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  • 1.
    Andersson, Gunnel
    Örebro University, School of Health and Medical Sciences.
    Urinary incontinence: prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews.

    Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI.

    Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems.

    In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.

    List of papers
    1. Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    Open this publication in new window or tab >>Urinary incontinence prevalence, impact on daily living and desire for treatmentt: a population-based study
    2004 (English)In: Scandinavian journal of urology and nephrology, ISSN 0036-5599, Vol. 38, no 2, p. 125-130Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:

    To investigate the prevalence of urinary incontinence in a representative population in Sweden, and to assess to what extent the condition affects daily life and to what degree those afflicted desire treatment.

    MATERIAL AND METHODS:

    In a population-based study, a postal questionnaire comprising 12 questions on urinary incontinence was sent to a representative sample of 15 360 randomly selected residents (aged 18-79 years) of Orebro County, Sweden. This was a supplement to a comprehensive survey of public health and general living conditions.

    RESULTS:

    The response rate was 64.5%. The prevalence of urinary incontinence was 19% when defined as "any leakage" and 7% when defined as "at least once a week". Women were more afflicted than men, and the proportion of people with urinary incontinence increased markedly with increasing age. Most considered their problems to be minor, having little impact on daily life, which was reflected by the fact that only 18% of those with urinary incontinence desired treatment. About 17% of those with urinary incontinence reported severe problems that interfered with daily life. Of respondents with severe problems, 42% did not want treatment.

    CONCLUSION:

    According to this population-based study, urinary incontinence is not a major problem for most people in the community. Although a considerable proportion of the population report urinary incontinence, the majority experience minor problems and only 18% desire treatment. For a limited group of people, urinary incontinence is a severe problem. It is important that healthcare resources are optimized to identify and meet the needs of those who are most afflicted.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2004
    Keywords
    impact on daily life, population‐based study, prevalence, urinary incontinence Read More: http://informahealthcare.com/doi/abs/10.1080/00365590310022608
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3043 (URN)10.1080/00365590310022608 (DOI)000221058000005 ()15204395 (PubMedID)2-s2.0-1942422250 (Scopus ID)
    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2018-11-16Bibliographically approved
    2. Urinary incontinence - why refraining from treatment?: a population based study
    Open this publication in new window or tab >>Urinary incontinence - why refraining from treatment?: a population based study
    Show others...
    2005 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 39, no 4, p. 301-307Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To investigate why persons with urinary incontinence (UI) refrain from seeking care and treatment.

    MATERIAL AND METHODS: A population-based study was undertaken in which a public health survey and a specific UI questionnaire were sent to 15 360 randomly selected residents (age 18-79 years) of Orebro County, Sweden. For all persons reporting UI, the expressed wish for treatment or no treatment was analyzed in relation to relevant variables from both inquiry forms using binary logistic regression analysis.

    RESULTS: The response rate was 64.5%. UI was reported by 2194 persons, 1724 of whom comprised the study population. A statistically significant association was found between the degree of UI and a desire for treatment. Persons who did not experience daily leakage and those who did not perceive the leakage as troublesome or having an affect on their daily life mostly stated that they did not desire treatment. Socioeconomic or other health-related factors were not associated with desiring or not desiring treatment for UI.

    CONCLUSIONS: Our results show that it is the perceived severity of UI that determines whether afflicted persons desire treatment or not. Other factors, relating to seeking healthcare in general, were not found to be of importance. Interventions to identify those in need of treatment for UI should primarily be directed towards those with severe symptoms.

    Place, publisher, year, edition, pages
    London: Taylor & Francis, 2005
    Keywords
    : Healthcare-seeking behavior, population-based study, urinary incontinence
    National Category
    Medical and Health Sciences Urology and Nephrology Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-4540 (URN)10.1080/00365590510031129 (DOI)000231453100007 ()16118105 (PubMedID)2-s2.0-27144476977 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Available from: 2008-04-14 Created: 2008-04-14 Last updated: 2017-12-14Bibliographically approved
    3. Accepting and adjusting: Older women's experiences of living with urinary incontinence
    Open this publication in new window or tab >>Accepting and adjusting: Older women's experiences of living with urinary incontinence
    2008 (English)In: Urologic Nursing, ISSN 1053-816X, Vol. 28, no 2, p. 115-121Article in journal (Refereed) Published
    Abstract [en]

    In-depth interviews were performed with 11 Swedish women who contacted a district nurse to obtain sanitary protection. Three key constituents (themes) emerged: "learning to live with it despite difficulties," "other illnesses are more important," and "reluctance to seek care." The essence of the phenomenon of living with urinary incontinence (Ul) was expressed as "a situation to accept and adjust to."

    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3045 (URN)- ()18488587 (PubMedID)2-s2.0-45849087670 (Scopus ID)
    Note

    Part of thesis: http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-2713

    Funding agency:Orebro CountyCouncil's Research Fund

    Available from: 2009-01-12 Created: 2009-01-12 Last updated: 2019-05-22Bibliographically approved
    4. Perceptions of urinary incontinence among syrian Christian women living in Sweden
    Open this publication in new window or tab >>Perceptions of urinary incontinence among syrian Christian women living in Sweden
    2009 (English)In: Journal of Transcultural Nursing, ISSN 1043-6596, E-ISSN 1552-7832, Vol. 20, no 3, p. 296-303Article in journal (Refereed) Published
    Abstract [en]

    The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. DESIGN: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. FINDINGS: Three categories emerged, "Thoughts on UI," "Managing UI," and "Communication With the Health Care System." Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. DISCUSSION: and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.

    Keywords
    urinary incontinence, ethnic group, interpreter, focus group discussion, psychosocial factors
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-7355 (URN)10.1177/1043659609334850 (DOI)000267504000005 ()19372538 (PubMedID)2-s2.0-67650503250 (Scopus ID)
    Available from: 2009-06-22 Created: 2009-06-22 Last updated: 2017-10-18Bibliographically approved
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  • 2.
    Anderzén-Carlsson, Agneta
    Örebro University, Department of Clinical Medicine.
    Children with cancer: focusing on their fear and on how their fear is handled2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Various fears in children with cancer have previously been identified as a result of studying e.g. symptom experiences, distress and uncertainty within this population. Studies of the meaning the children give to their fear, as well as the handling of their fear seem to be sparse, however. Also, fear has not been an exclusive focus in previous studies. Professionals in clinical practice have pointed to the need for such research, which has prompted the present research work. The overall aim of this thesis was therefore twofold; firstly, the aim was to elucidate fear in children and adolescents with cancer in order to gain an understanding from the perspective of adolescents and parents. Secondly, it was to elucidate parents’ and professionals’ handling of the fear. This in order to gain a deeper understanding of what performances and manners the children and adolescents can face when being fearful. A qualitative descriptive design was adopted in the five included studies. The methods used in the data analysis were phenomenological hermeneutical method (studies I–III) and qualitative content analysis (studies IV–V).

    In study I six adolescent girls, aged 14–16 years, with experiences of various cancer diagnoses, but now declared fit, were interviewed. The results reveal that they experience their fear as embodied, which in the comprehensive understanding of the results was interpreted as a threat to their personal self, their whole existence. Their fear was seen as a holistic intertwined experience, including fear related to the physical body and to the social self. Also, existential fear was described. Their described experience was interpreted as suffering.

    Studies II and III share the same data. Fifteen parents of children at various ages with various cancer diagnoses were interviewed in focus groups about their experience of their child’s fear. In study II the result reveals how the parents experienced and understood their child’s fear. The fear was described as a multidimensional phenomenon, which was not always easy to identify. It was contrasted to feelings of unease and to absence of fear. In the comprehensive understanding the fear was interpreted as a suffering, as that was regarded to be what was the common meaning in the narratives. The suffering was interpreted as an ethical demand to the parents to take action. In study III the parents described their actions, i.e. they described how they dealt with the fear. Their actions were described as acting in the best interests of the child, which included striving to make the child feel secure and experience wellbeing, up to a certain point. However, after this point the parents used their parental authority to maintain the child’s physical health rather than trying to prevent or relieve the child’s fear. In the comprehensive understanding the parents’ handling of their child’s fear was interpreted as revealing mercy and as being synonymous with meeting the ethical demand put on them.

    In study IV ten experienced nurses and physicians were individually interviewed about how they handled fear in children with cancer. The result reveals that the existential issues were dealt with within the relationship with the child, on a sliding scale between closeness and distance, and that the fear related to medical procedures occurred on a continuum between support and lack of support. The various actions involved, and the manner in which these actions were performed, was described.

    In the observational study (study V) eleven parents and their children as well as eleven health professionals participated. They were observed at children’s routine visits at the outpatient clinic. The aim was to study the interactions related to fear. The result reveals that when children were fearful they expressed this both verbally and non-verbally. The parents’ and professionals’ actions and interactions in these situations were found to be characterized by recognition of the fear or lack of attention to the fear.

    The findings can contribute to a broadened knowledge on fear in children and adolescents with cancer. Awareness and understanding of the meaning adolescents give to their fear, and furthermore, of the parents’ experience and understanding of their child’s fear can provide tools for interacting with these groups. The findings on how fear is dealt with by the ones children have claimed as important sources for support, can give insights into what the child may face when being fearful. These insights can form the basis for individual, as well as collegial, reflections on what is done when children face fear, how fear is handled on an everyday basis and why it is handled in this way. Such reflections could lead to an ethical awareness of handling fear in children with cancer.

    List of papers
    1. Embodied suffering: experiences of fear in adolescent girls with cancer
    Open this publication in new window or tab >>Embodied suffering: experiences of fear in adolescent girls with cancer
    2008 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, no 2, p. 129-143Article in journal (Refereed) Published
    Abstract [en]

    Previously, fear in adolescents with cancer has been sparsely described from an emic perspective. The aim of this study was to illuminate fear in adolescents with personal experience of cancer. The participants were six adolescent girls between the age of 14 and 16 years who were no longer under active treatment for cancer but still went for regular check-ups. Open interviews were conducted. Data were analysed according to the phenomenological hermeneutic method. In the result one main theme was identified: `an embodied fear — a threat to the personal self'. This theme was built up by three separate but intertwined themes: `experiencing fear related to the physical body', `experiencing existential fear' and `experiencing fear related to the social self'. In the comprehensive understanding the fear was interpreted from youth cultural aspects as well as a holistic perspective. The importance of professionals taking the whole person and their situation into account when meeting the fear is underlined.

    Place, publisher, year, edition, pages
    London: Sage, 2008
    National Category
    Medical and Health Sciences Surgery Cancer and Oncology
    Research subject
    Oncology
    Identifiers
    urn:nbn:se:oru:diva-5377 (URN)10.1177/1367493508088550 (DOI)
    Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2017-12-14Bibliographically approved
    2. Children's fear as experienced by the parents of children with cancer
    Open this publication in new window or tab >>Children's fear as experienced by the parents of children with cancer
    2007 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, no 3, p. 233-244Article in journal (Refereed) Published
    Abstract [en]

    It is known that children with cancer experience and express fear, but little is found in the literature about how the parents experience their child's fear. This study aimed to highlight the parents' lived experience and understanding of their child's fear. Focus group interviews with 15 parents were performed. Data were analyzed through a phenomenological hermeneutic method. Fear in children with cancer is described by the parents as a multidimensional phenomenon, which is somehow difficult to identify. It appears in contrast to the absence of fear. The comprehensive understanding of the results reveals that the parents experience their children's fear as both a suffering and an ethical demand for the parents to answer.

    Place, publisher, year, edition, pages
    Amsterdam: Elsevier, 2007
    Keywords
    Cancer, barn, rädsla, upplevelse
    National Category
    Pediatrics Other Social Sciences not elsewhere specified Nursing Medical and Health Sciences Social Sciences Interdisciplinary
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-3979 (URN)10.1016/j.pedn2007.03.003 (DOI)
    Available from: 2007-08-31 Created: 2007-08-31 Last updated: 2018-01-13Bibliographically approved
    3. Parental handling of fear in children with cancer: caring in the best interests of the child
    Open this publication in new window or tab >>Parental handling of fear in children with cancer: caring in the best interests of the child
    (English)Manuscript (Other academic)
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2837 (URN)
    Available from: 2007-05-04 Created: 2007-05-04 Last updated: 2017-10-18Bibliographically approved
    4. How physicians and nurses handle fear in children with cancer
    Open this publication in new window or tab >>How physicians and nurses handle fear in children with cancer
    2007 (English)In: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 22, no 1, p. 71-80Article in journal (Refereed) Published
    Abstract [en]

    Previous research on fear in children with cancer has often focused on interventions to alleviate fear related to medical procedures and less on how to meet the challenges related to existential fear. This study aimed to describe how experienced nurses and physicians handle fear in children with cancer. Ten nurses and physicians with more than 10 years of experience in child oncology from a university hospital in Sweden were interviewed, and a qualitative content analysis was performed on the data. Nurses' and physicians' handling of fear encompasses commitment and closeness and yet also a distancing from fear and its expressions

    National Category
    Social Sciences Interdisciplinary Nursing Other Social Sciences not elsewhere specified Medical and Health Sciences Pediatrics
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2838 (URN)10.1016/j.pedn.2006.05.010 (DOI)
    Available from: 2007-05-04 Created: 2007-05-04 Last updated: 2018-01-13Bibliographically approved
    5. Fear in children with cancer: observations at an outpatient visit
    Open this publication in new window or tab >>Fear in children with cancer: observations at an outpatient visit
    Show others...
    2008 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 12, no 3, p. 191-208Article in journal (Refereed) Published
    Abstract [en]

    The aim of the study was to describe interactions within the family and between them and professionals on a routine visit at a paediatric oncology outpatient clinic where the visiting child was likely to be fearful. Observations were performed. Data were analysed by qualitative content analysis. The behaviours most frequently observed as expressing fear were being quiet, withdrawn or providing detailed descriptions of experiences. Within the theme `Recognition of the fear', an attentive attitude to the fear was traced; fear was confirmed and cooperation was seen. Although many efforts were made to meet the fear, this was not always successful. Within the theme `Lack of attention to the fear', the fear was not in focus due to parental worries and concerns about the child's health, and organizational disturbances. The results can serve as a basis for collegial reflections of how to handle fear in children with cancer.

    Place, publisher, year, edition, pages
    London: Sage, 2008
    National Category
    Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-5375 (URN)10.1177/1367493508092519 (DOI)
    Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2017-12-14Bibliographically approved
  • 3.
    Böttiger, Anna
    Örebro University, School of Health and Medical Sciences.
    Genetic variation in the folate receptor-alpha and methylenetetrahydrofolate reductase genes as determinants of plasma homocysteine concentrations2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Elevated total plasma homocysteine (tHcy) is a risk factor for cardiovascular disease and neurocognitive disease such as dementia. The B vitamins folate and B12 are the main de terminants of tHcy. tHcy concentration can also be affected by mutations in genes coding for receptors, enzymes and transporters important in the metabolism of Hcy. This thesis focuses on mutations in the genes for folate receptor-alpha and methylenetetrahydrofolate reductase (MTHFR) and the effect they have on tHcy concentrations.

    Six novel mutations in the gene for folate receptor-alpha were described in Paper I. Taken together they exist in a population with a prevalence of approximately 1% and thus are not unusual. There may be an association of –69dupA and –18C>T to tHcy but for the 25-bp deletion, –856C>T, –921T>C and –1043G>A there is probably no association to tHcy. Mutation screening was continued and four additional mutations, 1314G>A, 1816delC, 1841G>A and 1928C>T, were described in Paper II. The prevalences for the heterozygotes were between 0.5% and 13% in an elderly population. There was no significant difference in prevalence between the elderly subjects and patients with dementia. The 1816(–)-allele and the 1841A-allele were in complete linkage and the haplotype 1816(–)-1841A may possibly have a tHcy raising effect. The 1314G>A and 1928C>T mutations had no association to tHcy.

    The genotype prevalences and haplotype frequencies of the MTHFR 677C>T, 1298A>C and 1793G>A polymorphisms were determined in a population sample of Swedish children and adolescents (Paper III). The MTHFR 677T-allele was associated with increased tHcy concentrations in both children and adolescents. A small elevating effect of the 1298C-allele and a small lowering effect of the 1793A-allele could be shown. In an epidemiological sample of adults from the Canary Islands, Spain, data for serum folate and vitamin B12 were used for a broader study of the nutrigenetic impact on tHcy (Paper IV). The 677T-allele had a significant tHcy increasing effect in men but not in women. The 1298C-allele had a minor elevating effect on tHcy in men with the 677CT genotype. It was not possible to document any effect of the 1793A-allele on tHcy due to its low prevalence. A slightly superior explanatory power for the genetic impact was obtained using the MTHFR haplotypes in the analysis compared to the MTHFR 677C>T genotype-based approach in both the Swedish children and adolescents and in the Spanish adults. Therefore MTHFR haplotypes should be considered when analysing the impact of the MTHFR 677C>T, 1298A>C and 1793G>A polymorphisms on tHcy.

    Notwithstanding the large geographical distance between our study populations the haplotype composition is quite similar. The MTHFR 677T-allele is slightly more prevalent in Spain compared to Sweden but it has only an effect on tHcy in the Spanish men. Age, gender and factors linked to the ethnicity of the studied subjects, seem to be able to override the nutrigenetic impact of tHcy-raising genotypes or haplotypes in particular settings, such as in the Spanish women in our study. Gene-nutrient interactions on plasma tHcy levels thus may or may not exist in a certain population. The transferability of nutrigenetic findings may therefore be limited, and must be re-evaluated for each particular setting of age-gender-ethnicity.

    List of papers
    1. Novel mutations in the 5'-UTR of the FOLR1 gene
    Open this publication in new window or tab >>Novel mutations in the 5'-UTR of the FOLR1 gene
    2006 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 44, no 2, p. 161-167Article in journal (Refereed) Published
    Abstract [en]

    We have previously reported two novel mutations in the 5'-untranslated region (UTR) of the gene for folate receptor-alpha (FOLR1). In our search for additional mutations, 92 patient samples with elevated levels of homocysteine were screened by single-strand conformation polymorphism (SSCP) between nt -425 and -782, and -712 and -1110. Between nt -425 and -782 we did not find any mutations. Between nt -712 and -1110 there were three novel mutations. One subject had two mutations very close to each other, c.-856C>T and c.-921T>C. Two subjects had a c.-1043G>A mutation. To get an idea of the prevalence of FOLR1 mutations in an unselected population, we also screened 692 healthy school children for mutations. In this cohort, between nt -188 and +272 we discovered one novel mutation, a single nucleotide substitution, c.-18C>T, in addition to five children with the 25-bp deletion mutation previously described by us. Thus, so far we have discovered six novel mutations in the 5'-UTR region of the gene for folate receptor-alpha. We genotyped all 17 subjects with a FOLR1 mutation for the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism, and developed new single-nucleotide polymorphism (SNP) genotyping protocols for MTHFR 1298A>C and 1793G>A utilising Pyrosequencing technology. None of the 17 subjects had the 677TT genotype, which ruled out this as a cause of elevated homocysteine levels, which was observed in some of the subjects. Further studies of mutations in the 5'-UTR of FOLR1, and in particular of their interplay with folate intake status, are warranted.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3035 (URN)10.1515/CCLM.2006.029 (DOI)16475900 (PubMedID)
    Available from: 2008-11-15 Created: 2008-11-15 Last updated: 2020-01-29Bibliographically approved
    2. Mutations in exons 2 and 3 of the FOLR1 gene in demented and non-demented elderly subjects
    Open this publication in new window or tab >>Mutations in exons 2 and 3 of the FOLR1 gene in demented and non-demented elderly subjects
    2007 (English)In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 20, no 5, p. 653-662Article in journal (Refereed) Published
    Abstract [en]

    We have previously reported six novel mutations in the 5'-UTR of the gene for folate receptor-alpha (FOLR1). In our search for additional mutations we screened patients, referred for investigation of suspected dementia (DGM subgroup) by SSCP and DNA sequencing from the end of exon 1 to the first bases of intron 3. We found 4 sequence variations, FOLR1 g.1314G>A, g.1816delC, g.1841G>A, and g.1928C>T. Pyrosequencing genotyping assays were developed for all of them, and 389 active seniors (AS subgroup) and the 202 DGM patients were genotyped for these mutations. The frequency q of the mutated allele was, among the AS subjects, 0.068, 0.0026, 0.0026, and 0.024 respectively, and among the DGM subjects, 0.067, 0.0076, 0.0078, and 0.023. The g.1816delC and g.1841G>A mutations thus were more frequent in the DGM than in the AS subgroup, but the difference did not reach statistical significance. The mutated alleles, FOLR1 1816(-) and 1841A, always occurred together in the same subjects, suggestive of a rare double-mutant haplotype. The two common polymorphisms, FOLR1 g. 1314G>A and g.1928C>T seemed not to raise tHcy plasma levels, whereas the double-mutated g.1816(-)-g.1841A haplotype may possibly have a slight tHcy-raising effect. Thus, so far 8 novel rare FOLR1 mutations with a combined prevalence of approximately 1.3% in Whites as well as two common polymorphisms with 5% and 13%, respectively, have been demonstrated. Only a few of the rare mutations may potentially be associated with raised plasma tHcy concentrations. No association with dementia was found.

    Place, publisher, year, edition, pages
    Athens, Greece: D.A. Spandidos, 2007
    National Category
    Medical and Health Sciences Geriatrics
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3036 (URN)17912458 (PubMedID)
    Available from: 2008-11-15 Created: 2008-11-15 Last updated: 2017-12-14Bibliographically approved
    3. Association of total plasma homocysteine with methylenetetrahydrofolate reductase genotypes 677C>T, 1298A>C, and 1793G>A and the corresponding haplotypes in Swedish children and adolescents
    Open this publication in new window or tab >>Association of total plasma homocysteine with methylenetetrahydrofolate reductase genotypes 677C>T, 1298A>C, and 1793G>A and the corresponding haplotypes in Swedish children and adolescents
    Show others...
    2007 (English)In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 19, no 4, p. 659-665Article in journal (Refereed) Published
    Abstract [en]

    We studied 692 Swedish children and adolescents (aged 9-10 or 15-16 years, respectively), in order to evaluate the effect of the methylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C, and 1793G>A polymorphisms on total plasma homocysteine concentrations (tHcy). Genotyping was performed with Pyrosequencing technology. The MTHFR 677C>T polymorphism was associated with increased tHcy concentrations in both the children and the adolescents (P<0.001 for both age groups) in both genders. The effect of MTHFR 1298A>C was studied separately in subjects with the 677CC and 677CT genotypes, and the 1298C allele was found to be associated with higher tHcy levels both when children were stratified according to 677C>T genotypes, and when using haplotype analyses and diplotype reconstructions. The 1793A allele was in complete linkage disequilibrium with the 1298C allele. It was still possible to show that the 1793A allele was associated with lower tHcy levels, statistically significant in the adolescents. In conclusion, a haplotype-based approach was slightly superior in explaining the genetic interaction on tHcy plasma levels in children and adolescents than a simple genotype based approach (R2 adj 0.44 vs. 0.40). The major genetic impact on tHcy concentrations is attributable to the MTHFR 677C>T polymorphism. The common 1298A>C polymorphism had a minor elevating effect on tHcy, whereas the 1793G>A polymorphism had a lowering effect on tHcy.

    Place, publisher, year, edition, pages
    Athens, Greece: D.A. Spandidos, 2007
    Keywords
    Molecular medicine
    National Category
    Medical and Health Sciences Medical Genetics
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3037 (URN)17334642 (PubMedID)
    Available from: 2008-11-15 Created: 2008-11-15 Last updated: 2020-01-29Bibliographically approved
    4. Plasma homocysteine and MTHFR genotypes and haplotypes: gene-nutrient interactions in the Canary Islands Nutrition Study (ENCA)
    Open this publication in new window or tab >>Plasma homocysteine and MTHFR genotypes and haplotypes: gene-nutrient interactions in the Canary Islands Nutrition Study (ENCA)
    (English)Manuscript (preprint) (Other (popular science, discussion, etc.))
    Keywords
    molecular medicine, medical genetics
    National Category
    Medical and Health Sciences Medical Genetics
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3038 (URN)
    Available from: 2008-11-15 Created: 2008-11-15 Last updated: 2018-01-13Bibliographically approved
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  • 4.
    Eliasson, Henrik
    Örebro University, School of Health and Medical Sciences.
    Tularemia: epidemiological, clinical and diagnostic aspects2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Tularemia is a zoonosis caused by the small, fastidious, gram-negative rod Francisella tularensis that appears over almost the entire Northern Hemisphere. In Sweden, tularemia has appeared mainly in restricted areas in northern parts of central Sweden.

    The disease can be transmitted through several routes: direct contact with infected animals, by vectors, through contaminated food or water or through inhalation of aerosolized bacteria. Distinct clinical forms of the disease are seen, depending on the route of transmission. During the last years, tularemia has emerged in new areas in central Sweden, south of the endemic area. The emergence of tularemia in the County of Örebro prompted the investigations presented in this thesis.

    We performed a case-control study, using a mailed questionnaire, to identify risk factors for acquiring tularemia in Sweden (Paper I). After multivariate analysis, mosquito bites and cat ownership could be associated with tularemia in all studied areas while farming appeared as a risk factor only in endemic areas.

    In Paper II, we evaluated a PCR analysis, targeting the tul4 gene, used on samples from primary lesions in patients with ulceroglandular tularemia. The method performed well, with a sensitivity of 78% and a specifi city of 96%. The clinical characteristics of tularemia in an emergent area in Sweden were studied Paper III), using case fi les and a questionnaire. Of 278 cases of tularemia reported during the years 2000 to 2004, 234 had been in contact with a doctor from the Department of Infectious Diseases at Örebro University Hospital, and were thus included. The ulceroglandular form of the disease was seen in 89% of the cases, with the primary lesion, in most cases, on the lower leg. An overwhelming majority of cases occurred during late summer and early autumn, further supporting transmission by mosquitoes. Erythemas overlying the affected lymph node areas were seen in 19% of patients with forms of tularemia affecting peripheral lymph nodes. Late skin manifestations, of various appearances, were seen in 30% of the cases, predominantly in women. A raised awareness of tularemia among physicians in the county during the course of the outbreak was found, as documented by the development of shorter doctor’s delay and less prescription of antibiotics inappropriate in tularemia.

    Finally, we developed a simplifi ed whole-blood lymphocyte stimulation test, as a diagnostic tool in tularemia (Paper IV). The level of IFN-γ, as a proxy for lymphocyte proliferation, was measured after 24-h stimulation. Additionally, a tularemia ELISA with ultra-purifi ed LPS as the antigen was evaluated, showing a high sensitivity. The lymphocyte stimulation test, when performed on consecutive samples from subjects with ongoing tularemia was able to detect the disease earlier in the course of the disease than both the new ELISA and the tube agglutination test. Furthermore, all tularemia cases became positive in the lymphocyte stimulation test within 12 days of disease. In conclusion, this thesis describes risk factors for acquiring tularemia as well as the clinical characteristics of the disease in Sweden. Additionally, a Francisella PCR analysis and a tularemia ELISA based on highly purifi ed LPS is evaluated, and a simplified lymphocyte stimulation test, for early confirmation of the disease, is developed.

    List of papers
    1. The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden
    Open this publication in new window or tab >>The 2000 tularemia outbreak: a case-control study of risk factors in disease-endemic and emergent areas, Sweden
    Show others...
    2002 (English)In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 8, no 9, p. 956-960Article in journal (Refereed) Published
    Abstract [en]

    A widespread outbreak of tularemia in Sweden in 2000 was investigated in a case-control study in which 270 reported cases of tularemia were compared with 438 controls. The outbreak affected parts of Sweden where tularemia had hitherto been rare, and these "emergent" areas were compared with the disease-endemic areas. Multivariate regression analysis showed mosquito bites to be the main risk factor, with an odds ratio (OR) of 8.8. Other risk factors were owning a cat (OR 2.5) and farm work (OR 3.2). Farming was a risk factor only in the disease-endemic area. Swollen lymph nodes and wound infections were more common in the emergent area, while pneumonia was more common in the disease-endemic area. Mosquito bites appear to be important in transmission of tularemia. The association between cat ownership and disease merits further investigation.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2913 (URN)12194773 (PubMedID)
    Available from: 2008-02-20 Created: 2008-02-20 Last updated: 2017-12-14Bibliographically approved
    2. Clinical use of a diagnostic PCR for Francisella tularensis in patients with suspected ulceroglandular tularaemia
    Open this publication in new window or tab >>Clinical use of a diagnostic PCR for Francisella tularensis in patients with suspected ulceroglandular tularaemia
    2005 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, no 11, p. 833-837Article in journal (Refereed) Published
    Abstract [en]

    A retrospective analysis to evaluate the clinical use of a diagnostic PCR for Francisella tularensis in patients with suspected ulceroglandular tularaemia was performed. 154 samples, 129 from patients with definitive tularaemia and 25 from patients where tularaemia could be ruled out, were analysed. The diagnostic PCR had a specificity of 96%, a sensitivity of 78.3%, and a Positive Predictive Value of 99%. Especially samples from encrusted lesions, even up to 4 weeks old, in patients with tularaemia, were PCR positive to a high degree when taken properly. The diagnostic PCR is useful in suspected ulceroglandular tularaemia, giving a fast and accurate diagnosis.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2914 (URN)10.1080/00365540500400951 (DOI)16308216 (PubMedID)
    Available from: 2008-02-20 Created: 2008-02-20 Last updated: 2017-12-14Bibliographically approved
    3. Tularaemia in an emergent area in Sweden: An analysis of 234 cases in five years
    Open this publication in new window or tab >>Tularaemia in an emergent area in Sweden: An analysis of 234 cases in five years
    2007 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 39, no 10, p. 880-889Article in journal (Refereed) Published
    Abstract [en]

    A retrospective study of clinical tularaemia in an emergent area in Sweden is presented. 234 patients seen during the y 2000-2004 were studied, using case files and a questionnaire. There was a predominance of ulceroglandular tularaemia (89%), occurring in late summer and early autumn, reflecting the dominance of mosquito-borne transmission. The incubation period varied from a few hours to 11 d, with a median of 3 d. Cutaneous manifestations of tularaemia, apart from primary lesions, were noted in 43% of the cases. Coughing was common, even in patients with ulceroglandular tularaemia, supporting the view that haematogenous spread to the respiratory system occurs. Regular laboratory tests, such as WBC, ESR and C-reactive protein, were in general only moderately elevated. In the earlier y studied, the Doctor's Delay was substantial as was the misdiagnosis and prescription of inadequate antibiotics. In the later y, however, the delay and misdiagnosis were significantly lower, reflecting the increased recognition of the disease by the physicians in the area. A few relapses occurred, all in patients treated with doxycycline. No lethality was seen, reflecting the benign course of tularaemia type B infection.

    Place, publisher, year, edition, pages
    London: Taylor & Francis, 2007
    National Category
    Medical and Health Sciences Infectious Medicine
    Research subject
    Infectious Diseases
    Identifiers
    urn:nbn:se:oru:diva-2915 (URN)10.1080/00365540701402970 (DOI)
    Available from: 2008-02-20 Created: 2008-02-20 Last updated: 2017-12-14Bibliographically approved
    4. Kinetics of immune response in tularemia: comparison between ELISA, tube agglutination and a novel whole blood lymphocyte stimulation test
    Open this publication in new window or tab >>Kinetics of immune response in tularemia: comparison between ELISA, tube agglutination and a novel whole blood lymphocyte stimulation test
    Show others...
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-2916 (URN)
    Available from: 2008-02-20 Created: 2008-02-20 Last updated: 2017-10-18Bibliographically approved
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  • 5.
    Gustafsson, Mattias
    Örebro University, Department of Clinical Medicine.
    Vilken betydelse har skelettscintigrafi vid diagnos av scaphoideumfraktur?2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    En scaphoideumfraktur är den vanligaste frakturen bland karpalbenen i handen. Frakturen orsakas vanligen av ett kraftigt extensionsvåld mot handleden.

    Scaphoideums stora rörlighet i handen och dess begränsade blodförsörjning bidrar till att scaphoideumfrakturer kan vara svårläkta.

    Scaphoideumfrakturer kan vara svåra att påvisa på konventionell röntgen, även vid upprepade undersökningar. Visar konventionell röntgen ett negativt resultat, men klinisk misstanke om fraktur kvarstår, finns olika undersökningsmetoder att tillgå för att en säker diagnos ska kunna ställas.

    Syftet med den här litteraturstudien var att undersöka betydelsen av skelettscintigrafi som undersökningsmetod vid diagnos av scaphoideumfraktur.

    Resultatet visar att skelettscintigrafi har stor betydelse vid diagnos av en scaphoideumfraktur.

    Kan inte en säker diagnos ställas på konventionell röntgen är skelettscintigrafi en metod som båda kan påvisa och exkludera en scaphoideumfraktur.

  • 6.
    Hahn-Strömberg, Victoria
    Örebro University, School of Health and Medical Sciences.
    Cell adhesion proteins in different invasive patterns of colon carcinomas: a morphometric and molecular genetic study2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Colorectal carcinoma is the second most common type of cancer in both men and women in Sweden. Cancer of the colon and rectum are often considered together and their ten year survival rate is approximately 50 – 60 % depending on sex and location. Different histopathological characteristics of such cancers, including the complexity of growth, are of importance for prognosis.

    This thesis has compared different morphometric methods in order to achieve a quantitative and objective measurement of the invasive front of colon carcinoma. Since the growth pattern is dependent on the cell adhesiveness of different proteins we studied the distribution and localization of E-cadherin, Beta-catenin, Claudin 1,2,7 and Occludin as well as screened the genes for mutations.

    We found a perturbed protein expression of E-cadherin, Beta-catenin, Claudin 1,2,7 and Occludin in tumor sections compared to normal mucosa, but no relation to tumor volume or growth pattern could be seen. The tumor volume was found to be correlated to the growth pattern but not responsible to the perturbed protein expression. In the mutation screening we found a SNP in exon 13 the E-cadherin gene in the tumor, as well as in exon 2 of Claudin 1 and exon 4 of Claudin 7 in both tumor and normal mucosa. No correlation between mutations and growth pattern or tumor volume was found.

    In conclusion, this thesis shows that the computer image analysis with estimation of fractal dimension and number of free tumor cell clusters is superior to the semi quantitative visual grading of tumor invasive complexity. The aberrant expression of cell adhesion proteins in the tumor compared to normal mucosa as well as polymorphisms in the cell adhesion genes CLDN1 and CLDN7 in both tumor and normal mucosa can suggest that these aberrations are important in the tumorigenesis of colon carcinoma.

     

    List of papers
    1. Characterization of colon carcinoma growth pattern by computerized morphometry: definition of a complexity index
    Open this publication in new window or tab >>Characterization of colon carcinoma growth pattern by computerized morphometry: definition of a complexity index
    2008 (English)In: International Journal of Molecular Medicine, ISSN 1107-3756, E-ISSN 1791-244X, Vol. 22, no 4, p. 465-472Article in journal (Refereed) Published
    Abstract [en]

    The invasive front of carcinomas may vary in complexity from smooth to highly complex when the front splits up into small cell clusters or even single cancer cells. The degree of complexity is usually estimated visually and semiquantitatively by a pathologist, although more objective methods based on computer-assisted image analysis are available. In this study, we compared the visual estimation of the irregularity of the tumour invasion front of colon carcinomas to different quantitative image analytical techniques and defined a complexity index for the invasive margin. Sections from 29 archived colon carcinomas were stained immunohistochemically for cytokeratin 8. Images of the tumour invasion front were read into a computer and thresholded so that the tumour tissue became black and the background white or so that the tumour front was outlined by a single pixel line. The invasive front was visually classified into four degrees of irregularity by a pathologist. The complexity of the front was then assessed using four different image analysis techniques, i.e. the estimation of fractal dimension, tumour front length, number of tumour cell clusters and lacunarity. Fractal dimension and tumour cell clusters together gave the best correlation to visual grading using a discriminant analysis. A cluster analysis and a tree diagram analysis were then performed and were found to be superior to visual estimation. The clusters represent different degrees of complexity and the result of the tree diagram analysis can be used to assign complexity indices to colon tumours. The fractal dimension separated tumours up to a certain level (1.5-1.6) of complexity. When the tumour front split up into small cell clusters, the counting of tumour cell clusters separated the cells over and above the fractal dimension. This new technique can be used to objectively and quantitatively describe the complexity of the invasive front of tumours.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3031 (URN)10.3892/ijmm_00000044 (DOI)18813853 (PubMedID)
    Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
    2. Disturbed expression of E-cadherin, beta-catenin and tight junction proteins in colon carcinoma is unrelated to growth pattern and genetic polymorphisms
    Open this publication in new window or tab >>Disturbed expression of E-cadherin, beta-catenin and tight junction proteins in colon carcinoma is unrelated to growth pattern and genetic polymorphisms
    2008 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 116, no 4, p. 253-262Article in journal (Refereed) Published
    Abstract [en]

    Adhesion proteins are responsible for the structural integrity of epithelial tissue and in tumors this integrity is often lost, resulting in a disorganization of the tissue. In the present study the complexity of the invasive front of colon carcinomas was correlated with cell adhesion protein expression and with polymorphisms in their genes. A complexity index was constructed from 32 colon carcinomas using computer-assisted morphometry estimating fractal dimension and tumor cell clusters followed by tree analysis. Immunohistochemical staining of beta-catenin, E-cadherin, occludin and claudin 2 was used for assessment of protein expression. Genetic screening of tissue from the tumor invasion front with laser microdissection was performed using SSCP and DNA sequencing. Adhesion protein distribution was significantly disturbed in most carcinomas. A single mutation in the gene of beta-catenin was found but there was no correlation between protein expression and genetic polymorphism. Nor was there any correlation between the complexity of the invasive border and protein distribution or genetic alterations. The results indicate that the complexity of colon carcinoma invasion is not dependent on genetic derangements in the genes of adhesion proteins or the protein distribution. Rather, aberrations in the function of other proteins related to the adhesive proteins could be responsible.

    Keywords
    patology, molecular cell biology
    National Category
    Medical and Health Sciences Cell and Molecular Biology
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3032 (URN)10.1111/j.1600-0463.2008.00894.x (DOI)18397460 (PubMedID)
    Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2018-01-13Bibliographically approved
    3. Tumor volume of colon carcinoma is related to the invasive pattern but not to the expression of cell adhesion proteins
    Open this publication in new window or tab >>Tumor volume of colon carcinoma is related to the invasive pattern but not to the expression of cell adhesion proteins
    2009 (English)In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 117, no 3, p. 205-211Article in journal (Refereed) Published
    Abstract [en]

    Tumor volume increases during growth and due to tumor progression various mutations appear that may cause phenotypic changes. The invasive pattern may thus be affected resulting in a more disorganized growth. This phenomenon might be due to mutations in the genome of the adhesion proteins, which are responsible for the structural integrity of epithelial tissue. Tumor volume was assessed in whole mount sections of 33 colon carcinomas using Cavalieri's principle. Images from the entire invasive border were captured and used for calculating the irregularity of the border (Complexity Index). The expression of the adhesion proteins E-cadherin, beta-catenin, Claudin 2 and Occludin was assessed after immunohistochemical staining of two randomly selected areas of the invasive front of the tumor. Statistical significance for differences in volume was obtained for tumor Complexity Index, tumor stage (pT) and lymph node status (pN). Expression of adhesion proteins was significantly perturbed in the tumors compared with normal mucosa but only infrequently correlated to tumor differentiation or invasive pattern. The results show that when tumor volume increases the invasive pattern becomes more irregular which is compatible with tumor progression. A direct contribution of adhesion protein derangement to this process appears to be insignificant.

    Place, publisher, year, edition, pages
    Wiley-Blackwell Publishing Inc., 2009
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3033 (URN)10.1111/j.1600-0463.2008.00011.x (DOI)000265487600006 ()19245593 (PubMedID)2-s2.0-61349175837 (Scopus ID)
    Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-12-14Bibliographically approved
    4. Claudin 1 and Claudin 7 gene polymorphisms and protein derangement are unrelated to the growth pattern of colon carcinoma
    Open this publication in new window or tab >>Claudin 1 and Claudin 7 gene polymorphisms and protein derangement are unrelated to the growth pattern of colon carcinoma
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-3034 (URN)
    Available from: 2008-11-10 Created: 2008-11-10 Last updated: 2017-10-18Bibliographically approved
    Download full text (pdf)
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  • 7.
    Ivarsson, Niklas
    Örebro University, School of Health and Medical Sciences.
    An inquiry to a possible fatty acid metabolism defect due to carnitine deficiency in patient fibroblast, analysed with a tritium release assay2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The formation of tritiated water from [9,10-3H]-palmitic acid has been recommended as an adequate screening method to detect patients with fatty acid oxidation disorders. Intact cultured fibroblasts from three patients (a young girl, the Mother and Grandfather) plus controls have been studied using this method with 3H-palmitic acid at the presence or absent of excess of carnitine. The patients were suspected to have an aberrant carnitine transport over the cell membrane, which probably could secondary affects the fatty acid metabolism.

    No differences were found in β-oxidation of 3H-palmytic acid between fibroblasts from patients compared to healthy controls. Excess of carnitine did not shown any effect on β-oxidation of 3H-palmytic acid either

    The results showed that the patients’ fibroblasts did not have a decreased β-oxidation capacity and no significant difference when treated with carnitine compared to the matched healthy controls. This study cannot link the patient’s symptoms with an aberrant carnitine transport over cell membrane or any defect in β-oxidation of fatty acid metabolism.

  • 8.
    Johansson, Jessica
    Örebro University, Department of Clinical Medicine.
    Effect of interleukin-1beta on tyrosine uptake in fibroblasts of schizophrenic patients and healthy controls2007Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    A repeated finding in schizophrenic patients is an aberrant tyrosine transport, shown in fibroblast cell model. Altered levels of the pro-inflammatory cytokine interleukin-1beta (IL-1β) are indicated in schizophrenic patients and IL-1β has shown to have inhibitory effect on amino acid transport systems. Based on these findings, the aim of this study was to examine the effect of IL-1β on tyrosine uptake in fibroblasts of schizophrenic patients and healthy controls. Fibroblast cell lines from schizophrenic patients (n=10) and healthy controls (n=10) were treated with IL-1β and uptake of 14C (U)-L-tyrosine was measured using the cluster tray method. Fibroblasts untreated with IL-1β were used as controls. Treatment with IL-1β significantly inhibited the tyrosine uptake in fibroblasts of schizophrenic patients and controls. No difference in uptake levels between fibroblasts of schizophrenic patients and controls was found. This study provides one potential explanation for the aberrant tyrosine transport seen in patients with schizophrenia and thus combines the immunological and neuropharmacological factors implicated in the pathophysiology/etiology of schizophrenia.

  • 9.
    Nilsson, Andreas
    Örebro University, School of Health and Medical Sciences.
    Physical activity assessed by accelerometry in children2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Physical activity (PA) is likely to constitute an important aspect of health-related behaviour in growing children. However, the knowledge on levels and patterns of PA in children is limited, due to the difficulty of precisely measuring this complex behaviour in normal daily living. Information on variables that significantly contributes to the variability in PA patterns is warranted as it may inform strategies for promoting physically active lifestyles in school-age youth. The overall purpose of the present studies was to increase the knowledge about the use of accelerometry when assessing PA in children, and examine sources of variability in objectively assessed PA behaviour in children. The study samples included 1954 nine- and 15-year-old children from four geographical locations in Europe (Norway, Denmark, Estonia and Portugal), and additionally 16 Swedish seven-year-old boys and girls. PA was assessed by the MTI accelerometer during free-living conditions, including both weekdays and weekend days. A part of the PA assessment was conducted using different time sampling intervals (epochs). Predictions of estimates of daily energy expenditure from accelerometer output were calculated using previously published equations. Potential correlates of PA behaviour were assessed by self-report. The main findings were; a) the epoch setting had a significant effect when interpreting time spent at higher intensities of PA in young children, b) predicted energy expenditure differed substantially between equations, c) between- and within-day differences in overall levels of PA, time spent at moderate-to-vigorous intensity physical activity and time spent sedentary differed between age, gender and geographical location, d) outdoor play and sports participation were differentially associated with objectively measured PA in 9- and 15-year-old children. It is concluded that the sporadic nature of children’s physical activity require very short epoch settings for detecting high intensity PA, and that different published equations for estimations of daily energy expenditure cannot be used interchangeably. The interpretations of average energy expenditure from available equations should be made with caution. Based on a large sample of children of different ages, weekend days and leisure time during weekdays seem appropriate targets when promoting PA in order to increase the proportion of children achieving current recommendations on health enhancing PA. Further, significant correlates of PA behaviour dependent on age group are presented, which should be considered when planning interventions for promoting PA in school-age youth.

    List of papers
    1. Assessing physical activity among children with accelerometers using different time sampling intervals and placements
    Open this publication in new window or tab >>Assessing physical activity among children with accelerometers using different time sampling intervals and placements
    2002 (English)In: Pediatric Exercise Science, ISSN 0899-8493, Vol. 14, no 1, p. 87-96Article in journal (Refereed) Published
    Abstract [en]

    The aim was to investigate (a) the effect of five different time sampling intervals (epoch settings) on different intensity levels when assessing physical activity with an accelerometer (CSA, WAM 7164), and (b) whether the placement of the monitor (on the hip and back) would affect the outcome. Sixteen children (aged 7 yrs) were monitored for four consecutive days. A significant main epoch effect was found for time spent at very high (p < 01) and high (p < 01) intensity activities. No significant difference between the two placements regarding total amount of physical activity (cnts times mm super (-1)) or different intensity levels was observed. In conclusion, different time sampling intervals, but not placement, should be carefully considered when assessing physical activity.

    National Category
    Social Sciences Interdisciplinary Sport and Fitness Sciences Medical and Health Sciences
    Research subject
    Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2875 (URN)
    Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2020-01-29Bibliographically approved
    2. Comparison of equations for predicting energy expenditure from accelerometer counts in children
    Open this publication in new window or tab >>Comparison of equations for predicting energy expenditure from accelerometer counts in children
    Show others...
    2008 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 18, no 5, p. 643-650Article in journal (Refereed) Published
    Abstract [en]

    Several prediction equations developed to convert body movement measured by accelerometry into energy expenditure have been published. The aim of this study was to examine the degree of agreement between three different prediction equations, when applied to data on physical activity in a large sample of children. We examined 1321 children (663 boys, 658 girls; mean age 9.6+/-0.4 years) from four different countries. Physical activity was measured by the MTI accelerometer. One equation, derived from doubly labeled water (DLW) measurements, was compared with one treadmill-based (TM) and one room calorimeter-based (CAL) equation (mixture of activities). Predicted physical activity energy expenditure (PAEE) was the main outcome variable. In comparison with DLW-predicted PAEE, both laboratory-derived equations significantly (P<0.001) overestimated PAEE by 17% and 83%, respectively, when based on a 24-h prediction, while the TM equation significantly (P<0.001) underestimated PAEE by 46%, when based on awake time only. In contrast, the CAL equation agreed better with the DLW equation under the awake time assumption. Predicted PAEE differ substantially between equations, depending on time-frame assumptions, and interpretations of average levels of PAEE in children from available equations should be made with caution. Further development of equations applicable to free-living scenarios is needed.

    Place, publisher, year, edition, pages
    Oxford: Blackwell, 2008
    National Category
    Medical and Health Sciences Social Sciences Interdisciplinary Sport and Fitness Sciences
    Research subject
    Sports Science
    Identifiers
    urn:nbn:se:oru:diva-2876 (URN)10.1111/j.1600-0838.2007.00694.x (DOI)
    Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2019-09-20Bibliographically approved
    3. Between- and within-day variability in physical activity and inactivity in 9- and 15-year-old European children
    Open this publication in new window or tab >>Between- and within-day variability in physical activity and inactivity in 9- and 15-year-old European children
    Show others...
    2009 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 1, p. 10-18Article in journal (Refereed) Published
    Abstract [en]

    To examine differences in levels of physical activity (PA), time spent at moderate-to-vigorous intensity PA (MVPA) and time spent sedentary between and within days in children from four European countries, 1954 9 - and 15-year-olds were included. PA was measured during 2 weekdays and 2 weekend days using the manufacturing technology-incorporated (MTI) accelerometer. Average count per minute, time spent sedentary, time spent at MVPA and the proportion of children accumulating > or =60 min of MVPA were calculated. Data were compared between weekdays and weekend days and between school time and leisure-time. Although not entirely consistent across countries, overall PA, time spent sedentary and the proportion of children accumulating > or =60 min of MVPA were higher during weekdays compared with weekend days. Differences in overall PA between school time and leisure-time were highly inconsistent between countries. Few children (4-31%) accumulated > or =60 min of MVPA either during school time or during leisure-time. Differences in activity patterns between weekdays and weekend days are explained by less accumulated time in MVPA during weekend days. Weekend days and leisure-time during weekdays seem appropriate targets when promoting PA in order to increase the proportion of children achieving current recommendations on health-enhancing PA.

    Place, publisher, year, edition, pages
    Oxford: Wiley-Blackwell, 2009
    National Category
    Social Sciences Interdisciplinary Sport and Fitness Sciences Medical and Health Sciences
    Research subject
    Sports Science; Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2877 (URN)10.1111/j.1600-0838.2007.00762.x (DOI)000262901500003 ()18248534 (PubMedID)2-s2.0-59149094073 (Scopus ID)
    Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2019-09-20Bibliographically approved
    4. Correlates of objectively assessed physical activity and sedentary time in children: a cross-sectional study (The European Youth Heart Study)
    Open this publication in new window or tab >>Correlates of objectively assessed physical activity and sedentary time in children: a cross-sectional study (The European Youth Heart Study)
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    2009 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 9, article id 322Article in journal (Refereed) Published
    Abstract [en]

    Background

    Identifying leisure time activities performed before and after school that influence time in physical activity (PA) and/or time spent sedentary can provide useful information when designing interventions aimed to promote an active lifestyle in young people. The purpose of this study was to examine associations between mode of transportation to school, outdoor play after school, participation in exercise in clubs, and TV viewing with objectively assessed PA and sedentary behaviour in children.

    Methods

    A total of 1327 nine- and 15-year-old children from three European countries (Norway, Estonia, Portugal) participated as part of the European Youth Heart Study. PA was measured during two weekdays and two weekend days using the MTI accelerometer, and average percent of time in moderate-to-vigorous PA (MVPA) and time spent sedentary were derived. Potential correlates were assessed by self-report. Independent associations between self-reported correlates with percent time in MVPA and percent time sedentary were analysed by general linear models, adjusted by age, gender, country, measurement period, monitored days and parental socio-economic status.

    Results

    In 9-year-olds, playing outdoors after school was associated with higher percent time in MVPA (P < 0.01), while participation in sport clubs was associated with higher percent time in MVPA (P < 0.01) in 15-year-olds. No associations with percent time sedentary were observed in either age group.

    Conclusion

    Frequency of outdoor play after school is a significant correlate for daily time in MVPA in 9-year-olds, while this correlate is attenuated in favour of participation in sport and exercise in clubs in 15-year-olds. Targeting walking to school or reduced TV viewing time in order to increase time in daily MVPA in children is unlikely to be sufficient. Correlates related to time spent sedentary need further examination.

    Place, publisher, year, edition, pages
    London: BioMed Central, 2009
    Keywords
    assessment, accelerometer, children, health behaviours
    National Category
    Social Sciences Interdisciplinary Sport and Fitness Sciences Medical and Health Sciences
    Research subject
    Sports Science; Biomedicine
    Identifiers
    urn:nbn:se:oru:diva-2878 (URN)10.1186/1471-2458-9-322 (DOI)000270675100001 ()19735565 (PubMedID)2-s2.0-70349311819 (Scopus ID)
    Available from: 2009-06-03 Created: 2009-05-25 Last updated: 2019-09-20Bibliographically approved
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  • 10.
    Norén, Torbjörn
    Örebro University, Department of Clinical Medicine.
    Clostridium difficile: epidemiology and antibiotic resistance2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Clostridium difficile is a spore-forming toxin-producing intestinal bacterium abundant in soils and waters. This pathogen relies on increased growth by a disturbed intestinal microflora and the production of two cytotoxins, toxin A and toxin B, which may cause anything from mild self-limiting C. difficile associated diarrhea (CDAD) to severe and fatal pseudomembranous colitis (PMC). Typically CDAD following antibiotic therapy is due either to overgrowth of endogenous C. difficile or through spores transmitted from the environment. The hospital setting provides frequent antibiotic use and the source of numerous infective spores from CDAD patients, the environment or nursing staff. Today we experience a 10-fold increase of incidence in the US and Canada (1991-2003) apparently due to a current epidemic C. difficile strain (NAP1/027). Current incidence from Canada is estimated to 156/100 000 compared to 50/100 000 in Sweden 1995.

    In the following thesis, investigations of CDAD in Örebro County in central Sweden resulted in the discovery an epidemic nosocomial C. difficile strain (SE17, serogroup C), found to be clindamycin-resistant. The majority of the isolates carried a gene (ermB) related to this resitance. We found an overall incidence during 1999-2000 of 97/100 000 or, if including recurrent episodes, 135/100 000 i.e. more than 100% increase since 1995. The incidence among hospitalized individuals was 1300-fold that in the community and 78% of episodes were classified as hospital-associated. This reflects a 37-fold difference in antibiotic consumption, as well as the predominance of the resistant SE17 hospital-associated strain (22% of hospital isolates compared to 6% of community isolates, p=0.008). Only 10% of the recurrent cases were found to be reinfections indicating that CDAD is mainly caused by endogenous strains and not by hospital transmission.

    Recent reports on failure of standard metronidazole therapy urge for alternative treatment agents and fusidic acid has been proven as effective in the treatment of CDAD. We could verify this, but in both treatment groups we found that persistence of C. difficile isolates post-treatment related to an increased risk of recurrent CDAD compared to the patients who were culture negative at follow-up (p=0.03). Most importantly, 55% of patients with follow-up isolates and who had been treated with fusidic acid, the strains had developed fusidic acid resistance. The corresponding pre-treatment identity of isolate genotype indicated selection of mutants. Relating to the known fusA resistance mechanism in Staphylococcus aureus we used the published sequence for this gene in Clostridium perfringens and found homologous fusA in the sequence of the referent strain C. difficile 630. Comparing fusA of the resistant mutants with the initial wild-type isolates, we identified novel mutations in fusA as the genetic key to fusidic acid resistance in C. difficile.

    List of papers
    1. Clindamycin resistant strains of Clostridium difficile isolated from cases of C. difficile associated diarrhea (CDAD) in a hospital in Sweden
    Open this publication in new window or tab >>Clindamycin resistant strains of Clostridium difficile isolated from cases of C. difficile associated diarrhea (CDAD) in a hospital in Sweden
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    2002 (English)In: Diagnostic microbiology and infectious disease, ISSN 0732-8893, E-ISSN 1879-0070, Vol. 42, no 2, p. 149-151Article in journal (Refereed) Published
    Abstract [en]

    Fifty three strains of C. difficile recovered from the stools of 13 patients with clinical C. difficile associated diarrhea (CDAD) were analyzed for the presence of the ermB gene, for toxigenicity and fingerprinting profile by PCR based assays. Forty five percent of the isolates were resistant to clindamycin and positive for the ermB gene. All clindamycin resistant isolates were ermB positive and belonged to the same fingerprinting group, suggesting clonal spread. These preliminary results suggest that clindamycin resistant isolates may be common etiologic agents of CDAD in Sweden.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-3198 (URN)10.1016/S0732-8893(01)00337-6 (DOI)
    Available from: 2006-11-23 Created: 2006-11-23 Last updated: 2017-12-14Bibliographically approved
    2. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county
    Open this publication in new window or tab >>Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county
    Show others...
    2004 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 42, no 8, p. 3635-3643Article in journal (Refereed) Published
    Abstract [en]

    All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15678 (URN)10.1128/jcm.42.8.3635-3643.2004 (DOI)000223286500038 ()
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-12-11Bibliographically approved
    3. Frequent emergence of resistance in Clostridium difficile during treatment of C-difficile-associated diarrhea with Fusidic acid
    Open this publication in new window or tab >>Frequent emergence of resistance in Clostridium difficile during treatment of C-difficile-associated diarrhea with Fusidic acid
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    2006 (English)In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 50, no 9, p. 3028-3032Article in journal (Refereed) Published
    Abstract [en]

    Samples from patients with Clostridium difficile-associated diarrhea (CDAD) that were randomized to fusidic acid (n = 59) or metronidazole (n = 55) therapy for 7 days were cultured for Clostridium difficile in feces on days 1, 8 to 13, and 35 to 40. Of the patients who were culture positive only before treatment, 77% (36/47) were permanently cured (no treatment failure and no clinical recurrence), compared to 54% (22/41) of those with persistence of C. difficile at one or both follow-ups (P = 0.03). A similar association between bacterial persistence and a worse outcome of therapy was seen in both treatment groups. Resistance to fusidic acid was found in 1 of 88 pretherapy isolates available, plus in at least 1 subsequent isolate from 55% (11/20) of patients who remained culture-positive after fusidic acid therapy. In 10 of these 11 patients, the resistant follow-up isolate(s) belonged to the same PCR ribotype as the susceptible day 1 isolate, confirming frequent emergence of resistance to fusidic acid during treatment. Despite this, 5 of these 11 patients were permanently cured with fusidic acid, relative to 5 of 9 patients with susceptible C. difficile at follow-up (P = 1.0). None of the 36 PCR ribotypes of C. difficile identified was associated with any particular clinical outcome or emergence of fusidic acid resistance. In conclusion, culture positivity for C. difficile was common after both fusidic acid and metronidazole therapy and was associated with treatment failure or recurrence of CDAD. Development of resistance in C. difficile was frequent in patients given fusidic acid, but it was without apparent negative impact on therapeutic efficacy in the actual CDAD episode.

    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15679 (URN)10.1128/AAC.00019-06 (DOI)000240297000019 ()
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-12-11Bibliographically approved
    4. Nucleotide polymorphisms in fusA associated with post-therapy fusidic acid resistance in Clostridium difficile
    Open this publication in new window or tab >>Nucleotide polymorphisms in fusA associated with post-therapy fusidic acid resistance in Clostridium difficile
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    (English)Manuscript (preprint) (Other academic)
    National Category
    Medical and Health Sciences
    Research subject
    Medicine
    Identifiers
    urn:nbn:se:oru:diva-15681 (URN)
    Available from: 2011-05-24 Created: 2011-05-24 Last updated: 2017-10-17Bibliographically approved
  • 11.
    Stillfors, Caroline
    Örebro University, School of Health and Medical Sciences.
    Ultraljudsscreening av bukaortaaneurysm: precision och reproducerbarhet2008Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abdominellt aortaaneurysm (AAA) är en sjukdom som främst drabbar äldre män. Sjukdomen är förknippat med en mycket hög dödlighet. Det är viktigt att patienterna fångas upp under den latenta delen av sjukdomsförloppet (före ruptur), och erbjuds behandling. En hälsoundersökning (screening) av patienter i riskzonen skulle kunna sänka den AAA-relaterade mortaliteten. För denna typ av screening används ultraljud. Ofta är det läkare som utför undersökningarna men med dagens läkarbrist behöver man tänka om. Denna litteraturstudie undersöker om screening för AAA kan sänka mortaliteten i sjukdomen, men också precisionen och reproducerbarheten hos ultraljud som undersökningsmetod och om annan vårdpersonal kan utföra screeningen. Resultaten visar på ultraljudets höga precision och reproducerbarhet. Användarvänligheten gör att annan vårdpersonal efter adekvat utbildning med fördel kan utföra undersökningen. Screening för AAA sänker dramatiskt dödligheten i sjukdomen. Ytterligare forskning behövs kring screening för AAA hos andra riskgrupper, samt kring de patofysiologiska orsakerna bakom utveckling, expansion och ruptur.

  • 12.
    Ström, Jakob O.
    et al.
    Linköping University, Linköping, Sweden; County Council of Östergötland, Linköping, Sweden.
    Ingberg, Edvin
    Linköping University, Linköping, Sweden; County Council of Östergötland, Linköping, Sweden.
    Druvefors, Emma
    Ryhov County Hospital, County Council of Jönköping, Jönköping, Sweden.
    Theodorsson, Annette
    Linköping University, Linköping, Sweden; County Council of Östergötland, Linköping, Sweden.
    Theodorsson, Elvar
    Linköping University, Linköping, Sweden; County Council of Östergötland, Linköping, Sweden.
    The female menstrual cycle does not influence testosterone concentrations in male partners2012In: Journal of Negative Results in Biomedicine, ISSN 1477-5751, E-ISSN 1477-5751, Vol. 11, p. 1-7, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: The time of ovulation has since long been believed to be concealed to male heterosexual partners. Recent studies have, however, called for revision of this notion. For example, male testosterone concentrations have been shown to increase in response to olfactory ovulation cues, which could be biologically relevant by increasing sexual drive and aggressiveness. However, this phenomenon has not previously been investigated in real-life human settings. We therefore thought it of interest to test the hypothesis that males' salivary testosterone concentrations are influenced by phases of their female partners' menstrual cycle; expecting a testosterone peak at ovulation.

    Methods: Thirty young, healthy, heterosexual couples were recruited. During the course of 30-40 days, the women registered menses and ovulation, while the men registered sexual activity, physical exercise, alcohol intake and illness (confounders), and obtained daily saliva samples for testosterone measurements. All data, including the registered confounders, were subjected to multiple regression analysis.

    Results: In contrast to the hypothesis, the ovulation did not affect the testosterone levels, and the resulting testosterone profile during the menstrual cycle was on the average flat. The specific main hypothesis, that male testosterone levels on the day of ovulation would be higher than day 4 of the cycle, was clearly contradicted by a type II error(β)-analysis (< 14.3% difference in normalized testosterone concentration; β = 0.05).

    Conclusions: Even though an ovulation-related salivary testosterone peak was observed in individual cases, no significant effect was found on a group level.

  • 13.
    Ström, Jakob O.
    et al.
    Linköping University Hospital, Linköping, Sweden.
    Theodorsson, Annette
    Linköping University Hospital, Linköping, Sweden.
    Theodorsson, Elvar
    Linköping University Hospital, Linköping, Sweden.
    Substantial discrepancies in 17beta-oestradiol concentrations obtained with three different commercial direct radioimmunoassay kits in rat sera2008In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 68, no 8, p. 806-813Article in journal (Refereed)
    Abstract [en]

    The extensive use of oestrogen for contraception and amelioration of post-menopausal symptoms has made it the subject of substantial recent research efforts, and ovariectomized (ovx) rats treated with exogenous ovarial hormones are important when investigating the effects and mechanisms of oestrogen actions. The crucial need to control and monitor plasma levels of 17beta-oestradiol calls for accurate, precise and robust assay methods. The performance of direct radioimmunoassays (RIAs) in measurement of 17beta-oestradiol has been reported previously for human samples, but to our knowledge not for rat samples. In the current study, 552 serum samples from ovx, native and hormone-treated rats were used to compare the performance of three commercially manufactured direct RIAs from the companies DPC (Siemens Healthcare Diagnostics Inc., formerly Diagnostic Products Corporation), DSL (Diagnostic Systems Labs) and MPB (MP Biomedicals, formerly ICN Biomedicals). Substantial differences in results between the three assay methods were found when measuring serum 17beta-oestradiol concentrations. The following formulas describing the relation between the different methods were obtained using weighted Deming's orthogonal regression (based on pg/mL): DSL = 0.43*DPC+12.3, MPB = 2.1*DPC+84.7 and DSL = 4.8*MPB+22.2. Furthermore, a preceding diethyl ether extraction step of the serum appears to impair the performance of the RIAs in the present samples (based on pg/mL): DPC(ex) = 0.39*DPC(unex)+0.76, DSL(ex) = 0.32*DSL(unex)-1.7 and MPB(ex) = 0.22*MPB(unex)+1.4.

  • 14.
    Sundh, Josefin
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Respiratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ställberg, Björn
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Lisspers, Karin
    Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
    Kämpe, Mary
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Janson, Christer
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Comparison of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) in a Clinical Population2016In: COPD: Journal of Chronic Obstructive Pulmonary Disease, ISSN 1541-2555, E-ISSN 1541-2563, Vol. 13, no 1, p. 57-65Article in journal (Refereed)
    Abstract [en]

    Introduction: The COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ) are both clinically useful health status instruments. The main objective was to compare CAT and CCQ measurement instruments.

    Methods: CAT and CCQ forms were completed by 432 randomly selected primary and secondary care patients with a COPD diagnosis. Correlation and linear regression analyses of CAT and CCQ were performed. Standardised scores were created for the CAT and CCQ scores, and separate multiple linear regression analyses for CAT and CCQ examined associations with sex, age (≤ 60, 61-70 and >70 years), exacerbations (≥1 vs 0 in the previous year), body mass index (BMI), heart disease, anxiety/depression and lung function (subgroup with n = 246).

    Results: CAT and CCQ correlated well (r = 0.88, p < 0.0001), as did CAT ≥ 10 and CCQ ≥ 1 (r = 0.78, p < 0.0001). CCQ 1.0 corresponded to CAT 9.93 and CAT 10 to CCQ 1.29. Both instruments were associated with BMI < 20 (standardised adjusted regression coefficient (95%CI) for CAT 0.56 (0.18 to 0.93) and CCQ 0.56 (0.20 to 0.92)), exacerbations (CAT 0.77 (0.58 to 0.95) and CCQ 0.94 (0.76 to 1.12)), heart disease (CAT 0.38 (0.17 to 0.59) and CCQ 0.23 (0.03 to 0.43)), anxiety/depression (CAT 0.35 (0.15 to 0.56) and CCQ 0.41 (0.21 to 0.60)) and COPD stage (CAT 0.19 (0.05 to 0.34) and CCQ 0.22 (0.07 to 0.36)).

    Conclusions: CAT and CCQ correlate well with each other. Heart disease, anxiety/depression, underweight, exacerbations, and low lung function are associated with worse health status assessed by both instruments.

  • 15.
    Svantesson, Mia
    Örebro University, School of Health and Medical Sciences.
    Postpone death?: Nurse-physician perspectives on life-sustaining treatment and ethics rounds2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics.

    In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

    List of papers
    1. End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?
    Open this publication in new window or tab >>End-of-life decisions in Swedish ICUs: how do physicians from the admitting department reason?
    2003 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 19, no 4, p. 241-251Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE:

    To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs).

    DESIGN:

    Qualitative interview that applies a phenomenological approach.

    SETTING:

    Two ICUs at one secondary and one tertiary referral hospital in Sweden.

    PARTICIPANTS:

    Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment.

    RESULTS:

    The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process.

    CONCLUSION:

    This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

    National Category
    Nursing
    Research subject
    Caring sciences
    Identifiers
    urn:nbn:se:oru:diva-2974 (URN)10.1016/S0964-3397(03)00055-7 (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2017-12-14Bibliographically approved
    2. Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients
    Open this publication in new window or tab >>Nurses’ and physicians’ opinions on aggressiveness of treatment for general ward patients
    2006 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 13, no 2, p. 147-162Article in journal (Refereed) Published
    Abstract [en]

    The aim of this study was to evaluate agreement between nurses’ and physicians’ opinions regarding aggressiveness of treatment and to investigate and compare the rationales on which their opinions were based. Structured interviews regarding 714 patients were performed on seven general wards of a university hospital. The data gathered were then subjected to qualitative and quantitative analyses. There was 86% agreement between nurses’ and physicians’ opinions regarding full or limited treatment when the answers given as ‘uncertain’ were excluded. Agreement was less (77%) for patients with a life expectancy of less than one year. Disagreements were not associated with professional status because the physicians considered limiting life-sustaining treatment as often as the nurses. A broad spectrum of rationales was given but the results focus mostly on those for full treatment. The nurses and the physicians had similar bases for their opinions. For the majority of the patients, medical rationales were used, but age and quality of life were also expressed as important determinants. When considering full treatment, nurses used quality-of-life rationales for significantly more patients than the physicians. Respect for patients’ wishes had a minor influence.

    National Category
    Social Sciences Interdisciplinary Nursing Humanities and the Arts Religious Studies
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2975 (URN)10.1191/0969733006ne861oa (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
    3. Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds
    Open this publication in new window or tab >>Learning a way through ethical problems: Swedish nurses’ and doctors’ experiences from one model of ethics rounds
    Show others...
    2008 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 399-406Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate one ethics rounds model by describing nurses' and doctors' experiences of the rounds.

    METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses' expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous.

    CONCLUSION: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented.

    National Category
    Humanities and the Arts Religious Studies Social Sciences Interdisciplinary Nursing
    Research subject
    Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-2976 (URN)10.1136/jme.2006.019810 (DOI)
    Available from: 2008-04-22 Created: 2008-04-22 Last updated: 2018-01-13Bibliographically approved
    4. Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds
    Open this publication in new window or tab >>Interprofessional ethics rounds concerning dialysis patients: staff's ethical reflections before and after rounds
    Show others...
    2008 (English)In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 34, no 5, p. 407-413Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To evaluate whether ethics rounds stimulated ethical reflection. METHODS: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd's framework but were also statistical in nature. FINDINGS: Seventy-six per cent of the respondents reported a moderate to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p < 0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. CONCLUSION: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice.

    Place, publisher, year, edition, pages
    London: BMJ Publ. Group, 2008
    National Category
    Nursing Social Sciences Interdisciplinary Humanities and the Arts
    Research subject
    vårdvetenskap
    Identifiers
    urn:nbn:se:oru:diva-5376 (URN)10.1136/jme.2007.023572 (DOI)
    Available from: 2009-02-06 Created: 2009-02-06 Last updated: 2018-01-13Bibliographically approved
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    FULLTEXT01
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