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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, E-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.

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  • 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, E-ISSN 1098-4275, Vol. 120, no 5, p. 958-965Article 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.

    Keywords
    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: 2022-01-28Bibliographically 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, p. 358-362Article 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.

    Keywords
    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: 2017-12-14Bibliographically 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, p. 89-93Article 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.

    Keywords
    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: 2022-01-28Bibliographically 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
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  • 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, E-ISSN 1536-7118, Vol. 11, no 2, p. 112-127Article 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. Akpiroro Peters, Marie Berit
    et al.
    Kassa, Eszter
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Biochemistry.
    Yau, Wai-Lok
    Lindqvist, Richard
    Nilsson, Emma
    Siljedahl, Michaela
    Ivarsson, Ylva
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Biochemistry.
    Lundmark, Richard
    Överby, Anna K.
    Tick-borne flaviviruses recruits the pro viral factor NUP153 to the replication siteManuscript (preprint) (Other academic)
  • 6.
    Alant, Erna
    et al.
    Univ Pretoria, Pretoria, South Africa; Indiana Univ, Bloomington, IN 47405 USA.
    Basil, Carmen
    Univ Barcelona, Barcelona, Spain.
    Jennische, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Loncke, Filip
    Univ Virginia, Charlottesville, VA USA.
    McNaughton, Shirley
    ‎Blissymbol Commun Inst, Toronto, ON, Canada.
    Murray, Janice
    Manchester Metropolitan Univ, Manchester, Lancs, England.
    Renner, Gregor
    Catholic Univ Appl Sci, Freiburg, Germany.
    Smith, Martine
    Trinity Coll Dublin, Dublin, Ireland.
    Soto, Gloria
    San Francisco State Univ, San Francisco, CA 94132 USA.
    van Balkom, Hans
    San Francisco State Univ, San Francisco, CA 94132 USA.
    von Tetzchner, Stephen
    Univ Oslo, Oslo, Norway.
    At the end of the journey Lyle Lewis Lloyd (August 10 1934-February 12 2020)2020In: Augmentative and Alternative Communication, ISSN 0743-4618, Vol. 36, no 1, p. 1-3Article in journal (Other academic)
  • 7.
    Albrecht, Lisa M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Andersson, Dan I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Cross-Resistance to Antibiotics After Exposure to Qaternary Ammonium CompoundsManuscript (preprint) (Other academic)
    Abstract [en]

    Quaternary ammonium compounds (QACs) are common antimicrobials that are used in a variety of consumer products, such as lotions, sunscreen, hair conditioners and hand sanitizers, to inhibit bacterial growth. However, it has been noted that bacteria exposed to QACs can develop resistance, and additionally, resistance to QACs has been observed to provide cross-resistance to antibiotics. In order to identify genetic adaptations for this resistance pattern, we exposed E. coli to three different QACs at sub-MIC and above-MIC concentrations, and identified genetic changes by whole genome sequencing. We found that initial adaptation, at sub-MIC levels, happened through efflux mechanisms, and that subsequent genetic changes, during above-MIC exposure, involved genes associated with the cell membranes and with transcription/translation. We also found that these genetic changes provided cross-resistance to other QACs as well as to several antibiotics.

  • 8.
    Albrecht, Lisa M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Andersson, Dan I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Potentiation of the Selective Effect of Antibiotics by Metal IonsManuscript (preprint) (Other academic)
    Abstract [en]

    Complex mixtures of antibiotics and metals are present in many environments ranging from municipal sewage to irrigation water and manure used as agricultural fertilizer. Such mixtures of drugs and metals exert unique selection pressures on local bacterial communities and could function as hotspots for enrichment of antibiotic resistance genes. The presence of metals in the environment has previously been linked to increases in tolerance to antibiotics. In this study, we investigated metal-potentiated selection of antibiotic resistant Salmonella enterica strains. Six environmentally relevant metals were examined in combinations with three different antibiotics. By performing competitions between an antibiotic resistant mutant and the isogenic wild type in each metal-antibiotic combination, we assessed the minimal selective concentration (MSC) of the antibiotic for the resistant strain. The metals silver, cadmium and mercury all exhibited potentiating effects, reducing the MSC of the antibiotic up to 5-fold as compared to in the absence of the metal. We further show that the potentiating metals increased permeability of the cellular outer membrane. These results demonstrate that the presence of a metal can decrease the concentration of an antibiotic required to select for an antibiotic resistant strain, and they indicate that this process involves metal-facilitated uptake of the antibiotic following damage to the outer membrane.

  • 9.
    Albrecht, Lisa M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Sandegren, Linus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Andersson, Dan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Mutation in the Copper-Induced sil Operon Enables High-Level Silver Resistance and Silver Facilitated Co-Selection of Multidrug Resistance PlasmidManuscript (preprint) (Other academic)
    Abstract [en]

    Human activities are responsible for an accumulation of metals in health care and agricultural environments, and plasmid-encoded metal tolerance operons enable bacteria to rapidly adapt to metal exposure under such conditions. While the mechanisms of action of many metal resistance systems have been described, there is still limited understanding of their role in co-selection of antibiotic resistance in metal-containing environments. Whether plasmid-encoded metal resistance genes confer significant selective advantages is of interest as it has implications for plasmid enrichment and the spread of plasmid-borne antibiotic resistance genes. To increase our understanding of plasmid-mediated metal resistance, we studied the sil operon and its phenotypes in E. coli during growth in the absence and presence of silver and copper. We found that the sil operon provides resistance to both silver and copper. However, it is induced by copper only, and constitutive expression due to point mutations in the two-component silS gene provides high-level silver resistance. Furthermore, we showed that a high-level silver resistant mutant could be enriched in the presence of silver. This enrichment entailed co-selection of the multidrug resistance plasmid pUUH239.2. Our results show that a copper resistance operon can provide high-level silver resistance following a single point mutation, and that the silver resistance phenotype subsequently can co-select for antibiotic resistance in the presence of silver. 

  • 10.
    Ali, M
    et al.
    NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
    Ben Basat, A Lifshitz
    Department of Communication Disorders, Ariel University, Ariel, Israel.
    Berthier, M
    Cognitive Neurology and Aphasia Unit, Centro De Investigaciones Médico-Sanitarias, Instituto De Investigación Biomédica De Málaga (IBIMA), University of Malaga, Malaga, Spain.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Blom Johansson: Speech-Language Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Breitenstein, C
    Dept. Of Neurology with Institute of Translational Neurology, University of Muenster, Germany.
    Cadilhac, D A
    Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Australia.
    Constantinidou, F
    Department of Psychology and Center for Applied Neuroscience, University of Cyprus Nicosia, Cyprus.
    Cruice, M
    City, University of London, London, UK.
    Davila, G
    Cognitive Neurology and Aphasia Unit, Centro De Investigaciones Médico-Sanitarias, Instituto De Investigación Biomédica De Málaga (IBIMA), University of Malaga, Malaga, Spain Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
    Gandolfi, M
    Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
    Gil, M
    Department of Communication Disorders, Loewenstein Rehabilitation Hospital, Israel.
    Grima, R
    Department of Communication Therapy, Faculty of Health Sciences, University of Malta Imsida, Malta.
    Godecke, E
    School of Medical and Health Sciences, Edith Cowan University, Australia; Speech Pathology Department, Sir Charles Gairdner Hospital, Australia & Centre for Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia.
    Jesus, L
    School of Health Sciences (ESSUA) and Institute of Electronics and Informatics Engineering of Aveiro (IEETA), University of Aveiro, Portugal.
    Jiminez, L Martinez
    Universidad De Talca, Talca, Chile.
    Kambanaros, M
    Allied Health and Human Performance, University of South Australia, Adelaide South, Australia.
    Kukkonen, T
    Department of ENT/Phoniatry, Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland.
    Laska, A
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Mavis, I
    Speech and Language Therapy Department, Anadolu University, Eskişehir, Turkey.
    Mc Menamin, R
    Discipline of Speech and Language Therapy, School of Health Sciences, National University of Ireland, Galway, Ireland.
    Mendez-Orellana, C
    Carrera De Fonoaudiología, Departamento Ciencias De La Salud, Facultad De Medicina, Pontificia Universidad Católica De Chile, Santiago- Chile.
    Obrig, H
    Clinic for Cognitive Neurology, University Hospital Leipzig & MPI for Human Cognitive and Brain Sciences, Leipzig, Germany.
    Ostberg, P
    Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
    Robson, H
    Psychology and Language Sciences, University College London, London, UK.
    Sage, K
    Department of Nursing, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University UK.
    Van De Sandt-Koenderman, M
    Dept of Rehabilitation Medicine, Rijndam Rehabilitation Centre & Erasmus MC, Rotterdam, The Netherlands.
    Sprecht, K
    Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen Norway.
    Visch-Brink, E
    Department of Neurology and Neurosurgery, Erasmus University Medical Center, Rotterdam, Netherlands.
    Wehling, E
    Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
    Wielaert, S
    Dept of Rehabilitation Medicine, Rijndam Rehabilitation Centre & Erasmus MC, Rotterdam, The Netherlands.
    Wallace, S J
    Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia.
    Williams, L J
    Usher Institute, University of Edinburgh, UK.
    Brady, M C
    NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
    Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)2022In: Aphasiology, ISSN 0268-7038, E-ISSN 1464-5041, Vol. 36, no 4, p. 534-554Article in journal (Refereed)
    Abstract [en]

    Background: We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia.

    Aim: To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia.

    Methods & Procedures: Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months.

    Conclusion: International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

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  • 11.
    Alm, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Blom Johansson: Speech-Language Pathology.
    Streptococcal infection as a major historical cause of stuttering: data, mechanisms, and current importance2020In: Frontiers in Human Neuroscience, E-ISSN 1662-5161, Vol. 14, article id 569519Article in journal (Refereed)
    Abstract [en]

    Stuttering is one of the most well-known speech disorders, but the underlying neurological mechanisms are debated. In addition to genetic factors, there are also major non-genetic contributions. It is here proposed that infection with group A beta-hemolytic streptococcus (GAS) was a major underlying cause of stuttering until the mid-1900s when penicillin was introduced in 1943. The main mechanism proposed is an autoimmune reaction from tonsillitis, targeting specific molecules, for example within the basal ganglia. It is here also proposed that GAS infections may have continued to cause stuttering to some extent, to the present date, though more rarely. If so, early diagnosis of such cases would be of importance. Childhood cases with sudden onset of stuttering after throat infection may be particularly important to assess for possible GAS infection. The support for this hypothesis primarily comes from three lines of argument. First, medical record data from the 1930s strongly indicates that there was one type of medical event in particular that preceded the onset of childhood stuttering with unexpected frequency: diseases related to GAS throat infections. In particular, this included tonsillitis and scarlet fever, but also rheumatic fever. Rheumatic fever is a childhood autoimmune sequela of GAS infection, which was a relatively widespread medical problem until the early 1960s. Second, available reports of changes of the childhood prevalence of stuttering indicate striking parallels between stuttering and the incidence of rheumatic fever, with: (1) decline from the early 1900s; (2) marked decline from the introduction of penicillin in the mid 1940s; and (3) reaching a more stable level in the 1960s. The correlations between the data for stuttering and rheumatic fever after the introduction of penicillin are very high, at about 0.95. Third, there are established biological mechanisms linking GAS tonsillitis to immunological effects on the brain. Also, a small number of more recent case reports have provided further support for the hypothesis linking stuttering to GAS infection. Overall, it is proposed that the available data provides strong evidence for the hypothesis that GAS infection was a major cause of stuttering until the mid-1900s, interacting with genetic predisposition.

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  • 12.
    Al-Nuaimi, Ateka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Patienternas inställning till användningen av en patientaktiverande frågelista i farmaceutmötet på svenska apotek - en enkätstudie2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Mål: Syftet med studien är att beskriva patienternas inställningar till användningen av en QPL, huruvida det är ett möjligt redskap att använda under farmaceutmötet på svenska öppenvårdsapotek. Dessutom att undersöka den rapporterade skillnaden i kunskapsnivå efter användningen av QPL mellan patienterna som valde att använda QPL:en under farmaceutmötet och patienterna som valde att inte göra det. Samt att undersöka om olika bakgrundsfaktorer påverkar användningen av QPL.

        

    Metod: En kvantitativ analys av redan besvarade enkäter genomfördes för att besvara syftet och frågeställningen. Enkäterna analyserades deskriptivt med hjälp av beskrivande mått och genom inferentiell statistik i Microsoft Excel. Delstudien bestod av 179 enkäter. 

     

    Resultat: Totalt kodades 179 enkäter utifrån inklusionskriterierna. Patienterna rapporterade att QPL introducerades i 96% (n=172) och användes i 46% (n=83) av farmaceutmöten. Majoriteten av patienterna (n=101) upplevde att QPL inte tog mycket tid att läsa och (n=121) tyckte att frågorna var enkla att förstå. Å andra sidan rapporterade patienterna som hämtade minst ett nytt läkemedel och patienterna som hade svenska som modersmål att de använde QPL mer än andra. Samtidigt upplevde patienterna som använde QPL:en under farmaceutmötet en ökad kunskapsnivå om läkemedel jämfört med patienterna som inte använde QPL:en under mötet.

     

    Slutsats: Patienterna upplevde att QPL:en var ett funktionellt verktyg som fick de att ställa fler frågor och förstå sitt sjukdomstillstånd bättre. QPL:en kan effektiviseras ytterligare genom att förkortas ned och finnas i fler språk. Samtidigt bör farmaceut-patientkommunikation på öppenvårdsapotek effektiviseras ytterligare.

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  • 13.
    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. 

  • 14.
    Anaker, Anna
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    von Koch, Lena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neurovasc Dis, Stockholm, Sweden..
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Sjostrand, Christina
    Karolinska Univ Hosp, Dept Neurovasc Dis, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Elf, Marie
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Chalmers Univ Technol, Dept Architecture & Civil Engn, Sch Architecture, Gothenburg, Sweden..
    The physical environment and multi-professional teamwork in three newly built stroke units2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 7, p. 1098-1106Article in journal (Refereed)
    Abstract [en]

    Purpose To explore multi-professional teamwork in relation to the physical environment in three newly built or renovated stroke units. Materials and methods An observational study was undertaken. The participants were all staff members of a multi-professional team working in the reviewed stroke units. The data were collected using behavioural mapping and semi-structured observations, and they were analysed by content analysis and descriptive statistics. Results Out of all the observations in the behavioural mapping, very few were of two or more members from the team together with a patient. None of the included stroke units had a co-location for all the members of the multi-professional team. Three main categories emerged from the analysis of the interviews: (i) the hub of the unit; (ii) the division of places; and (iii) power imbalance. All the categories reflected the teamwork in relation to parts of the physical environment. Conclusion The design of the physical environment is important for multi-professional teamwork. Emphasis must be placed on better understanding the impact of the physical environment and on incorporating the evidence related to multi-professional teamwork during the design of stroke units.

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  • 15.
    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, p. 14-16Article 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.

  • 16. Andersson, Arne
    et al.
    Lau Börjesson, Joey
    Scholarly publishing threatened?2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 4, p. 205-206Article in journal (Other academic)
  • 17.
    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, p. 353-354Article in journal (Refereed)
  • 18.
    Andersson, Linus
    et al.
    Swedish Institute for Social Research Stockholm University Stockholm Sweden.
    Chudnovskaya, Margarita
    Swedish Institute for Social Research Stockholm University Stockholm Sweden.
    Shahbazian, Roujman
    Swedish Institute for Social Research Stockholm University Stockholm Sweden.
    Ghaznavi, Cyrus
    Medical Education Program Washington University School of Medicine St. Louis Missouri USA.
    Ueda, Peter
    Clinical Epidemiology Division Department of Medicine Karolinska Institutet Solna Stockholm Sweden.
    Nationwide study of trends in physician partner choice for childbearing unions2022In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 292, no 1, p. 165-167Article in journal (Other academic)
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  • 19.
    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, Clinical and experimental 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, E-ISSN 1932-6203, Vol. 9, no 12, p. e115911-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.

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  • 20. Annoni, Marco
    et al.
    Blease, Charlotte
    Program in Placebo Studies and the Therapeutic Encounter, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard, USA;School of Psychology, University College Dublin, Ireland.
    A critical (and cautiously optimistic) appraisal of moerman’s" meaning response"2018In: Perspectives in biology and medicine, ISSN 0031-5982, E-ISSN 1529-8795, Vol. 61, no 3, p. 379-387Article in journal (Refereed)
    Abstract [en]

    In this article we propose a critical reassessment of Daniel Moerman's "meaning response." First, we reconstruct and criticize Moerman's original proposal of introducing the "meaning response" as a way of clarifying some terminological and conceptual issues in the placebo debate. Next we evaluate the criticisms that Moerman's proposal is epistemically moot since other existing and more empirically grounded models already account for all the phenomena that fall under the concept of the "meaning response." We conclude that Moerman's original proposal is inherently problematic and that, in order to be instrumentally useful in the future, the meaning response must be reconceived so that it may finally support, rather than oppose, other theoretical and empirical lines of research currently ongoing in the field of placebo studies.

  • 21.
    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, p. 40-46Article 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.

  • 22. Awortwe, Victoria
    et al.
    Litela Asare, Jennifer
    Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
    Logoniga Gariba, Samuel
    Aalborg University, Aalborg, Denmark.
    Rakibu Mbamba, Crispin
    University at Albany, New York, USA.
    Ansie, Vera
    Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
    Witchcraft accusations and older adults: insights from family members on the struggles of well-being2023In: Journal of Religion, Spirituality & Aging, ISSN 1552-8030, p. 1-13Article in journal (Refereed)
    Abstract [en]

    In Africa, witch doctors are consulted not only for healing diseases, but also for invoking curses. There has been a paradigm shift involving the types of people often accused of using witchcraft in response to the changing political, economic, and social landscape, and the most affected group is older adults. While efforts are being made to eliminate accusations and lynching, little attention is paid to understanding the experiences of accused older adults and their families. The study collected data through face-to-face interviews from 12 family members of accused older adults who are living in their communities to identify their wellbeing challenges. The findings of this study will offer significant contributions because a lot of attention has been given to older adults confined in “witch” camps, but this paper looks at those in the communities. The study found that ostracism and marginalization, as well as emotional and psychological distress, are key wellbeing challenges experienced by older adults and their families accused of witchcraft. The findings suggest that there is a need for governmental involvement in actively enforcing existing laws that criminalize banishment of accused persons and recognizing that victims of such accusations need trauma-related support services which is currently non-existent. Specifically, a clarion call is placed on the Ministry of Gender, Children and Social Protection to spearhead reforms around trauma-related support provision.

  • 23.
    Barbora, Gustafsson
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Malmberg, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Ansträngningsutlösta andningssymtom bland ungdomar på ett idrottsgymnasium i Sverige: könsskillnader och samband med Body mass-index2021Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 24.
    Baunsgaard, Carsten Bach
    et al.
    Univ Copenhagen, Rigshosp, Clin Spinal Cord Injuries, Havnevej 25, DK-3100 Hornbaek, Denmark.
    Nissen, Ulla Vig
    Univ Copenhagen, Rigshosp, Clin Spinal Cord Injuries, Havnevej 25, DK-3100 Hornbaek, Denmark.
    Brust, Anne Katrin
    SPC, Nottwil, Switzerland.
    Frotzler, Angela
    SPC, Nottwil, Switzerland.
    Ribeill, Cornelia
    Ulm Univ, SCI Ctr Orthopaed Dept, Ulm, Germany.
    Kalke, Yorck-Bernhard
    Ulm Univ, SCI Ctr Orthopaed Dept, Ulm, Germany.
    Leon, Natacha
    FLM, Madrid, Spain.
    Gomez, Belen
    FLM, Madrid, Spain.
    Samuelsson, Kersti
    Linkoping Univ, Dept Rehabil Med, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Antepohl, Wolfram
    Linkoping Univ, Dept Rehabil Med, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Holmstrom, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. Uppsala Univ Hosp, Spinal Cord Rehabil Unit, Uppsala, Sweden.
    Marklund, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery. Uppsala Univ Hosp, Spinal Cord Rehabil Unit, Uppsala, Sweden.
    Glott, Thomas
    Sunnaas Rehabil Hosp, Nesoddtangen, Norway.
    Opheim, Arve
    Sunnaas Rehabil Hosp, Nesoddtangen, Norway;Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Rehabil Med, Gothenburg, Sweden;Reg Vastra Gotaland, Habilitat & Hlth, Gothenburg, Sweden.
    Benito Penalva, Jesus
    Neurorehabil Hosp, Inst Guttmann, Barcelona, Spain.
    Murillo, Narda
    Neurorehabil Hosp, Inst Guttmann, Barcelona, Spain.
    Nachtegaal, Janneke
    Heliomare Rehabil Ctr, Wijk Aan Zee, Netherlands.
    Faber, Willemijn
    Heliomare Rehabil Ctr, Wijk Aan Zee, Netherlands.
    Biering-Sorensen, Fin
    Univ Copenhagen, Rigshosp, Clin Spinal Cord Injuries, Havnevej 25, DK-3100 Hornbaek, Denmark.
    Exoskeleton Gait Training After Spinal Cord Injury: An Exploratory Study on Secondary Health Conditions2018In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 50, no 9, p. 806-813Article in journal (Refereed)
    Abstract [en]

    Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training.

    Design: Prospective, observational, open-label multicentre study. Methods: Three training sessions per week for 8 weeks using an Ekso GT robotic exoskeleton (Ekso Bionics). Included were individuals with recent (<1 year) or chronic (>1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women.

    Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (p< 0.001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p= 0.008) and improved life satisfaction (p= 0.036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (p<0.001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time.

    Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

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  • 25.
    Beretta, Chiara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics.
    Svensson, Elina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics. Department of Neuroinflammation, UCL Queen Square Institute of Neurology, 1 Wakefield Street, WC1N 1PJ London, United Kingdom of Great Britain and Northern Ireland.
    Dakhel, Abdulkhalek
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics.
    Zyśk, Marlena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics.
    Hanrieder, J.
    Sehlin, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics.
    Michno, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Erlandsson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Molecular Geriatrics.
    Amyloid-β deposits in human astrocytes contain truncated and highly resistant proteoforms2024In: Molecular and Cellular Neuroscience, ISSN 1044-7431, E-ISSN 1095-9327, Vol. 128, article id 103916Article in journal (Refereed)
    Abstract [en]

    Alzheimer's disease (AD) is a neurodegenerative disorder that develops over decades. Glial cells, including astrocytes are tightly connected to the AD pathogenesis, but their impact on disease progression is still unclear. Our previous data show that astrocytes take up large amounts of aggregated amyloid-beta (Aβ) but are unable to successfully degrade the material, which is instead stored intracellularly. The aim of the present study was to analyze the astrocytic Aβ deposits composition in detail in order to understand their role in AD propagation. For this purpose, human induced pluripotent cell (hiPSC)-derived astrocytes were exposed to sonicated Aβ42 fibrils and magnetic beads. Live cell imaging and immunocytochemistry confirmed that the ingested Aβ aggregates and beads were transported to the same lysosomal compartments in the perinuclear region, which allowed us to successfully isolate the Aβ deposits from the astrocytes. Using a battery of experimental techniques, including mass spectrometry, western blot, ELISA and electron microscopy we demonstrate that human astrocytes truncate and pack the Aβ aggregates in a way that makes them highly resistant. Moreover, the astrocytes release specifically truncated forms of Aβ via different routes and thereby expose neighboring cells to pathogenic proteins. Taken together, our study establishes a role for astrocytes in mediating Aβ pathology, which could be of relevance for identifying novel treatment targets for AD.

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  • 26. Bernstein, Michael H
    et al.
    Magill, Molly
    Weiss, Arnold-Peter
    Kaptchuk, Ted J
    Blease, Charlotte
    Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center/Harvard Medical School Program, Boston, MA, USA;School of Psychology, University College Dublin, Dublin, Ireland.
    Kirsch, Irving
    Rich, Josiah D
    Becker, Sara
    Mach, Steven
    Beaudoin, Francesca L
    Are conditioned open placebos feasible as an adjunctive treatment to opioids?: results from a single-group dose-extender pilot study with acute pain patients2019In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 88, no 6, p. 380-382Article in journal (Refereed)
  • 27.
    Bhandage, Amol K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiology.
    Jin, Zhe
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiology.
    Korol, Sergiy V.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiology. Uppsala University.
    Shen, Qiujin
    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 tools.
    Pei, Yu
    Karolinska Institute, Stockholm, Sweden.
    Deng, Qiaolin
    Karolinska Institute, Stockholm, Sweden.
    Espes, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Kamali-Moghaddam, Masood
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular tools. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Birnir, Bryndis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiology.
    GABA Regulates Release of Inflammatory Cytokines From Peripheral Blood Mononuclear Cells and CD4+ T Cells and Is Immunosuppressive in Type 1 Diabetes2018In: EBioMedicine, E-ISSN 2352-3964, Vol. 30, p. 283-294Article in journal (Refereed)
    Abstract [en]

    The neurotransmitter γ-aminobutyric acid (GABA) is an extracellular signaling molecule in the brain and in pancreatic islets. Here, we demonstrate that GABA regulates cytokine secretion from human peripheral blood mononuclear cells (PBMCs) and CD4+ T cells. In anti-CD3 stimulated PBMCs, GABA (100nM) inhibited release of 47 cytokines in cells from patients with type 1 diabetes (T1D), but only 16 cytokines in cells from nondiabetic (ND) individuals. CD4+ T cells from ND individuals were grouped into responder or non-responder T cells according to effects of GABA (100nM, 500nM) on the cell proliferation. In the responder T cells, GABA decreased proliferation, and inhibited secretion of 37 cytokines in a concentration-dependent manner. In the non-responder T cells, GABA modulated release of 8 cytokines. GABA concentrations in plasma from T1D patients and ND individuals were correlated with 10 cytokines where 7 were increased in plasma of T1D patients. GABA inhibited secretion of 5 of these cytokines from both T1D PBMCs and ND responder T cells. The results identify GABA as a potent regulator of both Th1- and Th2-type cytokine secretion from human PBMCs and CD4+ T cells where GABA generally decreases the secretion.

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    GABA Regulates Release of Inflammatory Cytokines From PBMCs & CD4+ T Cells... (2018)
  • 28.
    Bjornsdottir, Sigrun Vala
    et al.
    Univ Iceland, Fac Med, Ctr Publ Hlth Sci, Reykjavik, Iceland;HNLFI Rehabil Clin, Hverageroi, Iceland.
    Triebel, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. HNLFI Rehabil Clin, Hverageroi, Iceland.
    Arnljotsdottir, Margret
    HNLFI Rehabil Clin, Hverageroi, Iceland.
    Tomasson, Gunnar
    Univ Iceland, Fac Med, Ctr Publ Hlth Sci, Reykjavik, Iceland.
    Valdimarsdottir, Unnur Anna
    Univ Iceland, Fac Med, Ctr Publ Hlth Sci, Reykjavik, Iceland;Harvard Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.
    Long-lasting improvements in health-related quality of life among women with chronic pain, following multidisciplinary rehabilitation2018In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 15, p. 1764-1772Article in journal (Refereed)
    Abstract [en]

    Purpose:

    To determine whether observed health-related quality-of-life improvements after four-week traditional multidisciplinary pain management program and additional neuroscience education and mindfulness-based cognitive therapy for chronic pain are sustained at six-month follow-up.

    Method:

    This observational longitudinal follow-up study, with complete follow-up of 75 women, 61.5% of initial traditional approach group (treated 2001-2005) and 56 (62.2%) receiving the new approach (treated 2006-2009). Pain intensity and quality of life were measured at baseline and six months after interventions. Analysis of variance (ANOVA) and paired samples t-tests were used for statistical analysis.

    Results:

    Both groups showed sustained improvements in pain intensity (traditional approach = -10.6 [p < 0.001]; new approach = -14.5 [p < 0.001]) and quality of life (traditional approach = 6.4 [p < 0.001]; new approach = 6.9 [p < 0.001]). Sleep was not sustained among traditional approach group (change = 2.4 [p = 0.066]), whereas all other domains among both groups were sustained. Significant decline was observed from discharge to six month among both groups with the exception of the sleep domain among the traditional approach group, pain intensity among the new approach and financial status among both groups. No baseline differences were revealed between responders and nonresponders.

    Conclusions:

    Multidisciplinary interventions for women with chronic pain conditions improved quality of life and pain intensity with lasting improvements observed half a year after treatment completion.

  • 29.
    Björck, Martin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery. Editor-in-Chief, Eur J Vasc Endovasc Surg.
    Kakkos, Stavros K.
    Section editor, Venous and Lymphatic Disease, Vascular Access, Eur J Vasc Endovasc Surg;Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
    Lyons, Oliver T. A.
    Section editor, Methodology and Statistics, Randomised Trials, Eur J Vasc Endovasc Surg;Department of Vascular Surgery, University of Otago, Christchurch, New Zealand.
    How did we select the candidates, who were they, and who are the winners?2023In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 66, no 6, p. 751-752Article in journal (Other academic)
  • 30.
    Blaise, Dushime
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Computational study on interindividual variability in composition of dog intestinal fluids and its effect on the solubilization pattern for poorly soluble drugs2021Independent thesis Advanced level (degree of Master (Two Years)), 30 credits / 45 HE creditsStudent thesis
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  • 31.
    Blease, Charlotte
    Program in Placebo Studies, General Medicine, and Primary Care Research, Beth Israel Deaconess Medical Center, Harvard Medical School, USA;School of Psychology, University College Dublin, Ireland.
    Consensus in placebo studies: lessons from the philosophy of science2018In: Perspectives in biology and medicine, ISSN 0031-5982, E-ISSN 1529-8795, Vol. 61, no 3, p. 412-429Article in journal (Refereed)
    Abstract [en]

    In the relatively nascent field of placebo studies, empirical studies have burgeoned. Yet debate about how to define the terms placebo and "placebo effect" has not abated. A number of prominent scholars (drawn from medical practice, as well as philosophy, psychology, and anthropology) continue to propose and defend different conceptual models for these terms, and the perception that conceptual debate persists is often given as one justification for new definitions. Paradoxically in spite of this lively debate this article finds considerable underlying agreement about definitional matters within placebo studies. Drawing on key insights from philosophy of science, and by exploring the nature of scientific consensus and normal scientific research, this paper argues that well-developed placebo concepts form the basis for a placebo paradigm and that conceptual disagreement is overstated.

  • 32.
    Blease, Charlotte
    Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, USA;UCD School of Psychology, University College Dublin, Dublin, Ireland.
    The role of placebos in family medicine: Implications of evidence and ethics for general practitioners2019In: Australian Journal of General Practice, ISSN 2208-794X, Vol. 48, no 10, p. 700-705Article in journal (Refereed)
    Abstract [en]

    Background

    Placebo use is prevalent in primary care. A wealth of discourse on the ethical use of placebos in clinical contexts invariably assumes that placebos oblige practitioners to peddle in deception. However, the recent surge in empirical findings within the field of 'placebo studies' provides a very different perspective: namely, that placebos may yet prove to be both effective and ethical.

    Objective

    The aim of this article is to synthesise state-of-the-art scientific and bioethical research to provide up-to-date recommendations on placebo use for general practitioners.

    Discussion

    After disambiguating placebo concepts, this article outlines experimental studies into placebo effects and explores the ethical and evidence-based arguments for prescribing placebos. Evaluating the latest research into 'open-label placebos', it can be surmised that there are not yet persuasive grounds to incorporate these treatments into routine clinical care. Notwithstanding, the quality of physician interactions may go some way to harnessing remedial placebo effects among patients.

  • 33. Blease, Charlotte
    et al.
    Annoni, Marco
    Hutchinson, Phil
    Editors’ Introduction to Special Section on Meaning Response and the Placebo Effect2018In: Perspectives in biology and medicine, ISSN 0031-5982, E-ISSN 1529-8795, Vol. 61, no 3, p. 349-352Article in journal (Other academic)
  • 34.
    Blease, Charlotte
    et al.
    General Medicine and Primary Care, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; School of Psychology, University College Dublin, Dublin, Ireland.
    Bell, Sigall K
    Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety2019In: Diagnosis, ISSN 2194-8011, E-ISSN 2194-802X, Vol. 6, no 3, p. 213-221Article in journal (Refereed)
    Abstract [en]

    Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10-15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has focused on factors pertaining to: (a) physician cognition and (b) ergonomic or systems factors related to the physician's working environment. A third factor - the role of patients in diagnostic processes - remains relatively under-investigated. Yet, as a growing number of researchers acknowledge, patients hold unique knowledge about themselves and their healthcare experience, and may be the most underutilized resource for mitigating diagnostic error. This opinion article examines recent findings from patient surveys about sharing visit notes with patients online. Drawing on these survey results, we suggest three ways in which sharing visit notes with patients might enhance diagnostic processes: (1) avoid delays and missed diagnoses by enhancing timely follow up of recommended tests, results, and referrals; (2) identify documentation errors that may undermine diagnostic accuracy; and (3) strengthen patient-clinician relationships thereby creating stronger bidirectional diagnostic partnerships. We also consider the potential pitfalls or unintended consequences of note transparency, and highlight areas in need of further research.

  • 35.
    Blease, Charlotte
    et al.
    General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA;School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland.
    Geraghty, Keith
    Are ME/CFS Advocacy Organisations militant?: Patient Protest in a Medical Controversy2018In: Journal of Bioethical Inquiry, ISSN 1176-7529, E-ISSN 1872-4353, Vol. 15, no 3, p. 393-401Article in journal (Refereed)
    Abstract [en]

    Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) is a contested illness category. This paper investigates the common claim that patients with ME/CFSand by extension, ME/CFS patient organizations (POs)exhibit militant social and political tendencies. The paper opens with a history of the protracted scientific disagreement over ME/CFS. We observe that ME/CFS POs, medical doctors, and medical researchers exhibit clear differences in opinion over how to conceptualize this illness. However, we identify a common trope in the discourse over ME/CFS: the claim of militant patient activism. Scrutinizing this charge, we find no compelling evidence that the vast majority of patients with ME/CFS, or the POs representing them, have adopted any such militant political policies or behaviours. Instead, we observe key strategic similarities between ME/CFS POs in the United Kingdom and the AIDs activist organizations of the mid-1980s in the United States which sought to engage scientists using the platform of public activism and via scientific publications. Finally, we explore the contours of disagreement between POs and the medical community by drawing on the concept of epistemic injustice. We find that widespread negative stereotyping of patients and the marginalization and exclusion of patient voices by medical authorities provides a better explanation for expressions of frustration among patients with ME/CFS.

  • 36.
    Blease, Charlotte R
    et al.
    Beth Israel Deaconess Medical Center, Boston, MA, USA.
    Delbanco, Tom
    Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
    Torous, John
    Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
    Ponten, Moa
    Karolinska Institutet, Stockholm, Sweden.
    DesRoches, Catherine M
    Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
    Hägglund, Maria
    Beth Israel Deaconess Medical Center, Boston, MA, USA.
    Walker, Jan
    Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
    Kirsch, Irving
    Beth Israel Deaconess Medical Center, Boston, MA, USA. Harvard Medical School, Boston, MA, USA.
    Sharing clinical notes, and placebo and nocebo effects: Can documentation affect patient health?2022In: Journal of Health Psychology, ISSN 1359-1053, E-ISSN 1461-7277, Vol. 27, no 1, p. 135-146, article id 1359105320948588Article in journal (Refereed)
    Abstract [en]

    This paper connects findings from the field of placebo studies with research into patients' interactions with their clinician's visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians' written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse health effects among patients. Bridging placebo studies with (a) survey data assaying patient and clinician experiences with portals and (b) randomized controlled trials provides preliminary support for our hypotheses. We conclude with actionable proposals for testing our understanding of the health effects of access to visit notes.

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  • 37.
    Blease, Charlotte R
    et al.
    OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
    O'Neill, Stephen
    Walker, Jan
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women's and children's health), Clinical Psychology in Healthcare.
    Torous, John
    Sharing notes with mental health patients: balancing risks with respect2020In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 7, no 11, p. 924-925Article in journal (Other academic)
  • 38.
    Blease, Charlotte
    et al.
    General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
    Salmi, Liz
    Rexhepi, Hanife
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    DesRoches, Catherine M
    Patients, clinicians and open notes: information blocking as a case of epistemic injustice2022In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 48, no 10, p. 785-793Article in journal (Refereed)
    Abstract [en]

    In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians ('open notes'). However, even in countries that have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients' access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety.

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  • 39.
    Blease, Charlotte
    et al.
    Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
    Torous, John
    Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women's and children's health), Clinical Psychology in Healthcare. Division of General Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
    Does Patient Access to Clinical Notes Change Documentation?2020In: Frontiers In Public Health, ISSN 2296-2565, Vol. 8, article id 577896Article in journal (Refereed)
    Abstract [en]

    Open, honest, and trustworthy communication is crucial to ensure the effective responses of citizens. Paralleling transparency in the arena of public health are new practice policies that are set to transform the transmission of information at the level of doctors and patients. While patients have legally been entitled to obtain copies of their records for many years, in March 2020 federal legislation in the United States (U.S.) mandated that health providers offer all patients rapid and secure online access to their clinical notes via patient portals (“open notes”) (1). Similar developments are underway in the United Kingdom (U.K.) where in April 2020 it was announced that patients in NHS England will be granted online access, albeit prospectively, to their full general practitioners' notes (2). Worldwide, open notes have already been enacted in more than ten countries including Sweden, Estonia, and Norway (3).

    A variety of surveys have been conducted into patients' and doctors' experiences of open notes but much less is understood about the objective changes in documentation that may arise as a result of patient access (4–7). We review current research into open notes including clinicians' reports on how they have modified their notes as a result of implementing the practice. Highlighting the potentially beneficial and harmful effects that different types of documentation changes might have on the therapeutic relationship and on patient outcomes, we argue that more research is needed to investigate objective changes in notes as a result of patient access.

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    Does Patient Access to Clinical Notes Change Documentation?
  • 40. Blease, Charlotte
    et al.
    Torous, John
    Kharko, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    DesRoches, Catherine M.
    Harcourt, Kendall
    O'Neill, Stephen
    Salmi, Liz
    Wachenheim, Deborah
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts2021In: JMIR Mental Health, E-ISSN 2368-7959, Vol. 8, no 4, article id e27397Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients.

    OBJECTIVE: The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care.

    METHODS: In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts' written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations.

    RESULTS: A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes.

    CONCLUSIONS: This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design.

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  • 41.
    Blease, Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Participatory eHealth and Health Data Research Group.
    Torous, John
    McMillan, Brian
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Participatory eHealth and Health Data Research Group.
    Mandl, Kenneth D
    Generative Language Models and Open Notes: Exploring the Promise and Limitations2024In: JMIR Medical Education, E-ISSN 2369-3762, Vol. 10Article in journal (Refereed)
    Abstract [en]

    Patients’ online record access (ORA) is growing worldwide. In some countries, including the United States and Sweden, access is advanced with patients obtaining rapid access to their full records on the web including laboratory and test results, lists of prescribed medications, vaccinations, and even the very narrative reports written by clinicians (the latter, commonly referred to as “open notes”). In the United States, patient’s ORA is also available in a downloadable form for use with other apps. While survey studies have shown that some patients report many benefits from ORA, there remain challenges with implementation around writing clinical documentation that patients may now read. With ORA, the functionality of the record is evolving; it is no longer only an aide memoire for doctors but also a communication tool for patients. Studies suggest that clinicians are changing how they write documentation, inviting worries about accuracy and completeness. Other concerns include work burdens; while few objective studies have examined the impact of ORA on workload, some research suggests that clinicians are spending more time writing notes and answering queries related to patients’ records. Aimed at addressing some of these concerns, clinician and patient education strategies have been proposed. In this viewpoint paper, we explore these approaches and suggest another longer-term strategy: the use of generative artificial intelligence (AI) to support clinicians in documenting narrative summaries that patients will find easier to understand. Applied to narrative clinical documentation, we suggest that such approaches may significantly help preserve the accuracy of notes, strengthen writing clarity and signals of empathy and patient-centered care, and serve as a buffer against documentation work burdens. However, we also consider the current risks associated with existing generative AI. We emphasize that for this innovation to play a key role in ORA, the cocreation of clinical notes will be imperative. We also caution that clinicians will need to be supported in how to work alongside generative AI to optimize its considerable potential.

  • 42.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Aphasia: as experienced by significant others2017Conference paper (Refereed)
  • 43.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Speech-Language Pathology.
    Experiences and need of support to significant others of persons with aphasia2023Conference paper (Refereed)
    Abstract [en]

    Background and aims: Significant others (SOs) of people with aphasia (PWA) can affect the individual’s social participation, conversational ability, and rehabilitation outcome [1]. SOs have been called the most valuable but also the most vulnerable resource of a patient [2]. To be a supportive SO and to remain healthy in a challenging situation SOs may need support themselves. The aim of this study was to investigate what support SOs of PWA have received, how they experienced the support, and their need for further support. 

    Methods: 173 SOs responded to a study-specific questionnaire (response rate: 67.8%). Quantitative data were analysed with descriptive and comparative statistics and answers to open-ended questions were analysed with qualitative content analysis. 

    Results and main contribution: The SOs appreciated knowledge, devotion, helpfulness, and empathy of health care staff and community services. Community services were perceived as being characterised by long processing times, lack of continuity of staff and insufficient understanding of the needs of the PWA and the SO. Most respondents were satisfied with the informal support provided by disability organizations, family, and relatives. There was however still a pronounced need of a more understanding environment (family, friends, health-care services). The strongest need expressed by the SOs was having time of their own. Despite an acknowledged burdensome situation and low emotional well-being among SOs of PWA [3], the need for counselling was the least perceived need (expressed by 16%).

    Conclusions: Feeling seen and acknowledged as well as having time of their own are important but perhaps underestimated needs of SOs of PWA. 

    Implications: This study highlights the importance to include the SOs in the rehabilitation of PWA but also to provide separate support to them.

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  • 44.
    Blom Johansson, Monica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Blom Johansson: Speech-Language Pathology.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Department of Health and Caring Science, University of Gävle, Gävle, Sweden.
    Östberg, Per
    Institutionen för Klinisk vetenskap, Intervention och Teknik (CLINTEC), Karolinska Institutet.
    Sonnander, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Self-reported changes in everyday life and health of significant others of people with aphasia: a quantitative approach2022In: Aphasiology, ISSN 0268-7038, E-ISSN 1464-5041, Vol. 36, no 1, p. 76-94Article in journal (Refereed)
    Abstract [en]

    Background: Changes in the everyday life and health of the significant others (SOs) of people living with stroke sequalae have been widely investigated. However, information regarding the frequency of the changes in daily life and the variables most associated with these perceived life changes is limited.

    Aims: To examine the extent to which SOs of persons with aphasia (PWAs) experience changes in everyday life and health after the stroke event and how they evaluate these changes and to identify which variables are associated with these perceived life changes.

    Methods & Procedures: A study-specific questionnaire about perceived changes in everyday life and health was completed by 173 SOs of PWAs living in Sweden (response rate 67.8%). The items concerned the SO’s working and financial situation, leisure time and social life, relationship with the PWA, household work and responsibility, and health and quality of life.

    Outcomes & Results: The everyday life and health of the SOs were greatly affected by the stroke event. The changes the SOs experienced were mainly appraised negatively. The relationships with the PWA and immediate family were least affected by the stroke. The perceived existence and severity of physical, cognitive, and language impairments of the PWA were the variables most strongly associated with the everyday life situation of the participants. The sex and age of the participants and the nature of the relationship with the PWA were only marginally associated with the experience of the situation.

    Conclusions: SOs’ perceptions of the PWA’s stroke-related disabilities and need for assistance may be a key factor in identifying SOs who may require support and guidance to help them cope with their new life situation.

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  • 45. Bondeson, Marie Louise
    Key insights into the protein tyrosine phosphatase PTPN11/SHP2 associated with noonan syndrome and cancer2017In: Human Mutation, ISSN 1059-7794, E-ISSN 1098-1004Article, book review (Other academic)
  • 46. 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, p. 8421-8426Article 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.

  • 47.
    Brock, Lucas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    In silico and in vitro study of peptidomimetic protease inhibitors against Ziks and Ticke-Borne Encephalitis Virus2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
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  • 48.
    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
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    2014 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 14, p. 296-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.

    Keywords
    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: 2022-09-15Bibliographically 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, E-ISSN 1472-6963, Vol. 13, p. 95-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.

    Keywords
    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: 2022-09-15Bibliographically 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, E-ISSN 1757-7241, Vol. 20, no 1, p. 57-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: 2024-01-17Bibliographically 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.
    Show others...
    (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
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  • 49. 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)
  • 50.
    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, E-ISSN 1472-6963, Vol. 14, p. 296-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.

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