| 1. |
- Amer-Wåhlin, Isis, et al.
(författare)
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Cardiotocography only versus cardiotocography plus ST analysis of fetal electrocardiogram for intrapartum fetal monitoring: a Swedish randomised controlled trial
- 2001
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Ingår i: The Lancet. - 1474-547X. ; 358:9281, s. 534-538
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Previous studies indicate that analysis of the ST waveform of the fetal electrocardiogram provides information on the fetal response to hypoxia. We did a multicentre randomised controlled trial to test the hypothesis that intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis results in an improved perinatal outcome compared with cardiotocography alone. METHODS: At three Swedish labour wards, 4966 women with term fetuses in the cephalic presentation entered the trial during labour after a clinical decision had been made to apply a fetal scalp electrode for internal cardiotocography. They were randomly assigned monitoring with cardiotocography plus ST analysis (CTG+ST group) or cardiotocography only (CTG group). The main outcome measure was rate of umbilical-artery metabolic acidosis (pH <7.05 and base deficit >12 mmol/L). Secondary outcomes included operative delivery for fetal distress. Results were first analysed according to intention to treat, and secondly after exclusion of cases with severe malformations or with inadequate monitoring. FINDINGS: The CTG+ST group showed significantly lower rates of umbilical-artery metabolic acidosis than the cardiotocography group (15 of 2159 [0.7%] vs 31 of 2079 [2%], relative risk 0.47 [95% CI 0.25-0.86], p=0.02) and of operative delivery for fetal distress (193 of 2519 [8%] vs 227 of 2447 [9%], 0.83 [0.69-0.99], p=0.047) when all cases were included according to intention to treat. The differences were more pronounced after exclusion of 291 in the CTG+ST group and 283 in the CTG group with malformations or inadequate recording. INTERPRETATION: Intrapartum monitoring with cardiotocography combined with automatic ST-waveform analysis increases the ability of obstetricians to identify fetal hypoxia and to intervene more appropriately, resulting in an improved perinatal outcome.
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| 2. |
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| 3. |
- Noren, Håkan, 1948, et al.
(författare)
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STAN in clinical practice--the outcome of 2 years of regular use in the city of Gothenburg
- 2006
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Ingår i: Am J Obstet Gynecol. ; 195:1, s. 7-15
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The purpose of this study was to monitor the introduction of the STAN-methodology (Noventa Medical, Moelndal, Sweden). STUDY DESIGN: This was a prospective observational study covering the total population of deliveries at term during 2 years. Four thousand eight hundred and thirty out of 14,687 term pregnancies were monitored using the STAN S 21 fetal heart monitor and the associated clinical guidelines. Cord artery metabolic acidosis, neonatal outcome, and rates of operative deliveries for fetal distress were assessed. RESULTS: The annual rate of STAN usage increased from 28.1% to 37.7% and was associated with a significant reduction in metabolic acidosis rate in the total population from 0.76% to 0.44% (P < .05). The compliance with the clinical guidelines increased in cases requiring intervention. The rates for moderate/severe hypoxic neonatal encephalopathy were consistently low, 0.55 and 0.68 per 1000 deliveries, respectively, and corresponding to previous findings. The rate of operative delivery did not change during the 2 years in the total population. CONCLUSION: Increasing STAN usage provided consistent improvements in fetal outcome equalling those noted in the Swedish randomized controlled trial (RCT) without increasing operative interventions for fetal distress.
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| 4. |
- Thorek, D L J, et al.
(författare)
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Prostate-specific kallikrein-related peptidases and their relation to prostate cancer biology and detection. Established relevance and emerging roles.
- 2013
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Ingår i: Thrombosis and haemostasis. - 0340-6245. ; 110:3, s. 484-92
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Tidskriftsartikel (refereegranskat)abstract
- Kallikreins are a family of serine proteases with a range of tissue-specific and essential proteolytic functions. Among the best studied are the prostate tissue-specific KLK2 and KLK3 genes and their secreted protease products, human kallikrein 2, hk2, and prostate-specific antigen (PSA). Members of the so-called classic kallikreins, these highly active trypsin-like serine proteases play established roles in human reproduction. Both hK2 and PSA expression is regulated by the androgen receptor which has a fundamental role in prostate tissue development and progression of disease. This feature, combined with the ability to sensitively detect different forms of these proteins in blood and biopsies, result in a crucially important biomarker for the presence and recurrence of cancer. Emerging evidence has begun to suggest a role for these kallikreins in critical vascular events. This review discusses the established and developing biological roles of hK2 and PSA, as well as the historical and advanced use of their detection to accurately and non-invasively detect and guide treatment of prostatic disease.
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| 5. |
- Örlefors, Håkan, et al.
(författare)
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Positron emission tomography with 5-hydroxytryprophan in neuroendocrine tumors
- 1998
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Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 16:7, s. 2534-2541
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Carcinoid tumors, especially those of midgut origin, produce serotonin via the precursors tryptophan and 5-hydroxytryptophan (5-HTP). We have evaluated the usefulness of positron emission tomography (PET) with carbon-11-labeled 5-HTP in the diagnosis and treatment follow-up evaluation of patients with neuroendocrine tumors. PATIENTS AND METHODS: PET using 11C-labeled 5-HTP was compared with computed tomography (CT) in 18 patients (14 midgut, one foregut, one hindgut carcinoid, and two endocrine pancreatic tumors [EPT]). In addition, 10 of 18 patients were monitored with PET examinations during treatment. RESULTS: All 18 patients, including two with normal urinary 5-hydroxyindole acetic acid (U-5-HIAA), had increased uptake of 11C-labeled 5-HTP in tumorous tissue as compared with normal tissue. Liver metastases, as well as lymph node, pleural, and skeletal metastases, showed enhanced 5-HTP uptake and PET could detect more lesions than CT in 10 patients and equal numbers in the others. Tumor visibility was better for PET than for CT due to the high and selective uptake of 5-HTP with a high tumor-to-background ratio. Binding studies indicated an irreversible trapping of 5-HTP in the tumors. Linear regression analyses showed a clear correlation (r = .907) between changes in U-5-HIAA and changes in the transport rate constant for 5-HTP during treatment. CONCLUSION: PET with 11C-labeled 5-HTP demonstrated high uptake in neuroendocrine gastrointestinal tumors and thereby allowed improved visualization compared with CT. The in vivo data on regional tumor metabolism, as expressed in 11C-5-HTP uptake and transport rate, provided additional information over conventional radiologic techniques. The close correlation between the changes in 11C-5-HTP transport rate and U-HIAA during medical treatment indicates the potential of 11C-5-HTP-PET as a means to monitor therapy.
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| 6. |
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| 7. |
- Abrahamsson, Per-Anders, et al.
(författare)
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Radioimmunoassay of beta-microseminoprotein, a prostatic-secreted protein present in sera of both men and women
- 1989
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Ingår i: Clinical Chemistry. - 0009-9147. ; 35:7, s. 1497-1503
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Tidskriftsartikel (refereegranskat)abstract
- We describe a simple radioimmunoassay of beta-microseminoprotein, one of the three most abundant secretory proteins of the prostate gland. The detection limit of the assay is 1 microgram/L, and its precision, expressed as the total coefficient of variation, is less than 10% for values between 10 and 150 micrograms/L. Using this assay, we found that beta-microseminoprotein immunoreactivity was present in sera from both sexes at about the same concentration. The protein detected had the same molecular size on gel chromatography as the protein isolated from seminal plasma, and dilution curves for the sera paralleled that for the pure protein. The findings suggest that beta-microseminoprotein is present in serum of healthy subjects of both sexes and that it originates in tissue other than the prostate gland. The range of the serum concentration was 0-10.6 micrograms/L (median 4.1) for 51 healthy adult women and 1.1-14.7 micrograms/L (median 6.2) for 35 healthy adult men not older than 40 years. In males with prostatic cancer the concentration in serum was highly variable and often greatly increased. The concentration of beta-microseminoprotein was correlated with that of creatinine in serum, suggesting that the protein is eliminated--at least partly--from the circulation by glomerular filtration. Little of the protein was present in the urine of women. In urine from men the concentration was high and variable, probably because of local contribution from the prostate gland to the urethral urine.
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| 8. |
- Aladdin Haglund, Berit, et al.
(författare)
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Unexpected out-of-hospital deliveries--experiences from the Gothenburg area. Centralized obstetrical care requires competent ambulance staff
- 2004
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Ingår i: Lakartidningen. ; 101:41, s. 3148-50
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Tidskriftsartikel (refereegranskat)abstract
- One hundred and sixty-seven women gave birth before arrival at the hospital during a six-year period in the Goteborg area. Most of these women had given birth before. The actual delivery most often started at term during the night, proceeded normally but rapidly and the neonatal outcome was good. Sixty-two per cent of the women delivered at home. Complicated lacerations or major hemorrhages were uncommon. The distance to the delivery ward was one of the risk factors for prehospital delivery. This is important to take into consideration in the ongoing process of centralizing the delivery clinics. Basic knowledge in obstetrics is mandatory for the ambulance personnel, as well as regular observation visits to the delivery ward and practice in birth simulators.
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| 9. |
- Andersson, Lena, et al.
(författare)
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Quartz and dust exposure in Swedish iron foundries
- 2009
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Ingår i: Journal of Occupational and Environmental Hygiene. - Philadelphia, PA : Taylor & Francis. - 1545-9624 .- 1545-9632. ; 6:1, s. 9-18
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Tidskriftsartikel (refereegranskat)abstract
- Exposure to respirable quartz continues to be a major concern in the Swedish iron foundry industry. Recommendations for reducing the European occupational exposure limit (EU-OEL) to 0.05 mg/m3 and the corresponding ACGIH® threshold limit value (ACGIH-TLV) to 0.025 mg/m3 prompted this exposure survey. Occupational exposure to respirable dust and respirable quartz were determined in 11 Swedish iron foundries, representing different sizes of industrial operation and different manufacturing techniques. In total, 436 respirable dust and 435 respirable quartz exposure measurements associated with all job titles were carried out and are presented as time-weighted averages. Our sampling strategy enabled us to evaluate the use of respirators in certain jobs, thus determining actual exposure. In addition, measurements using real-time dust monitors were made for high exposure jobs. For respirable quartz, 23% of all the measurements exceeded the EU-OEL, and 56% exceeded the ACGIH-TLV. The overall geometric mean (GM) for the quartz levels was 0.028 mg/m3, ranging from 0.003 to 2.1 mg/m3. Fettler and furnace and ladle repair operatives were exposed to the highest levels of both respirable dust (GM = 0.69 and 1.2 mg/m3; range 0.076-31 and 0.25-9.3 mg/m3 and respirable quartz (GM = 0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3. Fettlers often used respirators and their actual quartz exposure was lower (range 0.003-0.21 mg/m3, but in some cases it still exceeded the Swedish OEL (0.1 mg/m3. For furnace and ladle repair operatives, the actual quartz exposure did not exceed the OEL (range 0.003-0.08 mg/m3, but most respirators provided insufficient protection, i.e., factors less than 200. In summary, measurements in Swedish iron foundries revealed high exposures to respirable quartz, in particular for fettlers and furnace and ladle repair workers. The suggested EU-OEL and the ACGIH-TLV were exceeded in, respectively, 23% and 56% of all measurements regardless of the type of foundry. Further work on elimination techniques to reduce quartz concentrations, along with control of personal protection equipment, is essential.
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| 10. |
- Assel, Melissa, et al.
(författare)
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A Four-kallikrein Panel and β-Microseminoprotein in Predicting High-grade Prostate Cancer on Biopsy : An Independent Replication from the Finnish Section of the European Randomized Study of Screening for Prostate Cancer
- 2019
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Ingår i: European Urology Focus. - : Elsevier BV. - 2405-4569. ; 5:4, s. 561-567
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Tidskriftsartikel (refereegranskat)abstract
- Background: A panel of four kallikrein markers (total, free, and intact prostate-specific antigen [PSA] and human kallikrein-related peptidase 2 [hK2]) improves predictive accuracy for Gleason score ≥7 (high-grade) prostate cancer among men biopsied for elevated PSA. A four-kallikrein panel model was originally developed and validated by the Dutch center of the European Randomized Study of Screening for Prostate Cancer (ERSPC). The kallikrein panel is now commercially available as 4Kscore™. Objective: To assess whether these findings could be replicated among participants in the Finnish section of ERSPC (FinRSPC) and whether β-microseminoprotein (MSP), a candidate prostate cancer biomarker, adds predictive value. Design, setting, and participants: Among 4861 biopsied screening-positive participants in the first three screening rounds of FinRSPC, a case-control subset was selected that included 1632 biopsy-positive cases matched by age at biopsy to biopsy-negative controls. Outcome measurements and statistical analysis: The predictive accuracy of prespecified prediction models was compared with biopsy outcomes. Results and limitations: Among men with PSA of 4.0-25. ng/ml, 1111 had prostate cancer, 318 of whom had high-grade disease. Total PSA and age predicted high-grade cancer with an area under the curve of 0.648 (95% confidence interval [CI] 0.614-0.681) and the four-kallikrein panel increased discrimination to 0.746 (95% CI 0.717-0.774). Adding MSP to the four-kallikrein panel led to a significant (Wald test; p = 0.015) but small increase (0.003) in discrimination. Limitations include a risk of verification bias among men with PSA of 3.0-3.99. ng/ml and the absence of digital rectal examination results. Conclusions: These findings provide additional evidence that kallikrein markers can be used to inform biopsy decision-making. Further studies are needed to define the role of MSP. Patient summary: Four kallikrein markers and β-microseminoprotein in blood improve discrimination of high-grade prostate cancer at biopsy in men with elevated prostate-specific antigen. Four kallikrein markers and β-microseminoprotein (MSP) in blood improve discrimination of high-grade cancer at biopsy in men with elevated prostate-specific antigen. These kallikrein markers can be used to inform biopsy decision-making. Further studies are needed to define the role of MSP.
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| 11. |
- Bergqvist, Liselotte, et al.
(författare)
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Labor augmentation by means of oxytocin – women's experiences
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study labor experiences in women exposed to oxytocin treatment vs no or delayed treatment of spontaneous, but prolonged labor in nulliparos women. Study design A randomised controlled study. If labor was prolonged during the active phase with no further opening of the cervix for two hours, the subject were randomly allocated to either labor augmentation by means of oxytocin (SG) or expectancy (EG). 461 women filled out a questionnaire including the following items: level of sense of security, pain, sense of control, experience of their own role in labor, and satisfaction with healthcare. Results The oxytocin-treated women's labor experiences did not differ in secondary inertia as compared with the women who chose to delay oxytocin treatment for three hours. The number of women who experienced a labor that met with their expectations was significantly higher in the oxytocin group than in the delay group. Both groups had a high level of lasting memories from their labor experience that resulted in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%), with no significant difference between the two groups. Conclusion Although the labor experiences of both groups were equivalent, the women of the oxytocin group felt that their labor process had proceeded as expected to a higher degree than the women who postponed oxytocin treatment for three hours. Hence, this study does not support the assertion that there would be a difference in labor experience if oxytocin stimulation is postponed. Many patients with inertia have lasting memories from the labor process which result in a state of depression or low-spiritedness one month postpartum, SG (41%) and EG (35%). Questionnaires filled out from women without inertia showed that the group giving spontaneous birth withouth any intravenous drip the proportion for depression was 12%.
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| 12. |
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| 13. |
- Björk, Thomas, et al.
(författare)
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Comparison of analysis of the different prostate-specific antigen forms in serum for detection of clinically localized prostate cancer
- 1996
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Ingår i: Urology. - 1527-9995. ; 48:6, s. 882-888
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare different forms and ratios of serum prostate-specific antigen (PSA) to determine which form or ratio provides optimal diagnostic specificity and sensitivity in distinguishing between benign prostatic hyperplasia (BPH) and clinically localized prostate cancer. METHODS: Serum samples were obtained from 47 patients with BPH and 39 with clinically localized prostate cancer. Patients with BPH underwent either transurethral resection of the prostate or transurethral microwave thermotherapy. Patients with prostate cancer, all of whom had no metastases on radionucleotide bone scans and no pelvic lymph node involvement, underwent either radical external beam radiation therapy or radical retropubic prostatectomy. All patients had pretreatment serum PSA levels between 1 and 20 ng/mL. The different forms of serum PSA (free PSA [PSA-F], PSA complexed to alpha 1-antichymotrypsin [PSA-ACT], and total PSA [PSA-T]) were measured using different monoclonal antibodies against PSA and ACT and immunofluorometric assay techniques. Furthermore, three ratios (PSA-F/PSA-T, PSA-ACT/PSA-T, and PSA-F/PSA-ACT) were calculated. RESULTS: By receiver operating characteristic curve analysis, the performance of the different forms and ratios were compared. The PSA-F/PSA-T ratio had the greatest area under the curve (AUC, 0.776), significantly larger than that for PSA-T (0.612; P = 0.024). For PSA-ACT/PSA-T, the AUC was 0.695 (P = 0.283 versus PSA-T) and 0.773 for PSA-F/PSA-ACT (P = 0.051 versus PSA-T). At a cutoff level < 0.17, PSA-F/PSA-T had a sensitivity of 79%, a specificity of 66%, and a positive predictive value of 66% compared with 74%, 38%, and 50%, respectively, for PSA-T at a cutoff level > 4.0 ng/mL. CONCLUSIONS: The PSA-F/PSA-T ratio gives the best diagnostic performance compared with that for other forms and ratios of PSA and will reduce the number of prostatic biopsies in patients with BPH.
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| 14. |
- Bullarbo, Maria, 1958, et al.
(författare)
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Nitroglycerin for management of retained placenta: a multicenter study.
- 2012
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Ingår i: Obstetrics and gynecology international. - : Hindawi Limited. - 1687-9597 .- 1687-9589. ; 2012
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim was to determine if sequential administration of oxytocin and nitroglycerin is effective for management of retained placenta when performed by obstetricians with no experience of the method. Secondary aims were to examine possible adverse effects of nitroglycerin. One hundred and five women with retained placenta were randomly selected to receive either 1mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin had failed to expel the placenta. At two of the hospitals some of the midwives were familiar with the use of nitroglycerin. The other midwives and all the participating obstetricians had no clinical experience of the method. In the treatment group, detachment of placenta following nitroglycerin occurred in 37.3% of the women compared to 20.4% in the placebo group (P = 0.056). In the two hospitals with some experience of the method, placenta was removed in 9 of 19 (47.4%) women in the nitroglycerin group compared to 3 of 17 (15.0%) women in the placebo group. No adverse effects of clinical importance were registered. Although the difference between the two groups did not reach statistical significance, the higher success rate in the two hospitals with some experience could indicate that clinical experience is of importance in order to achieve placental detachment.
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| 15. |
- Cronberg, Tobias, et al.
(författare)
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Long-term neurological outcome after cardiac arrest and therapeutic hypothermia.
- 2009
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Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 80, s. 1119-1123
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Tidskriftsartikel (refereegranskat)abstract
- AIM OF THE STUDY: To analyse the neurological status of survivors after cardiac arrest (CA) treated with hypothermia. METHODS: We prospectively included all patients with CA treated with hypothermia at intensive care units (ICU) in two university hospitals and one regional hospital. All adult survivors at 6 months after CA, n=48, were invited for neurological follow-up and 43 accepted. History, clinical status, ability testing and questionnaires were administered to screen for difficulties, including Assessment of Motor and Process Skills, Neurobehavioral Cognitive Status Examination, Frontal Lobe Assessment Battery, EQ-VAS quality of life scale, Skåne Sleep Index, Hospital Anxiety and Depression Rating Scale, Self-reported Montgomery and Astrand Depression Rating Scale, Global Deterioration Scale, Rivermead Behavioural Memory Test, and the Cerebral Performance Categories (CPC). RESULTS: No patient was found to be in a chronic vegetative state and all patients were living at home, one with extensive help. Thirty-six patients were in CPC1 at follow-up, and some degree of neurological sequelae was found in 40 patients, but was mild in all but 3. Three patients had no subjective complaints, nor could any deficits be detected. Initial defects improved over-time. Short-term memory loss, executive frontal lobe dysfunction along with mild depression and sleep rhythm disturbances were the most common findings. CONCLUSIONS: Mild cognitive impairment is common following hypothermia-treated cardiac arrest but has little effect on activities of daily living or quality of life.
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| 16. |
- Dencker, Anna, 1956, et al.
(författare)
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A randomized trial of labor augmentation by oxytocin vs delayed oxytocin treatment or no oxytocin in nulliparous women with spontaneous contractions
- 2005
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Ingår i: American Journal of Obstetrics and Gynecology. ; 193:6
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Objective To study the effects of oxytocin treatment vs. no or delayed oxytocin treatment on the obstetrical and neonatal outcome of spontaneous but prolonged labor in nulliparous women. Study design A randomized controlled study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. If labor was prolonged during the active phase with no further opening of the cervix or descent of the head for two hours the women were randomly allocated to either labor augmentation by oxytocin infusion (standard care group= SG) or to expectancy (Expectant care group=EG) and observed for another 3 hours. If the women in the EG after the 3 hours still do not progress in their labor, a reassessment regarding the need for labor augmentation was done. Results Totally 516 women participated in the study, 276 in the SG and 241 in the EG. All 241 women in the SG received oxytocin vs 211 (87.6%) in the EG (p<0,001). There were no differences in gestational age between the groups. Mean gestational age was 40 weeks in both groups. There were no difference in cervical dilatation at randomization, cx dilatation in centimeters was 5,7 (SD1,5) in the SG vs 5,5 (SD 1,3), p= 0.17 in the EG. The time from randomization to delivery differed, 332 (SD=211) minutes in the SG vs 457 (SD=238) minutes in the EG (p <.0001). There was no differences in mode of delivery, Caesarean sectio 23 (8,3%) in the SG vs 21 (8,7%) in the EG, (p=0.9), operative vaginal delivery 44 (15,9%) SG vs 25 (10,4%) EG p=0.07, Spontaneous vaginal delivery 209 (75,7%) SG vs 195 (80,9%) EG p=0.2,. Usage of epidural anesthesia was 29 (10,5%) SG vs 39 (16,2%) EG p=0.07. Apgar score below 7 after 5 minutes was found in 5 (1.8%) in SG vs 9 (3.7%) in EG. Conclusion In nulliparous women at term with spontaneous contractions a policy of delaying the initiation of oxytocininfusion in prolonged active phase for 180 minutes resulted in no difference in mode of delivery, usage of epidural anesthesia or neonates with apgar score below 7 at 5 minutes. The time from randomization to delivery differed by 125 minutes.
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| 17. |
- Dencker, Anna, 1956, et al.
(författare)
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Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument.
- 2010
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Ingår i: BMC pregnancy and childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 10:81
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative experiences of first childbirth increase risks for maternal postpartum depression and may negatively affect mothers' attitudes toward future pregnancies and choice of delivery method. Postpartum questionnaires assessing mothers' childbirth experiences are needed to aid in identifying mothers in need of support and counselling and in isolating areas of labour and birth management and care potentially in need of improvement. The aim of this study was to develop and evaluate a questionnaire for assessing different aspects of first-time mothers' childbirth experiences. Methods: Childbirth domains were derived from literature searches, discussions with experienced midwives and interviews with first-time mothers. A draft version of the Childbirth Experience Questionnaire (CEQ) was pilot tested for face validity among 25 primiparous women. The revised questionnaire was mailed one month postpartum to 1177 primiparous women with a normal pregnancy and spontaneous onset of active labor and 920 returned evaluable questionnaires. Exploratory factor analysis using principal components analysis and promax rotation was performed to identify dimensions of the childbirth experience. Multitrait scaling analysis was performed to test scaling assumptions and reliability of scales. Discriminant validity was assessed by comparing scores from subgroups known to differ in childbirth experiences. Results: Factor analysis of the 22 item questionnaire yielded four factors accounting for 54% of the variance. The dimensions were labelled Own capacity, Professional support, Perceived safety, and Participation. Multitrait scaling analysis confirmed the fit of the four-dimensional model and scaling success was achieved in all four sub-scales. The questionnaire showed good sensitivity with dimensions discriminating well between groups hypothesized to differ in experience of childbirth. Conclusion: The CEQ measures important dimensions of the first childbirth experience and may be used to measure different aspects of maternal satisfaction with labour and birth.
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| 18. |
- Dencker, Anna, 1956, et al.
(författare)
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Deficiency in rest and nutrition increase the risk for prolonged labor in nulliparous women
- 2007
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Ingår i: American Journal of Obstetrics and Gynecology. ; 195:6
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Konferensbidrag (refereegranskat)abstract
- Objective To identify factors that may influence the labor progress in nulliparous women with spontaneous contractions. Study design A prospective study of healthy nulliparous women at term with normal pregnancies and spontaneous labor. At inclusion the women were asked to measure levels of pain and sense of security on a Visual Analogue Scale and asked to report amount of rest/sleep and intake of food during the last 24 hours before onset of active labor. The progress of labor was followed every 2-3 hours and new VAS-measurements were made postpartum. Prolonged labor was defined as no further opening of the cervix for two hours after amniotomy or rupture of the membranes in the first stage of labor. Results After informed consent 2,086 nulliparous women in active labor with spontaneous contractions were included in the study. Prolonged labor was defined in 29% of the women (n=614). The women who developed a prolonged labor reported fewer hours of rest/sleep (p<0.0001) and a lower intake of food (p<0.0001) during the last 24 hours than the women with normal progress in the first stage of labor. At inclusion the women with normal progress measured higher levels of labor pain (p=0.002) together with more frequent contractions (p<0.0001) at onset of active labor. Cesarean section was more often performed among the women with prolonged labor, 11.7% versus 1,3% (p<0.0001). Postpartum the women with prolonged labor measured lower levels of experienced sense of security during the delivery (p=0.0009). There was no difference in mean of experienced labor pain between the groups postpartum. Conclusion Low intake of food and few hours of rest can contribute to prolonged labor among low risk nulliparous women with spontaneous contractions.
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| 19. |
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| 20. |
- Dencker, Anna, 1956, et al.
(författare)
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Identification of latent phase factors associated with active labor duration in low-risk nulliparous women with spontaneous contractions
- 2010
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - 0001-6349. ; 89:8, s. 1034-1039
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this prospective study was to identify latent phase predictors of active labor duration. Design. Prospective clinical study. Setting. Two delivery units in Sweden. Sample. Healthy nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 cm or more on admission to the delivery ward (n = 2,072). Methods. The women were asked to answer questions concerning their food and fluid intake, amount of rest and sleep during the preceding 24 hours and to assess their labor pain, sense of security and expectations of the childbirth on a visual analog scale (VAS). Duration and intervals of contractions, cervical dilatation, and position of the fetal head were noted by the midwife. A multiple regression analysis was performed with active labor duration as the outcome variable. Main outcome measure. Predictive factors of active labor duration. Results. Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within 2 hours of admission, high maternal age and malposition of the fetal head were controlled for. Conclusion. New findings are that latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of labor duration. Read More: http://informahealthcare.com/doi/abs/10.3109/00016349.2010.499446
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| 21. |
- Dencker, Anna, 1956, et al.
(författare)
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Predictive factors related to labour duration in healthy nulliparous women with spontaneous onset of active labour - a prospective study
- 2011
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Ingår i: ICM 29th Triennial Congress i Durban, Sydafrika 19 - 23 Juni 2011.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Slow progress in labour is a major problem among nulliparous women as it is one of the main indications for emergency caesarean deliveries and related to several other adverse maternal and neonatal outcomes. Aim: To identify predictive factors of labour duration in healthy nulliparous women. Setting: Two delivery units in Sweden, between October 1998 and December 2003. Participants: Healthy nulliparous women (n=2.072) with a normal pregnancy, spontaneous onset of active labour at term and a cervical dilatation of 4 – 9 centimetres at admission to the delivery ward. All gave informed consent. Methods: At admission to the delivery ward the women were asked to answer questions concerning food and fluid intake, amount of rest/sleep the last 24 hours and to assess labour pain. Contractions, cervical dilation and the number and timing of interventions as epidural analgesia and oxytocin augmentation were noted by the midwife during childbirth. Key findings: Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within two hours of admission, high maternal age and malposition of the fetal head were controlled for. Amniotomy decreased and epidural analgesia increased labour duration. Use of oxytocin augmentation had most influence on decreased labour duration. Clinical implications: More attention should be devoted to latent phase factors in clinical practice and counseling to women who are about to give birth should include information about the benefits of food intake and rest during the latent phase.
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| 22. |
- Ekberg, Olle, et al.
(författare)
-
Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility
- 1995
-
Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 44-48
-
Tidskriftsartikel (refereegranskat)abstract
- The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.
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| 23. |
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| 24. |
- Eriksson, Barbro, et al.
(författare)
-
Positron emission tomography (PET) in neuroendocrine gastrointestinal tumors
- 1993
-
Ingår i: Acta Oncologica. - 0284-186X .- 1651-226X. ; 32:2, s. 189-196
-
Tidskriftsartikel (refereegranskat)abstract
- Positron emission tomography (PET) makes it possible to study effects of medical treatment in vivo. Carcinoid tumors with liver metastases, especially those of midgut origin, produce serotonin via the precursors tryptophan and 5-hydroxytryptophan (5-HTP) and this overproduction contributes to the clinical symptoms of the carcinoid syndrome. Seven patients with histopathologically verified neuroendocrine tumors and liver metastases, five of whom with ileal carcinoids, one a lung carcinoid and one an endocrine pancreatic tumor, were included in the study. All patients had elevation of urinary 5-HIAA with the exception of one patient with a solitary liver metastasis of midgut origin. After an intravenous injection of 11C-5-HTP, PET was performed and the uptake of radioactivity in tumor tissue, normal liver and plasma were compared. All patients with elevated urinary 5-HIAA and also the patient with a solitary liver metastasis and normal urinary 5-HIAA had high accumulation and signs of a high rate of binding of 5-HTP in the liver metastases. The uptake was relatively homogeneous in midgut carcinoid liver metastases but in large necrotic metastases the radioactivity was localized to the periphery. In three patients PET examination was repeated after 3 months of interferon treatment and in agreement with circulating tumor markers and ultrasonography the uptake of 5-HTP was unchanged. Another patient who received the somatostatin analog somatuline progressed on treatment and accordingly the uptake of 5-HTP also increased. The experience with PET in neuroendocrine gastrointestinal tumors is very limited. Our results so far indicate that 5-HTP can be used to visualize serotonin-producing neuroendocrine tumors and furthermore it might prove to be of value to monitor the effects of treatment, possibly also as an early predictive test of the outcome of treatment.
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| 25. |
- Fagevik Olsén, Monika, 1964, et al.
(författare)
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A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions
- 2007
-
Ingår i: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 86:3, s. 310-4
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Breast-feeding in the postpartum period is known to induce intense uterine contractions with pain in the lower abdomen. AIMS: The primary aim of this study was to compare the effects of high and low intensity, high frequency Transcutaneous Electric Nerve Stimulation (TENS) on pain and discomfort of postpartum uterine contractions. The secondary aim was to evaluate discomfort experienced from the stimulation itself. METHODS: Twenty-one newly delivered women participated in this single-blind trial, 12 women received high intensity, high-frequency TENS (HI TENS) and 9 women received low intensity, high-frequency TENS (LI TENS). The electrodes were placed abdominally on each side of the uterus. Stimulation was done during one minute. Visual analogue scales were used to evaluate the intensity of the pain before and after stimulation. A verbal scale was used to estimate sensation of discomfort before, during and after stimulation. RESULTS: The median decrease in pain ratings before and after treatment by VAS was larger in the HI TENS group -49 mm (95% CI -66.5--33.2) than in the LI TENS group -21 mm (95% CI -39.0--20.0). The reduction of pain was most pronounced in the HI TENS group (median difference 28 (95% CI was 14.0-53.0). Furthermore, the HI TENS group experienced significantly less discomfort of the uterine contractions after stimulation (p<0.01) but they also experienced more discomfort of the stimulation than women in the LI TENS group (p<0.01). CONCLUSION: The women treated with HI TENS, experienced significantly less postpartum pain and discomfort to those treated with LI TENS even though the discomfort from the stimulation with HI TENS was greater.
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| 26. |
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| 27. |
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| 28. |
- Jansson, T, et al.
(författare)
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Positron emission tomography studies in patients with locally advanced and/or metastatic breast cancer : a method for early therapy evaluation?
- 1995
-
Ingår i: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 13:6, s. 1470-1477
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To investigate if sequential positron emission tomographic (PET) scans with the glucose analog 18F-2-fluoro-2-deoxy-D-glucose (18FDG) and/or L-methyl-11C-methionine (11C-methionine) in patients with breast cancer could provide early information on the efficacy of polychemotherapy. PATIENTS AND METHODS: Sixteen patients with breast cancer (11 with locally advanced tumors, three with recurrent disease in the contralateral breast, two of them with distant and regional metastases, and two with distant metastases) underwent a baseline and two follow-up PET scans after the first and third/fourth polychemotherapy course. Tumor response was determined clinically/radiographically after three/four polychemotherapy courses. RESULTS: Five patients were investigated with 18FDG, seven with both 11C-methionine and 18FDG, and four with only 11C-methionine before polychemotherapy. 11C-methionine presented a more distinct visualization of primary/contralateral breast cancers in five of seven patients when compared with 18FDG. Twelve of 16 patients demonstrated a response using conventional methods after the third/fourth course of polychemotherapy. Eight of these 12 clinical responders had a significant decrease in tracer uptake at the first PET scan performed 6 to 13 days after the first polychemotherapy course, and these reductions were further augmented after the third/fourth course and corresponded to the conventional therapy evaluation (clinical examination, computed tomography [CT], ultrasonography, and mammography). CONCLUSION: Our data indicate that PET may be of clinical value in predicting response to chemotherapy in patients with locally advanced breast cancer and/or metastatic disease earlier than any other method used.
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| 29. |
- Lilja, Hans, et al.
(författare)
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Successful separation between benign prostatic hyperplasia and prostate cancer by measurement of free and complexed PSA
- 1996
-
Ingår i: Diagnosis and Treatment of Genitourinary Malignancies. - Boston, MA : Springer US. - 0927-3042. - 9781461379133 - 9781461563433 ; 88, s. 93-101
-
Bokkapitel (refereegranskat)abstract
- Prostate-specific antigen (PSA) is a serine protease belonging to the human glandular kallikrein gene family [1–3]. The expression of PSA is mainly androgen dependent, and the detection of very high expression levels is restricted to the prostate tissue, but extraprostatic production at much lower levels has been demonstrated in several other tissues such as normal and malignant breast epithelium, endometrium, and bulbourethral glands [4–10]. PSA is synthesized by the columnar epithelium in the glandular ducts and acini of the prostate, but not by any other cells in prostate tissue. It is secreted at high concentrations (0.2-5mg/mL) into seminal fluid [4–6,11]. PSA is synthesized as an inactive precursor [2,3,12]. Like other glandular kallikreins, the PSA-precursor is processed stepwise by release of a leader peptide followed by liberation of an activation peptide that results in conversion of the zymogen into enzymatically active PSA [12]. This process may occur in parallel with the secretory release from the prostate epithelium and most probably occurs prior to the ejaculatory mixing of secretions from the prostate, seminal vesicles, and epididymis, since PSA is active in ejaculates collected from subjects with defective seminal vesicles and deferent ducts [1]. The protease(s) responsible for processing of the PSA precursor have not been identified. The mature 237-amino-acid form of PSA is a single-chain serine protease with extensive structural similarity to the glandular kallikreins [1,12–14]. However, the substrate specificity is uniquely different from that of the trypsin-like glandular kallikreins and resembles that of chymotrypsin, since PSA catalyzes the hydrolysis of peptide bonds’ carboxy-terminal to residues of tyrosine and leucine [15–17]. Synthetic peptide substrates for chymotrypsin can be used to measure PSA activity, but they are hydrolyzed much less efficiently by PSA than by chymotrypsin and are therefore both nonspecific and insensitive in detecting PSA activity [16].
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| 30. |
- Lilja, Johan, et al.
(författare)
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A two-dimensional perspective on attractive quality
- 2007
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Ingår i: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3363 .- 1478-3371. ; 18:6, s. 667-679
-
Tidskriftsartikel (refereegranskat)abstract
- Attractive quality has for two decades been accentuated as a strong driver of loyalty, word-of-mouth and saleability. Recent elaborations of the concept of attractive quality however point to obstacles to the development of quality practices, such as engineering methods, to support the creation of attractive quality in practice. One obstacle is the lack of explanations as to why certain aspects of an offer are perceived as an attractive quality. There is a need to understand why attractive quality occurs. This paper aims to address these obstacles by presenting the results of a search for mechanisms claimed to cause attractive quality in literature. As a result, the paper identifies and relates two fundamentally different mechanisms considered important for the generation of attractive quality. The need-based roots of attractive quality point at an explanation in terms of the satisfaction of high-level needs. This is in sharp contrast to the currently dominant explanation of attractive quality as the exceeding of expectations. The two mechanisms are further distinguished and related to each other resulting in the classification of three different types of attractive quality. The three types are designated as 'Surprisers', 'Life Enrichers', and 'Attraction Boosters'. The 'Life Enrichers', which are defined as satisfying high-level needs of the customer, are highlighted as an important and promising area for future research.
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| 31. |
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| 32. |
- Lilja, Johan, et al.
(författare)
-
Getting emotional about quality: questioning and elaborating the satisfaction concept
- 2005
-
Ingår i: The Asian Journal of Quality. - 1598-2688. ; 6:3, s. 38-55
-
Tidskriftsartikel (refereegranskat)abstract
- Consumption has generally become more fragmented, hedonic and individual specific, satisfying not only functional but also emotional needs. In parallel, customer satisfaction is now thought to be both a cognitive and affective response, and the closely related concept of job satisfaction is commonly seen as an emotional reaction. The reasoning within quality management does, however, still lean heavily toward cognitive judgements (i.e. performance ratings), the emotional component clearly being under explored. Further, performance variables have shown not to be significant in predicting satisfaction for certain "experience products", the effect fully mediated by emotions. As a consequence a cognitive judgement based quality concept has lost its ability to predict satisfaction, which clearly contradicts with the modern quality definition, stressing quality as the ability to satisfy the customer. Emotions have however entered the quality discourse and it has been proposed that having customers that are merely feeling satisfied will not suffice. Instead, there has been a plethora of executive exhortations in the trade press calling on business to "delight the customer". Strategies for doing so have however usually been imprecise and unclear, and the different drivers of delight and satisfaction are not well explored. This paper aims to complement the previous cognitive dominance by exploring the multiple emotional responses involved in customer satisfaction. A conclusion being that we currently are measuring something, in terms of satisfied, that is more or less independent of what we aim for, in terms of delight. It is also most likely that - depending on the situation, product, and person � other positive and negative emotions are more important outcomes of purchase and usage than merely satisfaction. It is questioned whether a single, summary response such as satisfaction is feasible or even desirable.
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| 33. |
- Lilja, Johan, et al.
(författare)
-
Obstacles to the creation of attractive quality
- 2006
-
Ingår i: The TQM Journal. - : Emerald. - 0954-478X. ; 18:1, s. 55-66
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of the paper is to contribute to the solution, and understanding, of the current lack of activity concerning the development of practices, such as engineering methods, for the creation of attractive quality. The current situation is clearly problematic given the important positive effects assigned to attractive quality in the literature. Design/methodology/approach – First, different descriptions of attractive quality are examined in order to determine whether there is a common understanding of the concept. Second, the ability to manage attractive quality creation in accordance to a proactive ideal is approached by an examination of the current ability to predict the occurrence of attractive quality. Findings – Two obstacles that currently hinder the development of practices for attractive quality creation are identified. The first obstacle is the diversity of meanings given to the concept of attractive quality, resulting in confusion about what to obtain. The second obstacle identified is the current lack of valid explanations to the occurrence of attractive quality, resulting in an inability to develop proactive practices. Practical implications – The practical implications of bringing attention to, and overcoming, the two obstacles identified will potentially be substantial. A common attractive quality concept and valid explanations to the occurrence of attractive quality will constitute an essential base for the successful development of practices, such as engineering methods, for attractive quality creation. Originality/value – The paper contributes via the identification of two critical areas in need of intensified attention and future research in order to facilitate the sought-after development of practices for the creation of attractive quality.
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| 34. |
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| 35. |
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| 36. |
- Lilja, Johan
(författare)
-
The Realization of Attractive Quality : Conceptual and practical perspectives within the TQM system
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Within the quality community, quality management is often pictured as and referred to as rapidly evolving and continuously learning by interaction with the surrounding world. In general, an ability to evolve and transform is also seen as most desirable and the only choice for long term survival. In line with this picture, quality scholars, consultants, and practitioners strongly accentuate the necessity and great benefits from continuous improvement as well as systematic collection and usage of facts about what customers really value, to guide such improvement. This is reflected in the exhortations “improve continuously”, “focus on the customer” and “base decisions on facts”, found with minor variations in most modern quality literature. Strong exhortations mainly directed outwards, towards the many leaders and organizations out there. Towards leaders and organizations that still have not grasped the necessity and great winnings from continuous improvement, that are still not fully applying modern quality initiatives like Total Quality Management (TQM). However, while seemingly being busy exhorting others, doubts have been increasingly raised concerning whether TQM, as currently applied, actually lives up to these exhortations. Does TQM itself continuously improve and evolve? Is the current application of TQM really taking into account facts in the surrounding world about what customers value? When viewing TQM as a system, as now is commonly done, the problem implied is a lack of system goal fulfillment, questioning if the current TQM system’s structure and processes are really purposeful. More specifically the critics highlight the inadequacy of the current reactive one-sided defect avoidance focus, stressing that defects do not matter much if you are making a product no one wants to buy. What can be referred to as “an obsession with error avoidance” is in fact shown to stifle both innovation and value creation. As for what the TQM system currently is missing, the shortcoming is often referred to as a lack of focus on Attractive Quality. That is, a lack of focus on a different kind of quality elements, often described as being unrelated to the dissatisfaction expressed, but strongly contributing to the customer’s positive emotions, such as delight. The inclusion and realization of Attractive Quality has been widely emphasized as important and urgent for more than 20 years. However, a more systematic inclusion and realization within the TQM system has remained no more than merely “a vision”. A situation seemingly supporting the argument that TQM really has failed in terms of continuously evolving and improving. An inability to learn and adapt that in the long term will jeopardize the survival of the entire TQM system. This thesis then aims to move “from a vision to reality” both in terms of exploring the realization of Aattractive Qquality within TQM, and in a wider sense towards realizing the desired state of TQM as truly evolving and alive. In doing so the thesis addresses the three questions of what, why and how the vision of a more systematic creation of Aattractive Qquality creation actually should and could be realized within the system of TQM. Among the results presented in this thesis are a new two-dimensional perspective on Attractive Quality and a re-understanding of the TQM system. The thesis also introduces a new methodology called Attraction Detection Study (ADS) as part of the concluding suggestions about how Attractive Quality could be more systematically created within the system of TQM.
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| 37. |
- Lilja, Mirjam, 1981-
(författare)
-
Bioactive Surgical Implant Coatings with Optional Antibacterial Function
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Device associated infections are a growing problem in the field of orthopaedics and dentistry. Bacteria adhering to implant surfaces and subsequent biofilm formation are challenging to treat with systemic administered antibiotics. Functionalization of implant surfaces with therapeutic coatings that are capable of inhibiting bacterial adhesion are therefore considered as a straight forward strategy to treat and prevent implant related infections.In this thesis, the use of crystalline, arc deposited TiO2 and biomimetic hydroxyapatite (HA) coatings were evaluated with respect to their potential as antibacterial surface modifications for bone-anchored implants.UV light induced photocatalysis of anatase dominated TiO2 coated surfaces was shown to provide a bactericidal effect against S. epidermidis under clinically relevant illumination times and doses.Major parts of the drug release work carried out was based on biomimetic HA (HA-B) coated fixation pins. The analysis of the coating characteristics revealed that the nanoporous structure of HA-B coatings in addition to the chemical composition and surface charge are essential parameters that influence the drug carrier performance. Loading by adsorption was demonstrated to be a feasible approach to quickly incorporate antibiotics. The controlled release of antibiotics was shown to facilitate bactericidal effects against S. aureus over application-relevant time periods, even when exposed to biomechanical forces during insertion into bone model materials. Antibiotic incorporation during coating growth was shown to promote somewhat longer drug release time periods than those obtained using adsorption loading.In summary, functionalization of implant surfaces with bioactive and biocompatible coatings is a promising concept to impact the clinical success for bone-anchored applications. The additional feature of optional, on-demand antibacterial properties of these coatings through either on-site drug release or photocatalytic antibacterial treatment is advantageous for the prevention and effective treatment of devices-associated infections. Both strategies provide an immediate response to the implant contamination by bacteria and are believed to contribute towards minimizing the origin of post-surgical infections, while at the same time improving the interfacial stability between implant and bone.
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| 38. |
- Lilja, Mirjam, et al.
(författare)
-
Effect of deposition parameters on the photocatalytic activity and bioactivity of TiO(2) thin films deposited by vacuum arc on Ti-6Al-4V substrates
- 2012
-
Ingår i: Journal of Biomedical Materials Research. Part B - Applied biomaterials. - : Wiley. - 1552-4973 .- 1552-4981. ; 100B:4, s. 1078-1085
-
Tidskriftsartikel (refereegranskat)abstract
- This article evaluates the influence of the main parameters in a cathodic arc deposition process on the microstructure of titanium dioxide thin coatings and correlates these to the photocatalytic activity (PCA) and in vitro bioactivity of the coatings. Bioactivity of all as deposited coatings was confirmed by the growth of uniform layers of hydroxyapatite (HA) after 7 days in phosphate buffered saline at 37°C. Comparison of the HA growth after 24 h indicated enhanced HA formation on coatings with small titanium dioxide grains of rutile and anatase phase. The results from the PCA studies showed that coatings containing a mixed microstructure of both anatase and rutile phases, with small grain sizes in the range of 26-30 nm and with a coating thickness of about 250 nm, exhibited enhanced activity as compared with other microstructures and higher coating thickness. The results of this study should be valuable for the development of new bioactive implant coatings with photocatalytically induced on-demand antibacterial properties.
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| 39. |
- Lilja, Mirjam, 1981-, et al.
(författare)
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Influence of microstructure and chemical composition of sputter deposited TiO2 thin films on in vitro bioactivity
- 2011
-
Ingår i: Journal of materials science. Materials in medicine. - : Springer. - 0957-4530 .- 1573-4838. ; 22:12, s. 2727-2734
-
Tidskriftsartikel (refereegranskat)abstract
- Functionalisation of biomedical implants viasurface modifications for tailored tissue response is agrowing field of research. Crystalline TiO2 has been provento be a bone bioactive, non-resorbable material. In contactwith body fluids a hydroxyapaptite (HA) layer forms on itssurface facilitating the bone contact. Thus, the path ofimproving biomedical implants via deposition of crystallineTiO2 on the surface is interesting to follow. In thisstudy we have evaluated the influence of microstructureand chemical composition of sputter deposited titaniumoxide thin films on the in vitro bioactivity. We find thatboth substrate bias, topography and the flow ratio of thegases used during sputtering affect the HA layer formed onthe films after immersion in simulated body fluid at 37C.A random distribution of anatase and rutile crystals, formedat negative substrate bias and low Ar to O2 gas flow ratios,are shown to favor the growth of flat HA crystal structureswhereas higher flow ratios and positive substrate biasinduced growth of more spherical HA structures. Thesefindings should provide valuable information when optimizingthe bioactivity of titanium oxide coatings as well asfor tailoring process parameters for sputtered-based productionof bioactive titanium oxide implant surfaces.
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| 40. |
- Lilja, Mats, et al.
(författare)
-
Limited effect of over-the-counter doses of ibuprofen on mechanisms regulating muscle hypertrophy during resistance training in young adults.
- 2023
-
Ingår i: Journal of applied physiology. - : American Physiological Society. - 8750-7587 .- 1522-1601. ; 134:3, s. 753-765
-
Tidskriftsartikel (refereegranskat)abstract
- We have previously shown that maximal over-the-counter doses of ibuprofen, compared with low doses of acetylsalicylic acid, reduce muscle hypertrophy in young individuals after 8 weeks of resistance training. Because the mechanism behind this effect has not been fully elucidated, we here investigated skeletal muscle molecular responses and myofiber adaptations in response to acute and chronic resistance training with concomitant drug intake. Thirty-one young (aged 18-35 years) healthy men (n=17) and women (n=14) were randomized to receive either ibuprofen (IBU;1200mg daily; n=15) or acetylsalicylic acid (ASA; 75mg daily; n=16) while undergoing 8 weeks of knee extension training. Muscle biopsies from the vastus lateralis were obtained before, at week 4 after an acute exercise session, and after 8 weeks of resistance training and analyzed for mRNA markers and mTOR signaling, as well as quantification of total RNA content (marker of ribosome biogenesis) and immunohistochemical analyzes of muscle fiber size, satellite cell content, myonuclear accretion, and capillarization. There were only two treatment ´ time interaction in selected molecular markers after acute exercise (atrogin-1 and MuRF1 mRNA), but several exercise effects. Muscle fiber size, satellite cell and myonuclear accretion, and capillarization were not affected by chronic training or drug intake. RNA content increased comparably (~14%) in both groups. Collectively, these data suggest that established acute and chronic hypertrophy regulators (including mTOR signaling, ribosome biogenesis, satellite cell content, myonuclear accretion, and angiogenesis) were not differentially affected between groups and therefore do not explain the deleterious effects of ibuprofen on muscle hypertrophy in young adults.
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| 41. |
- Lilja, Mirjam, 1981-, et al.
(författare)
-
Photocatalytic and antimicrobial properties of surgical implant coatings of titanium dioxide deposited though cathodic arc evaporation
- 2012
-
Ingår i: Biotechnology letters. - : Springer Science and Business Media LLC. - 0141-5492 .- 1573-6776. ; 41:6, s. 740-746
-
Tidskriftsartikel (refereegranskat)abstract
- Nanostructured crystalline titaniumdioxide coatings deposited by cathodic arc evaporated on titanium grade five medical implant substrates were demonstrated to exhibit UV-induced photocatalytic activity that can be utilized to provide bactericidal effects against Staphylococcus epidermidis. The photocatalytic activity of the coatings was confirmedvia degradation of Rhodamine B under UV illumination.A 90 %reduction of viable bacteria was achieved in a clinically suitable time of only 2 min with a UVdose of 2.4 J delivered at 365 nm. These results areencouraging for the development of antimicrobialsurfaces in orthopedics and dentistry in order to prevent or treat post-surgical infections.
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| 42. |
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| 43. |
- Lilja, Mirjam, 1981-, et al.
(författare)
-
Photocatalytic and bioactive TiO2 thin films deposited by vacuum arc
- 2012
-
Ingår i: European Cells & Materials. - Aberystwyth : University of Wales. - 1473-2262. ; 23:Suppl. 5, s. 48-
-
Tidskriftsartikel (refereegranskat)abstract
- Improving biomedical implants via deposition of functionalised surface coatings is a growing field of research. With respect to implant surfaces, infections present a major problem, and result mostly from the contamination of the surface by bacteria during surgery. UV irradiation induced photocatalysis on crystalline TiO2 implant surfaces may present a promising way to decontaminate surfaces while at the same time providing a bioactive surface for enhanced tissue integration.
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| 44. |
- Lilja, Mirjam, 1981-, et al.
(författare)
-
The effect of Si-doping on the release of antibiotic from hydroxyapatite coatings
- 2013
-
Ingår i: Journal of Biomaterials and Nanobiotechnology. - : Scientific Research Publishing, Inc.. - 2158-7027 .- 2158-7043. ; 4:3, s. 237-241
-
Tidskriftsartikel (refereegranskat)abstract
- Herein, we show that incorporation of ions during biomimetic coating deposition may be utilized to tailor the drug loading capacity of hydroxyapatite (HA) coatings. Pure biomimetic HA (HA-B) and Si-doped equivalents (SiHA-B) where deposited by a biomimetic process onto titanium dioxide covered titanium substrates. The antibiotic Cephalothin was incorporated into the coatings by adsorptive loading and the release was studied in-vitro. SiHA-B coatings exhibited superior drug incorporation capacity compared to pure HA-B coatings, resulting in a drug release profile dominated by an initial 10 min burst effect while a more prolonged 10 hour release was observed from HA-B coatings. The results emphasize the possibility to impact the drug release kinetics from implant coatings by selective doping elements and the use of thin, biomimetic HA-coatings as drug delivery vehicles. Functionalizing metal implants with SiHA-B coatings presents an interesting strategy towards creating synergetic effects through ion- and antibiotic release and, hence, contributing both towards preventing post-surgical infections while at the same time enhancing the bone-bonding ability.
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| 45. |
- Mollberg, Margareta, 1953, et al.
(författare)
-
High birthweight and shoulder dystocia: the strongest risk factors for obstetrical brachial plexus palsy in a Swedish population-based study
- 2005
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Ingår i: Acta Obstet Gynecol Scand. ; 84:7, s. 654-9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obstetrical brachial plexus palsy (OBPP) is a serious form of neonatal morbidity. OBJECTIVE: The aim of this work was to study the incidence of OBPP and to analyze its risk factors. METHODS: This is a population-based retrospective case-control study. All deliveries recorded in the Swedish Medical Birth Registry between 1987 and 1997 (n = 1 213 987) were investigated. Cases (n = 2399) with OBPP were compared to all other cases. RESULTS: The incidence of OBPP increased from 0.17 in 1987 to 0.27% in 1997 (p = 0.002). During the same time period, the mean birthweight increased from 3483 to 3525 g. Birthweight increasing from 4000 g was associated with a progressive rise in OBPP risk. Other significant risk factors associated with the injury were shoulder dystocia, breech presentation in vaginal delivery, operative vaginal delivery, diabetes mellitus, induction of labor, protracted active phase, secondary arrest of dilatation, and epidural anesthesia. Cesarean section was associated with a decreased risk of OBPP. If 5000 g is chosen as cut-off for cesarean section, 85% of the infants in this weight class are underestimated using ultrasonography. Approximately, 331 abdominal deliveries have to be performed to avoid one case of OBPP. CONCLUSIONS: Shoulder dystocia and infant birthweight of 4500 g and more are the strongest risk factors for OBPP in a Swedish population.
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| 46. |
- Mollberg, Margareta, 1953, et al.
(författare)
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Risk factors for obstetric brachial plexus palsy among neonates delivered by vacuum extraction
- 2005
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Ingår i: Obstet Gynecol. ; 106:5 Pt 1, s. 913-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The risk of obstetric brachial plexus palsy (OBPP) is increased in infants delivered instrumentally. The aim of this study was to identify risk factors for OBPP and to evaluate the association between possible risk factors linked to the duration of the vacuum extraction procedure and the subsequent risk. METHODS: A population-based retrospective design was adopted. Using a national registry of operative vaginal deliveries linked to the Medical Birth Registry in Sweden, we evaluated by univariate and multiple logistic regression analyses the risk factors for OBPP in 13,716 women delivered by vacuum extraction. The variables assessed in the multiple logistic regression analysis were shoulder dystocia, fetal birth weight of 3,999 g or greater, fundal pressure, number of tractions, vacuum application time, parity, vacuum silicone cup, epidural anesthesia, and fetal head at the level of the ischial spines at vacuum application time. RESULTS: Obstetric brachial plexus palsy was recorded in 153 (1.1%) infants. The following variables increased significantly the risk of OBPP in the newborn: shoulder dystocia (odds ratio 16.0; 95% confidence interval 8.9-28.7), fetal birth weight of 3,999 g or greater (7.1; 4.8-10.5), and administration of fundal pressure (1.6; 1.1-2.3). The probability of the risk of OBPP in vacuum-assisted deliveries increased in relation to vacuum extraction time (minutes). CONCLUSION: Shoulder dystocia in the setting of vacuum extraction is a prominent risk factor for OBPP in the newborn. The risk of OBPP increases with the time required for vacuum extraction. LEVEL OF EVIDENCE: II-3.
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| 47. |
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| 48. |
- Palm, Klas, 1964-, et al.
(författare)
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Agencies, it’s Time to Innovate! : Exploring the current understanding of the Swedish government’s call for innovation
- 2015
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Ingår i: International Journal of Quality and Service Sciences. - Bingley : Emerald Group Publishing Limited. - 1756-669X .- 1756-6703. ; 7:1, s. 34-49
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Tidskriftsartikel (refereegranskat)abstract
- PurposeInnovation is currently at the top of many agendas worldwide: not only in the private sector, but also when it comes to increasing quality, efficiency, and effectiveness in public administration. InSweden, this is reflected in the recent call from the Government for innovation in public management. However, innovation has not traditionally occurred to any significant extent on the strategic level of Swedish public management. Furthermore, governmental administration is a complex system in need of coordination and alignment for this new call to be effectively realized in practice. The purpose of this paper is hence to explore the phenomenon of innovation in the current Swedish governmental administration system. More specifically, the paper explores the current understanding within the system of what innovation is, as well as why and how it should be achieved. Methodology/approach This study has been based on a qualitative approach with a case consisting of three embedded units: the Government itself, a ministry and a government agency. The data have been collected from documents and interviews. Findings The study shows that there is currently a notable disparity when it comes to how aspects of innovation are understood at different levels within the Swedish governmental administration system. Furthermore, the recent business development to increase the standardization of work processes is perceived as having created poorer preconditions for working with innovations. Practical implicationsThe results highlight critical areas of disparity and possibilities for improvement towards a shared understanding and aligned innovation actions within the system. Originality/valueThe articlecontributes knowledgeabout the current understanding of innovation in the Swedish governmental administration system.
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| 49. |
- Palm, Klas, 1964-
(författare)
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Balancing Control and Breakthrough in Public Management
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous research shows that a good balance between focus on development of existing processes with development of new and innovative products, processes or services has a positive effect on organizational excellence. However, the relationship between these two quality perspectives is not easy to maintain and it is a challenge for every organization to find an appropriate balance between them. Previous research shows also that there is often a striking overemphasis on continuous improvement and stepwise refinement at the expense of working with innovations. Consequently, it has become necessary to find forms for development of the balance between improvement of existing processes and innovations. It is a question of how to manage both exploitation (improvement of existing processes) and exploration (innovations). Being able to manage both exploitation and exploration and maintain a good balance is known as organizational ambidexterity.The purpose of this thesis is to develop existing knowledge of how organisational ambidexterity and innovation can be understood and developed as an approach to increasing customer value in the context of the public sector. In order to meet the purpose, the research behind this thesis was conducted through six studies. The results have been presented in six scientific articles. The analytical focus in the research has been on management of public organization. Thus, the unit of analysis has been public sector management both at national, regional and municipal level. The studies have been conducted with a qualitative approach and data collection has primarily been done through semi- structured interviews. Most of the data has been collected in Sweden.Through the studies, it appears that the current quality practice in the Swedish public sector to a large extent relates to and supports exploitation, but not exploration. The empirical findings give examples of organizations that have a large focus on systematic measurement and control of the work process. An inhibition of increased customer value is indicated in the studied organizations’ current emphasis on exploitation at the expense of exploration. The research also shows that there are a number of impediments for the public organizations studied to combine their current quality practice with an improved ability to explore. It appears that there is a need for development of the leeway for exploration in order to increase the ability to be ambidextrous.The research behind this thesis empirically identifies a number of enablers the public organization may need to work actively with in order to develop organizational ambidexterity. Some of these enabling factors harmonize with quality movement core values. This applies to core values like committed leadership, focus on customers and a holistic system perspective. In addition, the following factors are perceived to be enabling factors for organizational ambidexterity: specific budgets for both exploration and exploitation; development of a culture in which employees feel that they are allowed to make mistakes; a good dialogue both internally and with external stake holders; focusing on the implementation of innovations and clear incentives for work on exploration as well as for work on exploitation. Finally, the empirical data also shows that an enabling factor is to get different professions involved in explorative processes. This can be achieved by working through ambassadors who can promote the explorative processes.The enablers, which have been empirically identified in this research as important for organizational ambidexterity, have also previously been identified by scholars as enablers for innovations. The research behind this thesis contributes to the empirical sorting out which - out of a wide range of factors - may be the most important factors for organizational ambidexterity.
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| 50. |
- Palm, Klas, et al.
(författare)
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The challenge of integrating innovation and quality management practice
- 2016
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Ingår i: Total Quality Management and Business Excellence. - : Informa UK Limited. - 1478-3363 .- 1478-3371. ; 27:1-2, s. 34-47
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Tidskriftsartikel (refereegranskat)abstract
- Following in the footsteps of ‘New Public Management’, where quality management and quality control have become widely implemented concepts among public authorities, there is now a subsequent government demand to also be innovative. However, integrating and achieving a balance between improved quality and increased innovation is not an easy task. Previous research indicates a complex and ambiguous relation, raising questions as to how to optimally combine these two approaches organisationally, operationally, and culturally. Is there an ‘edge of chaos’ where there is maximal flexibility for innovation while maintaining sufficient order for quality? The purpose of this paper is to examine the potential integration of innovation and quality management practice within the public sector. The paper is based on a multiple case study design, confronted with existing literature, and shows that the current quality management practice is perceived as being related to standardisation, leading to a decrease in the space for innovation. Second, that there is an expectation and belief that innovation and quality management can be handled in parallel and reinforce each other instead of being mutually detrimental.
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