quality of life; role, social, and emotional functioning, and multiple symptom relief. Potential risk groups for worse HRQoL during PRRT were patients with overweight (BMI >25) who completed four cycles of PRRT and older patients (>65 years old). In conclusion, we found that PRRT improves HRQoL in patients with NETs. The results of this study may be used to improve person-centred care.
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| 5. |
- Lagergren, Fredrika, 1959, et al.
(author)
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Medborgarnas syn på skolans problem och på skolan som en viktig samhällsfråga
- 2024
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In: Andersson, U., Rönnerstrand, B. & Carlander, A. (red). SOM-undersökningen 2023, SOM-rapport nr 83. - Göteborg. - 0284-4788.
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Book chapter (peer-reviewed)abstract
- Vi har studerat medborgarnas syn på skolan och på olika åtgärder att styra skolan. Vid början av 1990-talet menade en liten andel av medborgarna att skolan var den viktigaste frågan i Sverige. Efter skolans avreglering och marknadsstyrning ökade andelen markant för att nå en topp när OECDs presenterade den svenska skolans nedgång genom internationella jämförelser. Våra analyser av den Nationella SOMundersökningen 2023 visade att den stora majoriteten av medborgarna anser att kvaliteten försämrats i svensk skola. Samtidigt menar opinionen i stort att lärarna är välutbildade och en mycket stor andel vill förbjuda företag att driva skolor med vinstsyfte. Utifrån dessa iakttagelser skapade vi en ”karta” över olika positioner i skolfrågor och undersökte hur medborgarna fördelade sig över dessa. Vi fann tydliga samband mellan medborgarnas skilda positioner i skolfrågor och deras politiska preferenser, yrkesverksamhet, och kön. Vilka positioner som får företräde när skolan definieras som problem blir då en viktig samhällsfråga.
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| 6. |
- Lagergren, Katarina, et al.
(author)
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The prevalence of primary ovarian insufficiency in Sweden; a national register study
- 2018
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In: BMC Women's Health. - : BMC. - 1472-6874. ; 18
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Journal article (peer-reviewed)abstract
- BackgroundThe current estimates of the prevalence of primary ovarian insufficiency (POI) are very variable, but are in most studies believed to be around 1%. It is also very likely tat the prevalence of POI differs between countries and over time. We therefore aimed to assess the prevalence of primary ovarian insufficiency in Sweden.MethodsAll 1,036,918 women born between 1973 and 1993 in Sweden were included. The prevalence of POI was based on data from the Swedish Patient Register through the diagnosis code or through the Prescribed Drug Register. The number of women below 40years of age diagnosed with the ICD-10 diagnoses E28.3 or E89.4, and women who had been dispensed drugs for treatment of climacteric symptoms were included.ResultsOut of the 1,036,918 women, 19,253 (1.9%) had POI. The prevalence of spontaneous POI was 1.7% and the prevalence of iatrogenic POI was 0.2%. Most women (98.8%) with POI were identified from the Prescribed Drug Register; only 4.1% were found in the Patient Register, whereas 2.9% were identified in both registers.ConclusionsThe total prevalence of POI was 1.9%, 95% CI: 1.7-2.1, indicating a higher prevalence than often previously reported.
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| 7. |
- Lindblad, Sverker, 1946, et al.
(author)
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Medborgarna om styrningen av den svenska skolan: Stat, marknad eller profession?
- 2022
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In: U. Andersson, H. Oscarsson, B. Rönnerstrand & N. Theorin (red.) Du sköra nya värld: SOM-undersökningen 2021, SOM-rapport nr 81. - Göteborg : Göteborgs Universitet: SOM-institutet. - 0284-4788. - 9789189673526 ; , s. 135-148
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Book chapter (peer-reviewed)abstract
- I den här studien undersöks medborgarnas inställning till olika skolfrågor mot bakgrund av den förändring av skolans styrning i riktning mot avreglering, decentralisering och marknadsstyrning som skett sedan 1990-talet. Data hämtas huvudsakligen från den nationella SOM-undersökningen 2021 som jämförs med uppgifter från tidigare undersökningar. Resultaten pekar på en hög tillit till svensk skola och lärares utbildning men också att en stor andel menar att kvaliteten hos svensk skola försämrats under senare år. Studien pekar vidare på en majoritet för ökad statlig styrning av skolan och för förbud att låta privata vinstintressen styra skolan. Dessa resultat analyseras som preferenser för olika sätt att styra skolan som institution bland medborgarna. De grupperingar som erhålls undersöks därefter närmare utifrån ålder, position i arbetslivet, partipolitiska sympatier och kön. Avslutningsvis förs ett resonemang om opinionens inställning till de styrmodeller som utvecklats inom skolväsendet i Sverige.
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| 8. |
- Patriksson, Katarina, et al.
(author)
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Midwives' Experiences of Intact Cord Resuscitation in Nonvigorous Neonates After Vaginal Birth in Sweden
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In: JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing. - 0884-2175.
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe midwives' experiences of intact cord resuscitation close to the mother for nonvigorous neonates after vaginal birth.DESIGN: Descriptive qualitative.SETTING: Four labor wards in Sweden.PARTICIPANTS: Midwives (N = 13) currently or previously employed in labor wards where the Sustained Cord Circulation and Ventilation (SAVE) study was conducted.METHODS: We analyzed semistructured interviews using reflexive thematic analysis.RESULTS: Participants' experiences are presented in an overarching theme: Midwives balance knowledge with doing the right thing in a challenging work environment during intact cord resuscitation. Three primary themes emerged: A New Workflow, Zero Separation: The Big Advantage, and The Midwife: Guardian of Childbirth.CONCLUSION: The participants were keen to keep the umbilical cord intact even for nonvigorous neonates. They wanted to work with the neonate close to the mother to facilitate zero separation and family participation. Ventilation with an intact umbilical cord was considered a routine to be implemented in the future, but the participants identified certain difficulties with the design of the SAVE study.
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| 9. |
- Patriksson, Katarina, et al.
(author)
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Neonatal healthcare professionals’ experiences of intact cord resuscitation in the mother´s bed : an interview study
- 2024
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In: BMC Pregnancy and Childbirth. - : Springer Science+Business Media B.V.. - 1471-2393. ; 24:1
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Journal article (peer-reviewed)abstract
- Background Intact cord resuscitation in the frst three minutes of life improves oxygenation and Apgar scores. Thepractise of intact cord resuscitation implies the umbilical cord still being connected to the placenta for at least oneminute while providing temperature control and equipment for resuscitation. Healthcare professionals describedpractical challenges in providing intact cord resuscitation. This study aimed to explore neonatal healthcare profession‑als’ experiences of providing intact cord resuscitation in the mother’s bed.Method An interview study with an inductive, interpretative approach was chosen and analysed according to refex‑ive thematic analysis by Braun & Clarke. An open interview guide was used and 20 individual interviews with neonatalhealthcare professionals were performed. The study was conducted at fve level I-III neonatal care units. In Sweden,resuscitation is performed either in or outside the labour room.Results The results contributed insight into the participants’ experiences of prerequisites for providing neonatal carein intact cord resuscitation. The sense of the mother’s vulnerability was noticeable, as the participants reported reduc‑ing the risk of exposure to protect and preserve the mother’s integrity. The practical challenges in the environmentinvolved working in a limited space. The desire for multi-professional team training comprised education and trainingas well as debriefng to manage intact cord resuscitation.Conclusion The result of the present study highlights the fact that neonatal healthcare professionals’ experiencesof providing ICR in the mother’s bed were positive and had signifcant benefts for the neonate, namely zero sepa‑ration between the neonate and parents and better physical recovery for the neonate. However, the fact that ICRin the mother’s bed can be challenging in several ways, such as emotionally, managing environmental circumstancesand ensuring efective team collaboration. Therefore, it is of the utmost importance that healthcare professionals aregiven the opportunity to refect and train together as a team. Future recommendations are to summarize evidencebased knowledge to design guidelines for ICR situation.
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