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  • 1.
    Adolfsson, Päivi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Disability Research.
    Food security and people with intellectual disabilities living in community residences in Sweden2012In: Journal of Intellectual Disability Research 56; 7/8, 2012Conference paper (Refereed)
  • 2. Aeinehband, Shahin
    et al.
    Lindblom, Rickard P F
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Thoracic Surgery.
    Al Nimer, Faiez
    Vijayaraghavan, Swetha
    Sandholm, Kerstin
    Khademi, Mohsen
    Olsson, Tomas
    Nilsson, Bo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Nilsson, Kristina Ekdahl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Darreh-Shori, Taher
    Piehl, Fredrik
    Complement Component C3 and Butyrylcholinesterase Activity Are Associated with Neurodegeneration and Clinical Disability in Multiple Sclerosis2015In: PLoS ONE, ISSN 1932-6203, Vol. 10, no 4Article in journal (Refereed)
    Abstract [en]

    Dysregulation of the complement system is evident in many CNS diseases but mechanisms regulating complement activation in the CNS remain unclear. In a recent large rat genomewide expression profiling and linkage analysis we found co-regulation of complement C3 immediately downstream of butyrylcholinesterase (BuChE), an enzyme hydrolyzing acetylcholine (ACh), a classical neurotransmitter with immunoregulatory effects. We here determined levels of neurofilament-light (NFL), a marker for ongoing nerve injury, C3 and activity of the two main ACh hydrolyzing enzymes, acetylcholinesterase (AChE) and BuChE, in cerebrospinal fluid (CSF) from patients with MS (n = 48) and non-inflammatory controls (n = 18). C3 levels were elevated in MS patients compared to controls and correlated both to disability and NFL. C3 levels were not induced by relapses, but were increased in patients with >= 9 cerebral lesions on magnetic resonance imaging and in patients with progressive disease. BuChE activity did not differ at the group level, but was correlated to both C3 and NFL levels in individual samples. In conclusion, we show that CSF C3 correlates both to a marker for ongoing nerve injury and degree of disease disability. Moreover, our results also suggest a potential link between intrathecal cholinergic activity and complement activation. These results motivate further efforts directed at elucidating the regulation and effector functions of the complement system in MS, and its relation to cholinergic tone.

  • 3.
    Ahlsson, Fredrik
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Women's and Children's Health.
    Being Born Large for Gestational Age: Metabolic and Epidemiological Studies2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Obesity is a major health problem in the Western world. Mean birth weight has increased during the last 25 years. One explanation is that the proportion of large for gestational age (LGA) infants has increased. Such infants risk developing obesity, cardiovascular disease and diabetes later in life. Despite the risk of neonatal hypoglycemia, their postnatal metabolic adaptation has not been investigated. Our data, obtained with stable isotope labeled compounds, demonstrate that newborn LGA infants have increased lipolysis and decreased insulin sensitivity. After administration of glucagon, the plasma levels of glucose and the rate of glucose production increased. The simultaneous increase in insulin correlated with the decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.

    We also demonstrated an intergenerational effect of being born LGA, since women born LGA, were at higher risk of giving birth to LGA infants than women not born LGA. Further, the LGA infants formed three subgroups: born long only, born heavy only, and born both long and heavy. Infants born LGA of women with high birth weight or adult obesity were at higher risk of being LGA concerning weight alone, predisposing to overweight and obesity at childbearing age. In addition we found that pregnant women with gestational diabetes were at increased risk of giving birth to infants that were heavy alone. This could explain the risk of both perinatal complications and later metabolic disease in infants of this group of women.

    To identify determinants of fetal growth, 20 pregnant women with a wide range of fetal weights were investigated at 36 weeks of gestation. Maternal fat mass was strongly associated with insulin resistance. Insulin resistance was related to glucose production, which correlated positively with fetal size. The variation in resting energy expenditure, which was closely related to fetal weight, was largely explained by BMI, insulin resistance, and glucose production. Lipolysis was not rate limiting for fetal growth in this group of women. Consequently, high maternal glucose production due to a high fat mass may result in excessive fetal growth.

    List of papers
    1. Lipolysis and Insulin Sensitivity at Birth in Infants Who Are Large for Gestational Age
    Open this publication in new window or tab >>Lipolysis and Insulin Sensitivity at Birth in Infants Who Are Large for Gestational Age
    2007 (English)In: Pediatrics, ISSN 0031-4005, Vol. 120, no 5, 958-965 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE. In addition to neonatal hypoglycemia, infants who are born large for gestational age are at risk for developing obesity, cardiovascular disease, and diabetes later in life. The aim of this study was to investigate glucose production, lipolysis, and insulin sensitivity in infants who were born large for gestational age to mothers without diabetes. The effect of glucagon administration on production of energy substrates was also investigated.

    METHODS. Ten healthy term infants who were born large for gestational age to mothers without diabetes were studied 16 ± 8 hours postnatally after a 3-hour fast. Rates of glucose production and lipolysis were analyzed by gas chromatography–mass spectrometry following constant rate infusion of [6,6-2H2]glucose and [2-13C]glycerol. Insulin sensitivity was assessed by the Homeostasis Assessment Model. In 8 of the infants, the effect of an intravenous injection of 0.2 mg/kg glucagon was also analyzed.

    RESULTS. Plasma glucose and glycerol averaged 3.8 ± 0.5 mmol/L and 384 ± 183 µmol/L, respectively. The glycerol production rate, reflecting lipolysis, was 12.7 ± 2.9 µmol/kg per min. Mean rate of glucose production was 30.2 ± 4.6 µmol/kg per min. Homeostasis Assessment Model insulin sensitivity corresponded to 82% ± 19%, β-cell function to 221% ± 73%, and insulin resistance to 1.3 ± 0.3. After glucagon administration, rate of glucose production increased by 13.3 ± 8.3 µmol/kg per min and blood glucose by 1.4 ± 0.5 mmol/L. Glycerol production decreased from 12.8 ± 3.0 to 10.7 ± 2.9 µmol/kg per min. Mean insulin concentration increased from 10.9 ± 3.0 to 30.9 ± 10.3 mU/L. There was a strong inverse correlation between the decrease in lipolysis and increase in insulin after glucagon administration.

    CONCLUSIONS. Infants who are born large for gestational age show increased lipolysis and a propensity for decreased insulin sensitivity already at birth. The simultaneous increase in plasma insulin correlated strongly with the noted decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.

    Keyword
    LGA, glucose production, lipolysis, newborn infant, insulin sensitivity
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97381 (URN)10.1542/peds.2007-0165 (DOI)000250618900004 ()17974732 (PubMedID)
    Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2011-01-18Bibliographically approved
    2. Females born large for gestational age have a doubled risk of giving birth to large for gestational age infants
    Open this publication in new window or tab >>Females born large for gestational age have a doubled risk of giving birth to large for gestational age infants
    2007 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 3, 358-362 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim: To analyse if females born large for gestational age (LGA) have an increased risk to give birth to LGA infants and to study anthropometric characteristics in macrosomic infants of females born LGA.Methods: The investigation was performed as an intergenerational retrospective study of women born between 1973 and 1983, who delivered their first infant between 1989 and 1999. Birth characteristics of 47 783 females, included in the Swedish Birth Register both as newborns and mothers were analysed. LGA was defined as >2 SD in either birth weight or length for gestational age. The infants were divided into three subgroups: born tall only, born heavy only and born both tall and heavy for gestational age. Multiple logistic and linear regression analyses were performed.Results: Females, born LGA with regard to length or weight, had a two-fold (adjusted OR 1.96, 95% Cl 1.54-2.48) increased risk to give birth to an LGA infant. Females, born LGA concerning weight only, had a 2.6 (adjusted OR 2.63, 95%, 1.85-3.75) fold increased risk of having an LGA offspring heavy only and no elevated risk of giving birth to an offspring that was tall only, compared to females born not LGA. In addition, maternal obesity was associated with a 2.5 (adjusted OR 2.56, 95%, 2.20-2.98) fold increased risk of having an LGA newborn, compared to mothers with normal weight.Conclusion: Females, born LGA, have an increased risk to give birth to LGA infants, compared to mothers born not LGA. Maternal overweight increases this risk even further.

    Keyword
    Females born LGA, Intergenerational study, LGA, Newborn infants
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97382 (URN)10.1111/j.1651-2227.2006.00141.x (DOI)000244716300009 ()17407456 (PubMedID)
    Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2011-02-10Bibliographically approved
    3. Gestational diabetes and offspring body disproportion
    Open this publication in new window or tab >>Gestational diabetes and offspring body disproportion
    Show others...
    2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 1, 89-93 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim:   It has been demonstrated that females born large for gestational age   (LGA) in weight but not length are at increased risk of being obese at   childbearing age. We addressed the question whether women with   gestational diabetes mellitus (GDM) are at increased risk of giving   birth to such infants.   Methods:   Birth characteristics of 884 267 infants of non-diabetic mothers and   7817 of mothers with GDM were analysed. LGA was defined as birth weight   or birth length > 2 standard deviation scores for gestational age.   Multiple logistic regression analysis was performed.   Results:   The odds ratio (OR) for a woman with GDM to give birth to an LGA infant   that was heavy alone was four times increased (OR: 3.71, 95% CI:   3.41-4.04). Furthermore, in the population of mothers giving birth to   LGA infants, the proportion heavy alone was 68% in the group of women   with GDM compared with 64.4% in the group of non-diabetic women. The   risks were independent of gender of the foetus.   Conclusion:   Women with GDM have an almost four times higher risk of delivering an   LGA infant that is heavy alone. The noted disproportion between weight   and length in infants of such mothers may have an impact on the risk of   later obesity.

    Keyword
    Body disproportion, Gestational diabetes, Large for gestational age, Newborn and obesity
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97383 (URN)10.1111/j.1651-2227.2009.01532.x (DOI)000272565800025 ()19814749 (PubMedID)
    Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2010-06-21Bibliographically approved
    4. Maternal glucose production and resting energy expenditure determine fetal size
    Open this publication in new window or tab >>Maternal glucose production and resting energy expenditure determine fetal size
    Show others...
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:uu:diva-97384 (URN)
    Available from: 2008-08-18 Created: 2008-08-18 Last updated: 2010-01-13Bibliographically approved
  • 4.
    Ahlström, Gerd
    et al.
    Department of Health Sciences, Lund University.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Enjoying work or Burdened by it?: How personal Assistants Experience and Handle Stress at Work2012In: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, Vol. 11, no 2, 112-127 p.Article in journal (Refereed)
    Abstract [en]

    A personal assistant has to promote equality in living conditions for persons with severe disabilities. The aim of this study was to explore how personal assistants experience their work and what strategies they employ to alleviate work-related stress. Thirty personal assistants were interviewed and latent content analysis was performed. The findings regarding the experiences of work-related stress could be brought together under the theme of “difficulties of being in a subordinate position,” and those regarding management strategies could be brought together under the theme of “coming to terms with the work situation.” There is a need to empower personal assistants through training programs including tailored education, working communities, and coaching.

  • 5.
    Al-Tamimi, Mohammed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Läkemedelsbehandling vid kronisk hjärtsvikt_ en tvärsnittsstudie baserad på Vårdanalysdatabasen i Stockholms läns landsting2014Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Kronisk hjärtsvikt (CHF) utvecklas ofta gradvis under en längre tid. Det drabbar vanligen äldre, som ofta har andra sjukdomar som hypertoni och ischemisk hjärtsjukdom. Enligt läkemedelsrekommendationer och riktlinjer ska patienter med CHF behandlas med kombinationer av angiotensinkonverterande enzymblockare (ACEI) eller angiotensinreceptorblockerare (ARB) och betablockerande läkemedel (BB) och vid NYHA funktionsklass III och IV ska patienter behandlas ytterligare med mineralkortikoidantagonister (MRA). Syfte: Syftet med studien är att analysera läkemedelsbehandlingen vid CHF, som ett underlag för att förbättra vården och till nytta för patienter med CHF och vårdgivare. Material och metoder: Denna studie var en deskriptiv tvärsnittsstudie ur den individbaserade, administrativa Vårdanalysdatabasen (VAL) vid Stockholms läns landsting (SLL). Studien inkluderade alla patienter som var ≥40 år och levde i SLL någon gång mellan juli-augusti 2012. Resultat: VAL-databasen innehöll totalt 32754 patienter med CHF. Andel patienter med CHF som behandlades med ACEI/ARB var 64 % och BB var 69 % samt MRA var 18 %. Andel patienter med CHF som behandlades med kombinationer av ACEI/ARB och BB var 40 % och med kombinationer av ACEI/ARB och BB samt MRA var 11 %. Andel män som behandlades med dessa läkemedel var högre än andel kvinnor, förutom behandling med MRA som var lika hos män och kvinnor. Behandling med dessa läkemedel minskade med stigande ålder. Konklusion: Tydliga ålders- och könsskillnader i behandling vid CHF observerades. Endast 40 % av patienter med CHF behandlades med rekommenderade kombinationer av ACEI/ARB och BB. Den rekommenderade läkemedelsbehandlingen hos patienter med CHF kan förbättras. 

  • 6.
    Andersson, Agneta
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Sjöberg, Marina
    Att bättre förstå ätstörningar och förmedla en sund kostmedvetenhet inom idrotten: Paradoxen och den svåra balansgången2011In: Dietistaktuellt, ISSN 1102-9285, Vol. 20, no 6, 14-16 p.Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Majoriteten av idrottare drabbas aldrig av ätstörningar trots hård träning, prestationsinriktning och en mer eller mindre noggrann kosthållning och viktreglering . Det finns dock idrottare som under lång tid kämpar med en ätstörningsproblemtik där ett komplicerat förhållande till mat och träning uppstått. Vissa studier talar vidare för att idrotten skulle kunna skydda individen för ätstörningar medan flera studier visar en högre förekomst av ätstör-ningar och stört ätbeteende inom än utanför idrottsvärlden, i synnerhet inom estetiska och viktrelaterade idrotter . Maten och träningen är båda komplexa fenomen och en djupare insikt och öppenhet kring hur man hanterar denna form av ”idrottsskada” är värdefullt såväl inom idrottsvärlden som inom hälso- och sjukvården. Dietisten med fördjupad kunskap inom idrott och ätstörningar förefaller vara en värdefull person i detta arbete.

  • 7.
    Andersson, Arne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Ronquist, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biochemial structure and function.
    A substantial increase of the impact factor2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 4, 353-354 p.Article in journal (Refereed)
  • 8.
    Andersson, Sandra
    et al.
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    Nilsson, Kenneth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Fagerberg, Linn
    Hallstrom, Bjorn M.
    Sundström, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Danielsson, Angelika
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Edlund, Karolina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Uhlen, Mathias
    Asplund, Anna
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    The Transcriptomic and Proteomic Landscapes of Bone Marrow and Secondary Lymphoid Tissues2014In: PLoS ONE, ISSN 1932-6203, Vol. 9, no 12, e115911- p.Article in journal (Refereed)
    Abstract [en]

    Background: The sequencing of the human genome has opened doors for global gene expression profiling, and the immense amount of data will lay an important ground for future studies of normal and diseased tissues. The Human Protein Atlas project aims to systematically map the human gene and protein expression landscape in a multitude of normal healthy tissues as well as cancers, enabling the characterization of both housekeeping genes and genes that display a tissue-specific expression pattern. This article focuses on identifying and describing genes with an elevated expression in four lymphohematopoietic tissue types (bone marrow, lymph node, spleen and appendix), based on the Human Protein Atlas-strategy that combines high throughput transcriptomics with affinity-based proteomics. Results: An enriched or enhanced expression in one or more of the lymphohematopoietic tissues, compared to other tissue-types, was seen for 693 out of 20,050 genes, and the highest levels of expression were found in bone marrow for neutrophilic and erythrocytic genes. A majority of these genes were found to constitute well-characterized genes with known functions in lymphatic or hematopoietic cells, while others are not previously studied, as exemplified by C19ORF59. Conclusions: In this paper we present a strategy of combining next generation RNA-sequencing with in situ affinity-based proteomics in order to identify and describe new gene targets for further research on lymphatic or hematopoietic cells and tissues. The results constitute lists of genes with enriched or enhanced expression in the four lymphohematopoietic tissues, exemplified also on protein level with immunohistochemical images.

  • 9.
    Anvari, Ebrahim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Wang, Xuan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Sandler, Stellan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Welsh, Nils
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    The H1-receptor antagonist cetirizine ameliorates high-fat diet-induced glucose intolerance in male C57BL/6 mice, but not diabetes outcome in female non-obese diabetic (NOD) mice2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 1, 40-46 p.Article in journal (Refereed)
    Abstract [en]

    Background. It has been proposed that the histamine 1-receptor (H1-receptor) not only promotes allergic reactions, but also modulates innate immunity and autoimmune reactions. In line with this, we have recently reported that the H1-receptor antagonist cetirizine partially counteracts cytokine-induced beta-cell signaling and destruction. Therefore, the aim of this study was to determine whether cetirizine affects diabetes in NOD mice, a model for human type 1 diabetes, and glucose intolerance in high-fat diet C57BL/6 mice, a model for human glucose intolerance. Methods. Female NOD mice were treated with cetirizine in the drinking water (25 mg/kg body weight) from 9 until 30 weeks of age during which precipitation of diabetes was followed. Male C57BL/6 mice were given a high-fat diet from 5 weeks of age. When the mice were 12 weeks of age cetirizine was given for 2 weeks in the drinking water. The effects of cetirizine were analyzed by blood glucose determinations, glucose tolerance tests, and insulin sensitivity tests. Results. Cetirizine did not affect diabetes development in NOD mice. On the other hand, cetirizine treatment for 1 week protected against high-fat diet-induced hyperglycemia. The glucose tolerance after 2 weeks of cetirizine treatment was improved in high-fat diet mice. We observed no effect of cetirizine on the insulin sensitivity of high-fat diet mice. Conclusion. Our results suggest a protective effect of cetirizine against high-fat diet-induced beta-cell dysfunction, but not against autoimmune beta-cell destruction.

  • 10. Bravi, Luca
    et al.
    Rudini, Noemi
    Cuttano, Roberto
    Giampietro, Costanza
    Maddaluno, Luigi
    Ferrarini, Luca
    Adams, Ralf H.
    Corada, Monica
    Boulday, Gwenola
    Tournier-Lasserve, Elizabeth
    Dejana, Elisabetta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Vascular Biology.
    Lampugnani, Maria Grazia
    Sulindac metabolites decrease cerebrovascular malformations in CCM3-knockout mice2015In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 112, no 27, 8421-8426 p.Article in journal (Refereed)
    Abstract [en]

    Cerebral cavernous malformation (CCM) is a disease of the central nervous system causing hemorrhage-prone multiple lumen vascular malformations and very severe neurological consequences. At present, the only recommended treatment of CCM is surgical. Because surgery is often not applicable, pharmacological treatment would be highly desirable. We describe here a murine model of the disease that develops after endothelial-cell-selective ablation of the CCM3 gene. We report an early, cell-autonomous, Wnt-receptor-independent stimulation of beta-catenin transcription activity in CCM3-deficient endothelial cells both in vitro and in vivo and a triggering of a beta-catenin-driven transcription program that leads to endothelial-tomesenchymal transition. TGF-beta/BMP signaling is then required for the progression of the disease. We also found that the anti-inflammatory drugs sulindac sulfide and sulindac sulfone, which attenuate beta-catenin transcription activity, reduce vascular malformations in endothelial CCM3-deficient mice. This study opens previously unidentified perspectives for an effective pharmacological therapy of intracranial vascular cavernomas.

  • 11.
    Burström, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Patient Safety in the Emergency Department: Culture, Waiting, and Outcomes of Efficiency and Quality2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to investigate patient safety in the emergency department (ED) and to determine whether this varies according to patient safety culture, waiting, and outcomes of efficiency and quality variables.

    I: Patient safety culture was described in the EDs of two different hospitals before and after a quality improvement project. The questionnaire “Hospital Survey on Patient Safety Culture” was used to investigate the patient safety culture. The main finding was that the staff at both hospitals scored more positively in the dimension Team-work within hospital after implementing a new work model aimed at improving patient flow and patient safety in the ED. Otherwise, we found only modest improvements.

    II: Grounded theory was used to explore what happens in the ED from the staff perspective. Their main concern was reducing patients’ non-acceptable waiting time. Management of waiting was improved either by increasing the throughput of patient flow by structure pushing and by shuffling patients, or by changing the experience of waiting by calming patients and by feinting to cover up.

    III: Three Swedish EDs with different triage models were compared in terms of efficiency and quality. The median length of stay was 158 minutes for physician-led team triage compared with 243 and 197 minutes for nurse–emergency physician and nurse–junior physician triage, respectively. Quality indicators (i.e., patients leaving before treatment was completed, the rate of unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days) improved under the physician-led team triage.

    IV: Efficiency and quality variables were compared from before (2008) to after (2012) a reorganization with a shift of triage model at a single ED. Time from registration to physician decreased by 47 minutes, and the length of stay decreased by 34 minutes. Several quality measures differed between the two years, in favour of 2012. Patients leaving before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days all improved despite the reduced admission rate.

    In conclusion, the studies underscore the need to improve patient safety in the ED. It is important to the patient safety culture to reduce patient waiting because it dynamically affects both patients and staff. Physician-led team triage may be a suitable model for reducing patient waiting time and increasing patient safety.

    List of papers
    1. The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study
    Open this publication in new window or tab >>The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study
    Show others...
    2014 (English)In: BMC Health Services Research, ISSN 1472-6963, Vol. 14, 296- p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

    Keyword
    Patient safety, Patient safety culture, Patient safety climate, Quality improvement, Team-work
    National Category
    Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:uu:diva-223979 (URN)10.1186/1472-6963-14-296 (DOI)000339219600001 ()
    Available from: 2014-04-28 Created: 2014-04-28 Last updated: 2015-09-23Bibliographically approved
    2. Waiting management at the emergency department - a grounded theory study
    Open this publication in new window or tab >>Waiting management at the emergency department - a grounded theory study
    2013 (English)In: BMC Health Services Research, ISSN 1472-6963, Vol. 13, 95- p.Article in journal (Refereed) Published
    Abstract [en]

    Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.

    Keyword
    Waiting, Management, Emergency department, Grounded theory, Focus group, Participant observation
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-200118 (URN)10.1186/1472-6963-13-95 (DOI)000317462000002 ()
    Available from: 2013-05-21 Created: 2013-05-20 Last updated: 2014-06-30Bibliographically approved
    3. Physician-led team triage based on lean principles may be superior for efficiency and quality?: A comparison of three emergency departments with different triage models
    Open this publication in new window or tab >>Physician-led team triage based on lean principles may be superior for efficiency and quality?: A comparison of three emergency departments with different triage models
    Show others...
    2012 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 20, no 1, 57- p.Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    The management of emergency departments (EDs) principally involves maintaining effective patient flow and care. Different triage models are used today to achieve these two goals. The aim of this study was to compare the performance of different triage models used in three Swedish EDs. Using efficiency and quality indicators, we compared the following triage models: physician-led team triage, nurse first/emergency physician second, and nurse first/junior physician second.

    METHODS:

    All data of patients arriving at the three EDs between 08:00- and 21:00 throughout 2008 were collected and merged into a database. The following efficiency indicators were measured: length of stay (LOS) including time to physician, time from physician to discharge, and 4-hour turnover rate. The following quality indicators were measured: rate of patients left before treatment was completed, unscheduled return within 24 and 72 hours, and mortality rate within 7 and 30 days.

    RESULTS:

    Data from 160,684 patients were analysed. The median length of stay was 158 minutes for physician-led team triage, compared with 243 and 197 minutes for nurse/emergency physician and nurse/junior physician triage, respectively (p < 0.001). The rate of patients left before treatment was completed was 3.1 % for physician-led team triage, 5.3 % for nurse/emergency physician, and 9.6 % for nurse/junior physician triage (p < 0.001). Further, the rates of unscheduled return within 24 hours were significantly lower for physician-led team triage, 1.0 %, compared with 2.1 %, and 2.5 % for nurse/emergency physician, and nurse/junior physician, respectively (p < 0.001). The mortality rate within 7 days was 0.8 % for physician-led team triage and 1.0 % for the two other triage models (p < 0.001).

    CONCLUSIONS:

    Physician-led team triage seemed advantageous, both expressed as efficiency and quality indicators, compared with the two other models.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-181961 (URN)10.1186/1757-7241-20-57 (DOI)000310207200001 ()22905993 (PubMedID)
    Available from: 2012-10-02 Created: 2012-10-02 Last updated: 2015-03-09Bibliographically approved
    4. Change of triage model to physician-led team triage explains better quality and efficiency at one emergency department.
    Open this publication in new window or tab >>Change of triage model to physician-led team triage explains better quality and efficiency at one emergency department.
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    (English)Article in journal (Refereed) Submitted
    National Category
    Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:uu:diva-223980 (URN)
    Available from: 2014-04-28 Created: 2014-04-28 Last updated: 2014-06-30
  • 12. Burström, Lena
    et al.
    Engström, Marie-Louise
    Castrén, Maaret
    Wiklund, Tony
    Enlund, Mats
    Change of triage model to physician-led team triage explains better quality and efficiency at one emergency department.Article in journal (Refereed)
  • 13.
    Burström, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Letterstal, Anna
    Engström, Marie-Loise Walker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Berglund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Enlund, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    The patient safety culture as perceived by staff at two different emergency departments before and after introducing a flow-oriented working model with team triage and lean principles: a repeated cross-sectional study2014In: BMC Health Services Research, ISSN 1472-6963, Vol. 14, 296- p.Article in journal (Refereed)
    Abstract [en]

    Background: Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety. Methods: A repeated cross-sectional design, using the Hospital Survey On Patient Safety Culture questionnaire before and after a quality improvement project in two emergency departments at a county hospital and a university hospital. The questionnaire was developed to obtain a better understanding of the patient safety culture of an entire hospital or of specific departments. The Swedish version has 51 questions and 15 dimensions. Results: At the county hospital, a difference between baseline and follow-up was observed in three dimensions. For two of these dimensions, Team-work within hospital and Communication openness, a higher score was measured at the follow-up. At the university hospital, a higher score was measured at follow-up for the two dimensions Team-work across hospital units and Team-work within hospital. Conclusion: The result showed changes in the self-estimated patient safety culture, mainly regarding team-work and communication openness. Most of the improvements at follow-up were seen by physicians, and mainly at the county hospital.

  • 14.
    Cameron, Camilla
    et al.
    Clinical Nutrition and Dieietics Karolinska University Hospital Stockholm.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Faxén Irving, Gerd
    Clinical Nutrition Karolinska Institute Stockholm.
    Dietary phosphorous intake among haemodialysis patients in relation to dosage of phosphate binders and hyperphosphatemia2012In: International Congress on Renal Nutrition and Metabolism (ICRNM) Honolulu, Hawaii 26-30 juni 2012, 2012, pos3-13- p.Conference paper (Other academic)
  • 15.
    Carlsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    The significance of fatigue in relatives of palliative patients2010In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 8, 137-142 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the significance of fatigue among relatives of palliative patients. 

    Method: This pilot study has a descriptive and cross-sectional design and is the report of four open-ended questions focusing on the relatives' experiences of fatigue. The study population consisted of relatives of patients who were cared for in palliative care settings either at home or in an institution in Uppsala County during a specific day. 

    Results: The relatives were very tired and identified worries, uncertainty, the patient's suffering, and many demands as the causes for the fatigue. The most obvious consequences of the tiredness were a lack of motivation, feelings of insufficiency and apathy, and putting their own interests aside. Many relatives expressed that having the company of close family members, taking exercise and spending time outdoors gave them strength to carry on. The health care system could make the situation easier for relatives of patients in palliative care by providing good care for the patient, and psychosocial support and respite care for the relatives. 

    Significance of results: The result of the pilot study is only preliminary, but it showed that relatives caring for patients in a late palliative phase suffer from great fatigue and require more attention, both scientifically and in the clinical settings.

  • 16.
    Carlstrand, Alexandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Eriksson, Emmelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Kan fonologisk språkstörning leda till läs- och skrivsvårigheter?: En studie om samband mellan fonologiska svårigheter under förskoleåren och läs- och skrivsvårigheter under skolåren.2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Phonological language impairment is the most common type of specific language impairment (SLI). The diagnosis includes difficulties with pronunciation and/or poor phonological awareness. The purpose of this study was to investigate whether children with the diagnosis are at risk for developing reading and writing disabilities. 14 children in third grade, who were diagnosed with phonological language impairment in kindergarten, were tested in phonological awareness, decoding of words and nonwords and spelling. The results showed that eight of the children have difficulties with reading- and writing and five of these showed signs of dyslexia. In an attempt to find correlations between components of the phonological ability in kindergarten and poor reading- and writing abilities , the children's medical records regarding speech-language treatment were analyzed. The authors found that the phonological awareness, which has been identified as the most reliable predictor of reading achievement, only had been tested in one out of 14 children. Any pattern of pronunciation difficulties in the children who showed signs of reading- and writing disabilities could not be found. The literature suggests that it should be possible to identify children at risk of developing reading and writing disabilities very early; perhaps even before they begin to learn how to read and write. The results of the present study indicate that children with phonological language impairment are at high risk of developing reading and writing disabilities, if their phonological awareness is poor, and that the phonological awareness therefore should be tested in all children with the diagnosis.

  • 17.
    Dahlqvist-Edberg, Ulla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Ekman, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Purification of a Ca2+-activated protease from rat erythrocytes and its possible effect on pyruvate kinase in vivo1981In: Biochimica et Biophysica Acta-Enzymology, ISSN 0005-2744, Vol. 660, no 1, 96-101 p.Article in journal (Refereed)
    Abstract [en]

    A Ca2+-activated protease with [32P]phosphopyruvate kinase as substrate was purified to about 50% from rat erythrocytes. The purification involved chromatography on Sepharose/Sephadex gels, DEAE-cellulose and (NH4)2SO4 precipitation. The protease required 3.3 mM Ca2+ for full activity. When pyruvate kinase (ATP: pyruvate 2-O-phosphotransferase, EC 2.7.1.40) was purified from erythrocytes incubated with [32P]phosphate it contained 0.5 mol [32P]phosphate/mol enzyme subunit. When 3.3 mM Ca2+ were added at hemolysis this incorporation decreased. The possible importance of this Ca2+-activated protease for the regulation of pyruvate kinase in erythrocytes is discussed.

  • 18.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Perinatal energy metabolism with reference to IUGR & SGA: Studies in pregnant women & newborn infants2009In: Indian Journal of Medical Research (IJMR), ISSN 0971-5916, Vol. 130, no 5, 612-617 p.Article, review/survey (Refereed)
    Abstract [en]

    Glucose is the most important fetal energy substrate. During the third trimester increased maternal glucose production and insulin resistance improves fetal glucose availability. Maternal malnutrition, chronic disease and/or placental dysfunction can disturb glucose delivery, resulting in intrauterine growth restriction (IUGR) and an infant born small for gestational age (SGA). Hypoglycaemia is a problem frequently occurring in infants born SGA; they are also at long-term risk of developing insulin resistance. In the studies presented, energy substrate production was investigated using stable isotope dilution technique, in normal pregnancies and pregnancies complicated by intrauterine growth restriction (IUGR). In addition energy substrate production in infants born SGA was studied on their first day of life. We found that late pregnancy was associated with an almost twofold increase in rate of lipolysis. This provides substrates for maternal energy metabolism, sparing glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late gestation, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Data on insulin and IGFBP-1 in the SGA infants indicate that insulin sensitivity is increased peripherally but reduced in the liver.

  • 19.
    Dinic, Jelena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Riehl, Astrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Adler, Jeremy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Parmryd, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    The T cell receptor resides in ordered plasma membrane nanodomains that aggregate upon patching of the receptor2015In: Scientific Reports, ISSN 2045-2322, Vol. 5, 10082Article in journal (Refereed)
    Abstract [en]

    Two related models for T cell signalling initiation suggest either that T cell receptor (TCR) engagement leads to its recruitment to ordered membrane domains, often referred to as lipid rafts, where signalling molecules are enriched or that ordered TCR-containing membrane nanodomains coalesce upon TCR engagement. That ordered domains form upon TCR engagement, as they do upon lipid raft marker patching, has not been considered. The target of this study was to differentiate between those three options. Plasma membrane order was followed in live T cells at 37 °C using laurdan to report on lipid packing. Patching of the TCR that elicits a signalling response resulted in aggregation, not formation, of ordered plasma membrane domains in both Jurkat and primary T cells. The TCR colocalised with actin filaments at the plasma membrane in unstimulated Jurkat T cells, consistent with it being localised to ordered membrane domains. The colocalisation was most prominent in cells in G1 phase when the cells are ready to commit to proliferation. At other cell cycle phases the TCR was mainly found at perinuclear membranes. Our study suggests that the TCR resides in ordered plasma membrane domains that are linked to actin filaments and aggregate upon TCR engagement.

  • 20.
    Ekman, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical and Physiological Chemistry.
    Eriksson, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical and Physiological Chemistry.
    The in vitro modification of phosphorylated pyruvate kinase by a Ca2+-activated protease from rat liver1980In: Acta Chemica Scandinavica, ISSN 0904-213X, Vol. 34, no 6, 419-422 p.Article in journal (Refereed)
    Abstract [en]

    A Ca/+-activated protease from rat liver cell sap was prepared. It was shown to act on rat liver pyruvate kinase that had been phosphorylated by the catalytic subunit of cyclic AMP-dependent protein kinase, the activity being optimum at neutral pH. The modified pyruvate kinase had the same Vmax as the phosphoenzyme but showed a lower affinity for the substrate phosphoenolpyruvate. The possibility that this proteolytic attack is the step that initiates further degradation in the cell is discussed.

  • 21. Emilsson, L.
    et al.
    Lindahl, Bertil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Koster, M.
    Lambe, M.
    Ludvigsson, J. F.
    Review of 103 Swedish Healthcare Quality Registries2015In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 277, no 1, 94-136 p.Article in journal (Refereed)
    Abstract [en]

    Background and objectives: In the past two decades, an increasing number of nationwide, Swedish Healthcare Quality Registries (QRs) focusing on specific disorders have been initiated, mostly by physicians. Here, we describe the purpose, organization, variables, coverage and completeness of 103 Swedish QRs. Methods: From March to September 2013, we examined the 2012 applications of 103 QRs to the Swedish Association of Local Authorities and Regions (SALAR) and also studied the annual reports from the same QRs. After initial data abstraction, the coordinator of each QR was contacted at least twice between June and October 2013 and asked to confirm the accuracy of the data retrieved from the applications and reports. Results: About 60% of the QRs covered 80% of their target population (completeness). Data recorded in Swedish QRs include aspects of disease management (diagnosis, clinical characteristics, treatment and lead times). In addition, some QRs retrieve data on self-reported quality of life (EQ5D, SF-36 and disease-specific measures), lifestyle (smoking) and general health status (World Health Organization performance status, body mass index and blood pressure). ConclusionDetailed clinical data available in Swedish QRs complement information from government-administered registries and provide an important source not only for assessment and development of quality of care but also for research.

  • 22.
    Enqvist, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Sundström, Martina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Standardisering av talperceptionstestet Lyssna-Säg: Diskrimination och identifikation av svenska konsonantkontraster i betingelserna tyst och babbel hos typiskt utvecklade barn2015Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Impaired speech perception occurs in several groups of children enrolled at Speech Language Pathology and Audiological clinics. There may be children with language impairment, cognitive impairments, hearing impairments and children with (Central)Auditory Processing Disorders (CAPD). At present no standardized speech perceptiontest in Swedish provides information about how children discriminate, identify and produce speech sound contrasts in words. It is therefore of great importance to develop diagnostic tools to obtain a reliable test procedure and enable differential diagnostics.The present study had two purposes, to prepare and standardize a new speech perceptiontest (the Listen-Say test) and to investigate how typically developing children in grade 1 and 2 perform in quiet and in babble noise. The study included 21 children. Results showed that the children discriminated significantly more correct consonant contrasts inquiet compared to babble noise for all consonant contrasts combined. The study alsoshowed differences in some of the contrasts that were examined, both between quiet andbabble noise and between grades, grade 2 discriminated more correct contrasts thangrade 1. Significantly shorter reaction times for correct recognition of target words inbabble noise compared to quiet was observed. It is necessary to develop the test additionally prior to use in clinical practice. Nevertheless, the first data collection highlights important aspects of speech perception of Swedish consonant contrasts inquiet and in babble noise.

  • 23.
    Enweji, Nizar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Kheri, Amani
    Kerje, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Abdel-Muhsin, Abdel-Muhsin
    Babiker, Hamza
    Swedberg, Göte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Dynamics of asymptomatic malaria infections as revealed by microsatellite typingManuscript (preprint) (Other academic)
  • 24.
    Enweji, Nizar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Sharif, Hanan
    Swedish University of agricultural Sciences.
    Abdel-Muhsin, Abdel-Muhsin
    Babiker, Hamza
    Swedberg, Göte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Real-time quantitative PCR for determining Plasmodium falciparum parasite density in patients with asymptomatic infection in a seasonal transmission area.Manuscript (preprint) (Other academic)
  • 25.
    Eriksson, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hammarström, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Värmeballongbehandling som endometriedestruktion vid rikliga gynekologiska blödningar: Utfallet av en behandling2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Mellan 200901 och 201212 genomgick 77 kvinnor värmeballongbehandling på grund av rikliga gynekologiska blödningar vid en gynekologisk klinik i Mellansverige. Postoperativt fick sju kvinnor stanna kvar över natten på grund av smärta och illamående, en kvinna fick stanna kvar då hon hade blödningsproblematik sedan tidigare och hennes blödningsbenägenhet kontrollerades, en kvinna fick problem med sitt blodsocker då hon var insulinbehandlad diabetiker och fick stanna för observation och tre kvinnor kunde inte tömma blåsan efter operationen. Sammanlagt åtta kvinnor fick endometrit efter värmeballongbehandlingen varav en fick läggas in för intravenös antibiotikabehandling. Fem av 77 kvinnor valde att hysterektomera sig inom ett år efter värmeballongbehandlingen, antigen på grund av fortsatta besvär med rikliga blödningar efter endometriedestruktionen eller på grund av kraftiga underlivssmärtor efter komplikationer som orsakades av värmeballongbehandlingen - enbart en kvinna valde på egen begäran hysterektomi trots ett normalt blödningsmönster efter värmeballongbehandlingen då hon önskade bli amenorreisk. 

  • 26. Folke, Fredrik
    et al.
    Hursti, Timo
    Kanter, Jonathan W
    Arinell, Hans
    Tungström, Stefan
    Söderberg, Per
    Ekselius, Lisa
    Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.2017In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349Article in journal (Refereed)
    Abstract [en]

    Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

  • 27.
    Folke, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Stefan, Tungström
    Per, Söderberg
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kanter, Jonathan W.
    Hursti, Timo
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Behavioral Activation for Depressive Symptoms in the Transition from Inpatient to Outpatient Psychiatry: a Pragmatic Randomized Clinical TrialManuscript (preprint) (Other academic)
  • 28.
    Folke, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Söderberg, Per
    Tungström, Stefan
    Hursti, Timo
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Kanter, Jonathan W.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Targeting Treatment Engagement on Psychiatric Inpatient Units with a Behavioral Group Intervention: an Interrupted Time Series Study.Manuscript (preprint) (Other academic)
  • 29. Färdig, Rickard
    et al.
    Lewander, Tommy
    Melin, Lennart
    Folke, Fredrik
    Fredriksson, Anders
    A randomized controlled trial of the illness management and recovery program for persons with schizophrenia.2011In: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 62, no 6, 606-12 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to evaluate the effects of the illness management and recovery (IMR) program on symptoms and psychosocial functioning of individuals with schizophrenia or schizoaffective disorder in an outpatient setting in Sweden.

    METHODS: A total of 41 persons with schizophrenia or schizoaffective disorder who were receiving treatment at six psychiatric outpatient rehabilitation centers were randomly assigned to either an IMR group for nine months or to treatment as usual (control condition). Assessments were conducted at baseline, posttreatment (nine months), and follow-up (21 months) and included self-reports and ratings by clinicians (both blind and nonblind to treatment assignment) of illness management, psychiatric symptoms, recovery, coping, quality of life, hospitalization, insight, and suicidal ideation.

    RESULTS: As measured by self-report and ratings of nonblinded clinicians, IMR program participants demonstrated significantly greater improvement in illness management than participants in the control condition. Ratings of psychiatric symptoms by blinded clinicians using the Psychosis Evaluation Tool for Common Use by Caregivers and self-reported ratings of psychosocial functioning on the Ways of Coping Questionnaire also showed better outcomes than for participants in treatment as usual. A statistically significant decrease in suicidal ideation between baseline and follow-up was found for IMR program participants.

    CONCLUSIONS: The study supports previous findings and suggests that the IMR program is effective in improving the ability of individuals with schizophrenia to better manage their illness.

  • 30.
    Gröndal, Hedvig
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Signs of bacteria: Enacting Sore Throat2015Conference paper (Refereed)
    Abstract [en]

    In this paper I analyse the diagnostic process in relation to bacterial sore throat and how this disease comes into being, or how it is enacted, at two Swedish health centres. The empirical data analysed consist of interviews with nurses and general practioners as well as observations at the health centres. The concept of enactment implies that disease is relationally constituted in and through relations between human and non-human actors. In the paper the relations between health care personnel, bodies, symptoms, instruments, bacteria and other actors are investigated, and I discuss how different enactments of bacterial sore throat come to being depending on how these relations are organized. When doing this the clinical gaze - the diagnosing gaze that interpret signs of an underlying pathology on the patients body – is explored and in relation to the empirical material this gaze is investigated, that is, how it is employed and how it is established in relation to a number of human and non-human actors. 

  • 31.
    Gustafsson, Gabriel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University.
    Alpha-Synuclein Oligomers: Cellular Mechanisms and Aspects of Antibody Treatment2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Parkinson’s disease (PD) and dementia with Lewy bodies (DLB), aggregated α-synuclein deposit inside cells within the brain. Smaller soluble α-synuclein aggregates, oligomers, are present both intra- and extracellularly. The α-synuclein oligomers are known to be particularly harmful, although the underlying neurotoxic mechanisms are not fully understood. The aim of this thesis was to investigate the pathogenic roles of α-synuclein oligomers and the possibility to target such species with antibody treatment.

    Passive immunotherapy with α-synuclein antibodies can lead to reduced pathology and ameliorated symptoms in transgenic mice. However, it remains unknown whether the antibodies are taken up by cells or whether they act extracellularly. In Paper I, we assessed cellular internalization of various α-synuclein monoclonal antibodies. The oligomer selective mAb47 displayed the highest uptake, which was promoted by the extracellular presence of α-synuclein.

    Alpha-synuclein aggregates can be found in both neurons and glial cells, but the pathogenic role of glial deposits has only been sparsely investigated. In Paper II, co-cultures of neurons and glia were exposed to α-synuclein oligomers. The astrocytes in the cultures rapidly accumulated oligomers, which were only partially degraded by lysosomes. The sustained intracellular α-synuclein deposits were associated with mitochondrial stress reactions in the astrocytes. 

    In Paper III, we sought to explore whether the astrocytic pathology induced by α-synuclein oligomers could be ameliorated by antibody treatment. Pre-incubation of oligomers with mAb47 promoted α-synuclein clearance, reduced astrocytic accumulation and rescued cells from mitochondrial stress. We could demonstrate that binding of the antibody to its antigen in the extracellular space was crucial for these effects to occur.

    The progressive pathology in PD is believed to be driven by cell-to-cell spreading of α-synuclein aggregates, potentially via exosomes and other extracellular vesicles (EVs). In Paper IV, we found that either fusing α-synuclein to a non-physiological protein tag or introducing the PD-causing A53T mutation directed α-synuclein towards EV secretion. Also, EV-associated α-synuclein was particularly prone to induce toxicity in recipient cells.

    In conclusion, this thesis sheds new light on the cellular dysfunction related to α-synuclein pathology and on how the underlying pathogenic processes may be targeted by antibody treatment.  

    List of papers
    1. Cellular Uptake of alpha-Synuclein Oligomer-Selective Antibodies is Enhanced by the Extracellular Presence of alpha-Synuclein and Mediated via Fc gamma Receptors
    Open this publication in new window or tab >>Cellular Uptake of alpha-Synuclein Oligomer-Selective Antibodies is Enhanced by the Extracellular Presence of alpha-Synuclein and Mediated via Fc gamma Receptors
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    2017 (English)In: Cellular and molecular neurobiology, ISSN 0272-4340, E-ISSN 1573-6830, Vol. 37, no 1, 121-131 p.Article in journal (Refereed) Published
    Abstract [en]

    Immunotherapy targeting aggregated alpha-synuclein has emerged as a potential treatment strategy against Parkinson's disease and other alpha-synucleinopathies. We have developed alpha-synuclein oligomer/protofibril selective antibodies that reduce toxic alpha-synuclein in a human cell line and, upon intraperitoneal administration, in spinal cord of transgenic mice. Here, we investigated under which conditions and by which mechanisms such antibodies can be internalized by cells. For this purpose, human neuroglioma H4 cells were treated with either monoclonal oligomer/protofibril selective alpha-synuclein antibodies, linear epitope monoclonal alpha-synuclein antibodies, or with a control antibody. The oligomer/protofibril selective antibody mAb47 displayed the highest cellular uptake and was therefore chosen for additional analyses. Next, alpha-synuclein overexpressing cells were incubated with mAb47, which resulted in increased antibody internalization as compared to non-transfected cells. Similarly, regular cells exposed to mAb47 together with media containing alpha-synuclein displayed a higher uptake as compared to cells incubated with regular media. Finally, different Fc gamma receptors were targeted and we then found that blockage of Fc gamma RI and Fc gamma RIIB/C resulted in reduced antibody internalization. Our data thus indicate that the robust uptake of the oligomer/protofibril selective antibody mAb47 by human CNS-derived cells is enhanced by extracellular alpha-synuclein and mediated via Fc gamma receptors. Altogether, our finding lend further support to the belief that alpha-synuclein pathology can be modified by monoclonal antibodies and that these can target toxic alpha-synuclein species in the extracellular milieu. In the context of immunotherapy, antibody binding of alpha-synuclein would then not only block further aggregation but also mediate internalization and subsequent degradation of antigen-antibody complexes.

    Keyword
    alpha-Synuclein, Parkinson's disease, Lewy bodies, Monoclonal antibodies, Antibody uptake, Fc gamma receptors
    National Category
    Geriatrics Cell and Molecular Biology
    Identifiers
    urn:nbn:se:uu:diva-316048 (URN)10.1007/s10571-016-0352-5 (DOI)000392407200013 ()26961542 (PubMedID)
    Funder
    Swedish Research Council, 2011-4519 2012-2172 2010-6745The Swedish Brain FoundationThe Dementia Association - The National Association for the Rights of the DementedMagnus Bergvall FoundationGerman Research Foundation (DFG)
    Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2017-07-05Bibliographically approved
    2. Extensive uptake of α-synuclein oligomers in astrocytes results in sustained intracellular deposits and mitochondrial damage
    Open this publication in new window or tab >>Extensive uptake of α-synuclein oligomers in astrocytes results in sustained intracellular deposits and mitochondrial damage
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    2017 (English)In: Molecular and Cellular Neuroscience, ISSN 1044-7431, E-ISSN 1095-9327, Vol. 82, 143-156 p.Article in journal (Refereed) Published
    Abstract [en]

    The presence of Lewy bodies, mainly consisting of aggregated α-synuclein, is a pathological hallmark of Parkinson's disease (PD) and dementia with Lewy bodies (DLB). The α-synuclein inclusions are predominantly found in neurons, but also appear frequently in astrocytes. However, the pathological significance of α-synuclein inclusions in astrocytes and the capacity of glial cells to clear toxic α-synuclein species remain unknown. In the present study we investigated uptake, degradation and toxic effects of oligomeric α-synuclein in a co-culture system of primary neurons, astrocytes and oligodendrocytes. Alpha-synuclein oligomers were found to co-localize with the glial cells and the astrocytes were found to internalize particularly large amounts of the protein. Following ingestion, the astrocytes started to degrade the oligomers via the lysosomal pathway but, due to incomplete digestion, large intracellular deposits remained. Moreover, the astrocytes displayed mitochondrial abnormalities. Taken together, our data indicate that astrocytes play an important role in the clearance of toxic α-synuclein species from the extracellular space. However, when their degrading capacity is overburdened, α-synuclein deposits can persist and result in detrimental cellular processes.

    Keyword
    Astrocytes, Glia, Mitochondria, Oligodendrocytes, Parkinson's disease, α-Synuclein oligomers
    National Category
    Other Medical Sciences
    Research subject
    Medical Science; Biology with specialization in Molecular Cell Biology
    Identifiers
    urn:nbn:se:uu:diva-326114 (URN)10.1016/j.mcn.2017.04.009 (DOI)000405977400015 ()28450268 (PubMedID)
    Funder
    Swedish Research Council, 2015-02671Magnus Bergvall Foundation, 2016-01714Marianne and Marcus Wallenberg FoundationThe Swedish Brain Foundation
    Available from: 2017-07-02 Created: 2017-07-02 Last updated: 2017-10-31Bibliographically approved
    3. Alpha-synuclein oligomer-selective antibodies reduce intracellular accumulation and mitochondrial impairment in alpha-synuclein exposed astrocytes
    Open this publication in new window or tab >>Alpha-synuclein oligomer-selective antibodies reduce intracellular accumulation and mitochondrial impairment in alpha-synuclein exposed astrocytes
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    (English)Article in journal (Other academic) Submitted
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-326116 (URN)
    Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2017-07-05
    4. Secretion and uptake of α-synuclein via extracellular vesicles in cultured cells
    Open this publication in new window or tab >>Secretion and uptake of α-synuclein via extracellular vesicles in cultured cells
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-326117 (URN)
    Available from: 2017-07-05 Created: 2017-07-05 Last updated: 2017-07-05
  • 32.
    Haake, Kim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dahlgren, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Föda utan rädsla: En utvärdering av förlossningsförberedelse i grupp2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: En förlossningsupplevelse har beskrivits som en central upplevelse i en kvinnas liv och något som hon och hennes partner bar med sig.

    Syftet: var att undersöka blivande föräldrars oro, rädsla, trygghet, tillit till sin egen förmåga och kroppsförståelse inför en förlossning, innan och efter genomgången Föda utan rädsla kurs samt om det fanns skillnader relaterat till sociodemografiska variabler. Metod: Studiens design var experimentell och utformades som en före- och eftermätning med huvudsakligen kvantitativ ansats. Ett semistrukturerat frågeformulär användes och 42 blivande föräldrar deltog i studien.

    Huvudresultat: Deltagarna kände större trygghet, mer tillit till den egna förmågan, större förståelse för vad som hände i kroppen samt mindre oro inför en förlossning, efter kursen. Den största oron inför förlossningen var kontrollförlust, oro för komplikationer, bristande vård och stöd samt distraktion. Deltagare med barn upplevde en lägre trygghet, mer oro och ökad rädsla inför förlossningen än de deltagare som inte hade barn. Efter kursen planerade deltagarna i större utsträckning, att använda sig av massage, andning och avslappning samt Föda utan rädsla metoden under förlossningen. Fler deltagare beskrev att samarbete och Föda utan rädsla metoden var de främsta verktygen som de tänkt använda. Fler deltagare ansåg att intimitet, humor, tystnad, lugn och avslappning samt musik tillhörde en förlossning, efter kursen. Deltagarna beskrev även en ökad känsla av förberedelse efter genomgången kurs.

    Slutsats: Föda utan rädsla kursen kan medföra ett bättre samarbete mellan paret och barnmorskan. Det kan även ge föräldrarna större möjligheter till olika val då de har mer kunskap om de alternativ som finns. Materialet i studien var dock relativt litet vilket innebär att inga säkra slutsatser gentemot populationen kunde dras. 

  • 33.
    Halilovic, Amra
    et al.
    Landstinget i Dalarna.
    Terner, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Standardized headings as a foundation for semantic interoperability in EHR2016In: MATEC Web of Conferences / [ed] N. Mastorakis, V. Mladenov and A. Bulucea, 2016, Vol. 76, 04001Conference paper (Refereed)
    Abstract [en]

    The new Swedish Patient Act, which allows patients to choose health care in county councils other than their own, creates the need to be able to share health-related information contained in electronic health records [EHRs) across county councils. This demands interoperability in terms of structured and standardized data. Headings in EHR could also be a part of structured and standardized data. The aim was to study to what extent terminology is shared and standardized across county councils in Sweden. Headings from three county councils were analyzed to see to what extent they were shared and to what extent they corresponded to concepts in SNOMED CT and the National Board of Health and Welfare’s term dictionary [NBHW’s TD). In total 41% of the headings were shared across two or three county councils. A third of the shared headings corresponded to concepts in SNOMED CT. Further, an eighth of the shared headings corresponded to concepts in NBHW’s TD. The results showed that the extent of shared and standardized terminology in terms of headings across the studied three county councils were negligible.

  • 34.
    Halvorsen, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 1, 11-19 p.Article in journal (Refereed)
    Abstract [en]

    Background. Our aim was to investigate cerebral and cardiac tissue injury subsequent to use of vasopressin and adrenaline in combination compared with vasopressin alone during cardiopulmonary resuscitation (CPR). Methods. In a randomized, prospective, laboratory animal study 28 anesthetized piglets were subject to a 12-min untreated cardiac arrest and subsequent CPR. After 1 min of CPR, 10 of the piglets received 0.4 U/kg of arg(8)-vasopressin (V group), and 10 piglets received 0.4 U/kg of arg(8)-vasopressin, 1 min later followed by 20 mu g/kg body weight of adrenaline, and another 1 min later continuous administration (10 mu g/kg/min) of adrenaline (VA group). After 8 min of CPR, the piglets were defibrillated and monitored for another 3 h. Then they were killed and the brain immediately removed pending histological analysis. Results. During CPR, the VA group had higher mean blood pressure and cerebral cortical blood flow (CCBF) but similar coronary perfusion pressure. After restoration of spontaneous circulation there was no difference in the pressure variables, but CCBF tended to be (36% +/- 16%) higher in the V group. Neuronal injury and signs of a disrupted blood-brain barrier (BBB) were greater, 20% +/- 4% and 21% +/- 4%, respectively, in the VA group. In a background study of repeated single doses of adrenaline every third minute after 5 min arrest but otherwise the same protocol, histological measurements showed even worse neural injury and disruption of the BBB. Conclusion. Combined use of vasopressin and adrenaline caused greater signs of cerebral and cardiac injury than use of vasopressin alone during experimental cardiopulmonary resuscitation.

  • 35.
    Hanson, Claudia
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Waiswa, Peter
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Marchant, Tanya
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Marx, Michael
    Evaplan GmbH the University of Heidelberg, Germany.
    Manzi, Fatuma
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Mbaruku, Godfrey
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Rowe, Alex
    Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
    Tomson, Göran
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Schellenberg, Joanna
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.2014In: Implementation science : IS, ISSN 1748-5908, Vol. 9, 41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

    METHODS: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.

    DISCUSSION: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.

    TRIAL REGISTRATION: PACTR201311000681314.

  • 36. Hastbacka, Johanna
    et al.
    Fredén, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hult, Maarit
    Bergquist, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Wilkman, Erika
    Vuola, Jyrki
    Sorsa, Timo
    Tervahartiala, Taina
    Huss, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Matrix Metalloproteinases-8 and-9 and Tissue Inhibitor of Metalloproteinase-1 in Burn Patients. A Prospective Observational Study2015In: PLoS ONE, ISSN 1932-6203, Vol. 10, no 5, e0125918Article in journal (Refereed)
    Abstract [en]

    Introduction Matrix metalloproteinases (MMPs) -8 and -9 are released from neutrophils in acute inflammation and may contribute to permeability changes in burn injury. In retrospective studies on sepsis, levels of MMP-8, MMP-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) differed from those of healthy controls, and TIMP-1 showed an association with outcome. Our objective was to investigate the relationship between these proteins and disease severity and outcome in burn patients. Methods In this prospective, observational, two-center study, we collected plasma samples from admission to day 21 post-burn, and burn blister fluid samples on admission. We compared MMP-8, -9, and TIMP-1 levels between TBSA<20% (N = 19) and TBSA>20% (N = 30) injured patients and healthy controls, and between 90-day survivors and non-survivors. MMP-8, -9, and TIMP-1 levels at 24-48 hours from injury, their maximal levels, and their time-adjusted means were compared between groups. Correlations with clinical parameters and the extent of burn were analyzed. MMP-8, -9, and TIMP-1 levels in burn blister fluids were also studied. Results Plasma MMP-8 and -9 were higher in patients than in healthy controls (P<0.001 and P = 0.016), but only MMP-8 differed between the TBSA<20% and TBSA>20% groups. MMP-8 and -9 were not associated with clinical severity or outcome measures. TIMP-1 differed significantly between patients and controls (P<0.001) and between TBSA<20% and TBSA>20% groups (P<0.002). TIMP-1 was associated with 90-day mortality and correlated with the extent of injury and clinical measures of disease severity. TIMP-1 may serve as a new biomarker in outcome prognostication of burn patients.

  • 37.
    Holmberg, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    McGill, Svena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ehrenborg, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Wesslen, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hjelm, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Darelid, J
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Blad, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Engstrand, L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Regnery, Russell
    Friman, Göran
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Evaluation of human seroreactivity to Bartonella species in Sweden1999In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 37, no 5, 1381-1384 p.Article in journal (Refereed)
    Abstract [en]

    Among the species that compose the expanding genus Bartonella, thus far only B. henselae and B. quintana have reportedly been isolated from humans in Europe. To evaluate the prevalence of Bartonella infection in Sweden,we conducted a retrospective serological examination of 126 human serum samples. These samples were analyzed for antibodies to B. henselae, B. quintana, and B. elizabethae, Serum samples from 100 blood donors, who spanned the ages of 20 to 60 and had no apparent clinical signs of illness, were also studied as a control group. An immunoglobulin G indirect fluorescence antibody assay revealed 4 and 8.3% Bartonella positivity rates for the blood donor and patient group, respectively, when a cutoff titer of greater than or equal to 64 was chosen. Among the blood donors, four were seropositive to B, elizabethae; one of these also had concordant positive titer to B. henselae, In the patient group, 14 serum samples were positive against Bartonella spp, These serum specimens represented nine patients. In three of these seropositive patients, paired serum samples displayed a fourfold increase in antibody titer to at least one of the three antigens, These three patients are discussed. In this report we also present a case study of a 60-year-old Swedish male with fatal myocarditis, Postmortem serological analysis revealed a high titer against B. elizabethae, PCR and nucleotide sequencing of the myocardial tissue from this patient, and of Liver tissue from one of the other three patients, showed sequences similar to B. quintana, The age, geographical origin, animal contacts, and serological response pattern to the different Bartonella antigens differed among the four patients. This study substantiates the presence of Bartonella spp, in Sweden, documents the seroreactivity to three Bartonella antigens in Swedish patients, and reports the first two cases of B. quintana-like infections in Sweden.

  • 38.
    Hulsart-Billström, Gry
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Bergman, Kristoffer
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - Ångström, Polymer Chemistry.
    Andersson, Brittmarie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hilborn, Jöns
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - Ångström, Polymer Chemistry.
    Larsson, Sune
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Jonsson, Kenneth B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    A uni-cortical femoral defect model in the rat: evaluation using injectable hyaluronan hydrogel as a carrier for bone morphogenetic protein-22015In: Journal of Tissue Engineering and Regenerative Medicine, ISSN 1932-6254, E-ISSN 1932-7005, Vol. 9, no 7, 799-807 p.Article in journal (Refereed)
    Abstract [en]

    The development of biomaterial for bone regeneration requires animal models that are reliable and designed to mimic clinically relevant situations. We have previously investigated hydrogels comprised of modified hyaluronic acid and polyvinyl alcohol in models of ectopic bone formation. This hydrogel induces bone regeneration when loaded with bone morphogenetic proteins (BMPs). To allow further optimization of hydrogels, we developed a new, femoral, non-critical-sized cortical defect model. In the rat femur, we drilled standardized, elongated unilateral cortical defects that did not require stabilization and that could be created bilaterally to allow paired comparisons of biomaterials. After optimizing the defect size, subsequent stress fractures occurred in only 8% and the defect healed partially over the 40 day study period. In a time-course experiment, we treated bone defects with the previously studied hyaluronan hydrogel loaded with 10 µg hydroxyapatite and 6 µg BMP-2. The shape of the defect allowed controlled containment of the material within the defect. The defect in the right leg was left untreated, while the left defect was filled with 40 µl of the BMP hydrogel. As determined by pQCT analysis, the treated defects had a higher bone mineral content, bone area and bone density than control defects. The relative difference was greatest between the groups at 10 and 20 days and diminished as the defect healed in the untreated legs. We conclude that this animal model allows facile and rapid screening of biomaterials for bone regeneration in cortical femoral defects without requiring external fixation.

  • 39.
    Humble, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Dahlqvist-Edberg, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Ekman, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Netzel, Elvy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Ragnarsson, Ulf
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Biochemistry. Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Biochemistry.
    Engström, Lorentz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Amino acid sequence at the phosphorylated site of rat liver fructose-1,6-diphosphatase and phosphorylation of a corresponding synthetic peptide1979In: Biochemical and Biophysical Research Communications - BBRC, ISSN 0006-291X, E-ISSN 1090-2104, Vol. 90, no 3, 1064-1072 p.Article in journal (Refereed)
    Abstract [en]

    Rat liver fructose-1,6-diphosphatase was phosphorylated with (32P)ATP and the catalytic subunit of cyclic AMP-dependent protein kinase from pig muscle. After digestion with pepsin, α-chymotrypsin and subtilisin a peptide with the amino-terminal sequence Ser-Arg-Tyr-(32P)SerP-Leu-Pro-Leu-Pro was isolated. A synthetic unphosphorylated heptapeptide with the same amino acid sequence, ending with leucine, was phosphorylated with an apparent Km of 400 μM, while the apparent Km value for fructose-1,6-diphosphatase was 30 μM (subunit concentration). The Vmax value was 20 times higher for the peptide than for the enzyme.

  • 40.
    Hänni, Arvo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Mårild, Staffan
    Göteborg.
    Övervikt och fetma2014In: Läkemedelsboken / [ed] Helena Ramström, Uppsala: Läkemedelsverket , 2014, 201-219 p.Chapter in book (Other academic)
  • 41.
    Hänni, Arvo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Mårild, Staffan
    Göteborg.
    Övervikt och fetma2011In: Läkemedelsboken / [ed] Helena Ramström, Uppsala: Läkemedelverket , 2011, 193-211 p.Chapter in book (Other academic)
  • 42.
    Härdelin, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Naylor, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Barn berättar på svenska och engelska: En explorativ studie om narrativer hos flerspråkiga barn i tidig skolålder2012Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Growing up in a multilingual environment is becoming more common in today’s society. In spite of this, there is limited knowledge of language assessment of multilingual children with language impairment. This study examined the narrative abilities of a group of multilingual children with typical language development in Sweden. The study was part of the research project COST IS0804. 20 Swedish and English speaking children between the ages 5;9 and 7;6 had the task of telling stories on the basis of two series of pictures. They were also given comprehension questions regarding the stories. The children’s stories were analysed regarding global narrative structure (including the expression of the protagonists’ goals, actions and ensuing results as well as their thoughts and feelings) and linguistic structure at clause level. The results showed that there were no differences between the languages on a global level, which has also been noted in previous research. The linguistic analysis did not reveal any major differences regarding a number of quantitative measures of productivity and complexity, for example the length of the stories and number of subordinate clauses. The qualitative analysis showed certain phenomena that were assessed as being related to the multilingualism of the children, so-called cross-linguistic influences. The results indicate that typically developing bilingual children have equal narrative abilities concerning global structure in their two languages. Quantitative measures of linguistic structure should be used with caution, as they can reflect general differences between the languages per se, as opposed to the child’s language ability. The atypical language use found in the qualitative analysis (i.e. crosslinguistic influences) should not be interpreted as signs of language impairment in multilingual children, even though these types of language use also occur in children with language impairment. Suggestions for future research are to study narrative ability in bilingual children in relation to the corresponding ability in monolingual children, as well as in relation to narrative ability in multilingual children with language impairment.

  • 43.
    Igelström, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Berntsen, Sveinung
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Exercise during and after curative oncological treatment – a mapping review2016In: Physical Therapy Reviews, ISSN 1083-3196, E-ISSN 1743-288XArticle in journal (Refereed)
  • 44.
    Jaenson, Thomas
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Systematic Biology.
    Antalet fästingar i Sverige ökar2011In: EPI-aktuellt, Vol. 10, no 28Article in journal (Other academic)
  • 45.
    Jaenson, Thomas
    Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology.
    Nya rön: Fästingen bär ofta på mer än en art av patogen mikroorganism2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 17Article in journal (Other academic)
  • 46.
    Johansson, Frida
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Åström, Mikaela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Upplevda sväljningssvårigheter vid cancer i struphuvud och nedre svalg: En studie baserad på patientrapportering efter cancerbehandling med inriktning på livskvalitet och logopedens insatser2012Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Cancer in the head and neck region and its treatment has been seen to lead to difficulties in swallowing in around 40 % of the patients. The swallowing difficulties have been shown to be most severe in laryngeal and hypopharyngeal cancer. Swallowing difficulties affect the quality of life according to several studies. The Speech and Language Pathologist (SLP) plays a central role in rehabilitation and treatment of swallowing difficulties in these patients. Measurements of swallowing difficulties with subjective or objective measures do not always agree. Many studies have an objective approach. It is important to also take into account the patient’s own experience of the swallowing. The purpose of this study was to survey the prevalence of patient-reported swallowing difficulties in patients treated for laryngeal and hypopharyngeal cancer and to put the difficulties in relation to quality of life. Further the study intended to compile patient reports of the work of the SLP. In the study the two forms based on individual reports, MDADI and EAT-10 and one questionnaire, constructed by the leaders of the project, was used as material. The forms were sent to 92 patients who had been treated for laryngeal or hypopharyngeal cancer at Akademiska sjukhuset in Uppsala between the years 2000 and 2009. 41 patients were included in the study. EAT-10 was excluded from the analysis due to that few forms were collected. The result showed that 44 % of the participants reported swallowing difficulties. The prevalence of patient-reported swallowing difficulties was higher in the group with hypopharyngeal cancer than in the group with laryngeal cancer. A statistically significant difference (p= 0,006) was found in prevalence of swallowing difficulties between the higher and the lower tumour stages. The combined treatment modality, surgery followed by radiation therapy, showed a greater prevalence of swallowing difficulties than other treatment modalities. The median of the score in total in MDADI (20= low functionality, 100= high functionality) was 69, 5/100 in the hypopharyngeal cancer group and 96/100 in the laryngeal cancer group and the spread of the total score was wide (23-100). Lower swallowing- related quality of life was correlated with a more advanced tumour stage (rho -0, 65, p<0,001).18 participants have had contact with a SLP and the most common reason was counselling. Six participants with swallowing difficulties who had not been offered contact with a SLP wanted it. The conclusions that can be drawn from the results is that the prevalence of patient-reported swallowing difficulties was greatest and had greatest impact on swallowing- related quality of life in patients treated for more advanced tumour stages and hypopharyngeal cancer. Future research could, as a suggestion, focus on quality of life in relation to the work of the SLPs. 

  • 47. Jonsdottir, Ingibjörg H.
    et al.
    Halford, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Eek, Frida
    Mental Health and Salivary Cortisol2012In: The Role of Saliva in Cortisol Measurement in Health and Disease: A Critical Evaluation of the Literature / [ed] Margareta Kristenson, Peter Garvin, Ulf Lundberg, Bentham eBooks, 2012, 129-166 p.Chapter in book (Refereed)
  • 48.
    Jönsson, Siv
    et al.
    Medical Products Agency, Uppsala, Sweden .
    Henningsson, Anja
    Edholm, Monica
    Salmonson, Tomas
    Contribution of modeling and simulation studies in the regulatory review: A European regulatory perspective2011In: Clinical Trial Simulations: Applications and trends / [ed] Kimko HHC, Peck CC, New York: Springer, 2011, 15-36 p.Chapter in book (Refereed)
  • 49.
    Jönsson, Siv
    et al.
    Clinical Pharmacology, AstraZeneca R&D Södertälje.
    Jonsson, E Niclas
    Hoffmann-La Roche Ltd., PDMP Modelling and Simulation, Grenzacherstr 124, Bldg. 15/1.052, CH-4070 Basel, Switzerland.
    Timing and efficiency in population pharmacokinetics/pharmacodynamic data analysis projects2007In: Pharmacometrics: the science of quantitative pharmacology / [ed] Ette EI, Williams PJ, Hoboken, New Jesey: John Wiley & Sons, 2007, 287-302 p.Chapter in book (Refereed)
  • 50.
    Kaarme, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hickman, Rachel A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Nevéus, Tryggve
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Blomberg, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine.
    Öhrmalm, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine.
    Reassuringly low carriage of enteropathogens among healthy Swedish children in day care centres2016In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 140, 221-227 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: Infectious gastroenteritis is one of the most common diseases among children and has a considerable impact on health and socio-economy. Day care centres are highrisk environments for infections. The aim of this study was to investigate if asymptomatic preschool children constitute a reservoir for potential enteropathogens. Study design: In total, 438 individual diapers were collected from day care centres in Uppsala, Sweden, during spring and autumn, and molecular techniques were used to estimate the prevalence of asymptomatic carriage of multiple enteropathogens. Methods: Faecal samples were analysed with multiplex polymerase chain reaction (PCR) (xTAG® Gastrointestinal Pathogen Panel; Luminex Corporation, Toronto, Canada) targeting 21 different pathogens. Samples with a median fluorescence intensity above threshold were re-analysed with a second PCR assay. Results: Sixteen of the 438 samples were positive for enteropathogens, 1.6% for enteric adenovirus, 0.7% for Campylobacter spp., and 0.7% for norovirus. Conclusions: Preschool children in Uppsala constitute a limited reservoir for potential enteropathogens

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