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  • 151.
    Holmberg, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Forslund, Kerstin
    Wahlberg, Anna Carin
    Fagerberg, Ingegerd
    The relationship with the ambulance clinicians as experienced by significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. E1-E8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Interpersonal relationships between clinicians and patients are important aspects of the ambulance care, requiring a balance between objectified acute medical treatment and a holistic care. Being a significant other (SO) in the ambulance care setting is described as being caught between hope and dread. Little research has focused on SOs' experiences of the relationship with the ambulance clinicians.

    AIM: To elucidate meanings of the relationship with the clinicians in the ambulance care setting as experienced by the patients' SOs.

    DESIGN: Qualitative lifeworld design.

    METHODS: Data was collected using open-ended interviews with nine SOs. The verbatim transcribed interviews were analysed with a phenomenological hermeneutic method.

    FINDINGS: The structural analysis resulted in one main theme: 'Being lonely together'. The main theme comprises three themes: 'Being in a shared struggle', 'To hand over the affected person in trust' and 'Being the second person in focus' and six subthemes. The main theme is for the SOs to share the struggles of the affected person with the ambulance clinicians and to be comforted while handing over the responsibility for the affected person. Hence the SO is excluded and lonely and on his/her own, while not the primary focus of the ambulance clinicians.

    CONCLUSIONS: The relationship with the ambulance clinicians from the perspective of the SOs can be understood as complex, involving both being lonely and together at the same time. The findings support a holistic approach towards the ambulance care involving SOs.

    RELEVANCE FOR CLINICAL PRACTICE: This study outlines the importance of an emergency ambulance care involving SOs as affected persons and supports a balance between emergency medical treatment to the patient and a holistic care, involving the SOs' suffering.

  • 152.
    Holmberg, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Forslund, Kerstin
    Wahlberg, Anna Carin
    Fagerberg, Ingegerd
    To surrender in dependence of another: the relationship with the ambulance clinicians as experienced by patients2014In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 3, p. 544-551Article in journal (Refereed)
    Abstract [en]

    Historically, the ambulance care has focused on acute transports and medical treatment, although ambulance care has also been reported as complex, encompassing more than just medical treatment and transports. Previous studies, on ambulance clinicians, have pointed out the importance of interpersonal caring activities complementary to the medical treatment. Those activities can be understood as taking part in the relationship between patients and ambulance clinicians, earlier described as essential and a core component of care. The aim of this study was to elucidate the meaning of the relationship with the ambulance clinicians as experienced by patients. Twenty ambulance patients were interviewed in the study. The interviews were transcribed verbatim and analysed with a phenomenological hermeneutical method to grasp meanings in the patients' experiences. The regional ethical committee approved the study. In the result emerged one main theme: To surrender in dependence of another. The main theme includes four themes: Being in the hands of another, Being in a caring temporary presence, Being important while involved and Being powerless while insignificant, and the themes comprise eleven subthemes. The main theme meant to have no other option than to surrender and to put their life into the hand of another. This surrender also meant to adapt to the clinicians' views even if not shared. This is experienced as excessive care. Summarised, the patients' experiences were both positive and negative and the findings provide a complex understanding of the relationship between the patient and the ambulance clinicians. Overall, the relationship embraces the whole person without reducing the patient to be a recipient of an objectified ambulance care.

  • 153.
    Holmberg, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wahlberg, Anna Carin
    Fagerberg, Ingegerd
    Forslund, Kerstin
    Ambulance clinicians' experiences of relationships with patients and significant others2016In: Nursing in Critical Care, ISSN 1362-1017, E-ISSN 1478-5153, Vol. 21, no 4, p. E16-E23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ambulance clinicians (ACs) have to provide advanced care and treatment to patients in a challenging and emotionally demanding environment, therefore they establish interpersonal relationships embracing both patients and significant others. Relationships in emergency care were earlier found to be short-lived and lacking a holistic understanding of the patient. In their relationship with the ambulance clinicians, it is for patients to surrender and become dependent, which may be interpreted as both a negative and a positive experience.

    AIM: The aim of this study was to elucidate ambulance clinicians' experiences of relationships with patients and significant others.

    METHODS: Data were collected from four focus group conversations, with a total of 18 participating ambulance clinicians. An inductive qualitative content analysis method was chosen.

    FINDINGS: The analysis resulted in one main category: 'To be personal in a professional role' and three generic categories: 'To be there for the affected person', 'To be personally involved' and 'To have a professional mission'. There were subsequently nine sub-categories. The main category was described as intertwining the experience of being both personal and professional. The ambulance clinicians adapt to a situation while having the affected person in focus. They involve themselves as persons but at the same time use the power of their professional role.

    CONCLUSION: The relationship with patients and significant others from the ambulance clinicians' perspective can be understood as embracing both personal and professional aspects.

    RELEVANCE TO CLINICAL PRACTICE: This study provides an understanding of the ambulance clinicians' professional role as embracing a personal perspective, which is important when developing an emergency ambulance service focusing on care that involves more than just emergency medical treatment.

  • 154. Holter-Chakrabarty, Jennifer L.
    et al.
    Pierson, Namali
    Zhang, Mei-Jie
    Zhu, Xiaochun
    Akpek, Goerguen
    Aljurf, Mahmoud D.
    Artz, Andrew S.
    Baron, Frederic
    Bredeson, Christopher N.
    Dvorak, Christopher C.
    Epstein, Robert B.
    Lazarus, Hillard M.
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Selby, George B.
    Williams, Kirsten M.
    Cooke, Kenneth R.
    Pasquini, Marcelo C.
    McCarthy, Philip L.
    The Sequence of Cyclophosphamide and Myeloablative Total Body Irradiation in Hematopoietic Cell Transplantation for Patients with Acute Leukemia2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 7, p. 1251-1257Article in journal (Refereed)
    Abstract [en]

    Limited clinical data are available to assess whether the sequencing of cyclophosphamide (Cy) and total body irradiation (TBI) changes outcomes. We evaluated the sequence in 1769 (CyTBI, n = 948; TBICy, n = 821) recipients of related or unrelated hematopoietic cell transplantation who received TBI (1200 to 1500 cGY) for acute leukemia from 2003 to 2010. The 2 cohorts were comparable for median age, performance score, type of leukemia, first complete remission, Philadelphia chromosome positive acute lymphoblastic leukemia, HLA-matched siblings, stem cell source, antithymocyte globulin use, TBI dose, and type of graft-versus-host disease (GVHD) prophylaxis. The sequence of TBI did not significantly affect transplantation-related mortality (24% versus 23% at 3 years, P = .67; relative risk, 1.01; P = .91), leukemia relapse (27% versus 29% at 3 years, P = .34; relative risk,.89, P = .18), leukemia-free survival (49% versus 48% at 3 years, P = .27; relative risk,.93; P = .29), chronic GVHD (45% versus 47% at 1 year, P = .39; relative risk,.9; P = .11), or overall survival (53% versus 52% at 3 years, P = .62; relative risk,.96; P = .57) for CyTBI and TBICy, respectively. Corresponding cumulative incidences of sinusoidal obstruction syndrome were 4% and 6% at 100 days (P = .08), respectively. This study demonstrates that the sequence of Cy and TBI does not impact transplantation outcomes and complications in patients with acute leukemia undergoing hematopoietic cell transplantation with myeloablative conditioning.

  • 155.
    Horst, Sandra
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kawati, Rafael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Rasmusson, J
    Department of Anesthesiology and Intensive Care, Gävle County Hospital, Gävle, Sweden.
    Pikwer, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Castegren, M
    Perioperative Medicine and Intensive Care, Karolinska University Hospital and CLINTEC, Karolinska Institute, Stockholm, Sweden.
    Lipcsey, Miklós
    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, Faculty of Medicine, Department of Surgical Sciences, Hedenstierna laboratory.
    Impact of resuscitation fluid bag size availability on volume of fluid administration in the intensive care unit2018In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 9, p. 1261-1266Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Iatrogenic fluid overload is associated with increased mortality in the intensive care unit (ICU). Decisions on fluid therapy may, at times, be based on other factors than physiological endpoints. We hypothesized that because of psychological factors volume of available fluid bags would affect the amount of resuscitation fluid administered to ICU patients.

    METHODS: We performed a prospective intervention cross-over study at 3 Swedish ICUs by replacing the standard resuscitation fluid bag of Ringer's Acetate 1000 mL with 500 mL bags (intervention group) for 5 separate months and then compared it with the standard bag size for 5 months (control group). Primary endpoint was the amount of Ringer's Acetate per patient during ICU stay. Secondary endpoints were differences between the groups in cumulative fluid balance and change in body weight, hemoglobin and creatinine levels, urine output, acute kidney failure (measured as the need for renal replacement therapy, RRT) and 90-day mortality.

    RESULTS: Six hundred and thirty-five ICU patients were included (291 in the intervention group, 344 in the control group). There was no difference in the amount of resuscitation fluid per patient during the ICU stay (2200 mL [1000-4500 median IQR] vs 2245 mL [1000-5630 median IQR]), RRT rate (11 vs 9%), 90-day mortality (11 vs 10%) or total fluid balance between the groups. The daily amount of Ringer's acetate administered per day was lower in the intervention group (1040 (280-2000) vs 1520 (460-3000) mL; P = .03).

    CONCLUSIONS: The amount of resuscitation fluid administered to ICU patients was not affected by the size of the available fluid bags. However, altering fluid bag size could have influenced fluid prescription behavior.

  • 156.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerden, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svensson, Ann-Marie
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.2018In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed)
    Abstract [en]

    AIMS: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM).

    METHODS: People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

    RESULTS: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).

    CONCLUSIONS: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

  • 157.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Adolfsson, Eva Thors
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 20132017In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    AIMS: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

    METHODS: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

    RESULTS: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

    CONCLUSIONS: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

  • 158.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Svensson, Ann-Marie
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide surveyIn: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210Article in journal (Refereed)
  • 159.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Eliasson, Björn
    Sahlgrens Univ Hosp, Dept Med, Gothenburg, Sweden.
    Jansson, Stefan
    Örebro Univ, Univ Hlth Care Res Ctr, Sch Med Sci, Örebro, Sweden.
    Jerdén, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Sörmland Cty Council, Drug & Therapeut Comm, Eskilstuna, Sweden.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svensson, Ann-Marie
    Natl Diabet Register, Ctr Registers, Gothenburg, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.2019In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186, article id S1751-9918(18)30277-8Article in journal (Refereed)
    Abstract [en]

    Aims: To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

    Methods: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

    Results: Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (< 0.05).

    Conclusions: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

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  • 160.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Svensson, Ann-Marie
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: a nationwide register-based cohort studyManuscript (preprint) (Other academic)
  • 161.
    Hvarfner, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Mora Hosp, Mora, Region Dalarna, Sweden.
    Blixt, Jonas
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.
    Schell, Carl Otto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden;Nykoping Hosp, Dept Internal Med, Nykoping, Region Sormland, Sweden.
    Castegren, Markus
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, CLINTEC, Stockholm, Sweden.
    Lugazia, Edwin R.
    Muhimbili Natl Hosp, Dept Anaesthesiol, Dar Es Salaam, Tanzania;Muhimbili Univ Hlth & Allied Sci, Dept Anaesthesiol, Dar Es Salaam, Tanzania.
    Mulungu, Moses
    Muhimbili Natl Hosp, Dept Anaesthesiol, Dar Es Salaam, Tanzania.
    Litorp, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.
    Baker, Tim
    Karolinska Univ Hosp, Perioperat Med & Intens Care, Stockholm, Sweden;Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden;Coll Med, Blantyre, Malawi.
    Vital Signs Directed Therapy for the Critically Ill: Improved Adherence to the Treatment Protocol Two Years after Implementation in an Intensive Care Unit in Tanzania2020In: Emergency Medicine International, ISSN 2090-2840, E-ISSN 2090-2859, Vol. 2020, article id 4819805Article in journal (Refereed)
    Abstract [en]

    Treating deranged vital signs is a mainstay of critical care throughout the world. In an ICU in a university hospital in Tanzania, the implementation of the Vital Signs Directed Therapy Protocol in 2014 led to an increase in acute treatments for deranged vital signs. The mortality rate for hypotensive patients decreased from 92% to 69%. In this study, the aim was to investigate the sustainability of the implementation two years later. An observational, patient-record-based study was conducted in the ICU in August 2016. Data on deranged vital signs and acute treatments were extracted from the patients' charts. Adherence to the protocol, defined as an acute treatment in the same or subsequent hour following a deranged vital sign, was calculated and compared with before and immediately after implementation. Two-hundred and eighty-nine deranged vital signs were included. Adherence was 29.8% two years after implementation, compared with 16.6% (p<0.001) immediately after implementation and 2.9% (p<0.001) before implementation. Consequently, the implementation of the Vital Signs Directed Therapy Protocol appears to have led to a sustainable increase in the treatment of deranged vital signs. The protocol may have potential to improve patient safety in other settings where critically ill patients are managed.

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  • 162.
    Höglund, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Carlsson, Marianne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Holmström, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Lännerström, Linda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Kaminsky, Elenor
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    From denial to awareness: a conceptual model for obtaining equity in healthcare2018In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 17, no 9Article in journal (Refereed)
  • 163.
    Jacobson, Dan N. O.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden.
    Lowing, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden;Karolinska Univ Hosp, Stockholm, Sweden.
    Hjelmarsson, Emma
    Karolinska Univ Hosp, Stockholm, Sweden.
    Tedroff, Krishna
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, Stockholm, Sweden.
    Exploring social participation in young adults with cerebral palsy2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 3, p. 167-174Article in journal (Refereed)
    Abstract [en]

    Objectives:

    To describe social outcomes for young adults with cerebral palsy, and to explore associations of social outcomes with their classification levels within the Gross Motor Function, Manual Ability and Communication Function Classification Systems, and with the presence of intellectual disability.

    Design:

    A cross-sectional study with a population-based inclusion approach at a neuropaediatric referral centre in Sweden.

    Subjects:

    Sixty-one young adults with cerebral palsy, age 20-22 years.

    Methods:

    Physical examination and questionnaires on social outcomes including living arrangements, relationships, occupation, personal finances, extent of family support with personal care, and physical examination.

    Results:

    Twenty percent of the young adults with cerebral palsy had moved out of the parental home. Forty-three percent were dependent on family support for basic activities of daily living. Seventy-nine percent of those without intellectual disability were employed or studying. The Communication Function Classification Systems, and presence of intellectual disability, demonstrated associations with most social outcomes, followed in significance by Manual Ability Classification System.

    Conclusion:

    In this study young adults with cerebral palsy to a high extent lived in the parental home, and more often without employment, compared with their peers. Many were dependent on parental support, financially, and with activities of daily living. Intellectual disability and communication function were important determinants of social participation. Interventions aimed at alleviating the impact of these particular disabilities should be prioritized.

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  • 164.
    Jacobson, Dan N O
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute.
    Löwing, Kristina
    Tedroff, Kristina
    Health-related quality of life, pain, and fatigue in young adults with cerebral palsy2020In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 62, no 3, p. 372-378Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health-related quality of life (HRQoL), pain, fatigue, and other health variables in young adults with cerebral palsy (CP), and to explore associations with the Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER) and physical activity.

    METHOD: This was a cross-sectional study of 61 young adults at a mean age of 21 years 2 months (standard deviation 8mo, range 20-22y) with CP, from a geographically defined area. Data collection included: Short Form 36 version 2 for HRQoL, Brief Pain Inventory - Short Form, Fatigue Severity Scale, level of physical activity, medical history, and physical examination.

    RESULTS: Overall HRQoL equalled that of population norms; however self-reported physical health was lower in GMFCS-ER levels III to V compared to GMFCS-ER levels I to II. Self-reported mental health was, inversely, lower in GMFCS-ER levels I to II compared to GMFCS-ER levels III to V. Pain prevalence was 49%, and pain was present across all GMFCS-ER levels. Fatigue, as well as sleep problems, had 41% prevalence, with fatigue severity decreasing with increasing level of physical activity.

    INTERPRETATION: General HRQoL in young adults with CP was comparable to population norms. Pain and fatigue are important to address in high motor-functioning individuals also. Physical activity could be a possible protective factor against fatigue.

    WHAT THIS PAPER ADDS:

    • Health-related quality of life in young adults with cerebral palsy (CP) was comparable to population norms.
    • Pain, fatigue, and sleep problems occurred at all Gross Motor Function Classification System levels.
    • There is a possible protective effect of physical activity on fatigue.
  • 165.
    Jason, Eva Andell
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, S-17176 Stockholm, Sweden.
    Tomson, Torbjorn
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden.
    Carisson, Sofia
    Karolinska Inst, Inst Environm Med, S-17177 Stockholm, Sweden.
    Tedroff, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, S-17176 Stockholm, Sweden;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Neuropediat Dept, Stockholm, Sweden.
    Amark, Per
    Karolinska Inst, Dept Womens & Childrens Hlth, Neuropediat Unit, S-17176 Stockholm, Sweden;Karolinska Univ Hosp, Astrid Lindgren Childrens Hosp, Neuropediat Dept, Stockholm, Sweden.
    Neurodevelopmental comorbidities and seizure control 24 months after a first unprovoked seizure in children2018In: Epilepsy Research, ISSN 0920-1211, E-ISSN 1872-6844, Vol. 143, p. 33-40Article in journal (Refereed)
    Abstract [en]

    Purpose: To follow children with newly diagnosed unprovoked seizures to determine (1) whether the prevalence of neurodevelopmental comorbidities and cerebral palsy (CP) changed after the initial seizure, and (2) the association between studied comorbidities and seizures 13-24 months after seizure onset or initiation of treatment. Methods: Analyses were based on 750 children (28 days-18 years) with a first unprovoked seizure (index) included in a population-based Incidence Registry in Stockholm between 2001 and 2006. The children were followed for two years and their medical records were examined for a priori defined neurodevelopmental/psychiatric comorbidities and CP and seizure frequency. Baseline information was collected from medical records from before, and up to six months after, the index seizure. Odds ratios (OR) of repeated seizures 13-24 months after the first seizure or after initiation of anti-epileptic drug treatment was calculated by logistic regression and adjusted for age and sex. Results: At baseline, 32% of the children had neurodevelopmental/psychiatric comorbidities or CP compared to 35%, 24 months later. Children with such comorbidities more often experienced seizures 13-24 months after the index seizure (OR 2.87, CI 2.07-3.99) with the highest OR in those with CP or attention deficit hyperactivity disorder (ADHD). Children diagnosed at age < 1 year exhibited the highest prevalence of comorbidities as well as OR for repeated seizures. A combination of young age and comorbidity was associated with an OR for repeated seizures of 5.12 (CI 3.03-8.65). Among the children without comorbidities 76% were seizure free 13-24 months after the index seizure or after initiation of AED treatment compared to 53% of children with comorbidities. Conclusions: This study indicates that neurodevelopmental comorbidities and CP in children with epilepsy tend to be present already at seizure onset and that such comorbidities are strong indicators of poor outcome regarding seizure control with or without treatment.

  • 166.
    Jernbro, Carolina
    et al.
    Karlstad Univ, Karlstad, Sweden.
    Otterman, Gabriel
    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), Paediatric Inflammation Research.
    Lucas, Steven
    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), Paediatric Inflammation Research.
    Tindberg, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). 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), Paediatric Inflammation Research.
    Janson, Staffan
    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), Paediatric Inflammation Research. Karlstad Univ, Karlstad, Sweden.
    Disclosure of Child Physical Abuse and Perceived Adult Support among Swedish Adolescents2017In: Child Abuse Review, ISSN 0952-9136, E-ISSN 1099-0852, Vol. 26, no 6, p. 451-464Article in journal (Refereed)
    Abstract [en]

    Compared to child sexual abuse (CSA), little is known about disclosure of child physical abuse (CPA). Enhancing the understanding of the characteristics of disclosure is necessary for improved child protection. The aim of the present study was to examine disclosure of CPA and perceived adult support using both quantitative and qualitative data from a survey of child maltreatment carried out among a nationally representative sample of Swedish adolescents (n = 3202). We found that adolescents who experienced any child maltreatment (CPA, emotional abuse, neglect and witnessing intimate partner violence) were less likely to be able to identify an adult confidant compared to those without a history of abuse. Among the adolescents who reported severe CPA, 52 per cent had disclosed the abuse and the most frequent recipient of disclosure was a peer or sibling. Eleven per cent had disclosed to professionals within school, child protective services or law enforcement. Lack of trust in adults appeared to be the most prominent reason for non- disclosure. Several adolescents who had disclosed abuse to professionals perceived an ineffective response, primarily because of professionals' lack of a child perspective. Some respondents experienced supportive interventions, specifically from school social workers. These patterns showed close similarity to disclosure of CSA.

  • 167.
    Jernbro, Carolina
    et al.
    Division of Public Health Sciences, Department of Health Sciences, Karlstad University, Sweden.
    Tindberg, Ylva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lucas, Steven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Janson, Staffan
    Division of Public Health Sciences, Department of Health Sciences, Karlstad University, Sweden.
    Quality of life among Swedish school children who experiencedmulti-type child maltreatment2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 3, p. 320-325Article in journal (Refereed)
    Abstract [en]

    AIM: he aim of thisstudy was to examine the overlap between child maltreatment types and theirassociation with quality of life amongschool children.

    METHODS: A national cross-sectional study of 3,202 grade nine Swedish pupils of 15-years-of-agewas carried out in 2011 with an 84% response rate.Data were analysed usingPearson chi-squareandmultiple linear regression analyses.

    RESULTS: Of the total sample, 650 children (20%) reported at least one type of maltreatment.There was a large degree of overlap between maltreatment types.In particular,neglect and witnessing intimate partner violence overlapped with most other types of maltreatment.There was a significant relationship between the degree of abuse and multi-type maltreatment. Results showeda linear relationship between the number of types ofmaltreatment and quality of life (p<0.001), indicating a dose-response relationship.

    CONCLUSION: The results emphasise the negative impact of child maltreatment on children's lives and highlight the importance of taking the broad spectrum of child maltreatment into account in both research and practice. A more comprehensive assessment of the width of maltreatment among professionals may help to identify the most seriously maltreated children and lead to an improved ability to target intervention and prevention atthese children.

  • 168.
    Johansson, Andreas K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
    Lennernäs, Bo
    Isacsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
    Neurovascular Bundle Infiltration Can Explain Local Relapses Using Conformal Radiotherapy of Prostate Cancer.2017In: Anticancer Research, ISSN 0250-7005, E-ISSN 1791-7530, Vol. 37, no 4, p. 1825-1830Article in journal (Refereed)
    Abstract [en]

    AIM: To quantify the impact of decreased margins for two treatment techniques, three-dimensional conformal radiotherapy (3D-CRT) and volumetric-modulated arc therapy (VMAT), on local control in curative treatment of prostate cancer.

    MATERIALS AND METHODS: The planning target volume (PTV) margins were decreased in steps of 1 mm from 10 to 1 mm. Treatment plans using 3D-CRT and VMAT technique were produced for all margin sizes and the dose to the neuro vascular bundles (NVB), that was not included in the PTV, was investigated.

    RESULTS: Due to the more conformal dose delivery using VMAT, the dose to the NVB decreased more rapidly by VMAT compared to the 3D-CRT plans. The dose difference was significant for margins from 1-7 mm.

    CONCLUSION: One should be very cautious before clinical routines are changed, bearing in mind whether the change means more conformal treatment technique, smaller margins or target segmentation in different imaging modalities.

  • 169.
    Johansson, Emil
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala Örebro-Reg Res Council, Uppsala.
    Lubberink, Mark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Heurling, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Eriksson, Jan W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Skrtic, Stanko
    AstraZeneca R&D, Gothenburg; Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Antaros Medical, Mölndal.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Antaros Medical, Mölndal.
    Whole-Body Imaging of Tissue-specific Insulin Sensitivity and Body Composition by Using an Integrated PET/MR System: A Feasibility Study.2018In: Radiology, ISSN 0033-8419, E-ISSN 1527-1315, Vol. 286, no 1, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Purpose

    To develop, evaluate, and demonstrate the feasibility of a whole-body protocol for simultaneous assessment of tissue-specific insulin-mediated fluorine 18 (18F) fluorodeoxyglucose (FDG) influx rates, tissue depots, and whole-body insulin sensitivity (referred to as the M value).

    Materials and Methods

    An integrated positron emission tomography (PET)/magnetic resonance (MR) imaging system combined with hyperinsulinemic euglycemic clamp (HEC) was used. Dynamic whole-body PET imaging was used to determine the insulin-mediated 18F-FDG tissue influx rate (Ki) in the whole-body region by using the Patlak method. M value was determined with the HEC method at PET imaging. Tissue depots were quantified by using water-fat separated MR imaging and manual segmentations. Feasibility of the imaging protocol was demonstrated by using five healthy control participants and five patients with type 2 diabetes. Associations between M value and Ki were studied in multiple tissues by using the Pearson correlation.

    Results

    Positive correlations were found between M value and Ki in multiple tissues: the gluteus muscle (r = 0.875; P = .001), thigh muscle (r = 0.903; P , .001), calf muscle (r = 0.825; P = .003), and abdominal visceral adipose tissue (r = 0.820; P = .004). A negative correlation was found in the brain (r = 20.798; P = .006). The MR imaging–based method for quantification of tissue depots was feasible for determining adipose tissue volumes and fat fractions.

    Conclusion

    This PET/MR imaging protocol may be feasible for simultaneous assessment of tissue-specific insulin-mediated 18F-FDG influx rates, tissue depots, and M value.

  • 170.
    Johnsson, Linus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    How general practitioners decide on maxims of action in response to demands from conflicting sets of norms: a grounded theory study2019In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 20, article id 33Article in journal (Refereed)
    Abstract [en]

    Background: The work of general practitioners (GPs) is infused by norms from several movements, of which evidence based medicine, patient-centredness, and virtue ethics are some of the most influential. Their precepts are not clearly reconcilable, and structural factors may limit their application. In this paper, we develop a conceptual framework that explains how GPs respond, across different fields of interaction in their daily work, to the pressure exerted by divergent norms.

    Methods: Data was generated from unstructured interviews with and observations of sixteen Swedish GPs (who have by definition more than five years of experience after license to practice) and family medicine residents (with less than five years of experience) between 2015 and 2017. Straussian Grounded Theory was used for analysis.

    Results: We found that GPs’ maxims of action can be characterised in terms of dichotomous responses to demands from four distinct sets of norms, or “voices”: the situation, the self, the system, and the profession. From the interactions between these voices emerge sixteen clusters of maxims of action. Based on the common features of the maxims in each cluster, we have developed a conceptual framework that appears to be rich enough to capture the meaning of the ethical decisions that GPs make in their daily work, yet has a high enough level of abstraction to be helpful when discussing the factors that influence those decisions.

    Conclusions: Our four-dimensional model of GPs' responses to norms is a first step toward a middle-range theory of quality from GPs' perspective. It brings out the complexity of their practice, reveals tensions that easily remain invisible in more concrete accounts of their actions, and aids the transferability of substantive theories on GPs' ethical decision making. By explaining the nature of the ethical conflicts that they experience, we provide some clues as to why efforts to improve quality by imposing additional norms on GPs may meet with varying degrees of success.

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  • 171.
    Jones, Robert P.
    et al.
    Royal Liverpool Univ Hosp, Liverpool, Merseyside, England.
    Psarelli, Eftychia-Eirini
    Univ Liverpool, Liverpool, Merseyside, England.
    Jackson, Richard
    Univ Liverpool, Liverpool, Merseyside, England.
    Ghaneh, Paula
    Royal Liverpool Univ Hosp, Liverpool, Merseyside, England;Univ Liverpool, Liverpool, Merseyside, England.
    Halloran, Christopher M.
    Royal Liverpool Univ Hosp, Liverpool, Merseyside, England;Univ Liverpool, Liverpool, Merseyside, England.
    Palmer, Daniel H.
    Univ Liverpool, Liverpool, Merseyside, England;Clatterbridge Canc Ctr, Wirral, Merseyside, England.
    Campbell, Fiona
    Royal Liverpool Univ Hosp, Liverpool, Merseyside, England.
    Valle, Juan W.
    Univ Manchester Christie, Manchester, Lancs, England.
    Faluyi, Olusola
    Clatterbridge Canc Ctr, Wirral, Merseyside, England.
    O'Reilly, Derek A.
    Manchester Univ Fdn Trust, Manchester, Lancs, England.
    Cunningham, David
    Royal Marsden Hosp, London, England.
    Wadsley, Jonathan
    Weston Pk Hosp, Sheffield, S Yorkshire, England.
    Darby, Suzanne
    Weston Pk Hosp, Sheffield, S Yorkshire, England.
    Meyer, Tim
    Royal Free Hosp, London, England.
    Gillmore, Roopinder
    Royal Free Hosp, London, England.
    Anthoney, Alan
    St James Univ Hosp, Leeds, W Yorkshire, England.
    Lind, Pehr
    Karolinska Inst, Clin Res Sormland, Stockholm, Sweden;Malarsjukhuset Hosp, Eskilstuna, Sweden.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Falk, Stephen
    Bristol Haematol & Oncol Ctr, Bristol, Avon, England.
    Izbicki, Jakob R.
    Univ Hamburg, Med Inst UKE, Hamburg, Germany.
    Middleton, Gary William
    Royal Surrey Cty Hosp, Guildford, Surrey, England.
    Cummins, Sebastian
    Royal Surrey Cty Hosp, Guildford, Surrey, England.
    Ross, Paul J.
    Guys Hosp, London, England.
    Wasan, Harpreet
    Hammersmith Hosp, London, England.
    McDonald, Alec
    Beatson West Scotland Canc Ctr, Glasgow, Lanark, Scotland.
    Crosby, Tom
    Velindre Hosp, Cardiff, S Glam, Wales.
    Ting, Yuk
    Queen Elizabeth Hosp, Birmingham, W Midlands, England.
    Patel, Kinnari
    Churchill Hosp, Oxford, England.
    Sherriff, David
    Derriford Hosp, Plymouth, Devon, England.
    Soomal, Rubin
    Jersey Gen Hosp, Jersey, England.
    Borg, David
    Skane Univ Hosp, Lund, Sweden;Skane Univ Hosp, Malmo, Sweden.
    Sothi, Sharmila
    Univ Hosp Coventry, Coventry, W Midlands, England.
    Hammel, Pascal
    Hop Beaujon, Clichy, France.
    Lerch, Markus M.
    Greifswald Univ, Med, Greifswald, Germany.
    Mayerle, Julia
    Greifswald Univ, Med, Greifswald, Germany;Ludwig Maximilians Univ Munchen, Univ Hosp Munich, Munich, Germany.
    Tjaden, Christine
    Heidelberg Univ, Heidelberg, Germany.
    Strobel, Oliver
    Heidelberg Univ, Heidelberg, Germany.
    Hackert, Thilo
    Heidelberg Univ, Heidelberg, Germany.
    Buchler, Markus W.
    Heidelberg Univ, Heidelberg, Germany.
    Neoptolemos, John P.
    Heidelberg Univ, Heidelberg, Germany.
    Hill, Mark
    Kent Oncol Ctr, Maidstone, Kent, England.
    Corrie, Pippa
    Addenbrookes Hosp, Cambridge, England.
    Hickish, Tamas
    Royal Bournemouth Hosp, Bournemouth, Dorset, England.
    Napier, Mark
    North Devon Dist Hosp Barnstaple, Barnstaple, England.
    Slater, Sarah
    St Bartholomews Hosp, London, England.
    Valle, Juan
    North Manchester Gen Hosp, Manchester, Lancs, England.
    Shablak, Alaaeldin
    Salisbury Dist Hosp, Salisbury, Wilts, England.
    Cunnell, Michelle
    Nottingham City Hosp, Nottingham, England.
    Guimbaud, Rosine
    CHU Purpan, Toulouse, France.
    Roques, Tom
    Norfolk & Norwich Univ Hosp, Norwich, Norfolk, England.
    Iveson, Tim
    Southampton Gen Hosp, Southampton, Hants, England.
    Jamil, Arshad
    Univ Hosp North Staffordshire, Stoke, England;Leighton Hosp, Crewe, England.
    Robinson, Angus
    Conquest Hosp, Hastings, England.
    Garcia-Alonso, Angel
    Glan Clwyd Gen Hosp, Rhyl, Wales.
    Chang, David
    Royal Blackburn Hosp, Blackburn, Lancs, England.
    Tsang, David
    Southend Hosp, Westcliff On Sea, England.
    Wadd, Nick
    James Cook Univ Hosp, Middlesbrough, Cleveland, England.
    Wall, Lucy
    Western Gen Hosp, Edinburgh, Midlothian, Scotland.
    Nielsen, Niels Hilmer
    Norrlands Univ Sjukhus, Umea, Sweden.
    Lerch, Markus
    Ernst Moritz Arndt Univ Greifswald, Greifswald, Germany.
    Mehta, Ajay
    Royal Preston Hosp, Preston, Lancs, England.
    Sivaramalingam, Muthiah
    Blackpool Victoria Hosp, Blackpool, England.
    Fyfe, David
    Royal Lancaster Infirm, Lancaster, England.
    Osborne, Richard
    Poole Hosp, Poole, Dorset, England.
    Blesing, Claire
    Great Western Hosp, Swindon, Wilts, England.
    Bulusu, Venkata Ramesh
    Bedford Hosp, Bedford, England.
    Rathbone, Emma
    Huddersfield Royal Infirm, Huddersfield, W Yorkshire, England.
    Seitz, Jean-Francois
    CHU La Timone, Marseille, France.
    Beaumont, Erica
    Yeovil Dist Hosp, Yeovil, England.
    Dernedde, Ulrike
    James Paget Hosp, Great Yarmouth, England.
    McAdam, Karen
    Peterborough City Hosp, Peterborough, Cambs, England.
    Dimopoulos, Prokopios
    St Marys Hosp, Newport, Wight, England.
    Cominos, Mathilda
    Queen Elizabeth Queen Mother Hosp, Margate, England;William Harvey Hosp, Ashford, Kent, England.
    Askill, Colin
    Singleton Hosp, Swansea, England.
    Piwowar, Andrzej
    Vastmanlands Sjukhus, Vasteras, Sweden.
    Bachet, Jean-Baptiste
    Grp Hosp Pitie Salpetriere, Paris, France.
    Sumpter, Kate
    Freeman Rd Hosp, Newcastle, England.
    Raouf, Sherif
    Queens Hosp, Romford, Essex, England.
    Nicoll, Jonathan
    Cumberland Infirm, Carlisle, England.
    Rees, Charlotte
    Basingstoke & North Hampshire Hosp, Basingstoke, Hants, England.
    Dhinakaran, Kathirvelu
    Royal Shrewsbury Hosp, Shrewsbury, Salop, England.
    Haux, Johan
    Univ Sjukhuset Linkoping, Linkoping, Sweden.
    Bengrine-Lefevre, Leila
    Hop St Antoine, Paris, France.
    Terrebonne, Eric
    Hop Haut Leveque, Pessac, France.
    Shankland, Catherine
    Royal Derby Hosp, Derby, England.
    Palmer, Cheryl
    Hinchingbrooke Hosp, Huntingdon, England.
    Medley, Louise
    Torbay Hosp, Torquay, England.
    Toy, Elizabeth
    Royal Devon & Exeter Hosp, Exeter, Devon, England.
    Kaur, Jasvinder
    Darent Valley Hosp, Dartford, England.
    Gupta, Kamalnayan
    Alexandra Hosp, Redditch, England.
    Cheeseman, Sue
    Bradford Royal Infirm, Bradford, W Yorkshire, England.
    Patterson, Daniel
    West Suffolk Hosp, Bury St Edmunds, Suffolk, England.
    Candish, Charles
    Cheltenham Gen Hosp, Cheltenham, Glos, England.
    Thompson, Joyce
    Heartlands Hosp, Birmingham, W Midlands, England.
    Coxon, Fareeda
    Bishop Auckland Gen Hosp, Bishop Auckland, England;Darlington Mem Hosp, Darlington, Durham, England.
    Connolly, Caroline
    Stafford Hosp, Stafford, England.
    McPhail, Neil
    Raigmore Hosp, Inverness, Scotland.
    Williams, Rachel
    Ysbyty Gwynedd, Bangor, Gwynedd, Wales.
    Flygare, Petra
    Lanssjukhuset Sundsvall, Sundsvall, Sweden.
    Elmlund, Mattias
    Cent Sjukhuset Karlstad, Karlstad, Sweden.
    Artru, Pascal
    Hop Prive Jean Mermoz, Lyon, France.
    Millat, Bertrand
    Hop St Eloi, Montpellier, France.
    Patterns of Recurrence After Resection of Pancreatic Ductal Adenocarcinoma: A Secondary Analysis of the ESPAC-4 Randomized Adjuvant Chemotherapy Trial2019In: JAMA Surgery, ISSN 2168-6254, E-ISSN 2168-6262, Vol. 154, no 11, p. 1038-1048Article in journal (Refereed)
    Abstract [en]

    Importance: The patterns of disease recurrence after resection of pancreatic ductal adenocarcinoma with adjuvant chemotherapy remain unclear.

    Objective: To define patterns of recurrence after adjuvant chemotherapy and the association with survival.

    Design, Setting, and Participants: Prospectively collected data from the phase 3 European Study Group for Pancreatic Cancer 4 adjuvant clinical trial, an international multicenter study. The study included 730 patients who had resection and adjuvant chemotherapy for pancreatic cancer. Data were analyzed between July 2017 and May 2019.

    Interventions: Randomization to adjuvant gemcitabine or gemcitabine plus capecitabine.

    Main Outcomes and Measures: Overall survival, recurrence, and sites of recurrence.

    Results: Of the 730 patients, median age was 65 years (range 37-81 years), 414 were men (57%), and 316 were women (43%). The median follow-up time from randomization was 43.2 months (95% CI, 39.7-45.5 months), with overall survival from time of surgery of 27.9 months (95% CI, 24.8-29.9 months) with gemcitabine and 30.2 months (95% CI, 25.8-33.5 months) with the combination (HR, 0.81; 95% CI, 0.68-0.98; P=.03). The 5-year survival estimates were 17.1% (95% CI, 11.6%-23.5%) and 28.0% (22.0%-34.3%), respectively. Recurrence occurred in 479 patients (65.6%); another 78 patients (10.7%) died without recurrence. Local recurrence occurred at a median of 11.63 months (95% CI, 10.05-12.19 months), significantly different from those with distant recurrence with a median of 9.49 months (95% CI, 8.44-10.71 months) (HR, 1.21; 95% CI, 1.01-1.45; P=.04). Following recurrence, the median survival was 9.36 months (95% CI, 8.08-10.48 months) for local recurrence and 8.94 months (95% CI, 7.82-11.17 months) with distant recurrence (HR, 0.89; 95% CI, 0.73-1.09; P=.27). The median overall survival of patients with distant-only recurrence (23.03 months; 95% CI, 19.55-25.85 months) or local with distant recurrence (23.82 months; 95% CI, 17.48-28.32 months) was not significantly different from those with only local recurrence (24.83 months; 95% CI, 22.96-27.63 months) (P=.85 and P=.35, respectively). Gemcitabine plus capecitabine had a 21% reduction of death following recurrence compared with monotherapy (HR, 0.79; 95% CI, 0.64-0.98; P=.03).

    Conclusions and Relevance: There were no significant differences between the time to recurrence and subsequent and overall survival between local and distant recurrence. Pancreatic cancer behaves as a systemic disease requiring effective systemic therapy after resection.

    Trial Registration: ClinicalTrials.gov identifier: NCT00058201, EudraCT 2007-004299-38, and ISRCTN 96397434. This secondary analysis of a randomized clinical trial investigates patterns of recurrence after adjuvant chemotherapy in pancreatic cancer and the association with survival.

  • 172.
    Jonsson, Kent
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Nykoping Hosp, Dept Geriatr & Rehabil Med, Nykoping, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Samariterhemmet Acad Primary Hlth Care Ctr, Uppsala, Region Uppsala, Sweden.
    Peak expiratory flow rate and thoracic mobility in people with fibromyalgia. A cross sectional study2019In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 19, no 4, p. 755-763Article in journal (Refereed)
    Abstract [en]

    Background and aims:

    Fibromyalgia (FM) is characterized by chronic widespread pain and affects approximately 1-3% of the general population. Respiratory function has not been given much consideration in people with FM. Few studies have been published concerning FM and respiratory function and conflicting data still exist. The aim of this study was to compare differences in forced expiration, but also to investigate chest expansion, spinal mobility and segmental pain intensity between a group with fibromyalgia and heal thy controls.

    Methods:

    Forty-one women with diagnosed FM based on American College of Rheumatology 1990 criteria and forty-one controls without pain matched for age and gender participated in this cross-sectional study. For evaluation of forced expiration, a Wright peak expiratory flow rate meter was used. A tape measure was used to measure the mobility of the thorax at maximum inhalation and exhalation known as chest expansion. Spinal mobility was measured with the Cervico-thoracic ratio method. The spinal mobility was measured as range of motion from C7 to 15 cm below in flexion and manual palpation was conducted between C7-T5. For differences in pain intensity a palpation-index was defined for each level, respectively; C7-T1, T1-2, T2-3, T3-4 and T4-5 by calculating the mean value for the four different palpation points for each motion segment. A combined measure of expiration and thoracic mobility (expiratory/inspiratory ratio) was calculated by dividing peak expiratory flow rate (L/min) with chest expansion (cm). Statistical analyses included descriptive statistics to describe subjects and controls, means and standard deviation to compare differences between groups and student-t and Chi-square (chi(2)) tests, using SPSS 22 software. Confidence interval was set to 95%.

    Results:

    In the FM group 17 had the diagnosis for more than 5 years and 24 less than 5 years. The FM group demonstrated significantly lower forced expiration (p < 0.018), less thoracic expansion (p < 0.001), reduced spinal mobility (p < 0.029), higher expiratory-inspiratory ratio value (p < 0.001) and increased palpation pain over C7-T5 (p < 0.001) compared to healthy controls. There were more smokers in the FM group (n = 9) compared to the controls (n = 5) though this difference was not statistically significant (p < 0.24) and excluding the few smokers yielded similar result. No significant correlations for manual palpation, chest expansion, peak expiratory flow rate and spinal mobility were found in the FM group.

    Conclusions:

    Women with FM demonstrated significantly lower forced expiration and thoracic mobility compared to healthy controls.

    Implications:

    The results of this study point to a plausible restriction of respiratory function which in turn may have effect on physical endurance and work capacity in people with FM.

  • 173. Jovel, Irina Tatiana
    et al.
    Kofoed, Poul-Erik
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Rodrigues, Amabelia
    Ursing, Johan
    Temporal and Seasonal Changes of Genetic Polymorphisms Associated with Altered Drug Susceptibility to Chloroquine, Lumefantrine, and Quinine in Guinea-Bissau between 2003 and 2012.2015In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 59, no 2, p. 872-9Article in journal (Refereed)
    Abstract [en]

    In 2008, artemether-lumefantrine was introduced in Guinea-Bissau, West Africa, but quinine has also been commonly prescribed for the treatment of uncomplicated Plasmodium falciparum malaria. An efficacious high-dose chloroquine treatment regimen was used previously. Temporal and seasonal changes of genetic polymorphisms associated with altered drug susceptibility to chloroquine, lumefantrine, and quinine have been described. P. falciparum chloroquine resistance transporter (pfcrt) K76T, pfmdr1 gene copy numbers, pfmdr1 polymorphisms N86Y and Y184F, and pfmdr1 sequences 1034 to 1246 were determined using PCR-based methods. Blood samples came from virtually all (n = 1,806) children <15 years of age who had uncomplicated P. falciparum monoinfection and presented at a health center in suburban Bissau (from 2003 to 2012). The pfcrt K76T and pfmdr1 N86Y frequencies were stable, and seasonal changes were not seen from 2003 to 2007. Since 2007, the mean annual frequencies increased (P < 0.001) for pfcrt 76T (24% to 57%), pfmdr1 N86 (72% to 83%), and pfcrt 76 + pfmdr1 86 TN (10% to 27%), and pfcrt 76T accumulated during the high transmission season (P = 0.001). The pfmdr1 86 + 184 NF frequency increased from 39% to 66% (from 2003 to 2011; P = 0.004). One sample had two pfmdr1 gene copies. pfcrt 76T was associated with a lower parasite density (P < 0.001). Following the discontinuation of an effective chloroquine regimen, probably highly artemether-lumefantrine-susceptible P. falciparum (with pfcrt 76T) accumulated, possibly due to suboptimal use of quinine and despite a fitness cost linked to pfcrt 76T. (The studies reported here were registered at ClinicalTrials.gov under registration no. NCT00137514 [PSB-2001-chl-amo], NCT00137566 [PSB-2004-paracetamol], NCT00426439 [PSB-2006-coartem], NCT01157689 [AL-eff 2010], and NCT01704508 [Eurartesim 2012].).

  • 174.
    Kaiser, Andreas
    et al.
    Karolinska Inst, Karolinska Univ Hosp, Dept Clin Sci Intervent & Technol, Huddinge, Sweden.
    Kale, Ajay
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Novozhilova, Ekaterina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Olivius, Petri
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    The Effects of Matrigel® on the Survival and Differentiation of a Human Neural Progenitor Dissociated Sphere Culture2020In: Anatomical Record Part A-discoveries in Molecular Cellular and Evolutionary Biology, ISSN 1552-4884, E-ISSN 1932-8494, Vol. 303, no 3, p. 441-450Article in journal (Refereed)
    Abstract [en]

    We have previously developed an in vitro organotypic culture setting in order to investigate the performance of cellular substrates transplanted to the auditory nervous system. We have utilized this system to predict the efficacy of human neural progenitor cells (HNPCs) in transplantation to the auditory nerve to facilitate regeneration of sensory auditory nerve structures in vivo and in vitro. To optimize the growth and differentiation of HNPCs we have introduced an expansion of our in vitro system, exploring the impact of a growth factor‐altered microenvironment. Here, we seeded HNPCs as a dissociated sphere culture on a hydrogel matrix coating (Matrigel®). We evaluated the performance of HNPCs by studying their survival, differentiation, and their axon‐forming capacity. In identical culture conditions, we found that the overall survival rate of HNPCs on Matrigel coated surfaces was better than that on surfaces that were not coated with Matrigel. Furthermore, cells on Matrigel differentiated into neuronal cells to a far greater extent leading to strong synaptic marker signatures. Overall, our findings show that the present Matrigel matrix setting offers an experimental environment for the HNPCs to grow where these cells show novel and promising phenotypic characteristics suitable for further in vivo transplantation to the auditory nerve.

  • 175.
    Kallak, Theodora Kunovac
    et al.
    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), Reproductive Health.
    Hellgren, Charlotte
    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), Reproductive Health.
    Skalkidou, Alkistis
    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), Obstetrics and Reproductive Health Research.
    Sandelin-Francke, Lotta
    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), Reproductive Health.
    Ubhayasekera, Kumari
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Bergquist, Jonas
    Uppsala University, Disciplinary Domain of Science and Technology, Chemistry, Department of Chemistry - BMC, Analytical Chemistry.
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). 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), Obstetrics and Reproductive Health Research.
    Comasco, Erika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neuro-psycho-pharmacology.
    Campbell, Rebecca E
    Centre for Neuroendocrinology, Department of Physiology, University of Otago School of Medical Sciences, Dunedin, New Zealand.
    Sundström Poromaa, Inger
    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), Reproductive Health.
    Maternal and female fetal testosterone levels are associated with maternal age and gestational weight gain2017In: European Journal of Endocrinology, ISSN 0804-4643, E-ISSN 1479-683X, Vol. 177, no 4, p. 379-388Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Prenatal androgen exposure has been suggested to play a role in polycystic ovary syndrome. Given the limited information on what maternal characteristics influence maternal testosterone levels, and the even less explored routes by which female fetus androgen exposure would occur, the aim of this study was to investigate the impact of maternal age, BMI, weight gain, depressed mood and aromatase SNPs on testosterone levels in maternal serum and amniotic fluid of female fetuses.

    METHODS: Blood samples from pregnant women (n = 216) obtained in gestational weeks 35-39, and pre-labor amniotic fluid samples from female fetuses (n = 56), taken at planned Caesarean section or in conjunction with amniotomy for induction of labor, were analyzed. Maternal serum testosterone and amniotic fluid testosterone and cortisol were measured by tandem mass spectrometry.

    RESULTS: Multiparity (β = -0.28, P < 0.001), self-rated depression (β = 0.26, P < 0.001) and weight gain (β = 0.18, P < 0.05) were independent explanatory factors for the maternal total testosterone levels. Maternal age (β = -0.34, P < 0.001), weight gain (β = 0.19, P < 0.05) and amniotic fluid cortisol levels (β = 0.44, P < 0.001) were independent explanatory factors of amniotic fluid testosterone in female fetuses, explaining 64.3% of the variability in amniotic fluid testosterone.

    WIDER IMPLICATIONS OF THE FINDINGS: Young maternal age and excessive maternal weight gain may increase the prenatal androgen exposure of female fetuses. Further studies are needed to explore this finding.

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  • 176. Kantele, Anu
    et al.
    Siikamaki, Heli
    Hannila-Handelberg, Tuula
    Laitinen, Kalevi
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Plasmodium falciparum-Malaria in Pregnant African Immigrants Often Goes Unrecognized2012In: Journal of Travel Medicine, ISSN 1195-1982, E-ISSN 1708-8305, Vol. 19, no 6, p. 380-382Article in journal (Refereed)
    Abstract [en]

    We report four cases of asymptomatic Plasmodium falciparum malaria in pregnant African women. They had immigrated to Finland 3 to 13 months earlier. The disease was revealed only by anemia. The diagnosis relied on blood smear which showed a parasitemia <0.2% in three cases. Medical personnel should be informed about the possibility of afebrile forms of malaria in pregnant women even months after immigration. Very low levels of parasitemia may call for a more sensitive diagnostic approach such as polymerase chain reaction.

  • 177.
    Karjala, Jaana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Malarsjukhuset Hosp, Dept Paediat, Eskilstuna, Sweden..
    Eriksson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Umea Univ, Dept Community Med & Rehabil, Physiotherapy, Umea, Sweden..
    Inter-rater reliability between nurses for a new paediatric triage system based primarily on vital parameters: the Paediatric Triage Instrument (PETI)2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e012748Article in journal (Refereed)
    Abstract [en]

    Introduction: The major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage Instrument (PETI) is primarily based on vital parameters and was developed exclusively for paediatric triage in patients with medical symptoms. The aim of this study was to assess the inter-rater reliability of this triage system in children when used by nurses. Methods: A design was employed in which triage was performed simultaneously and independently by a research nurse and an emergency department (ED) nurse using the PETI. All patients aged <= 12 years who presented at the ED with a medical symptom were considered eligible for participation. Results: The 89 participants exhibited a median age of 2 years and were triaged by 28 different nurses. The inter-rater reliability between nurses calculated with the quadratic-weighted kappa was 0.78 (95% CI 0.67 to 0.89); the linear-weighted kappa was 0.67 (95% CI 0.56 to 0.80) and the unweighted kappa was 0.59 (95% CI 0.44 to 0.73). For the patients aged <1, 1-3 and >3 years, the quadratic-weighted kappa values were 0.67 (95% CI 0.39 to 0.94), 0.86 (95% CI 0.75 to 0.97) and 0.73 (95% CI 0.49 to 0.97), respectively. The median triage duration was 6 min. Conclusions: The PETI exhibited substantial reliability when used in children aged <= 12 years and almost perfect reliability among children aged 1-3 years. Moreover, rapid application of the PETI was demonstrated. This study has some limitations, including sample size and generalisability, but the PETI exhibited promise regarding reliability, and the next step could be either a larger reliability study or a validation study.

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  • 178. Kassapidou, Maria
    et al.
    Franke Stenport, Victoria
    Hjalmarsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Johansson, Carina B
    Cobalt-chromium alloys in fixed prosthodontics in Sweden2017In: Acta Biomaterialia Odontologica Scandinavica, ISSN 0001-5369, E-ISSN 2333-7931, Vol. 3, no 1, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to compile the usage of Co-Cr alloys in fixed prosthodontics (FP) among dental laboratories in Sweden.

    Methods: From March to October 2015, questionnaires were sent to 542 registered dental laboratories in Sweden. The questionnaires were divided in two parts, one for fixed dental-supported prosthodontics (FDP) and one for fixed implant-supported prosthodontics (FIP). Reminders were sent three times.

    Results: In total of 542 dental laboratories, 55% answered the questionnaires. Most dental laboratories use Co-Cr in FP, 134 (74%) in FDP and 89(66%) in FIP. The laboratories used Co-Cr alloys of various compositions in the prostheses, 35 for FDP and 30 for FIP. The most commonly used Co-Cr alloys for tooth-supported FDPs were (a) Wirobond® 280, (b) Cara SLM and (c) Wirobond® C. For implant-supported frameworks the frequently used alloys were: (a) Cara SLM, (b) Cara Milled and (c) Wirobond® 280. Except for the difference in composition of these alloys, they were also manufactured with various techniques. In tooth-supported prostheses the dominating technique was the cast technique while newer techniques as laser-sintering and milling were more commonly reported for implant-supported constructions. A fourth technique; the ‘pre-state’ milling was reported in FDP.

    Conclusion: More than 30 different Co-Cr alloys were reported as being used in FP. Thus, there is a need for studies exploring the mechanical and physical behavior and the biological response to the most commonly used Co-Cr alloys.

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  • 179. Kassi, Eva
    et al.
    Dimas, Cleanthi
    Dalamaga, Marianna
    Panagiotou, Anna
    Papoutsi, Zoi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Spilioti, Eliana
    Moutsatsou, Paraskevi
    Sideritis euboea extract lowers total cholesterol but not LDL cholesterol in humans: a randomized controlled trial2013In: Clinical Lipidology, ISSN 1758-4299, Vol. 8, no 6, p. 627-634Article in journal (Refereed)
    Abstract [en]

    Aim:Sideritis euboea is used to prepare a widely consumed beverage. We evaluated the biological activity of S. euboea in healthy human subjects, focusing on serum cardiovascular factors, including lipids, inflammation and glucose homeostasis markers. Patients & methods: In a double-blind study, 54 participants were randomly assigned to consume S. euboea aqueous extract food (n = 27, intervention group) or a placebo food (n = 27, control group) for a 1-month period. A total of 47 participants were included in the final analysis. Serum lipids (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, lipoprotein lipase(a)), Homeostasis Model Assessment and inflammatory markers were determined. Results: Total cholesterol was reduced significantly in the intervention group, while no beneficial effects on other lipid parameters and inflammatory markers were observed. In females, S. euboea significantly ameliorated the Homeostasis Model Assessment index. Conclusion: The consumption of S. euboea induces only a significant total cholesterol lowering effect while it exerts insulin-sensitizing actions in females. Larger studies with a longer intervention period should be performed.

  • 180.
    Kaul, Ylva Fredriksson
    et al.
    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), Perinatal, Neonatal and Pediatric Cardiology Research.
    Rosander, Kerstin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Grönqvist, Helena
    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.
    Brodd, Katarina Strand
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). 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), Perinatal, Neonatal and Pediatric Cardiology Research.
    Hellström-Westas, Lena
    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), Perinatal, Neonatal and Pediatric Cardiology Research.
    von Hofsten, Claes
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Reaching skills of infants born very preterm predict neurodevelopment at 2.5 years2019In: Infant Behavior and Development, ISSN 0163-6383, E-ISSN 1879-0453, Vol. 57, article id 101333Article in journal (Refereed)
    Abstract [en]

    The purpose was to investigate associations between quality of reaching for moving objects at 8 months corrected age and neurodevelopment at 2.5 years in children born very preterm (gestational age (GA), 24–31 weeks). Thirtysix infants were assessed while reaching for moving objects. The movements were recorded by a 3D motion capture system. Reaching parameters included aiming, relative length of the reach, number of movement units, proportion of bimanual coupled reaches and number of hits. Neurodevelopment was assessed at 2.5 years by the Bayley Scales of Infant Development III. There were strong associations between infant reaching kinematics and neurodevelopment of cognition and language but the patterns differed: in children born extremely preterm (GA < 28 weeks), planning and control of reaching was strongly related to outcome, while in children born very preterm (GA 28–31 weeks) number of hits and bimanual strategies were of greater relevance. In conclusion, for extremely preterm infants, basic problems on how motion information is incorporated with action planning prevail, while in very preterm infants the coordination of bimanual reaches is more at the focus. We conclude that the results reflect GA related differences in neural vulnerability and that early motor coordination deficits have a cascading effect on neurodevelopment.

  • 181.
    Kaul, Ylva Fredriksson
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Rosander, Kerstin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Hofsten, von, Claes
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Brodd, Katarina Strand
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Holmström, Gerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ophthalmology.
    Kaul, Alexander
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Bohm, Birgitta
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Hellström-Westas, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Visual tracking in very preterm infants at 4 months predicts neurodevelopment at 3 years of age2016In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 80, no 1, p. 35-42Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Typically developing infants track moving objects with eye and head movements in a smooth and predictive way at 4 mo of age, but this ability is delayed in very preterm infants. We hypothesized that visual tracking ability in very preterm infants predicts later neurodevelopment. METHOD: In 67 very preterm infants (gestational age<32wk), eye and head movements were assessed at 4 mo corrected age while the infant tracked a moving object. Gaze gain, smooth pursuit, head movements, and timing of gaze relative the object were analyzed off line. Results of the five subscales included in the Bayley Scales of Infant Development (BSID-III) at 3 y of age were evaluated in relation to the visual tracking data and to perinatal risk factors. RESULTS: Significant correlations were obtained between gaze gain and cognition, receptive and expressive language, and fine motor function, respectively, also after controlling for gestational age, severe brain damage, retinopathy of prematurity, and bronchopulmonary dysplasia. CONCLUSION: This is the first study demonstrating that the basic ability to visually track a moving object at 4 mo robustly predicts neurodevelopment at 3 y of age in children born very preterm.

  • 182. Kayambankadzanja, Raphael Kazidule
    et al.
    Schell, Carl Otto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Namboya, Felix
    Phiri, Tamara
    Banda-Katha, Grace
    Mndolo, Samson Kwazizira
    Bauleni, Andy
    Castegren, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Baker, Tim
    The Prevalence and Outcomes of Sepsis in Adult Patients in Two Hospitals in Malawi.2020In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645Article in journal (Refereed)
    Abstract [en]

    There are an estimated 19.4 million sepsis cases every year, many of them in low-income countries. The newly adopted definition of sepsis uses Sequential Organ Failure Assessment Score (SOFA), a score which is not feasible in many low-resource settings. A simpler quick-SOFA (qSOFA) based solely on vital signs score has been devised for identification of suspected sepsis. This study aimed to determine in-hospital prevalence and outcomes of sepsis, as defined as suspected infection and a qSOFA score of 2 or more, in two hospitals in Malawi. The secondary aim was to evaluate qSOFA as a predictor of mortality. A cross-sectional study of adult in-patients in two hospitals in Malawi was conducted using prospectively collected single-day point-prevalence data and in-hospital follow-up. Of 1,135 participants, 81 (7.1%) had sepsis. Septic patients had a higher hospital mortality rate (17.5%) than non-septic infected patients (9.0%, p = 0.027, odds ratio 2.1 [1.1-4.3]), although the difference was not statistically significant after adjustment for baseline characteristics. For in-hospital mortality among patients with suspected infection, qSOFA ≥ 2 had a sensitivity of 31.8%, specificity of 82.1%, a positive predictive value of 17.5%, and a negative predictive value of 91.0%. In conclusion, sepsis is common and is associated with a high risk of death in admitted patients in hospitals in Malawi. In low-resource settings, qSOFA score that uses commonly available vital signs data may be a tool that could be used for identifying patients at risk-both for those with and without a suspected infection.

  • 183.
    Kayambankadzanja, Raphael Kazidule
    et al.
    Univ Malawi, Coll Med, Blantyre, Malawi;Queen Elizabeth Cent Hosp, Dept Anaesthesia & Intens Care, Blantyre, Malawi.
    Schell, Carl Otto
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden;Nykoping Hosp, Dept Internal Med, Nykoping, Sormland Region, Sweden.
    Nsanjama, Grace
    Queen Elizabeth Cent Hosp, Dept Anaesthesia & Intens Care, Blantyre, Malawi.
    Mbingwani, Isaac
    Chiradzulu Dist Hosp, Chiradzulu, Malawi.
    Mndolo, Samson Kwazizira
    Queen Elizabeth Cent Hosp, Dept Anaesthesia & Intens Care, Blantyre, Malawi.
    Rylance, Jamie
    Univ Liverpool Liverpool Sch Trop Med, Dept Clin Sci, Liverpool, Merseyside, England;Malawi Liverpool Wellcome Trust Clin Res Programm, Blantyre, Malawi.
    Baker, Tim
    Univ Malawi, Coll Med, Blantyre, Malawi;Queen Elizabeth Cent Hosp, Dept Anaesthesia & Intens Care, Blantyre, Malawi;Karolinska Inst, Dept Publ Hlth Sci, Global Hlth Hlth Syst & Policy, Stockholm, Sweden.
    Inability to Walk Predicts Death among Adult Patients in Hospitals in Malawi2019In: Emergency Medicine International, ISSN 2090-2840, E-ISSN 2090-2859, article id 6586891Article in journal (Refereed)
    Abstract [en]

    Objective: Vital signs are often used in triage, but some may be difficult to assess in low-resource settings. A patient's ability to walk is a simple and rapid sign that requires no equipment or expertise. This study aimed to determine the predictive performance for death of an inability to walk among hospitalized Malawian adults and to compare its predictive value with the vital signs-based National Early Warning Score (NEWS).

    Methods: It is a prospective cohort study of adult in-patients on selected days in two hospitals in Malawi. Patients were asked to walk five steps with close observation and their vital signs were assessed. Sensitivities, specificities, and predictive values for in-patient death of an inability to walk were calculated and an inability to walk was compared with NEWS.

    Results: Four-hundred and forty-three of the 1094 participants (40.5%) were unable to walk independently. In this group, 70 (15.8 %) died in-hospital compared to 16 (2.5%) among those who could walk: OR 7.4 (95% CI 4.3-13.0 p<0.001). Inability to walk had a sensitivity for death of 81.4%, specificity of 63.0%, positive predictive value (PPV) of 15.8%, and negative predictive value (NPV) of 97.5%. NEWS>6 had sensitivity 70.9%, specificity 70.6%, PPV 17.1%, and NPV 96.6%. An inability to walk had a fair concordance with NEWS>6 (kappa 0.21).

    Conclusion: Inability to walk predicted mortality as well as NEWS among hospitalized adults in Malawi. Patients who were able to walk had a low risk of death. Walking ability could be considered an additional vital sign and may be useful for triage.

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  • 184.
    Khandelwal, Pooja
    et al.
    Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplantat & Immune Deficiency, Cincinnati, OH 45229 USA.
    Millard, Heather R.
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.
    Thiel, Elizabeth
    Med Coll Wisconsin, Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI 53226 USA.
    Abdel-Azim, Hisham
    Univ Southern Calif, Keck Sch Med, Childrens Hosp Los Angeles, Div Hematol Oncol & Blood & Marrow Transplantat, Los Angeles, CA 90033 USA.
    Abraham, Allistair A.
    Childrens Natl Med Ctr, Div Blood & Marrow Transplantat, Ctr Canc & Blood Disorders, Washington, DC 20010 USA.
    Auletta, Jeffery J.
    Nationwide Childrens Hosp, Host Def Program, Div Hematol Oncol Bone Marrow Transplant & Infect, Columbus, OH USA.
    Boulad, Farid
    Mem Sloan Kettering Canc Ctr, Dept Pediat, New York, NY 10021 USA.
    Brown, Valerie I.
    Penn State Hershey Childrens Hosp, Coll Med, Div Pediat Hematol Oncol, Dept Pediat, Hershey, PA USA.
    Camitta, Bruce M.
    Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA;Med Coll Wisconsin, Midwest Ctr Canc & Blood Disorders, Milwaukee, WI 53226 USA.
    Chan, Ka Wah
    Texas Transplant Inst, Dept Pediat, San Antonio, TX USA.
    Chaudhury, Sonali
    Ann & Robert H Lurie Childrens Hosp Chicago, Div Pediat Hematol Oncol & Stem Cell Transplant, Dept Pediat, Chicago, IL 60611 USA.
    Cowan, Morton J.
    UCSF Benioff Childrens Hosp, Pediat Allergy Immunol & Blood & Marrow Transplan, San Francisco, CA USA.
    Angel-Diaz, Miguel
    Univ Nino Jesus, Hosp Infantil, Dept Hematol Oncol, Madrid, Spain.
    Gadalla, Shahinaz M.
    NCI, Div Canc Epidemiol & Genet, Clin Genet Branch, NIH, Rockville, MD USA.
    Gale, Robert Peter
    Imperial Coll London, Hematol Res Ctr, Div Expt Med, Dept Med, London, England.
    Hale, Gregory
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
    Kasow, Kimberly A.
    Univ North Carolina Chapel Hill, Div Hematol Oncol, Dept Pediat, Chapel Hill, NC USA.
    Keating, Amy K.
    Univ Colorado, Sch Med, Dept Pediat, Aurora, CO USA.
    Kitko, Carrie L.
    Vanderbilt Univ, Med Ctr, Pediat Hematol Oncol Div, Nashville, TN 37235 USA.
    MacMillan, Margaret L.
    Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN USA.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden.
    Page, Kristin M.
    Duke Univ, Med Ctr, Div Pediat Blood & Marrow Transplantat, Durham, NC USA.
    Seber, Adriana
    Univ Sao Paulo, Sch Med, Internal Med, Sao Paulo, Brazil.
    Smith, Angela R.
    Univ Minnesota, Blood & Marrow Transplant Program, Minneapolis, MN USA.
    Warwick, Anne B.
    Uniformed Serv Univ Hlth Sci, Dept Pediat, Bethesda, MD 20814 USA.
    Wirk, Baldeep
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Mehta, Parinda A.
    Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplantat & Immune Deficiency, Cincinnati, OH 45229 USA.
    Hematopoietic Stem Cell Transplantation Activity in Pediatric Cancer between 2008 and 2014 in the United States: A Center for International Blood and Marrow Transplant Research Report2017In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 23, no 8, p. 1342-1349Article in journal (Refereed)
    Abstract [en]

    This Center for International Blood and Marrow Transplant Research report describes the use of hematopoietic stem cell transplantation (HSCT) in pediatric patients with cancer, 4408 undergoing allogeneic (allo) and3076 undergoing autologous (auto) HSCT in the United States between 2008 and 2014. In both settings, there was a greater proportion of boys (n = 4327; 57%), children < 10 years of age (n = 4412; 59%), whites (n = 5787; 77%), and children with a performance score 90% at HSCT (n = 6187; 83%). Leukemia was the most common indication for an allo-transplant (n = 4170; 94%), and among these, acute lymphoblastic leukemia in second complete remission (n = 829; 20%) and acute myeloid leukemia in first complete remission (n = 800; 19%) were the most common. The most frequently used donor relation, stem cell sources, and HLA match were unrelated donor (n = 2933; 67%), bone marrow (n = 2378; 54%), and matched at 8/8 HLA antigens (n = 1098; 37%) respectively. Most allo-transplants used myeloablative conditioning (n = 4070; 92%) and calcineurin inhibitors and methotrexate (n = 2245; 51%) for acute graft-versus-host disease prophylaxis. Neuroblastoma was the most common primary neoplasm for an auto-transplant (n = 1338; 44%). Tandem auto-transplants for neuroblastoma declined after 2012 (40% in 2011, 25% in 2012, and 8% in 2014), whereas tandem auto transplants increased for brain tumors (57% in 2008 and 77% in 2014). Allo-transplants from relatives other than HLA-identical siblings doubled between 2008 and 2014 (3% in 2008 and 6% in 2014). These trends will be monitored in future reports of transplant practices in the United States.

  • 185. Khatib, Rani
    et al.
    Lee, Geraldine A
    Marques-Sule, Elena
    Hopstock, Laila Arnesdatter
    O'Donnell, Sharon
    Svavarsdóttir, Margrét Hrönn
    Andreae, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Vellone, Ercole
    Goossens, Eva
    Strömberg, Anna
    Kjellström, Barbro
    Jaarsma, Tiny
    Stewart, Chloe
    Evaluating the Extent of Patient-Centred Care in a Selection of ESC Guidelines.2019In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, article id qcz025Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Patient-centred care (PCC) is the cornerstone for healthcare professionals (HCP) to promote high quality care for patients with cardiovascular conditions. It is defined as 'Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions'. PCC can improve patient outcomes and allow patients and HCP to manage care collaboratively using best available evidence. However, there is no clear understanding how extensively these guidelines incorporate PCC recommendations. The aim of the study was to evaluate the incorporation of PCC into a selection of guidelines published by the European Society of Cardiology (ESC).

    METHODS: Using a narrative literature review and expert consensus, the Science Committee within the Cardiovascular Nursing and Allied Professions (ACNAP) developed a checklist to determine PCC incorporation in clinical guidelines. Nine ESC guidelines were reviewed evaluated with committee members independently evaluating five PCC aspects: patient voice & involvement, multidisciplinary involvement, holistic care recommendations, flexibility to meet patients' needs, and provision of patient tools. The level of congruence in item ratings by experts was then compared.

    RESULTS: The incorporation of PCC using these respective five categories, ranged from 4% (patient tools) to 53% in the 'multidisciplinary involvement' category.

    CONCLUSIONS: Overall, the inclusion of PCC was low, indicating that patient perspectives and needs were less likely to be taken into account when developing, endorsing or formulating recommendations. Future development of guidelines should ensure better incorporation of patients' perspective, in particular, and other PCC aspects highlighted in this study.

  • 186. Kilander, C.
    et al.
    Lagergren, J.
    Konings, P.
    Sadr-Azodi, Omid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Environm Med, Stockholm, Sweden.
    Brusselaers, N
    Menopausal hormone therapy and biliary tract cancer: a population-based matched cohort study in Sweden2019In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 58, no 3, p. 290-295Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study tested the hypothesis that contemporary menopausal hormonal therapy (MHT) increases the risk of biliary tract cancer. The risk of cancer of the biliary tract (gallbladder and extra-hepatic bile ducts) may be increased following estrogen exposure.

    MATERIAL AND METHODS: This was a nationwide population-based matched cohort study in Sweden. Data from the Swedish Prescribed Drug Register identified all women exposed to systemic MHT in 2005-2012. Group-level matching (1:3 ratio) was used to select women unexposed to MHT from the same study base, matched for history of delivery, thrombotic events, hysterectomy, age, smoking- and alcohol related diseases, obesity, and diabetes. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI).

    RESULTS: Comparing 290,186 women exposed to MHT with 870,165 unexposed, MHT did not increase the OR of biliary tract cancer. The OR of gallbladder cancer was rather decreased in MHT users (OR 0.58, 95% CI 0.43-0.79), but this association became attenuated and statistically non-significant after adjusting for gallstone disease (OR 0.84, 95% CI 0.60-1.15). The OR of extra-hepatic bile duct cancers was 0.83 (95% CI 0.61-1.15). There were no clear differences when the analyses were stratified for estrogen or estrogen/progestogen combinations. MHT increased the risk of gallstone disease (OR 6.95, 95% CI 6.64-7.28).

    CONCLUSIONS: Contemporary MHT does not seem to increase the risk of biliary tract cancer. The decreased risk of gallbladder cancer may be explained by the increased use of surgery for symptomatic gallstones in MHT users.

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  • 187.
    Kilander, Carl
    et al.
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.
    Lagergren, Jesper
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden;Kings Coll London, Div Canc Studies, London, England.
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Sadr-Azodi, Omid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    The population-based incidence and mortality of biliary tract cancer in Sweden2018In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 56, p. 14-20Article in journal (Refereed)
    Abstract [en]

    Background: The incidence trends of biliary tract cancer need to be established. This study investigated the incidence and mortality of biliary tract cancer in Sweden in 1970-2010. Methods: Sex-specific biliary tract cancer incidence and mortality rates were evaluated using data from the Swedish Cancer Register, Patient Register and Causes of Death Register. Case registration was separate for each register. Gallbladder cancer and cancers of the extra-hepatic bile ducts were analyzed separately. Standardized incidence rates were calculated and joinpoint regression was used to calculate annual percent changes (APC) with 95% Confidence Intervals (CIs). Results: The incidence of non-gallbladder extra-hepatic cancers assessed from the Cancer Register decreased in men and women from the mid 1980's (APC: -4.0, 95% CI -5.3 - -2.7 and APC -6.3, 95% CI -7.7 - -4.8, respectively), whereas the mortality of non-gallbladder extra-hepatic cancers rather increased until 1990 (APC: 2.1, 95% CI 1.4-2.8 and APC 2.7, 95% CI 1.3-4.1, in men and women respectively). Notably, the mortality rate was greater than the incidence rate as assessed from the Cancer Register from the early 1990's and onwards. The incidence of non-gallbladder extra-hepatic cancers derived from the Patient Register also increased over time. Gallbladder cancer incidence and mortality rates generally decreased. However, incidence rates assessed from the Patient Register decreased to a lesser extent. Conclusions: The incidence of gallbladder cancer seems to have decreased over the past decades in Sweden. The incidence trends for extra-hepatic tumors other than gallbladder cancer may however be obscured by under-reporting.

  • 188.
    Kilander, Carl
    et al.
    Karolinska Inst, Dept Mol Med & Surg, Norra Stn Gatan 67,2 Tr, S-17176 Stockholm, Sweden..
    Mattsson, Fredrik
    Karolinska Inst, Dept Mol Med & Surg, Norra Stn Gatan 67,2 Tr, S-17176 Stockholm, Sweden..
    Lu, Yunxia
    Karolinska Inst, Dept Mol Med & Surg, Norra Stn Gatan 67,2 Tr, S-17176 Stockholm, Sweden..
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17176 Stockholm, Sweden..
    Lagergren, Jesper
    Karolinska Inst, Dept Mol Med & Surg, Norra Stn Gatan 67,2 Tr, S-17176 Stockholm, Sweden.;Kings Coll London, Div Canc Studies, London WC2R 2LS, England..
    Sadr-Azodi, Omid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Inst Environm Med, Epidemiol Unit, S-17176 Stockholm, Sweden.;Eskilstuna Cty Hosp, Dept Surg, Eskilstuna, Sweden..
    Exogenous estrogen and the risk of biliary tract cancer: a population-based study in a cohort of Swedish men treated for prostate cancer2016In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 55, no 7, p. 846-850Article in journal (Refereed)
    Abstract [en]

    Background: To assess the role of exogenous estrogen in the etiology of biliary tract cancer, a nationwide population-based cohort study in Sweden was performed. Methods: The study included all men in Sweden with prostate cancer diagnosed in 1961-2008. Due to treatment standards, patients diagnosed in 1961-1980 were considered more exposed to estrogen, while those diagnosed in 1981-2008 were regarded less exposed. Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated to estimate the risk of biliary tract cancer in cohort members compared to the corresponding Swedish male population. Results: After 849 307 person-years of follow-up in 203 131 prostate cancer patients, there were 41 incident gallbladder cancers and 36 cancers of the extra-hepatic bile ducts. In overall, there were no apparent differences in the risk of gallbladder cancer or bile duct cancer between patients diagnosed in 1961-1980 and patients diagnosed in 1981-2008. However, in patients diagnosed in 1961-1980, there was a statistically non-significant increased risk of gallbladder cancer (SIR 1.34; 95% CI 0.71-2.29) and extra-hepatic bile duct cancer (SIR 1.20; 95% CI 0.55-2.28)>5 years of follow-up after the prostate cancer diagnosis. No such association was found for patients diagnosed in 1981-2008. Sensitivity analyses excluding prostate cancer patients exposed to potential confounding factors did not change the SIRs. Conclusions: Long exposure to high doses of exogenous estrogen might increase the risk of biliary tract cancer. However, any potential excess risk of bile duct cancer resulted by prolonged exposure to high doses of exogenous estrogen seems to be small.

  • 189.
    Kim, Haesook T.
    et al.
    Dana Farber Canc Inst, Dept Data Sci, 450 Brookline Ave, Boston, MA 02115 USA;Harvard Sch Publ Hlth, Boston, MA USA.
    Ahn, Kwang Woo
    Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.
    Hu, Zhen-Huan
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.
    Davids, Matthew S.
    Dana Farber Canc Inst, Dept Med Oncol, Div Hematol Malignancies, Boston, MA 02115 USA.
    Volpe, Virginia O.
    Univ Connecticut, Hlth Ctr, Div Oncol, Neag Canc Ctr,Dept Internal Med, Farmington, CT USA.
    Antin, Joseph H.
    Dana Farber Canc Inst, Dept Med Oncol, Div Hematol Malignancies, Boston, MA 02115 USA.
    Sorror, Mohamed L.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA;Univ Washington, Sch Med, Dept Med, Div Med Oncol, Seattle, WA 98195 USA.
    Shadman, Mazyar
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA;Univ Washington, Sch Med, Dept Med, Div Med Oncol, Seattle, WA 98195 USA.
    Press, Oliver
    Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA.
    Pidala, Joseph
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Hogan, William
    Mayo Clin, Dept Hematol, Rochester, MN USA;Mayo Clin, Transplant Ctr, Rochester, MN USA.
    Negrin, Robert
    Stanford Hlth Care, Stanford, CA USA.
    Devine, Steven
    CIBMTR, Natl Marrow Donor Program Match, Minneapolis, MN USA.
    Uberti, Joseph
    Karmanos Canc Inst, Detroit, MI USA.
    Agura, Edward
    Baylor Univ, Med Ctr, Dallas, TX USA.
    Nash, Richard
    Colorado Blood Inst, Denver, CO USA.
    Mehta, Jayesh
    Northwestern Med, Chicago, IL USA.
    McGuirk, Joseph
    Univ Kansas, Westood, KS USA.
    Forman, Stephen
    City Hope Med Ctr, Duarte, CA USA.
    Langston, Amelia
    Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA 30322 USA.
    Giralt, Sergio A.
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplantat Serv, 1275 York Ave, New York, NY 10021 USA.
    Perales, Miguel-Angel
    Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplantat Serv, 1275 York Ave, New York, NY 10021 USA.
    Battiwalla, Minoo
    Sarah Cannon BMT Program, Hematol Branch, Nashville, TN USA.
    Hale, Gregory A.
    Johns Hopkins All Childrens Hosp, Dept Hematol Oncol, St Petersburg, FL USA.
    Gale, Robert Peter
    Imperial Coll London, Dept Med, Div Expt Med, Hematol Res Ctr, London, England.
    Marks, David I.
    Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England.
    Hamadani, Mehdi
    Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.
    Ganguly, Sid
    Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA.
    Bacher, Ulrike
    Bern Univ Hosp, Inselspital, Dept Hematol, Bern, Switzerland;Univ Canc Ctr Hamburg, Interdisciplinary Clin Stem Cell Transplantat, Hamburg, Germany.
    Lazarus, Hillard
    Case Western Reserve Univ, Univ Hosp Cleveland, Med Ctr, Seidman Canc Ctr, Cleveland, OH 44106 USA.
    Reshef, Ran
    Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, New York, NY USA;Columbia Univ, Med Ctr, Columbia Ctr Translat Immunol, New York, NY USA.
    Hildebrandt, Gerhard C.
    Univ Kentucky, Markey Canc Ctr, Lexington, KY USA.
    Inamoto, Yoshihiro
    Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan.
    Cahn, Jean-Yves
    CHU Grenoble Alpes, Dept Hematol, Grenoble, France.
    Solh, Melhem
    Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA.
    Kharfan-Dabaja, Mohamed A.
    Mayo Clin, Blood & Marrow Transplantat Program, Div Hematol Oncol, Jacksonville, FL USA.
    Ghosh, Nilanjan
    Carolinas Healthcare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA.
    Saad, Ayman
    Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35294 USA.
    Aljurf, Mahmoud
    King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia.
    Schouten, Harry C.
    Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands.
    Hill, Brian T.
    Cleveland Clin, Taussig Canc Inst, Dept Hematol & Med Oncol, Cleveland, OH 44106 USA.
    Pawarode, Attaphol
    Univ Michigan, Dept Internal Med, Blood & Marrow Transplantat Program, Div Hematol Oncol,Med Sch, Ann Arbor, MI 48109 USA.
    Kindwall-Keller, Tamila
    Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA.
    Saba, Nakhle
    Tulane Univ, Med Ctr, New Orleans, LA USA.
    Copelan, Edward A.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA.
    Nathan, Sunita
    Rush Univ, Med Ctr, Chicago, IL 60612 USA.
    Beitinjaneh, Amer
    Univ Miami, Miami, FL USA.
    Savani, Bipin N.
    Vanderbilt Univ, Med Ctr, Dept Med, Div Hematol Oncol, Nashville, TN USA.
    Cerny, Jan
    UMASS, Mem Med Ctr, Worcester, MA USA.
    Grunwald, Michael R.
    Levine Canc Inst, Stem Cell Transplant Program, Carolinas Med Ctr, Blumenthal Canc Ctr, Charlotte, NC USA.
    Yared, Jean
    Univ Maryland, Dept Med, Blood & MarrowTransplantat Program, Greenebaum Canc Ctr,Div Hematol Oncol, Baltimore, MD 21201 USA.
    Wirk, Baldeep M.
    Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA.
    Nishihori, Taiga
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA.
    Chhabra, Saurabh
    Med Coll Wisconsin, Milwaukee, WI 53226 USA.
    Olsson, Richard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden.
    Bashey, Asad
    Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA.
    Gergis, Usama
    New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematolg Malignancies & Bone Marrow Transplant, New York, NY USA.
    Popat, Uday
    Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA.
    Sobecks, Ronald
    Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA.
    Alyea, Edwin
    Dana Farber Canc Inst, Dept Med Oncol, Div Hematol Malignancies, Boston, MA 02115 USA.
    Saber, Wael
    Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA.
    Brown, Jennifer R.
    Dana Farber Canc Inst, Dept Med Oncol, Div Hematol Malignancies, Boston, MA 02115 USA.
    Prognostic Score and Cytogenetic Risk Classification for Chronic Lymphocytic Leukemia Patients: Center for International Blood and Marrow Transplant Research Report2019In: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 25, no 16, p. 5143-5155Article in journal (Refereed)
    Abstract [en]

    Purpose: To develop a prognostic model and cytogenetic risk classification for previously treated patients with chronic lymphocytic leukemia (CLL) undergoing reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT).

    Experimental Design: We performed a retrospective analysis of outcomes of 606 patients with CLL who underwent RIC allogeneic HCT between 2008 and 2014 reported to the Center for International Blood and Marrow Transplant Research.

    Results: On the basis of multivariable models, disease status, comorbidity index, lymphocyte count, and white blood cell count at HCT were selected for the development of prognostic model. Using the prognostic score, we stratified patients into low-, intermediate-, high-, and very-high-risk [4-year progression-free survival (PFS) 58%, 42%, 33%, and 25%, respectively, P < 0.0001; 4-year overall survival (OS) 70%, 57%, 54%, and 38%, respectively, P < 0.0001]. We also evaluated karyotypic abnormalities together with del(17p) and found that del(17p) or >= 5 abnormalities showed inferior PFS. Using a multivariable model, we classified cytogenetic risk into low, intermediate, and high (P < 0.0001). When the prognostic score and cytogenetic risk were combined, patients with low prognostic score and low cytogenetic risk had prolonged PFS (61% at 4 years) and OS (75% at 4 years).

    Conclusions: In this large cohort of patients with previously treated CLL who underwent RIC HCT, we developed a robust prognostic scoring system of HCT outcomes and a novel cytogenetic-based risk stratification system. These prognostic models can be used for counseling patients, comparing data across studies, and providing a benchmark for future interventions. For future study, we will further validate these models for patients receiving targeted therapies prior to HCT.

  • 190.
    Kitutu, Freddy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Martensson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Wamani, Henry
    Makerere University School of Public Health.
    Ekholm Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kalyango, Joan
    Makerere University College of Health Sciences, Department of Pharmacy.
    Perceived quality of paediatric fever care from private drug shops and care-seeking choice in South Western Uganda: data from household surveys.In: Article in journal (Refereed)
    Abstract [en]

    Background

    Child mortality is influenced by interventions beyond the health sector such as adequate access to education, quality water and sanitation, transport and general socio-economic wellbeing. Child mortality due to febrile illnesses remains unevenly distributed within countries. The role of context and variables that act at a higher level such as a geographical location has been largely under-examined. Factors that act at group level are commonly described in literature as neighbourhood factors. The aim of the study was to investigate whether contextual differences in choice of childhood fever care-seeking in South Western Uganda remain after relevant individual and household characteristics have been taken into account, for three outcome variables, namely, choice of care-seeking in private versus government health facilities, choice of care-seeking in private health facilities versus community level and perceived quality of childhood fever care at drug shops, among households in Mbarara and Bushenyi districts.

    Methods

    Two household surveys were conducted at different time periods in Bushenyi and Mbarara districts. The first survey of 2261 households was conducted from July to October 2013 before implementation of an adapted integrated Community Case Management (iCCM) intervention for paediatric febrile illness in drug shops in Mbarara district. The second survey of 3073 households was done from April to May 2015 after the intervention. These data were analysed for effect of contextual factors, the iCCM intervention and other predictors on choice of care-seeking and perceived quality of care among the households in Mbarara and Bushenyi.

     

    Results:

    In the pre-intervention survey , more households in both Mbarara and Bushenyi reported time required to travel to either a private clinic (31%) or drug shop (43%) of 15 minutes or less as compared to a government health facility (12%). The crude second level (neighbourhood) variance of the odds ratio for care-seeking in private versus government health facility was 0.446 (SE, 0.089). The intra-neighbourhood correlation and median odds ratio were 11.9% and 1.89, respectively, for the crude model. After adjusting for covariates that were kept in the prediction model, the estimates of neighbourhood variance, intra-neighbourhood correlation and mean odds ratio decreased to 0.241 (0.069), 6.8% and 1.6, respectively.

     

    Conclusion:         

    In addition to individual factors, contextual characteristics of the neighbourhoods predict the choice of care-seeking from private versus government health facilities, private health facilities versus in the community and perceived quality of pediatric fever care at drug shops.

  • 191. Klompstra, Leonie
    et al.
    Johansson Östbring, Malin
    Jaarsma, Tiny
    Ågren, Susanna
    Fridlund, Bengt
    Hjelm, Carina
    Hjelmfors, Lisa
    Ingadottir, Brynja
    Liljeroos, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lundgren, Johan
    Mårtensson, Jan
    Mourad, Ghassan
    Thylen, Ingela
    Walfridsson, Ulla
    Strömberg, Anna
    The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.2019In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 37, no 10, p. 493-497Article in journal (Refereed)
  • 192.
    Klyuchnikov, Evgeny
    et al.
    Univ Canc Ctr Hamburg, Dept Stem Cell Transplantat, Hamburg, Germany..
    Bacher, Ulrike
    Univ Gottingen, Dept Hematol & Internal Oncol, D-37073 Gottingen, Germany..
    Kroeger, Nicolaus M.
    Univ Canc Ctr Hamburg, Dept Stem Cell Transplantat, Hamburg, Germany..
    Hari, Parameswaran N.
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Ahn, Kwang Woo
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA..
    Carreras, Jeanette
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Bachanova, Veronika
    Univ Minnesota, Med Ctr, Bone & Marrow Transplant Program, Minneapolis, MN 55455 USA..
    Bashey, Asad
    Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA..
    Cohen, Jonathon B.
    Emory Univ, Sch Med, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA USA..
    D'Souza, Anita
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Freytes, Cesar O.
    South Texas Vet Hlth Care Syst, San Antonio, TX USA.;Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA.;Univ London Imperial Coll Sci Technol & Med, Dept Med, Div Expt Med, Hematol Res Ctr, London, England..
    Gale, Robert Peter
    Ganguly, Siddhartha
    Univ Kansas, Med Ctr, Blood & Marrow Transplantat, Div Hematol & Oncol, Kansas City, KS 66103 USA..
    Hertzberg, Mark S.
    Prince Wales Hosp, Dept Haematol, Randwick, NSW 2031, Australia..
    Holmberg, Leona A.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Kharfan-Dabaja, Mohamed A.
    H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA..
    Klein, Andreas
    Tufts Med Ctr, Div Hematol Oncol, Dept Med, Boston, MA USA..
    Ku, Grace H.
    Univ Calif San Diego, Dept Med, Div Blood & Marrow Transplantat, San Diego, CA 92103 USA..
    Laport, Ginna G.
    Stanford Hosp & Clin, Div Bone Marrow Transplantat, Stanford, CA USA..
    Lazarus, Hillard M.
    Univ Hosp Case Med Ctr, Seidman Canc Ctr, Cleveland, OH USA..
    Miller, Alan M.
    Baylor Univ, Med Ctr, Dept Oncol, Dallas, TX USA..
    Mussetti, Alberto
    Fdn IRCCS Ist Nazl Tumori, SC Ematol & Trapianto Midollo Osseo, Milan, Italy.;Univ Milan, Milan, Italy..
    Olsson, Richard F.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden..
    Slavin, Shimon
    Int Ctr Cell Therapy & Canc Immunotherapy, Tel Aviv, Israel..
    Usmani, Saad Z.
    Carolinas HealthCare Syst, Levine Canc Inst, Dept Hematol, Med Oncol, Charlotte, NC USA..
    Vij, Ravi
    Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA..
    Wood, William A.
    Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA..
    Maloney, David G.
    Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA..
    Sureda, Anna M.
    Hosp Duran & Reynals, Inst Catala Oncol, Serv Hematol, Barcelona, Spain.;European Grp Blood & Marrow Transplantat, Milan, Italy..
    Smith, Sonali M.
    Univ Chicago, Sect Hematol Oncol, Chicago, IL 60637 USA..
    Hamadani, Mehdi
    Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA.;Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA..
    Reduced-Intensity Allografting as First Transplantation Approach in Relapsed/Refractory Grades One and Two Follicular Lymphoma Provides Improved Outcomes in Long-Term Survivors2015In: Biology of blood and marrow transplantation, ISSN 1083-8791, E-ISSN 1523-6536, Vol. 21, no 12, p. 2091-2099Article in journal (Refereed)
    Abstract [en]

    This study was conducted to compare long-term outcomes in patients with refractory/relapsed grades 1 and 2 follicular lymphoma (FL) after allogeneic (allo) versus autologous (auto) hematopoietic cell transplantation (HCT) in the rituximab era. Adult patients with relapsed/refractory grades 1 and 2 FL undergoing first reduced-intensity allo-HCT or first autograft during 2000 to 2012 were evaluated. A total of 518 rituximab-treated patients were included. Allo-HCT patients were younger and more heavily pretreated, and more patients had advanced stage and chemoresistant disease. The 5-year adjusted probabilities, comparing auto-HCT versus allo-HCT groups for nonrelapse mortality (NRM) were 5% versus 26% (P <.0001); relapse/progression: 54% versus 20% (P <.0001); progression-free survival (PFS): 41% versus 58% (P <.001), and overall survival (OS): 74% versus 66% (P =.05). Auto-HCT was associated with a higher risk of relapse/progression beyond 5 months after HCT (relative risk [RR], 4.4; P <.0001) and worse PFS (RR, 2.9; P <.0001) beyond 11 months after HCT. In the first 24 months after HO', auto-HCT was associated with improved OS (RR,.41; P <.0001), but beyond 24 months, it was associated with inferior OS (RR, 2.2; P =.006). A landmark analysis of patients alive and progression-free at 2 years after HO' confirmed these observations, showing no difference in further NRM between both groups, but there was significantly higher risk of relapse/progression (RR, 7.3; P <.0001) and inferior PFS (RR, 3.2; P <.0001) and OS (RR, 2.1; P =.04) after auto-HCT. The 10-year cumulative incidences of second hematological malignancies after allo-HCT and auto-HCT were 0% and 7%, respectively. Auto-HCT and reduced-intensity conditioned allo-HCT as first transplantation approach can provide durable disease control in grades 1 and 2 FL patients. Continued disease relapse risk after auto-HCT translates into improved PFS and OS after allo-HCT in long-term survivors.

  • 193.
    Koch, M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Malmo Univ, Fac Odontol, Dept Endodont, Malmo, Sweden.
    Englander, M
    Malmo Univ, Fac Hlth & Soc, Dept Social Work, Malmo, Sweden.
    Tegelberg, Å
    Malmo Univ, Fac Odontol, Dept Orofacial Pain & Jaw Funct, Malmo, Sweden.
    Wolf, E
    Malmo Univ, Fac Odontol, Dept Endodont, Malmo, Sweden.
    Successful clinical and organisational change in endodontic practice: a qualitative study2014In: European journal of dental education, ISSN 1396-5883, E-ISSN 1600-0579, Vol. 18, no 3, p. 121-127Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explicate and describe the qualitative meaning of successful clinical and organizational change in endodontic practice, following a comprehensive implementation program, including the integration of the nickel-titanium-rotary-technique. After an educational intervention in the Public Dental Service in a Swedish county, thematic in-depth interviews were conducted, with special reference to the participants' experience of the successful change. Interviews with four participants, were purposively selected on the basis of occupation (dentist, dental assistant, receptionist, clinical manager), for a phenomenological human scientific analysis. Four constituents were identified as necessary for the invariant, general structure of the phenomenon: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator. The perceived requirements for achieving successful clinical and organizational change in endodontic practice were clinical relevance, an atmosphere which facilitated discussion and allowance for individual learning patterns. The qualities required in the educator were acknowledged competence with respect to scientific knowledge and clinical expertise, as well as familiarity with conditions at the dental clinics. The results indicate a complex interelationship among various aspects of the successful change process.

  • 194.
    Koch, M
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wolf, E
    Tegelberg, A
    Petersson, K
    Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice2015In: International Endodontic Journal, ISSN 0143-2885, E-ISSN 1365-2591, Vol. 48, no 7, p. 680-689Article in journal (Refereed)
    Abstract [en]

    AIM: To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR).

    METHODOLOGY: A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fisher's exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression.

    RESULTS: Follow-up data were available for 229 (55%) of teeth treated pre- and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both pre- and post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up.

    CONCLUSIONS: Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.

  • 195. Kofoed, Poul-Erik
    et al.
    Ursing, Johan
    Rodrigues, Amabelia
    Rombo, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Paracetamol versus placebo in treatment of non-severe malaria in children in Guinea-Bissau: a randomized controlled trial2011In: Malaria Journal, ISSN 1475-2875, E-ISSN 1475-2875, Vol. 10, p. 148-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The current guidelines for treatment of malaria include paracetamol to children with fever. No convincing evidence for the beneficial effects of this practice exists. Studies show that time to parasite clearance is significantly longer in children treated with paracetamol, which questions the policy. Whether this is of clinical importance has not been investigated.

    METHODS:

    Children with Plasmodium falciparum monoinfection and ≥20 parasites per 200 leucocytes at the Bandim Health Centre, Guinea-Bissau were randomized to receive paracetamol or placebo together with chloroquine for three days in a double blind randomized study. Temperature and symptoms were recorded twice daily during treatment and on day 3. The participants were interviewed and a malaria film taken once weekly until day 35. The data is in the form of grouped failure-times, the outcome of interest being time until parasitaemia during follow-up. Mantel-Haenszel weighted odds ratios are given. Other differences between and within the two groups have been tested using the Chi-square test and Mann-Whitney U test.

    RESULTS:

    In the evening of the day of inclusion, the temperature was slightly, but statistically insignificant, higher in the placebo group and significantly more children complained of headache. At no other time was a significant difference in temperature or symptoms detected. However, 6 children from the placebo-group as compared to two children from the paracetamol-group were admitted to hospital with high fever and convulsions by day 3. No differences in the cumulative percentages of children with adequate clinical and parasitological response were found in the intention-to-treat analysis or in the per-protocol analysis.

    CONCLUSION:

    Fewer children had early treatment failure and the mean temperature was slightly lower in the afternoon on day 0 in the paracetamol group. However, the cumulative adequate clinical and parasitological cure rates were not significantly different during the period of study. It is doubtful whether adding paracetamol to the treatment of uncomplicated malaria in children is beneficial.

    TRIAL REGISTRATION:

    NCT00137566

  • 196. Kumagai, K.
    et al.
    Rouvelas, I.
    Tsai, J. A.
    Mariosa, D.
    Lind, Pehr A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Lindblad, M.
    Ye, W.
    Lundell, L.
    Schuhmacher, C.
    Mauer, M.
    Burmeister, B. H.
    Thomas, J. M.
    Stahl, M.
    Nilsson, M.
    Survival benefit and additional value of preoperative chemoradiotherapy in resectable gastric and gastro-oesophageal junction cancer: A direct and adjusted indirect comparison meta-analysis2015In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 41, no 3, p. 282-294Article, review/survey (Refereed)
    Abstract [en]

    Several phase I/II studies of chemoradiotherapy for gastric cancer have reported promising results, but the significance of preoperative radiotherapy in addition to chemotherapy has not been proven. In this study, a systematic literature search was performed to capture survival and postoperative morbidity and mortality data in randomised clinical studies comparing preoperative (chemo)radiotherapy or chemotherapy versus surgery alone, or preoperative chemoradiotherapy versus chemotherapy for gastric and/or gastro-oesophageal junction (GOJ) cancer. Hazard ratios (HRs) for overall mortality were extracted from the original studies, individual patient data provided from the principal investigators of eligible studies or the earlier published meta-analysis. The incidences of postoperative morbidities and mortalities were also analysed. In total 18 studies were eligible and data were available from 14 of these. The meta-analysis on overall survival yielded HRs of 0.75 (95% CI 0.65-0.86, P < 0.001) for preoperative (chemo)radiotherapy and 0.83 (95% CI 0.67-1.01, P = 0.065) for preoperative chemotherapy when compared to surgery alone. Direct comparison between preoperative chemoradiotherapy and chemotherapy resulted in an HR of 0.71 (95% CI 0.45-1.12, P = 0.146). Combination of direct and adjusted indirect comparisons yielded an HR of 0.86 (95% CI 0.69-1.07, P = 0.171). No statistically significant differences were seen in the risk for postoperative morbidity or mortality between preoperative treatments and surgery alone, or preoperative (chemo)radiotherapy and chemotherapy. Preoperative (chemo)radiotherapy for gastric and GOJ cancer showed significant survival benefit over surgery alone. In comparisons between preoperative chemotherapy and (chemo)radiotherapy, there is a trend towards improved survival when adding radiotherapy, without increased postoperative morbidity or mortality.

  • 197.
    Kvist, Therese
    et al.
    Karolinska Institutet, Huddinge, Sweden.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Dahllöf, Göran
    Karolinska Institutet, Huddinge, Sweden.
    Oral health in children investigated by Social services on suspicion of child abuse and neglect2018In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 76, p. 515-523, article id S0145-2134(17)30443-XArticle in journal (Refereed)
    Abstract [en]

    Child abuse and neglect (CAN) are likely to have negative consequences on health; however, for oral health, studies on associated outcomes are sparse. The purpose of this study was to assess oral health and oral health behaviors in relation to suspected CAN among children being investigated by the Swedish Social Services. The material comprised data from the Social Services and dental records; the sample, 86 children and 172 matched controls. The children in the study group had a higher prevalence of dental caries than the control group; in addition, levels of non-attendance and dental avoidance were high, as was parental failure to promote good oral health. We found four factors that, taken together, indicated a high probability of being investigated because of suspected CAN: prevalence of dental caries in primary teeth, fillings in permanent teeth, dental health service avoidance, and referral to specialist pediatric dentistry clinics. If all four factors were present, the cumulative probability of being investigated was 0.918. In conclusion, there is a high prevalence of dental caries, irregular attendance, and a need for referral a pediatric dental clinic among Swedish children under investigation due to suspected CAN. Social context is an important factor in assessing the risk of developing dental caries, the inclination to follow treatment plans, and the prerequisites for cooperation during treatment. Routinely requesting dental records during an investigation would provide important information for social workers on parental skills and abilities to fulfill the basic needs of children.

  • 198. Kvist, Therese
    et al.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sahlqvist, Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Flodmark, Olof
    Dahllöf, Göran
    Association between adolescents' self-perceived oral health and self-reported experiences of abuse2013In: European Journal of Oral Sciences, ISSN 0909-8836, E-ISSN 1600-0722, Vol. 121, no 6, p. 594-599Article in journal (Refereed)
    Abstract [en]

    This study investigated the association between self-perceived oral health and self-reported exposure to different types of child abuse. It was hypothesized that self-perceived oral health is compromised in exposed adolescents. All Grade-9 compulsory school and second-year high-school pupils in Södermanland County, Sweden (n = 7,262) were invited to take part in a population-based survey; 5,940 adolescents responded. Survey items on health and social wellbeing included self-perceived oral health and exposure to abuse. The results showed that poor self-perceived oral health was associated with self-reported experience of physical abuse, intimate partner violence, forced sex, and bullying (adjusted OR = 2.3-14.7). The likelihood of reporting poor oral health increased from an adjusted OR of 2.1 for a single incident of abuse to an adjusted OR of 23.3 for multiple abuses. In conclusion, poor self-perceived oral health and previous exposure to child physical abuse, intimate partner violence, bullying, and forced sex is associated. It is important that dental professionals recognize adolescents with poor subjective oral health and take into consideration child abuse as a possible cause in order to prevent these adolescents from further victimization. These results further strengthen that dental professionals are an important resource in child protection.

  • 199. Kvist, Therese
    et al.
    Cocozza, Madeleine
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Dahllöf, Göran
    Child maltreatment - prevalence and characteristics of mandatory reports from dental professionals to the social services2017In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 27, no 1, p. 3-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dental professionals are required to report suspicions of child maltreatment to the social services. As yet, no studies assess the prevalence of these mandated reports from dental care services or their content.

    AIM: This study investigates the prevalence and characteristics of mandated reports from dental professionals to the social services. Furthermore, it analyses associations between dental professionals reporting suspicions of maltreatment with such reports from other sources.

    DESIGN: The study collected dental mandatory reports from within one municipality of Sweden during 2008-2014. The material consisted of a total of 147 reports by dental professionals regarding 111 children.

    RESULTS: The total prevalence of reports from dental care services to the social services was 1.5 per 1000 children with a significant increase between 2008 and 2011 (P < 0.001). The primary cause for a report concerned parental deficiencies in care (n = 93) and secondly, a concern for dental neglect (n = 52) (P < 0.001). Among all reports, 86% involved children with prior contacts with the social services.

    CONCLUSION: Reports to the social services from dental care services on suspicions of child maltreatment concern parental deficiencies (failure to attend appointments) and neglect (dental neglect). Mandated reports from dental care services often co-occur with other mandated reports.

  • 200. Kårefjärd, Ann
    et al.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Effects of dog-assisted intervention on quality of life in nursing home residents with dementia2019In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 26, no 6, p. 433-440Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

    AIM: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

    MATERIALS AND METHODS: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

    RESULTS: The participants' total scores improved significantly between baseline and post-test 1 (p = < 0.001) and worsened significantly at post-test 2 (p = 0.025). The largest effect size was found for the item 'Verbalization suggests discomfort' (p = 0.001).

    CONCLUSION: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

    SIGNIFICANCE: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.

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