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  • 1. Amoudruz, Petra
    et al.
    Holmlund, Ulrika
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Sverremark-Ekström, Eva
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Maternal country of birth and previous pregnancies are associated with breast milk characteristics2009In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 20, no 1, p. 19-29Article in journal (Refereed)
    Abstract [en]

    Populations in high infectious exposure countries are at low risk of some immune-mediated diseases such as Crohn's disease and allergy. This low risk is maintained upon immigration to an industrialized country, but the offspring of such immigrants have a higher immune-mediated disease risk than the indigenous population. We hypothesize that early life exposures in a developing country shape the maternal immune system, which could have implications for the offspring born in a developed country with a low infectious load. The aim of this study was to investigate if exposures in childhood (indicated by country of origin) and subsequent exposures influence immunologic characteristics relevant to stimulation of offspring. Breast milk components among 64 mothers resident in Sweden, 32 of whom immigrated from a developing country, were examined using the ELISA and Cytometric Bead Array methods. Immigrants from a developing country had statistically significantly higher levels of breast milk interleukin-6 (IL-6), IL-8 and transforming growth factor-beta1. A larger number of previous pregnancies were associated with down-regulation of several substances, statistically significant for soluble CD14 and IL-8. The results suggest that maternal country of birth may influence adult immune characteristics, potentially relevant to disease risk in offspring. Such a mechanism may explain the higher immune-mediated disease risk among children of migrants from a developing to developed country. Older siblings may influence disease risk through the action of previous pregnancies on maternal immune characteristics.

  • 2. Bergqvist, L.
    et al.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences.
    Kronsberg, S.S.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Barton, B.
    Anand, K.J.S.
    Seeing through the blind!: ability of hospital staff to differentiate morphine from placebo, in neonates at a placebo controlled trial2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 7, p. 1004-1007Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate whether professional training and/or clinical experience affect the ability of caregiver to assess clinical signs of pre-emptive morphine analgesia. METHODS: In the Neurological Outcomes & Pre-emptive Analgesia In Neonates trial preterm infants undergoing mechanical ventilation were randomized to receive continuous infusion, either of morphine or placebo blinded. Staff from centres in Sweden (Stockholm and Orebro) completed an assessment form. RESULTS: A total of 360 assessment forms were collected from 52 neonates. In 59% of the cases, caregivers correctly identified patients group. Comparable proportion of answers were correct between physicians, nurses and assistant nurses (63, 60 and 54%, respectively, p = 0.60). Staff with Neonatal intensive care unit experience <1 year identified 63%, as compared to 65% for working 1-5 year, and 55% that has been working >5 years (p = 0.28). Staff's ability to correctly identify group assignment was reduced by amount of additional morphine (p < 0.01) and severity of illness (p = 0.01). CONCLUSIONS: Clinical medical staffs, including neonatologists, have great difficulties in assessing the presence and severity of pain. Further studies should focus on the methods for assessment of prolonged pain in preterm neonates, define the effects of adequate analgesia, and investigate the clinical factors that may alter neonatal responses to acute and prolonged pain.

  • 3.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hagberg, Jessika
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Leakage of isopropanol from port protectors used in neonatal intensive careManuscript (preprint) (Other academic)
  • 4.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm; Department of Statistics, Örebro University, Örebro, Sweden.
    Hygiene routines in the EXPRESS study: impact of hygiene routines and antibiotic prophylaxis on neonatal sepsis incidenceManuscript (preprint) (Other academic)
  • 5.
    Björkman Hjalmarsson, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business. Intervention and Implementation Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Department of Statistics, Örebro University, Örebro, Sweden.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics.
    Hygiene routines in the EXPRESS study: a Swedish national survey of hygiene practices in neonatal intensive careManuscript (preprint) (Other academic)
  • 6.
    Björkman, Louise
    et al.
    Örebro University, School of Medical Sciences. Department of Pediatrics, Örebro University Hospita, Örebro, Sweden.
    Hagberg, J.
    Department of Occupational and Environmental Medicine, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University, School of Medical Sciences.
    Ohlin, Andreas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Can the use of isopropanol impregnated caps cause alcohol leakage into intravenous lines?2017Conference paper (Refereed)
  • 7.
    Björkqvist, Maria
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Liljedahl, M.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Zimmermann, J.
    Department of Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Örebro University. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Söderquist, Bo
    Örebro University, School of Health and Medical Sciences. Department of Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Colonization pattern of coagulase-negative staphylococci in preterm neonates and the relation to bacteremia2010In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 29, no 9, p. 1085-1093Article in journal (Refereed)
    Abstract [en]

    Coagulase-negative staphylococci (CoNS) are the major cause of sepsis in extreme preterm (EPT) newborns, but data on the CoNS colonization in EPT newborns prior to invasive infection are limited. Our aim was to describe the early establishment of the CoNS microflora in EPT newborns and to compare the colonization pattern in neonates with and without positive CoNS blood cultures. From a cohort of 46 EPT neonates, newborns with positive CoNS blood culture were identified (n = 10) and compared with matched controls. Samples for bacterial cultures were obtained repetitively from nares, perineum, and umbilicus. All CoNS isolates were characterized using the PhenePlate system for biochemical fingerprinting. Persistent CoNS strains were found on day 2-3 after delivery in 7/20 newborns, and there was a tendency for earlier colonization in nares than in the perineum or umbilicus. The CoNS blood strains were prevalent in superficial sites prior to positive blood culture (11/14 blood strains), but no single invasive pathway was identified. Most CoNS blood strains (9/14) persisted on superficial sites after antibiotic treatment. We hypothesize that the invasive pathways in neonatal CoNS sepsis are complex and that the colonization of mucosal membranes and umbilical catheters might be of equal importance.

  • 8.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Storm, Hanne
    Fremming, Asbjörn
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Skin conductance compared to a combined behavioural and physiologicalpain measure in newborn infants2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 1, p. 27-30Article in journal (Refereed)
    Abstract [en]

    AIM: To assess the ability of galvanic skin response (GSR) to differentiate between tactile and painful stimulation in newborn infants, and to compare this with the ability of the premature infant pain profile (PIPP). METHODS: Thirty-two healthy full-term infants undergoing routine blood sampling were recruited. In a randomized order they were subjected to tactile and painful stimulation. The three GSR variables conductance baseline level, number of waves per second and mean amplitude of the waves were recorded together with the behavioural and physiological variables of PIPP. RESULTS: The GSR variables number of waves and amplitude of the waves increased more during painful stimulation than during tactile stimulation, as did also the PIPP score. Receiver operating characteristic curves analysis revealed no significant differences between the studied methods. CONCLUSION: GSR can differentiate painful from tactile stimulation, but more research is needed to achieve a clinically useful application.

  • 9. Falk, Gabriella
    et al.
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Magnuson, Anders
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Nilsson, Kerstin
    Örebro University, Department of Clinical Medicine.
    Teenage mothers: a high-risk group for new unintended pregnancies2006In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 74, no 6, p. 471-475Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: One of the targets of national health programs is to prevent unintended pregnancies, especially among teenagers. It is well established that these often lead to abortion. Preventive programs aimed at decreasing abortion rates should identify target groups at risk for unintended pregnancies.

    PURPOSE: This study was conducted to determine whether young mothers under 20 years of age constitute a group at risk for new unintended pregnancies.

    METHODS: A retrospective cohort study comprising teenagers giving birth to their first child from 1996 to 2000 was performed at Orebro University Hospital, Sweden. Data were collected from antenatal and medical records with particular regard to compliance with the postpartum visit and to whether a contraceptive method was prescribed. Information concerning repeat pregnancies during the 12 months after delivery was obtained.

    RESULTS: A total of 250 deliveries were recorded; 70% of the mothers attended the postpartum visit, and 71% received contraceptive prescriptions. At the 12-month follow-up, 56 (25%) had a new pregnancy, and of those, 20 (36%) had a legal abortion, making the abortion rate fivefold higher than expected in this age group.

  • 10. Fridström, Margareta
    et al.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Crossner, Claes-Göran
    Evaluating Emdogain and healing of replanted teeth using an intra-individual experimental-control study design2008In: Dental Traumatology, ISSN 1600-4469, E-ISSN 1600-9657, Vol. 24, p. 299-304Article in journal (Refereed)
    Abstract [en]

    The purpose of the present investigation was to use an intra-individual experimental-control study design to explore if application of Emdogain prior to re-plantation after a dry extra-alveolar period of 60 min would promote a favorable healing of the periodontal ligament cells. Ten patients, for whom already decisions had been taken to extract two maxillary premolars because of crowding, participated in the study. The teeth were extracted and endodontic treatment was performed extra orally. The experimental tooth and its alveolar socket were covered with Emdogain prior to replantation. The contra lateral tooth served as a control and was replanted without any prior treatment. The teeth were stabilized with a retainer for 3-7 days and the patients were followed up every third week. After 13 weeks, the teeth were finally extracted and prepared for histological examination. Radiographs were taken before the study period, at day 29 and prior to the final extraction. The results were in favor of Emdogain, but the overall difference between the Emdogain-treated tooth and its control was rather small, and it seemed questionable if the registered differences could be of any obvious practical clinical importance. Histologically, all the teeth showed some degree of pathology after such a long dry extra-oral time and the outcome seemed to be more correlated to the individual than to the treatment. Given more favorable conditions regarding storage medium and/or extra-oral time, Emdogain might still be of value for an uncomplicated healing after replantation.

  • 11.
    Holmlund, Ulrika
    et al.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Amoudruz, P.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Johansson, M. A.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden.
    Haileselassie, Y.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Ongoiba, A.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Kayentao, K.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Traoré, B.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Doumbo, S.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Doumbo, O.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences. Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden; Dept Primary Care & Social Med, Charing Cross Hosp, Univ London Imperial Coll Sci Technol & Med, London, England.
    Sverremark-Ekström, E.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Maternal country of origin, breast milk characteristics and potential influences on immunity in offspring2010In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 162, no 3, p. 500-509Article in journal (Refereed)
    Abstract [en]

    Breast milk contains pro- and anti-inflammatory cytokines and chemokines with potential to influence immunological maturation in the child. We have shown previously that country of birth is associated with the cytokine/chemokine profile of breast milk. In this study we have investigated how these differences in breast milk affect the cellular response of cord blood mononuclear cells (CBMCs) and intestinal epithelial cells (IECs, cell line HT-29) to microbial challenge. Ninety-five women were included: 30 from Mali in West Africa, 32 Swedish immigrants and 33 native Swedish women. CBMCs or IECs were stimulated in vitro with breast milk, alone or in combination with lipopolysaccharide (LPS) or peptidoglycan (PGN). Breast milk in general abrogated the LPS-induced down-regulation of surface CD14 and Toll-like receptor (TLR)-4 expression on CB monocytes, while inhibiting the PGN-induced TLR-2 up-regulation. However, breast milk from immigrant women together with LPS induced a lower CBMC release of interleukin (IL)-6 (P = 0 center dot 034) and CXCL-8/IL-8 (P = 0 center dot 037) compared with breast milk from Swedish women, while breast milk from Swedish women and Mali women tended to increase the response. The same pattern of CXCL-8/IL-8 release could be seen after stimulation of IECs (HT-29). The lower CBMC and IEC (HT-29) responses to microbial compounds by breast milk from immigrant women could be explained by the fact that breast milk from the immigrant group showed a divergent pro- and anti-inflammatory content for CXCL-8/IL-8, transforming growth factor-beta 1 and soluble CD14, compared to the other two groups of women. This may have implications for maturation of their children's immune responses.

  • 12.
    Ivarsson, Mikael
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Björkqvist, Maria
    Örebro University Hospital.
    Staphylococcus epidermidis and Staphylococcus aureus trigger different interleukin-8 and intercellular adhesion molecule-1 in lung cells: implications for inflammatory complications following neonatal sepsis2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 10, p. 1010-1016Article in journal (Refereed)
    Abstract [en]

    Aim: Staphylococci are a major contribution for neonatal sepsis, which is the main risk factor for bronchopulmonary dysplasia. This study investigated the expression of pro-inflammatory mediators in endothelial and respiratory cells from newborns exposed to staphylococci.

    Methods: Human vascular endothelial cells and small airway epithelial cells were incubated with neonatal blood isolates of Staphylococcus epidermidis (n = 14) and Staphylococcus aureus (n = 14). The extracellular release of IL-8, IL-10, sICAM-1, ICAM-1 mRNA and the expression of membrane bound ICAM-1 were assessed by ELISA, RT-PCR and immunofluorescence microscopy.

    Results: Staphylococcus epidermidis induced higher levels of IL-8 (mean 38.5 ng/mL) and ICAM-1 mRNA (mean ratio 1.037) in the small airway epithelial cells than S. aureus (IL-8 mean 22.2 ng/mL, p < 0.01 and ICAM-1 mRNA mean ratio 0.715, p < 0.01). In the endothelial cells, ICAM-1 remained more integrated in the cell membranes after exposure to S. epidermidis compared with S. aureus, which induced disintegration and release of soluble ICAM-1 into the supernatants.

    Conclusion: Staphylococcus epidermidis induced a higher chemoattractive response than S. aureus. A persistent transmigration of granulocytes into the lung tissue in neonatal S. epidermidis sepsis might contribute to the development of bronchopulmonary dysplasia.

  • 13.
    Jackson, Karin
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ternestedt, Britt-Marie
    Örebro University, School of Health and Medical Sciences. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Magnuson, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Parental stress and toddler behaviour at age 18 months after pre-term birth2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 2, p. 227-232Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.

  • 14.
    Jackson, Karin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Ternestedt, Britt-Marie
    Örebro University, Department of Nursing and Caring Sciences. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Magnuson, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Quality of care of the preterm infant: the parent and nurse perspective2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 1, p. 29-37Article in journal (Refereed)
    Abstract [en]

    AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.

    METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.

    RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.

    CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.

  • 15.
    Jackson, Karin
    et al.
    Örebro University, Department of Health Sciences.
    Ternestedt, Britt-Marie
    Schollin, Jens
    Development and construction of parental identity in preterm birth: qualitative analysis of mothers' and fathers' narrativesManuscript (preprint) (Other academic)
  • 16.
    Jackson, Karin
    et al.
    Örebro University, Department of Nursing and Caring Sciences.
    Ternestedt, Britt-Marie
    Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    From alienation to familiarity: experiences of mothers and fathers of preterm infants2003In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 43, no 2, p. 120-129Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The birth of a preterm infant has a long-term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse.

    AIM: The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life.

    METHODS: Seven consecutively selected sets of parents of preterm infants born at </=34 weeks of gestation with no serious congenital defects were interviewed 1-2 weeks after the infant's birth and at 2, 6 and 18 months of age, and the findings were analysed using a phenomenological method.

    FINDINGS: Internalization of parenthood was described as a time-dependent process, with four syntheses of experiences - alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full-term infants.

    CONCLUSIONS: The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents' expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.

  • 17. Liljedahl, Magnus
    et al.
    Martin, Helena
    Magnuson, Anders
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia: a pilot study2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, p. 909-914Article in journal (Refereed)
    Abstract [en]

    

    Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).

    Methods: Children born at ≤ 30 weeks 1994–2000 were investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.

    Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.

    Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.

  • 18. Nahmias, André J.
    et al.
    Schollin, Jens
    Örebro University.
    Abramowsky, Carlos
    Evolutionary-developmental perspectives on immune system interactions among the pregnant woman, placenta, and fetus, and responses to sexually transmitted infectious agents2011In: The evolution of infectious agents in relation to sex / [ed] André Nahmias, Dan Danielsson, Susa Beckman Nahmias, Oxford: Blackwell Science , 2011, Vol. 1230, p. 25-47Conference paper (Other academic)
    Abstract [en]

    A balance has evolved over deep time between the various immune systems of the "triad" that is linked together for a short period: the pregnant woman, the fetus, and the placenta. This balance is affected by, and helps to determine, the immune responses to maternal infectious agents that may be transmitted to the fetus/infant transplacentally, intrapartum, or via breast milk. This review identifies newer evolutionary concepts and processes related particularly to the human placenta, innate and adaptive immune systems involved in tolerance, and in responses to sexually transmitted infectious (STI) agents that may be pathogenic to the fetus/infant at different gestational periods and in the first year of life. An evolutionary developmental (EVO-DEVO) perspective has been applied to the complexities within, and among, the different actors and their beneficial or deleterious outcomes. Such a phylogenetic and ontogenic approach has helped to stimulate several basic questions and suggested possible explanations and novel practical interventions.

  • 19.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
    Björkman, Louise
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Serenius, Fredrik
    Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics.
    Källén, Karin
    Department of Obstetrics and Gynecology, Clinical Sciences, Centre of Reproduction Epidemiology, University of Lund, Lund, Sweden.
    Sepsis as a risk factor for neonatal morbidity in extremely preterm infants2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 11, p. 1070-1076Article in journal (Refereed)
    Abstract [en]

    Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.

    Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.

    Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

    Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

  • 20.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott M.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden;.
    Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1635-1640Article in journal (Refereed)
    Abstract [en]

    Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

    Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

    Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

    Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

  • 21. Ohlin, Andreas
    et al.
    Bäckman, Anders
    Björkqvist, Maria
    Mölling, Paula
    Jurstrand, Margaretha
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 10, p. 1376-1380Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.

  • 22.
    Ohlin, Andreas
    et al.
    Örebro University, School of Health and Medical Sciences.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Diagnosis of neonatal sepsis by broad range 16S real-time PCRManuscript (preprint) (Other academic)
    Abstract [en]

    Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.

  • 23.
    Ohlin, Andreas
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Björkqvist, Maria
    Örebro University, School of Health and Medical Sciences. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Diagnosis of neonatal sepsis by broad-range 16S real-time polymerase chain reaction2012In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 101, no 4, p. 241-246Article in journal (Refereed)
    Abstract [en]

    Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 16S polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis. Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Methods: Immediately after blood culture, a study sample of 0.5–1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis. Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PCR (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample. Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics.

  • 24. Peerzada, Jehanna M.
    et al.
    Schollin, Jens
    Örebro University, Department of Clinical Medicine.
    Håkansson, Stellan
    Delivery room decision-making for extremely preterm infants in Sweden2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 117, no 6, p. 1988-1995Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess neonatologists' attitudes and practices regarding treatment of extremely preterm infants in the delivery room, particularly in response to parental wishes. STUDY DESIGN: Cross-sectional survey of all neonatologists in Sweden registered with the Swedish Pediatric Society. RESULTS: The response rate was 71% (88 of 124 neonatologists). At 24[1/7] to 24[6/7] weeks of gestation, 68% of neonatologists considered treatment clearly beneficial; at 25[1/7] to 25[6/7] weeks of gestation, 93% considered it clearly beneficial. When respondents consider treatment clearly beneficial, 97% reported that they would resuscitate in the delivery room despite parental requests to withhold treatment. At or below 23[0/7] weeks of gestation, 94% of neonatologists considered treatment futile. Nineteen percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, 99% reported that they would resuscitate when parents request it, 99% reported that they would resuscitate when parents are unsure, and 25% reported that they would follow parental requests to withhold treatment. CONCLUSION: Although neonatologists' attitudes and practices varied, respondents to our survey in general envisioned little parental role in delivery room decision-making for extremely preterm infants.

  • 25.
    Schollin, Jens
    et al.
    Örebro University, School of Medical Sciences.
    Lindgren, Stefan
    Lund University, Malmö, Sweden .
    Starten på det yrkeslivslånga lärandet som läkare [A new internationally harmonized Swedish basic medical education]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, no 35-36, article id FR4SArticle in journal (Refereed)
    Abstract [sv]

    The Swedish Parliament and Government has recently sanctioned a new 6 year undergraduate medical degree leading directly to license, followed by a 12 month introduction to work as a certified doctor. The undergraduate education is internationally harmonized and the 23 learning outcomes address competence needs in future Swedish and international health-care. Particular attention is given to professional competence, critical thinking, team-work and health promotion. All 23 learning outcomes must be documented before the University can issue a MD degree. After license, the doctor applies for a 12 month introduction to employment as doctor in the Swedish health-care system. This introduction is mandatory for all, regardless of the country where the license was issued. The introduction comprises clinical service in general medicine, emergency medicine and elective disciplines. Assessment of 10 learning outcomes is carried out in a formative wav by experienced and trained clinicians during the clinical service. After the introduction, the doctor is duly qualified to apply for specialist training.

  • 26.
    Stenberg, Reidun
    et al.
    Örebro University, School of Health and Medical Sciences.
    Dahle, Charlotte
    Lindberg, Eva
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Increased prevalence of anti-gliadin antibodies and anti-tissue transglutaminase antibodies in children with cerebral palsy2009In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 49, no 4, p. 424-429Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVE:: The aim of the study was to investigate whether there is any association between cerebral palsy (CP) and celiac disease (CD) in children.

    PATIENTS AND METHODS:: Ninety children between 18 months and 18 years of age (median 9 years) with CP were included. Antibodies (IgA and IgG) against gliadin (AGA), endomysium (EMA), and tissue transglutaminase (tTG) were measured. Children with elevated levels of these antibodies were offered a small-bowel biopsy. RESULTS:: Thirty-nine children showed an elevated level of 1 or more of the tested antibodies (43%). None had raised EMA antibodies. Presence of tetraplegia or dyskinesia was associated with increased antibody levels (P = 0.045), as was a more severe functional type of CP (P = 0.008). Children with elevated antibodies had a lower body weight (P = 0.049), height (P = 0.041), and body mass index (BMI) (P = 0.014). Small-bowel biopsies were performed in 27 out of 39 children; 1 had CD and 2 had intraepithelial lymphocytosis.

    CONCLUSIONS:: A large number of children with CP had elevated AGA and/or anti-tTG. Because these elevations were associated with lower weight, height, and BMI, it seemed of interest to speculate on how these findings correlated to CP and CD. However, we found no correlation between CP and CD.

  • 27.
    Stenberg, Reidun
    et al.
    Örebro University, School of Health and Medical Sciences.
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Is there a connection between severe cerebral palsy and increased gluten sensitivity?2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 1, p. 132-134Article in journal (Refereed)
    Abstract [en]

    In nine children with severe cerebral palsy (CP), feeding difficulties and poor development of weight and height, laboratory markers for metabolic and enteral dysfunction were studied. CONCLUSION: Four of the nine patients with CP had increased levels of antigliadin antibodies AGA (IgA), a finding which calls for further studies concerning the possible connection between increased celiac markers and CP.

  • 28. Wall, Kent
    et al.
    Oddsson, Hjörtur
    Ternestedt, Britt-Marie
    Jonzon, Anders
    Nylander, Eva
    Schollin, Jens
    Örebro University, School of Health and Medical Sciences.
    Thirty-year electrocardiographic follow-up after repair of tetralogy of Fallot or atrial septal defect2007In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 40, no 2, p. 214-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: Knowledge about long-term electrocardiographic changes after surgery for congenital heart disease is limited. METHODS: Eleven patients with corrected tetralogy of Fallot (ToF) and 14 with corrected atrial septal defect (ASD) were followed up at 20 and 30 years after surgery. RESULTS: Approximately 50% of the ASD group developed prolonged QRS duration. In the ToF group, 7 increased QRS duration by more than 20 milliseconds. Nearly all had right bundle-branch block, and 30% of them also had bifascicular block. Two in the ASD group developed first grade atrioventricular block. Five ASD and 6 ToF had prolonged corrected QT duration in the late postoperative phase. CONCLUSIONS: Even after primarily good results of surgery in congenital heart disease, unknown late effects may occur not only in complex lesions such as ToF but also after ASD correction. Regular medical checkups are important after surgical correction in congenital heart disease.

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