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  • 147401.
    Waiswa, Peter
    et al.
    Makerere University School of Public Health, Kampala, Uganda.
    Peterson, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Internationell mödra- och barnhälsovård (IMCH).
    Tomson, Goran
    Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Pariyo, George W
    Makerere University School of Public Health, Kampala, Uganda.
    Poor newborn care practices: a population based survey in eastern Uganda2010Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 10, artikkel-id 9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Four million neonatal deaths are estimated to occur each year and almost all in low income countries, especially among the poorest. There is a paucity of data on newborn health from sub-Saharan Africa and few studies have assessed inequity in uptake of newborn care practices. We assessed socioeconomic differences in use of newborn care practices in order to inform policy and programming in Uganda.

    METHODS:

    All mothers with infants aged 1-4 months (n = 414) in a Demographic Surveillance Site were interviewed. Households were stratified into quintiles of socioeconomic status (SES). Three composite outcomes (good neonatal feeding, good cord care, and optimal thermal care) were created by combining related individual practices from a list of twelve antenatal/essential newborn care practices. Multiple logistic regression analysis was used to identify determinants of each dichotomised composite outcome.

    RESULTS:

    There were low levels of coverage of newborn care practices among both the poorest and the least poor. SES and place of birth were not associated with any of the composite newborn care practices. Of newborns, 46% had a facility delivery and only 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding. Mothers were putting powder on the cord; using a bottle to feed the baby; and mixing/replacing breast milk with various substitutes. Multiparous mothers were less likely to have safe cord practices (OR 0.5, CI 0.3 - 0.9) as were mothers whose labour began at night (OR 0.6, CI 0.4 - 0.9).

    CONCLUSION:

    Newborn care practices in this setting are low and do not differ much by socioeconomic group. Despite being established policy, most neonatal interventions are not reaching newborns, suggesting a "policy-to-practice gap". To improve newborn survival, newborn care should be integrated into the current maternal and child interventions, and should be implemented at both community and health facility level as part of a universal coverage strategy.

  • 147402.
    Wajda, Aldona
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Engström, Helena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Persson, Lennart
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Lungmedicinska kliniken US.
    Medical talc pleurodesis: which patient with cancer benefits least?2014Inngår i: Journal of Palliative Medicine, ISSN 1096-6218, E-ISSN 1557-7740, Vol. 17, nr 7, s. 822-828Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    Successful talc pleurodesis (TP) for malignant pleural effusion (MPE) gives symptom relief, but may be too exhaustive in cases with poor performance status. The selection of eligible patients is therefore a challenging task. The study was undertaken to evaluate frequency of successful TPs, side effects, complications, performance status, hospitalization time, remaining time alive, and the responsible physician's prediction of a successful TP judged by radiologic findings prior to TP.

    METHODS:

    Side effects of TPs performed during a 1-year period were consecutively recorded and the TP outcomes were retrospectively evaluated 6 years later.

    RESULTS:

    TP success rate was 56% and 79% among best support of care subjects (BSC; n=10) and subjects eligible for cancer therapy (non-BSC; n=19), respectively, while side effects did not differ. Performance status was poorer and survival shorter among BSC subjects. Time spent in hospital of the remaining time alive for BSC and non-BSC subjects was 42%±27% and 4%±4%, respectively. Poor performance status of subjects with lung cancer correlated with short survival time, which in turn correlated with many days at hospital for TP. The physician's prediction of a successful TP was correct in 50% of all cases.

    CONCLUSIONS:

    Performance status of BSC subjects are probably too poor for TP and these subjects have to spend too much time at hospital during the procedure. The responsible physician is able to correctly predict a successful TP outcome in only every second case, supporting the need of additional predictive analysis.

  • 147403. Wakamatsu, Kazumasa
    et al.
    Takasaki, Akihiko
    Kågedal, Bertil
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för klinisk kemi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Kageshita, Toshiro
    Ito, Shosuke
    Determination of eumelanin in human urine2006Inngår i: Pigment Cell Research, ISSN 1755-1471, E-ISSN 1755-148X, Vol. 19, nr 2, s. 163-169Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Normal and malignant melanocytes produce melanins and melanin-related metabolites, most of which are retained in the cells but some are secreted into the blood and then excreted in the urine. In this study, we developed a method to measure levels of eumelanin in urine samples and evaluated its clinical significance in comparison with the melanin-related metabolites 6-hydroxy-5-methoxyindole-2-carboxylic acid (6H5MI2C) and 5-S-cysteinyldopa (5-S-CD), and with pheomelanin, measured after degradation as 4-amino-3-hydroxyphenylalanine (4-AHP). The method is based on the production of pyrrole-2,3,5-tricarboxylic acid (PTCA) on permanganate oxidation of eumelanin, followed by quantification by liquid chromatography. For 118 urine samples from 10 control subjects, mean urinary excretions of PTCA, 6H5MI2C, 5-S-CD and 4-AHP were 19, 67, 37 and 59 μmol/mol creatinine respectively. In melanoma patients (n = 45), the mean urinary excretions of PTCA, 6H5MI2C, 5-S-CD, and 4-AHP were 91, 926, 4070 and 3530 μmol/mol creatinine respectively. Median level of PTCA in melanoma patients was elevated 2.1-fold compared with control subjects. The degrees of elevation for 6H5MI2C, 5-S-CD, and 4-AHP were 1.8-, 22- and 6.2-fold respectively. Thus, although urinary PTCA is of little clinical value in following the progression of melanoma, urinary 4-AHP appears to be of considerable value in this respect. © 2006 Blackwell Munksgaard.

  • 147404.
    Wakasugi, Masahiro
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Nilsson, Heléne
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Hornwall, Johan
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet.
    Vikström, Tore
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet.
    Rüter, Anders
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Can performance indicators be used for pedagogic purposes in disaster medicine training?2009Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 17, nr 15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although disaster simulation trainings were widely used to test hospital disaster plans and train medical staff, the teaching performance of the instructors in disaster medicine training has never been evaluated. The aim of this study was to determine whether the performance indicators for measuring educational skill in disaster medicine training could indicate issues that needed improvement.

    METHODS: The educational skills of 15 groups attending disaster medicine instructor courses were evaluated using 13 measurable performance indicators. The results of each indicator were scored at 0, 1 or 2 according to the teaching performance.

    RESULTS: The total summed scores ranged from 17 to 26 with a mean of 22.67. Three indicators: 'Design', 'Goal' and 'Target group' received the maximum scores. Indicators concerning running exercises had significantly lower scores as compared to others.

    CONCLUSION: Performance indicators could point out the weakness area of instructors' educational skills. Performance indicators can be used effectively for pedagogic purposes.

  • 147405. Wake, Deborah J
    et al.
    Rask, Eva
    Livingstone, Dawn E W
    Söderberg, Stefan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Walker, Brian R
    Local and systemic impact of transcriptional up-regulation of 11beta-hydroxysteroid dehydrogenase type 1 in adipose tissue in human obesity.2003Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 88, nr 8, s. 3983-3988Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In idiopathic obesity circulating cortisol levels are not elevated, but high intraadipose cortisol concentrations have been implicated. 11beta-Hydroxysteroid dehydrogenase type 1 (11HSD1) catalyzes the conversion of inactive cortisone to active cortisol, thus amplifying glucocorticoid receptor (GR) activation. In cohorts of men and women, we have shown increased ex vivo 11HSD1 activity in sc adipose tissue associated with in vivo obesity and insulin resistance. Using these biopsies, we have now validated this observation by measuring 11HSD1 and GR mRNA and examined the impact on intraadipose cortisol concentrations, putative glucocorticoid regulated adipose target gene expression (angiotensinogen and leptin), and systemic measurements of cortisol metabolism. From aliquots of sc adipose biopsies from 16 men and 16 women we extracted RNA for real-time PCR and steroids for immunoassays. Adipose 11HSD1 mRNA was closely related to 11HSD1 activity [standardized beta coefficient (SBC) = 0.58; P < 0.01], and both were positively correlated with parameters of obesity (e.g. for BMI, SBC = 0.48; P < 0.05 for activity, and SBC = 0.63; P < 0.01 for mRNA) and insulin sensitivity (log fasting plasma insulin; SBC = 0.44; P < 0.05 for activity, and SBC = 0.33; P = 0.09 for mRNA), but neither correlated with urinary cortisol/cortisone metabolite ratios. Adipose GR-alpha and angiotensinogen mRNA levels were not associated with obesity or insulin resistance, but leptin mRNA was positively related to 11HSD1 activity (SBC = 0.59; P < 0.05) and tended to be associated with parameters of obesity (BMI: SBC = 0.40; P = 0.09), fasting insulin (SBC = 0.65; P < 0.05), and 11HSD1 mRNA (SBC = 0.40; P = 0.15). Intraadipose cortisol (142 +/- 30 nmol/kg) was not related to 11HSD1 activity or expression, but was positively correlated with plasma cortisol. These data confirm that idiopathic obesity is associated with transcriptional up-regulation of 11HSD1 in adipose, which is not detected by conventional in vivo measurements of urinary cortisol metabolites and is not accompanied by dysregulation of GR. Although this may drive a compensatory increase in leptin synthesis, whether it has an adverse effect on intraadipose cortisol concentrations and GR-dependent gene regulation remains to be established.

  • 147406. Wakelee, Heather A.
    et al.
    Chang, Ellen T.
    Gomez, Scarlett L.
    Keegan, Theresa H.
    Feskanich, Diane
    Clarke, Christina A.
    Holmberg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Yong, Lee C.
    Kolonel, Laurence N.
    Gould, Michael K.
    West, Dee W.
    Lung cancer incidence in never smokers2007Inngår i: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 25, nr 5, s. 472-478Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited. METHODS: We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study. RESULTS: Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers. CONCLUSION: Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.

  • 147407.
    Walby, Sylvia
    et al.
    Lancaster University, Lancaster, UK.
    Olive, Philippa
    Lancaster University, Lancaster, UK.
    Towers, Jude
    Lancaster University, Lancaster, UK.
    Francis, Brian
    Lancaster Univertsity, Lancaster, UK.
    Strid, Sofia
    Örebro universitet, Institutionen för humaniora, utbildnings- och samhällsvetenskap.
    Krizsan, Andrea
    Central European University, Budapest, Slovakia.
    Lombardo, Emanuela
    Universidad Complutense, Madrid, Spain.
    May-Chahal, Corinne
    Lancaster University, Lancaster, UK.
    Franzway, Suzanne
    University of South Australia, Adelaide, Australia.
    Sugarman, David
    Lancaster University, Lancaster, UK.
    Agarwal, Bina
    University of Dehli, Dehli, India.
    Stopping rape: towards a comprehensive policy2015Bok (Fagfellevurdert)
  • 147408. Walch, A.
    et al.
    Sjöberg, Mats
    Meshkat, M.
    Gustavsson, A.
    Järnerot, G.
    Vogelsang, H.
    Hertervig, E.
    Novacek, G.
    Friis-Liby, I.
    Blomquist, L.
    Angelberger, S.
    Karlen, P.
    Grännö, C.
    Vilien, M.
    Ström, M.
    Verbaan, H.
    Hellström, P. M.
    Ngo, Y.
    Halfvarson, Jonas
    Reinisch, W.
    Tysk, Curt
    Örebro universitet, Hälsoakademin.
    Outcome of rescue therapy in steroid-resistant ulcerative colitis: a retrospective study comparing cyclosporine and infliximab2008Inngår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 57(Suppl II), s. A265-Artikkel i tidsskrift (Fagfellevurdert)
  • 147409.
    Walczak Larsson, Beata
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Rheborg, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Synen på den kroppsliga hälsan: En intervjustudie med unga vuxna med psykossjukdom2014Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund 

    Många studier visar att personer med psykiska besvär oftare drabbas av fysisk ohälsa och unga personer med psykossjukdom utgör en speciellt utsatt grupp.

    Syfte

    Syftet var att undersöka hur unga vuxna med psykossjukdomar upplever sin kroppsliga hälsa. Arbetet syftade även till att kartlägga patienternas uppfattning om hjälp- och stödbehov när det gäller upprätthållande/förbättring av hälsotillståndet.

    Metod

    En kvalitativ studie med intervjuer med tio patienter. Intervjuerna analyserades med kvalitativ innehållsanalys.

    Resultat

    Analysen ledde fram till ett tema: Synen på den kroppsliga hälsan är en strävan efter att med stöd och hjälp leva ett liv som alla andra. Temat uppstod utifrån fyra kategorier.

    1. Hur man lever livet – livsstilsaspekter som studiedeltagarna förknippade med kroppslig hälsa, dvs. motion, kost, rökning, rutiner i vardagen.

    2. Att känna sig frisk – kroppslig hälsa som motsats till sjukdom. Kategorin inkluderar även balans och energi.

    3. Hälsa som en process – beskrivning av hälsa i följande dimensioner: gemenskap och självständighet, vändpunkt och förändring samt sorg och hopp.

    4. Stöd och hjälp från hälso- och sjukvården – studiedeltagarnas erfarenhet av tillit samt önskemål om större tillgänglighet, mer individanpassade insatser och utökat finansiellt stöd.

    Slutsats

    Unga vuxna med psykossjukdom uppfattade kroppslig hälsa som ett mångdimensionellt fenomen som gick långt utanför den biomedicinska traditionen där hälsa ses som frånvaro av sjukdom. Det är patientens egen förståelse av hens hälsa som borde styra psykiatrisjuksköterskans omvårdnadsarbete i stort och hälsofrämjande insatser i synnerhet.

  • 147410.
    Waldau, Markus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    A study on the feasibility of predicting depression symptoms using DNA methylation data on five genes of interest2017Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
  • 147411.
    Waldau, Markus
    Örebro universitet, Institutionen för läkarutbildning.
    Does BMI and muscle strength in adolescents affect the risk of type 2 diabetes later in life?2014Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 147412.
    Waldau, Susanne
    Västerbottens läns landsting. Umeå universitet, Institutionen för folkhälsa och klinisk medicin.
    Att skapa förutsättningar för prioriteringsarbete i ett landsting2013Inngår i: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson och Susanne Waldau, Lund: Studentlitteratur, 2013, 1:1, s. 169-188Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 147413.
    Waldau, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Västerbotten County Council, Sweden.
    Bottom-up priority setting revised: a second evaluation of an institutional intervention in a Swedish health care organisation2015Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, nr 9, s. 1226-1236Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. Aims: Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. Methods: An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. Results: Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. Conclusions: Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required.

  • 147414.
    Waldau, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Creating organisational capacity for priority setting in health care: using a bottom-up approach to implement a top-down policy decision2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In this thesis, priority setting to the form of the Swedish parliamental decision on priority setting, 1997, is considered an innovation for implementation in health care. The features of this innovation are investigated. The practical implications of implementation are identified by investigating the user organisation, ie, Swedish health care organisations and management systems.

    Also, a case of a three-stage process for macro-level priority setting that engaged the entire organisation in the Västerbotten County Council (VCC) is presented. This is done against a background of preceding implementation efforts in the VCC.

    Four specific research efforts and papers are presented.

    In Paper I, priority setting is operationalised into a multi-dimensional resource allocation task. On that basis, with the help of interviews (1998) and surveys (2002 and 2005) primarily of VCC health care managers, the impact of implementation is measured by prioritisation structures, processes and decisions. Survey response rates were low. Results were used as qualitative data, internally compared, and interpreted as: a) responses reflected mainly “early adopters’” opinions; b) priority setting is an ambiguous concept; c) indicating limited overall implementation; d) reinterpretation of the prioritisation task occurred over time among respondents; and, e) this group took increasingly personal responsibility as stakeholders in priority setting.

    Paper II reports a case study intervention of explicit, departmental level priority setting with the aim of improving cost-effectiveness in in vitro fertilization resource use and a rationing of services perceived legitimate by all stakeholders. The intervention combined priority setting and structured quality improvement techniques. Results were: a) improved operational efficiency of diagnostic procedures that allowed resources to be reallocated to treatment; and b) patients were prioritized and treatment resources were rationed based on evidence of treatment effect among subgroups. Evaluation showed that the procedure met stated criteria for legitimacy.

    In Paper III, a full-format test of the macro level prioritisation process is described and evaluated by participants with the help of surveys after each completed stage. Participants report the need for improvement of elements in the overall process and of procedural specifics. However, overall there was a strong commitment to the initiative and satisfaction with the process and the resulting decisions.

    In Paper IV, procedural specifics of the prioritisation process are evaluated. They are also compared to the Program Budgeting and Marginal Analysis (PBMA) framework when used for macro level purposes. Procedures provided intended results such as vertical and horizontal priority setting and a consistent process. However, economic targets were not fully achieved in any of the stages.

    Conclusions include that health care management systems are not prepared for priority setting and need profound restructuring and that the prioritisation process described in Papers III and IV was successful because: a) the process satisfied politicians’ directives; b) participants were satisfied with the procedures and perceived the subsequent reallocation decisions as legitimate; and, c) methods resulted in the intended outcome.

    Factors suggested as the basis of success include: long-term overall preparations; broad and deep participation; a readiness for change among participants; a stage for horizontal priority setting that added to the quality, feasibility and perceived validity of the knowledge base; a strong process leadership; and politicians determined to protect the process from opportunistic disturbances.

  • 147415.
    Waldau, Susanne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Local prioritisation work in health care: assessment of an implementation process2007Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 81, nr 2-3, s. 133-145Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Political, horizontal prioritisation requires knowledge on local health care resource use on unit or patient group level. This in turn requires unit level structures (meeting forums) and processes for creation of knowledge and continuous, open decision-making on prioritisation. Ideally, for decisions to be legitimate, such procedures should meet the "Accountability for reasonableness"-criteria of Daniels and Sabin [Daniels N. Accountability for reasonableness. Establishing a fair process for priority setting is easier than agreeing on principles. British Medical Journal 2000;321:1300-1]. A strategy, aiming at shaping such an organisational culture, was developed and set to work within a regional health care organisation, responsible for around 250000 inhabitants. This pilot study regarding topic and methodology assesses the changes of knowledge in open prioritisation as well as structures, processes for and results of such work on unit level in that organisation 1998 through early 2005. Initial interviews and two consecutive surveys were analysed. Results indicate that only early adopters respond to the surveys and among them a growing knowledge in priority setting, acceptance of personal leadership for local priority setting work and recognition of a need for adequate structures and processes. Among respondents, one could note a development: A tentative model expressing different positions towards prioritisation was developed.

  • 147416.
    Waldau, Susanne
    Västerbottens läns landsting.
    Prioriteringar i Västerbottens läns landsting 2008 Del I. Procedur, genomförande och uppföljning2009Rapport (Annet vitenskapelig)
    Abstract [sv]

    Prioriteringsarbetet i Västerbottens läns landsting hösten 2008 syftade till omfördelning, att finansiera ny och högprioriterad verksamhet genom att begränsa utbudet av de lägst prioriterade tjänsterna. I full enighet över partigränserna och med tjänstemannaledningen bestämde sig landstingets politiska ledning för att på en och samma gång både konstruera en procedur och testa den i full skala på hela organisationen.

    Arbetet kom att omfatta tre olika faser där helt olika metoder användes och där även aktörerna delvis byttes ut. Proceduren i sin helhet byggdes utifrån ambitionen att politiker, ledning och verksamhet skulle ta ömsesidigt ansvar.

    Fas I innefattade vertikal prioritering. Här skulle alla basenheter identifiera sin lägst prioriterade verksamhet, motsvarande tio procent av nettobudgeten. För detta användes den nationella modellen för vertikala prioriteringar.

    Avsikten var också att arbetet skulle innehålla ett moment som involverade verksamhetschefer och andra nyckelpersoner i verksamheten för att jämföra och jämna ut resursfördelningen mellan enheter, d v s horisontell prioritering på verksamhetsnivå. För detta konstruerades en särskild procedur, Fas II, horisontell prioritering.

    Fas III innefattade en nybildad mötesplats, Prioriteringsforum, samt politisk beredning och beslut. Politikerna ville ta ansvar för prioriteringsbesluten – det som skulle begränsas eller tas bort men även det som skulle introduceras eller förstärkas. Med andra ord skulle arbetet även innefatta horisontell prioritering på den politiska nivån. För detta konstruerades Prioriteringsforum. Där presenterade verksamhetsföreträdare och landstingets tjänstemannaledning förslagen till begränsning av utbudet för ledarna för samtliga politiska partier i landstinget. Likaså presenterades högprioriterade åtgärder aktuella för finansiering. De högprioriterade åtgärderna hade identifierats genom en särskild procedur. Sedan vidtog politisk beredning i styrgruppen och sedermera i partigrupperna. Den följdes av ett beslut i landstingsstyrelsen kring begränsning av åtagandet och finansiering av högt prioriterade åtgärder samt åtföljande justering i landstingsfullmäktige av verksamheternas budgetramar för 2009. Totalt omfördelades 114 miljoner kronor från lågt till högt prioriterade åtgärder och verksamheter.

    För att utvärdera arbetssättet följdes det noga bl a med enkäter. De konstruerades under gång och utfördes av landstinget i samverkan med Umeå universitet och i samråd med en landstingsintern referensgrupp. Enkäterna syftade i första hand till att avspegla deltagarnas attityder till och erfarenheter av arbetet som grund för fortsatt utveckling av processen.

  • 147417.
    Waldau, Susanne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Results of a full-format priority setting process: evaluating proceduresManuskript (preprint) (Annet vitenskapelig)
  • 147418.
    Waldau, Susanne
    et al.
    Vasterbotten Cty Council, Strateg Hlth Care Management .
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Some corrective notes regarding recent priority setting in Sweden2011Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 39, nr 5, s. 553-554Artikkel i tidsskrift (Fagfellevurdert)
  • 147419.
    Waldau, Susanne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindholm, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Wiechel, Anna Helena
    Priority setting in practice: participants opinions on vertical and horizontal priority setting for reallocation2010Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 96, nr 3, s. 245-254Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In the Västerbotten County Council in Sweden a priority setting process was undertaken to reallocate existing resources for funding of new methods and activities. Resources were created by limiting low priority services. A procedure for priority setting was constructed and fully tested by engaging the entire organisation. The procedure included priority setting within and between departments and political decision making. Participants' views and experiences were collected as a basis for future improvement of the process. Results indicate that participants appreciated the overall approach and methodology and wished to engage in their improvement. Among the improvement proposals is prolongation of the process in order to improve the knowledge base quality. The procedure for identification of new items for funding also needs to be revised. The priority setting process was considered an overall success because it fulfilled its political goals. Factors considered crucial for success are a wish among managers for an economic strategy that addresses existing internal resource allocation; process management characterized by goal orientation and clear leadership; an elaborate communications strategy integrated early in the process and its management; political unity in support of the procedure, and a strong political commitment throughout the process. Generalizability has already been demonstrated by several health care organisations that performed processes founded on this working model.

  • 147420.
    Waldau, Viktor
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Elfvik, Max
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Äldre patienters upplevelser av ADL inom slutenvården2014Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund

    Förlust av förmågan att utföra självständig ADL är ett vanligt problem hos äldre i slutenvården. Detta leder till lidande och förlängda vårdtider. För att kunna utveckla omvårdnaden och för att motverka detta behövs ökad insikt om patienternas upplevelser vid minskad ADL-förmåga.

    Syfte

    Att beskriva äldre patienter med försämrad ADL-förmågas upplevelser av sin vård gällande utförande av ADL inom slutenvården.

    Metod

    Kvalitativ intervjustudie med åtta äldre patienter inneliggande på ett svenskt universitetssjukhus.

    Resultat

    Studiedeltagarna upplevde överlag att vården och personalen fungerade bra och att detta förbättrade deras upplevelse av att ha minskat i ADL-förmåga. Studiedeltagarna tyckte det var jobbigt att vara beroende av andra och få hjälp med personlig hygien. Vårdavdelningarnas rutiner och upplevelsen av att personalen var stressad gjorde att studiedeltagarna inte ville vara till besvär och ställa krav.

    Slutsats

    Resultaten visar att det finns ett behov av att utveckla ett mer personcentrerat förhållningsätt där riskpatienter identifieras och får möjlighet att vara delaktiga i arbetet för att stärka förmågan till självständigt utförande av ADL.

  • 147421.
    Walde, Emma
    et al.
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Isaksson, Cecilia
    Linnéuniversitetet, Fakulteten för Hälso- och livsvetenskap (FHL), Institutionen för hälso- och vårdvetenskap (HV).
    Sjuksköterskans upplevelse av att vårda barn med cancer: En systematisk litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Varje år insjuknar cirka 320 barn i cancer i Sverige. När ett barn diagnostiseras med cancer drabbas inte bara barnet utan även hela familjen. Sjuksköterskan ska fungera som stöd både för patienten och dess anhöriga. Joyce Travelbees teori har varit utgångspunkt i denna studie. Syfte: Syftet med denna studie var att belysa sjuksköterskans upplevelse att vårda barn med cancer. Metod: En systematisk litteraturstudie som bearbetats genom en kvalitativ innehållsanalys. Resultat: Resultatet utgår från två kategorier: Sjuksköterskans yrkesroll och Sjuksköterskans kompetens. Att skapa goda och förtroendefulla relationer samt ha en god kommunikation till patienten och familjen identifierades som grunden för god vård. I rollen som sjuksköterska är det även viktigt att inneha kunskap och erfarenhet för att ge en trygg och säker vård till barnet och familjen. Slutsats: Sjuksköterskan har en viktig roll i vårdandet av barn med cancer och att skapa en relation till patienten och dennes familj är en grundläggande faktor för allt som vården innebär. Det krävs även att sjuksköterskan innehar kunskap och erfarenhet för att bedriva en trygg vård. För att ge stöd och tröst till patienten och familjen krävs en god och individanpassad kommunikation.

  • 147422.
    Waldebring, Jessica
    Linnéuniversitetet, Fakultetsnämnden för naturvetenskap och teknik, Institutionen för naturvetenskap, NV.
    Kan diskrepanser i journalens läkemedelslista minskas genom egenavstämning och/eller läkemedelsverifiering och är minskningen i så fall relaterad till ålder?2012Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Läkemedelsrelaterade problem, som t.ex. felmedicinering, kostar samhället mycket pengar och patienterna lidande. Problemet med felmedicineringar drabbar framför allt äldre som ofta är ordinerade flera läkemedel. En viktig faktor för att undvika felmedicineringar är att underlaget för medicineringen är korrekt. Nätverk för Sveriges Läkemedelskommittéer (LOK) rekommenderar att patientjournalens elektroniska läkemedelslista används som underlag. Föreliggande studie utfördes under februari 2012 på tre hälsocenter (HC) i Kalmar län och inkluderade 85 patienter. Syftet med studien var att undersöka om det var någon skillnad i antalet avvikelser i läkemedelslistan efter ett återbesök hos läkare på HC beroende på om patienten gjort en egenavstämning eller en läkemedelsverifiering (LM-verifiering) tillsammans med en farmaceutstudent, och om denna skillnad i så fall var relaterad till åldersgrupperna ”yngre äldre” (63-74 år) och ”äldre äldre” (> 75 år). Patienterna i studien hade i genomsnitt drygt 11 läkemedelsordinationer. Före läkarbesöket var 20-33 % av ordinationerna diskrepanser i de undersökta grupperna. Efter läkarbesöket hade de minskat till 5-16 %. Resultatet visade att antalet diskrepanser kan minskas både genom egenavstämning och LM-verifiering. Inga entydiga slutsatser kunde dras om minskningen var åldersrelaterad. I framtiden borde fokus ligga på att upprätta bra rutiner inom vården för att säkerställa att patienten alltid har tillgång till en aktuell läkemedelslista.

  • 147423.
    Waldegren, Tomas
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Sjukgymnastik.
    Neurological soft signs in double-diagnosed adults assessed for AD/HD : Towards a psychiatric evaluation scale2011Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
  • 147424. Waldeland, Einar
    et al.
    Hole, Eli Olaug
    Stenerlöw, Bo
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Enheten för biomedicinsk strålningsvetenskap.
    Grusell, Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för onkologi, radiologi och klinisk immunologi, Avdelningen för sjukhusfysik.
    Sagstuen, Einar
    Malinen, Eirik
    Radical formation in lithium formate EPR dosimeters after irradiation with protons and nitrogen ions2010Inngår i: Radiation Research, ISSN 0033-7587, E-ISSN 1938-5404, Vol. 174, nr 2, s. 251-257Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Radical formation in polycrystalline lithium formate monohydrate after irradiation with gamma rays, protons and nitrogen ions at room temperature was studied by continuous-wave electron paramagnetic resonance (EPR) spectroscopy. The linear energy transfer (LET) of the various radiation beams was 0.2, 0.7-3.9 and 110-164 keV/microm for gamma rays, protons and nitrogen ions, respectively. Doses between 5 and 20 Gy were given. The EPR reading (the area under the EPR absorption resonance) increased linearly with dose for all types of radiation. As the LET increased, the relative effectiveness (the EPR reading per dose relative to that for gamma rays) decreased, while the EPR line width increased. Track structure theory and modeling of detector effectiveness predicted the dosimeter response observed after proton and nitrogen-ion irradiation. A semi-empirical line broadening model including dipolar spin-spin interactions was developed that explained the dependence of the line width on LET. The findings indicate that the local radical density in lithium formate is increased after high-LET irradiation.

  • 147425.
    Waldemar, Axdorph
    Örebro universitet, Institutionen för läkarutbildning.
    Staphyscope – Microbiological occurrence on stethoscopes within the inpatient care2015Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 147426.
    Walden, Tomas B
    et al.
    Stockholms universitet, Naturvetenskapliga fakulteten, Wenner-Grens institut, Avdelningen för fysiologi.
    Hansen, Ida R
    Stockholms universitet, Naturvetenskapliga fakulteten, Wenner-Grens institut, Avdelningen för fysiologi.
    Timmons, James A
    Cannon, Barbara
    Stockholms universitet, Naturvetenskapliga fakulteten, Wenner-Grens institut, Avdelningen för fysiologi.
    Nedergaard, Jan
    Stockholms universitet, Naturvetenskapliga fakulteten, Wenner-Grens institut, Avdelningen för fysiologi.
    Recruited vs. nonrecruited molecular signatures of brown, “brite,” and white adipose tissues2011Inngår i: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 302, nr 1, s. E19-E31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Mainly from cell culture studies, a series of genes have been identified that have been suggested to be characteristic of different types of adipocytes. Here we have examined gene expression patterns in nine defined adipose depots: interscapular BAT, cervical BAT, axillary BAT, mediastinic BAT, cardiac WAT, inguinal WAT, retroperitoneal WAT, mesenteric WAT and epididymal WAT. We found that each depot displayed a distinct gene expression fingerprint, but that three major types of depots were identifiable: the brown, the brite and the white. Although differences in gene expression pattern were generally quantitative, some gene markers showed, even in-vivo, remarkable depot specificities: Zic1 for the classical brown adipose tissue depots, Hoxc9 for the brite depots, Hoxc8 for the brite and white in contrast to the brown, and Tcf21 for the white depots. The significance of these gene expression patterns both for understanding the developmental background of the depots and as possible master regulators is discussed.

  • 147427.
    Waldenborg, Micael
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction2014Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles.

    Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated.

    By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction.

    Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

  • 147428.
    Waldenborg, Micael
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Lidén, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Kähäri, Anders
    Department of Radiology, School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Emilsson, Kent
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy2015Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 49, nr 1, s. 27-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Takotsubo cardiomyopathy (TTC) is a condition of transient left ventricular (LV) dysfunction. The effects on LV mass (LVM) and geometry have not been studied enough in TTC. Retrospectively, we analyzed our TTC cohort both by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), for comparative purposes.

    Design: Thirteen women undergoing TTE and MRI, at onset and three months later, were included. LVM was estimated by MRI, and two TTE-methods. Segmental wall thickness (SWT) was measured, whilst radial strain was assessed by TTE. Data analysis included Wilcoxon's test (between phases), Mann Whitney U- and McNemar's tests (between and within groups). Bland-Altman analyzes were used for intertechnique coherence, whilst interactions regarding TTE were tested using Spearman's coefficient.

    Results: LVM decreased during recovery (p<0.05), by MRI and one of the TTE-methods; truncated ellipsoid formula (TEF), which also showed relatively better coherence compared to MRI. SWT decreased in two of three sites, by both modalities, but with ambiguous coherence therebetween. The TEF-data interacted partially with a demonstrated increase in radial strain.

    Conclusions: TTC associates with acute increase in LVM, which appears to be an apical effect, tending to follow the changes in concentric wall motion. MRI and TTE show adequate coherence; primarily for the TEF-method regarding LVM.

  • 147429.
    Waldenborg, Micael
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathyManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Aims: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) dysfunction. The effects, from acute to recovery phase, on LV mass (LVM) and the LV geometry are not thoroughly enough studied at TTC, which were the main aims of the present study. Retrospectively, we analyzed our cohort of TTC-patients, both with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), to further investigate these changes, including intertechnique comparison.

    Methods: We studied 13 female TTC-patients, undergoing TTE and MRI acutely, and three months later at follow-up. LVM was measured with MRI- and five different TTE-methods. Segmental wall thickness (SWT) was assessed, and used for LV hypertrophy (LVH) geometry categorization. Radial strain was measured at TTE. Data analysis included Wilcoxon signed-test (between phases), Mann Whitney U- and McNemar’s tests (between and within groups). Spearman’s coefficient was used for intertechnique coherence (with BlandAltman plots) and for correlations of simultaneous TTE changes.

    Results: LVM decreased significantly between phases (p<0.05), by MRI and with two TTE-methods. Two of three SWT-sites became significantly thinner, with adequate correlation (rs≥0.69) between techniques, while LVH categories remained unchanged. Relatively better consistency, compared with MRI, was shown for one of the TTE-methods used to estimate LVM (truncated ellipsoid (TE)). Radial strain improved significantly, with partial correlation towards the TE-method.

    Conclusions: TTC associates with acute increase in LVM, which seems to be a local effect, tending to occur in parallel with changes in concentric wall motion. MRI and TTE shows adequate consistency, primarily for the TE-method regarding LVM.

  • 147430.
    Waldenborg, Micael
    et al.
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Soholat, Mona
    Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Kähäri, Anders
    Department of Radiology, Orebro University Hospital, Orebro, Sweden.
    Emilsson, Kent
    Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
    Fröbert, Ole
    Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
    Multidisciplinary assessment of takotsubo cardiomyopathy: a prospective case study2011Inngår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, s. 14-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.

    Methods: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Asberg depression rating scale, self rated version, MADRS-S).

    Results: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).

    Conclusions: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.

  • 147431.
    Waldenborg, Mikael
    Örebro universitet, Hälsoakademin.
    Blodflödesmätning intramuskulärt och på hud med Laser Doppler Perfusion Monitoring: -en reliabilitetsstudie2006Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    I samband med denna studie genomfördes upprepade blodflödesmätningar intramuskulärt och på hud med Laser Doppler-teknik. Syftet var att studera variationen avseende dessa parametrar inom en grupp friska individer. Resultatet får betydelse för reliabiliteten hos denna teknik, vid användning av Periflux System 5000, en kliniskt vedertagen Laser Doppler-utrustning.

    Studien genomfördes vid institutionen för klinisk medicin, biomedicin, Örebro universitet. För registrering av intramuskulärt blodflöde samt hudblodflöde användes Laser Doppler Perfusion Monitoring (LDPM). Denna metod bygger på den s.k. Doppler-principen och har under senare år använts inom flertalet kliniskt medicinska områden, vid blodflödesmätning i olika vävnader.

    Metoden har många fördelar, bland annat att den utförs perkutant vilket gör att den är säker och enkel att genomföra. Detta till trots har metoden inte riktigt slagit igenom, bland annat p.g.a. praktiska problem. Ett sätt att bidra till en ökning av metodanvändandet är att utföra kliniska studier av denna sort.

    Sex friska försökspersoner (3 män och 3 kvinnor) med medelåldern 27,3 år (range 21-39 år) deltog i studien. Försökspersonernas fysiska träningsnivå var av varierande grad. Mätningarna skedde i vila, unilateralt i höger ben. Mätning genomfördes lokalt i m. Tibialis anterior och i

    m. Vastus lateralis, samt på hudområdet i angränsning till dessa muskler. Försökspersonerna genomgick 5 registreringar vardera med minst 3 dygns intervall mellan respektive mättillfälle. Varje mättillfälle omfattade minst 10 minuters artefaktfri registrering från var och en av de aktuella musklerna.

    Resultaten visar tydliga skillnader över tid avseende intramuskulärt- och hudangränsande blodflöde, vid upprepade mätningar för de studerade musklerna. Variationen inom individen talar för att LDPM är bäst lämpad för kontinuerlig flödesregistrering, och inte upprepade mätningar. Erhållna resultat stärker teorin om att mikrocirkulationen är varierande över tid.

  • 147432.
    Waldenby, Anna
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Svanberg, Karin
    Högskolan i Skövde, Institutionen för vård och natur.
    Hög köttkonsumtion och hur den kan påverka risken för folksjukdomar: en litteraturstudie baserad på kvinnor2012Independent thesis Basic level (university diploma), 5 poäng / 7,5 hpOppgave
    Abstract [sv]

    Bakgrund: Vi äter allt mer kött. Tidigare forskning har visat på samband mellan högt köttintag och bland annat hjärt- och kärlsjukdomar och cancer. Information om skyddsfaktorer som minskar risken för folksjukdom är begränsad. Forskning om hälsa och sjukdom hos kvinnor är begränsad och därför behövs kvinnors hälsa lyftas fram. Syfte: Litteraturstudiens syfte var att undersöka huruvida ett högt köttintag kan påverka risken för folksjukdomar hos kvinnor. Resultat: Resultatet tyder på en koppling mellan ett högt intag av rött och bearbetat kött och folksjukdomar hos kvinnor. Samband har funnits mellan högt köttintag och bröstcancer, diabetes och hjärt- och kärlsjukdomar. Riskerna har visat sig kunna minska vid ett utbyte från det röda och bearbetade köttet till andra animaliska proteinkällor eller vegetabilier. Diskussion: Kosten bör vara en viktig förebyggande insats när det gäller folksjukdomar. Kostråd för kvinnor bör innefatta ett lågt intag av rött och bearbetat kött och en kost rik på frukt, grönsaker och protein från andra källor än rött och bearbetat kött. Slutsats: Tydliga och enhetliga kostråd bör tas fram för att minska folksjukdomarna hos den kvinnliga befolkningen.

  • 147433. Waldenlind, Lennart
    et al.
    Grundmark, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
    Azarbayjani, Faranak
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Borjesson, Andreas
    Olaisson, Hans
    Is the risk of narcolepsy also increased with non-adjuvanted flu vaccines?2013Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 346, s. f2769-Artikkel i tidsskrift (Fagfellevurdert)
  • 147434.
    Waldenmark, Emil
    Örebro universitet, Hälsoakademin.
    Faktorer som påverkar patientens motivation att följa behandling2011Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 147435.
    Waldenmark, Karolina
    Örebro universitet, Hälsoakademin.
    Sjuksköterskors upplevelse av given vård till vuxna patienter med diabetes melltius typ I2011Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 147436.
    Waldenstedt, Sophia
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Mobil IntensivvårdsGrupp vid Norrlands Universitetssjukhus - hur fungerar det i praktiken?2012Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 147437. Waldenstrom, Anders
    et al.
    Genneback, Nina
    Hellman, Urban
    Ronquist, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Cardiomyocyte Microvesicles Contain DNA/RNA and Convey Biological Messages to Target Cells2012Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 4, s. e34653-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Shedding microvesicles are membrane released vesicles derived directly from the plasma membrane. Exosomes are released membrane vesicles of late endosomal origin that share structural and biochemical characteristics with prostasomes. Microvesicles/exosomes can mediate messages between cells and affect various cell-related processes in their target cells. We describe newly detected microvesicles/exosomes from cardiomyocytes and depict some of their biological functions.

    Methodology/Principal Findings: Microvesicles/exosomes from media of cultured cardiomyocytes derived from adult mouse heart were isolated by differential centrifugation including preparative ultracentrifugation and identified by transmission electron microscopy and flow cytometry. They were surrounded by a bilayered membrane and flow cytometry revealed presence of both caveolin-3 and flotillin-1 while clathrin and annexin-2 were not detected. Microvesicle/exosome mRNA was identified and out of 1520 detected mRNA, 423 could be directly connected in a biological network. Furthermore, by a specific technique involving TDT polymerase, 343 different chromosomal DNA sequences were identified in the microvesicles/exosomes. Microvesicle/exosomal DNA transfer was possible into target fibroblasts, where exosomes stained for DNA were seen in the fibroblast cytosol and even in the nuclei. The gene expression was affected in fibroblasts transfected by microvesicles/exosomes and among 333 gene expression changes there were 175 upregulations and 158 downregulations compared with controls.

    Conclusions/Significance: Our study suggests that microvesicles/exosomes released from cardiomyocytes, where we propose that exosomes derived from cardiomyocytes could be denoted "cardiosomes", can be involved in a metabolic course of events in target cells by facilitating an array of metabolism-related processes including gene expression changes.

  • 147438. Waldenstrom, Anders
    et al.
    Ronquist, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Role of Exosomes in Myocardial Remodeling2014Inngår i: Circulation Research, ISSN 0009-7330, E-ISSN 1524-4571, Vol. 114, nr 2, s. 315-324Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Exosomes are nanovesicles released from cells through exocytosis and are known to be mediators of proximal as well as distant cell-to-cell signaling. They are surrounded by a classical bilayered membrane with an exceptionally high cholesterol/phospholipid ratio. Exosomes were first described in 1977, then named prostasomes, and in 1987 the name exosome was coined. Exosomes contain surface proteins, some of which can act as labels in order to find their target cells. Exosomes also contain messages in the form of proteins and nucleic acids (RNA and DNA) that are transferable to target cells. Little is known and written about cardiac exosomes, although Gupta and Knowlton described exosomes containing HSP60 in 2007. It is now known that exosomes from cardiomyocytes can transfect other cells and that the metabolic milieu of the parental cell decides the quality of exosomes released such that they induce differential gene expression in transfected cells. Future clinical use of exosomes in diagnosis, monitoring disease progress, and treatment is promising.

  • 147439.
    Waldenstrom, Jesper
    et al.
    University of Gothenburg, Sweden .
    Konar, Jan
    Sahlgrens University Hospital, Sweden .
    Ekermo, Bengt
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Transfusionsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Diagnostikcentrum, Klinisk immunologi och transfusionsmedicin.
    Norder, Helene
    University of Gothenburg, Sweden .
    Lagging, Martin
    University of Gothenburg, Sweden .
    Neonatal transfusion-transmitted hepatitis C virus infection following a pre-seroconversion window-phase donation in Sweden2013Inngår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, nr 10, s. 796-799Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A 9-day-old child developed a transfusion-transmitted hepatitis C virus (HCV) infection following a pre-seroconversion window-phase donation. Retrospective analysis of donor plasma revealed detectable HCV core antigen (154 fmol/l), as well as HCV RNA (87,000 IU/ml). Of 5.24 million Swedish plasma samples from December 1998 to September 2012, 5 additional window-phase donations were identified.

  • 147440. Waldenstrom, Ulla
    et al.
    Aasheim, Vigdis
    Britt, Anne
    Nilsen, Vika
    Rasmussen, Svein
    Pettersson, Hans Jarnbert
    Shytt, Erica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning Dalarna.
    Adverse Pregnancy Outcomes Related to Advanced Maternal Age Compared With Smoking and Being Overweight2014Inngår i: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 123, nr 1, s. 104-112Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To investigate the association between advanced maternal age and adverse pregnancy outcomes and to compare the risks related to advanced maternal age with those related to smoking and being overweight or obese. METHODS: A population-based register study including all nulliparous women aged 25 years and older with singleton pregnancies at 22 weeks of gestation or greater who gave birth in Sweden and Norway from 1990 to 2010; 955,804 women were analyzed. In each national sample, adjusted odds ratios (ORs) of very preterm birth, moderately preterm birth, small for gestational age, low Apgar score, fetal death, and neonatal death in women aged 30-34 years (n=319,057), 35-39 years (n=94,789), and 40 years or older (n=15,413) were compared with those of women aged 25-29 years (n=526,545). In the Swedish sample, the number of additional cases of each outcome associated with maternal age 30 years or older, smoking, and overweight or obesity, respectively, was estimated in relation to a low-risk group of nonsmokers of normal weight and aged 25-29 years. RESULTS: The adjusted OR of all outcomes increased by maternal age in a similar way in Sweden and Norway; and the risk of fetal death was increased even in the 30-to 34-year-old age group (Sweden n=826, adjusted OR 1.24, 95% confidence interval [CI] 1.13-1.37; Norway n=472, adjusted OR 1.26, 95% CI 1.12-1.41). Maternal age 30 years or older was associated with the same number of additional cases of fetal deaths (n=251) as overweight or obesity (n=251). CONCLUSION: For the individual woman, the absolute risk for each of the outcomes was small, but for society, it may be significant as a result of the large number of women who give birth after the age of 30 years.

  • 147441.
    Waldenström, Anders
    et al.
    Umeå universitet.
    Erlandsson, Björn-Erik
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Systemsäkerhet och organisation.
    Incidenter i vården: Hur tar vi tillvara erfarenheterna för en säkrare vård?2014Konferansepaper (Fagfellevurdert)
    Abstract [sv]

    Sjukvården blir alltmer komplicerad. Möjligheterna ökar med även riskerna. Mångåriga neddragningar i delar av vården kan inte ske utan risk att påverka säkerheten. Samhället har ett ansvar att minimera dessa risker. Med erfarenhet av ett fall utrett av Statens Haverikommission vill vi ventilera dessa frågor för att skapa debatt om hur detta arbete bäst kan bedrivas.

  • 147442.
    Waldenström, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Gennebäck, Nina
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Hellman, Urban
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ronquist, Gunnar
    Cardiomyocyte microvesicles contain DNA/RNA and convey biological messages to target cells2012Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, nr 4, s. e34653-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Shedding microvesicles are membrane released vesicles derived directly from the plasma membrane. Exosomes are released membrane vesicles of late endosomal origin that share structural and biochemical characteristics with prostasomes. Microvesicles/exosomes can mediate messages between cells and affect various cell-related processes in their target cells. We describe newly detected microvesicles/exosomes from cardiomyocytes and depict some of their biological functions.

    Methodology/Principal Findings: Microvesicles/exosomes from media of cultured cardiomyocytes derived from adult mouse heart were isolated by differential centrifugation including preparative ultracentrifugation and identified by transmission electron microscopy and flow cytometry. They were surrounded by a bilayered membrane and flow cytometry revealed presence of both caveolin-3 and flotillin-1 while clathrin and annexin-2 were not detected. Microvesicle/exosome mRNA was identified and out of 1520 detected mRNA, 423 could be directly connected in a biological network. Furthermore, by a specific technique involving TDT polymerase, 343 different chromosomal DNA sequences were identified in the microvesicles/exosomes. Microvesicle/exosomal DNA transfer was possible into target fibroblasts, where exosomes stained for DNA were seen in the fibroblast cytosol and even in the nuclei. The gene expression was affected in fibroblasts transfected by microvesicles/exosomes and among 333 gene expression changes there were 175 upregulations and 158 downregulations compared with controls.

    Conclusions/Significance: Our study suggests that microvesicles/exosomes released from cardiomyocytes, where we propose that exosomes derived from cardiomyocytes could be denoted "cardiosomes", can be involved in a metabolic course of events in target cells by facilitating an array of metabolism-related processes including gene expression changes.

  • 147443. Waldenström, Anders
    et al.
    Haney, M.
    Biber, B.
    Kavianipour, Mohammad
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Moritz, T.
    Strandén, P.
    Wikström, Gerhard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Ronquist, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Ischaemic preconditioning is related to decreasing levels of extracellular adenosine that may be metabolically useful in the at-risk myocardium: an experimental study in the pig2010Inngår i: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 199, nr 1, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: 'Pre-treatment' with short repetitive periods of ischaemia (ischaemic preconditioning) has proved to be a powerful mechanism for modification of the extent of myocardial damage following acute coronary artery occlusion. The exact mechanism of protection induced by ischaemic preconditioning is not known. We herewith put forward a contributing component for protection with preconditioning involving a shift in the adenylate kinase (AK) equilibrium reaction in favour of adenosine triphosphate (ATP) formation. Methods: A coronary artery was occluded in anaesthetized thoracotomized pigs to induce ischaemic preconditioning as well as a longer period of ischaemia. Microdialysis probes were inserted in ischaemic and control myocardium and were infused with (14)C- adenosine with two different specific activities. (14)C-lactate was identified and measured in the effluent. Results: (14)C-adenosine was taken up by non-preconditioned and preconditioned myocardium during ischaemia. Significantly increased levels of (14)C-lactate were recovered in preconditioned myocardium. (14)C-adenosine with high specific activity resulted in a specific activity of lactate that was 2.7 times higher than that of lactate after administration of (14)C-adenosine with low specific activity. Mass spectrography verified the identity of (14)C-lactate. Conclusions: Preconditioning up-regulates a new metabolic pathway (starting with 5'-nucleotidase and ending up with lactate) resulting in ATP formation in the micromolar range on top of another effect terminating in a useful shift in the AK equilibrium reaction in favour of ATP generation in the millimolar range. Although the up-regulation of the purine nucleoside phosphorylase pathway is clearly demonstrated, its biological relevance remains to be proved.

  • 147444.
    Waldenström, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Haney, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Biber, Björn
    Kavianipour, Mohammad
    Moritz, Thomas
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Umeå Plant Science Centre (UPSC).
    Strandén, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Wikström, Gerhard
    Ronquist, Gunnar
    Ischaemic preconditioning is related to decreasing levels of extracellular adenosine that may be metabolically useful in the at-risk myocardium: an experimental study in the pig2010Inngår i: Acta Physiologica, ISSN 1748-1708, E-ISSN 1748-1716, Vol. 199, nr 1, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: 'Pre-treatment' with short repetitive periods of ischaemia (ischaemic preconditioning) has proved to be a powerful mechanism for modification of the extent of myocardial damage following acute coronary artery occlusion. The exact mechanism of protection induced by ischaemic preconditioning is not known. We herewith put forward a contributing component for protection with preconditioning involving a shift in the adenylate kinase (AK) equilibrium reaction in favour of adenosine triphosphate (ATP) formation. Methods: A coronary artery was occluded in anaesthetized thoracotomized pigs to induce ischaemic preconditioning as well as a longer period of ischaemia. Microdialysis probes were inserted in ischaemic and control myocardium and were infused with (14)C- adenosine with two different specific activities. (14)C-lactate was identified and measured in the effluent. Results: (14)C-adenosine was taken up by non-preconditioned and preconditioned myocardium during ischaemia. Significantly increased levels of (14)C-lactate were recovered in preconditioned myocardium. (14)C-adenosine with high specific activity resulted in a specific activity of lactate that was 2.7 times higher than that of lactate after administration of (14)C-adenosine with low specific activity. Mass spectrography verified the identity of (14)C-lactate. Conclusions: Preconditioning up-regulates a new metabolic pathway (starting with 5'-nucleotidase and ending up with lactate) resulting in ATP formation in the micromolar range on top of another effect terminating in a useful shift in the AK equilibrium reaction in favour of ATP generation in the millimolar range. Although the up-regulation of the purine nucleoside phosphorylase pathway is clearly demonstrated, its biological relevance remains to be proved.

  • 147445.
    Waldenström, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ronquist, Gunnar
    Role of Exosomes in Myocardial Remodeling2014Inngår i: Circulation Research, ISSN 0009-7330, E-ISSN 1524-4571, Vol. 114, nr 2, s. 315-324Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Exosomes are nanovesicles released from cells through exocytosis and are known to be mediators of proximal as well as distant cell-to-cell signaling. They are surrounded by a classical bilayered membrane with an exceptionally high cholesterol/phospholipid ratio. Exosomes were first described in 1977, then named prostasomes, and in 1987 the name exosome was coined. Exosomes contain surface proteins, some of which can act as labels in order to find their target cells. Exosomes also contain messages in the form of proteins and nucleic acids (RNA and DNA) that are transferable to target cells. Little is known and written about cardiac exosomes, although Gupta and Knowlton described exosomes containing HSP60 in 2007. It is now known that exosomes from cardiomyocytes can transfect other cells and that the metabolic milieu of the parental cell decides the quality of exosomes released such that they induce differential gene expression in transfected cells. Future clinical use of exosomes in diagnosis, monitoring disease progress, and treatment is promising.

  • 147446. Waldenström, Anders
    et al.
    Ronquist, Gunnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk kemi.
    Aberg, Anna-Maja
    Ahlström, Katarina
    Hauck, Philip
    Abrahamsson, Pernilla
    Johansson, Göran
    Biber, Björn
    Haney, Michael F
    Ischaemic preconditioning reduces myocardial calcium overload in coronary-occluded pig hearts shown by continuous in vivo assessment using microdialysis2012Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, nr 2, s. 133-138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During ischaemia, ATP depletion leads to insufficient fuelling for Na+/K+ ATPase, decreased electrochemical potential and increased influx of calcium ions. This study demonstrated a means to assess the effects of ischaemic preconditioning (IP) on the free intracellular Ca2+ pool during prolonged ischaemia. In a porcine myocardial ischaemia model, microdialysis (MD) was used for sampling of metabolic and injury markers in IP and non-IP (control) groups. 45Ca2+ was delivered in microperfusate locally to ischaemic myocardium, with distribution and uptake assessed by 45Ca2+ recovery in microdialysate. Cardiomyocytes in vitro were exposed to a Ca2+ ionophore and tested for 45Ca2+ uptake. An accentuated myocardial calcium ion influx (observed as an increased microdialysate 45Ca2+ recovery in the extracellular milieu) was noted in control pigs compared with IP pigs during ischaemia. Suspended cardiomyocytes preincubated with a Ca2+ ionophore to increase the intracellular calcium ion pool and subsequently incubated with 45Ca2+, displayed lower 45Ca2+ uptake in cells compared with control cells not exposed to the ionophore, corroborating the idea of a strong relationship between degree of intracellular calcium overload and microdialysate 45Ca2+ recovery. The ischaemic insult was differentially verified by metabolic and injury markers. We introduce an in vivo method for serial assessment of myocardial calcium overload during ischaemia, using a MD technique and 45Ca2+ inclusion. IP leads to relatively less calcium overload as assessed by this new method, and we interpret this to mean that reduction in calcium overload is an important part of the IP protective effect.

  • 147447.
    Waldenström, Anders
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Ronquist, Gunnar
    Åberg, Anna-Maja
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Ahlstrom, Katarina
    Hauck, Philip
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Abrahamsson, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Johansson, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Biber, Björn
    Haney, Michael F.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Ischaemic preconditioning reduces myocardial calcium overload in coronary-occluded pig hearts shown by continuous in vivo assessment using microdialysis2012Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 32, nr 2, s. 133-138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During ischaemia, ATP depletion leads to insufficient fuelling for Na+/K+ ATPase, decreased electrochemical potential and increased influx of calcium ions. This study demonstrated a means to assess the effects of ischaemic preconditioning (IP) on the free intracellular Ca2+ pool during prolonged ischaemia. In a porcine myocardial ischaemia model, microdialysis (MD) was used for sampling of metabolic and injury markers in IP and non-IP (control) groups. 45Ca2+ was delivered in microperfusate locally to ischaemic myocardium, with distribution and uptake assessed by 45Ca2+ recovery in microdialysate. Cardiomyocytes in vitro were exposed to a Ca2+ ionophore and tested for 45Ca2+ uptake. An accentuated myocardial calcium ion influx (observed as an increased microdialysate 45Ca2+ recovery in the extracellular milieu) was noted in control pigs compared with IP pigs during ischaemia. Suspended cardiomyocytes preincubated with a Ca2+ ionophore to increase the intracellular calcium ion pool and subsequently incubated with 45Ca2+, displayed lower 45Ca2+ uptake in cells compared with control cells not exposed to the ionophore, corroborating the idea of a strong relationship between degree of intracellular calcium overload and microdialysate 45Ca2+ recovery. The ischaemic insult was differentially verified by metabolic and injury markers. We introduce an in vivo method for serial assessment of myocardial calcium overload during ischaemia, using a MD technique and 45Ca2+ inclusion. IP leads to relatively less calcium overload as assessed by this new method, and we interpret this to mean that reduction in calcium overload is an important part of the IP protective effect.

  • 147448.
    Waldenström, Ann-Charlotte
    et al.
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Olsson, Caroline
    Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Wilderäng, Ulrica
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Dunberger, Gail
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Lind, Helena
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    al-Abany, Massoud
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden / Department of Hospital Physics, Karolinska University Hospital, Stockholm, Sweden.
    Palm, Åsa
    Departments of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Åvall-Lundqvist, Elisabeth
    Department of Gynecologic Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Johansson, Karl-Axel
    Departments of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Steineck, Gunnar
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Pain and mean absorbed dose to the pubic bone after radiotherapy among gynecological cancer survivors.2011Inngår i: International journal of radiation oncology, biology, physics, ISSN 1879-355X, Vol. 80, nr 4, s. 1171-1180Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To analyze the relationship between mean absorbed dose to the pubic bone after pelvic radiotherapy for gynecological cancer and occurrence of pubic bone pain among long-term survivors.

    METHODS AND MATERIALS: In an unselected, population-based study, we identified 823 long-term gynecological cancer survivors treated with pelvic radiotherapy during 1991-2003. For comparison, we used a non-radiation-treated control population of 478 matched women from the Swedish Population Register. Pain, intensity of pain, and functional impairment due to pain in the pubic bone were assessed with a study-specific postal questionnaire.

    RESULTS: We analyzed data from 650 survivors (participation rate 79%) with median follow-up of 6.3 years (range, 2.3-15.0 years) along with 344 control women (participation rate, 72 %). Ten percent of the survivors were treated with radiotherapy; ninety percent with surgery plus radiotherapy. Brachytherapy was added in 81%. Complete treatment records were recovered for 538/650 survivors, with dose distribution data including dose-volume histograms over the pubic bone. Pubic bone pain was reported by 73 survivors (11%); 59/517 (11%) had been exposed to mean absorbed external beam doses <52.5 Gy to the pubic bone and 5/12 (42%) to mean absorbed external beam doses ≥ 52.5 Gy. Thirty-three survivors reported pain affecting sleep, a 13-fold increased prevalence compared with control women. Forty-nine survivors reported functional impairment measured as pain walking indoors, a 10-fold increased prevalence.

    CONCLUSIONS: Mean absorbed external beam dose above 52.5 Gy to the pubic bone increases the occurrence of pain in the pubic bone and may affect daily life of long-term survivors treated with radiotherapy for gynecological cancer.

  • 147449.
    Waldenström, Ann-Charlotte
    et al.
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Olsson, Caroline
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Wilderäng, Ulrica
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
    Dunberger, Gail
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Lind, Helena
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Alevronta, Eleftheria
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    al-Abany, Massoud
    Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden / Department of Hospital Physics, Karolinska University Hospital, Stockholm, Sweden.
    Tucker, Susan
    Department of Bioinformatics and Computational Biology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
    Åvall-Lundqvist, Elisabeth
    Department of Gynecologic Oncology, Karolinska University Hospital, Stockholm, Sweden.
    Johansson, Karl-Axel
    Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Steineck, Gunnar
    Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden / Division of Clinical Cancer Epidemiology, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
    Relative importance of hip and sacral pain among long-term gynecological cancer survivors treated with pelvic radiotherapy and their relationships to mean absorbed doses.2012Inngår i: International Journal of Radiation Oncology, Biology, Physics, ISSN 0360-3016, E-ISSN 1879-355X, Vol. 84, nr 2, s. 428-436Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To investigate the relative importance of patient-reported hip and sacral pain after pelvic radiotherapy (RT) for gynecological cancer and its relationship to the absorbed doses in these organs.

    METHODS AND MATERIALS: We used data from a population-based study that included 650 long-term gynecological cancer survivors treated with pelvic RT in the Gothenburg and Stockholm areas in Sweden with a median follow-up of 6 years (range, 2-15) and 344 population controls. Symptoms were assessed through a study-specific postal questionnaire. We also analyzed the hip and sacral dose-volume histogram data for 358 of the survivors.

    RESULTS: Of the survivors, one in three reported having or having had hip pain after completing RT. Daily pain when walking was four times as common among the survivors compared to controls. Symptoms increased in frequency with a mean absorbed dose >37.5 Gy. Also, two in five survivors reported pain in the sacrum. Sacral pain also affected their walking ability and tended to increase with a mean absorbed dose >42.5 Gy.

    CONCLUSIONS: Long-term survivors of gynecological cancer treated with pelvic RT experience hip and sacral pain when walking. The mean absorbed dose was significantly related to hip pain and was borderline significantly related to sacral pain. Keeping the total mean absorbed hip dose below 37.5 Gy during treatment might lower the occurrence of long-lasting pain. In relation to the controls, the survivors had a lower occurrence of pain and pain-related symptoms from the hips and sacrum compared with what has previously been reported for the pubic bone.

  • 147450. Waldenström, Jonas
    et al.
    Axelsson-Olsson, Diana
    Olsen, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Hasselquist, Dennis
    Griekspoor, Petra
    Jansson, Lena
    Teneberg, Susann
    Svensson, Lovisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Ellström, Patrik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk bakteriologi.
    Campylobacter jejuni colonization in wild birds: results from an infection experiment2010Inngår i: 10.1371/journal.pone.0009082, ISSN 1932-6203, Vol. 5, nr 2, s. e9082-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Campylobacter jejuni is a common cause of bacterial gastroenteritis in most parts of the world. The bacterium has a broad host range and has been isolated from many animals and environments. To investigate shedding patterns and putative effects on an avian host, we developed a colonization model in which a wild bird species, the European Robin Erithacus rubecula, was inoculated orally with C. jejuni from either a human patient or from another wild bird species, the Song Thrush Turdus philomelos. These two isolates were genetically distinct from each other and provoked very different host responses. The Song Thrush isolate colonized all challenged birds and colonization lasted 6.8 days on average. Birds infected with this isolate also showed a transient but significant decrease in body mass. The human isolate did not colonize the birds and could be detected only in the feces of the birds shortly after inoculation. European Robins infected with the wild bird isolate generated a specific antibody response to C. jejuni membrane proteins from the avian isolate, which also was cross-reactive to membrane proteins of the human isolate. In contrast, European Robins infected with the human isolate did not mount a significant response to bacterial membrane proteins from either of the two isolates. The difference in colonization ability could indicate host adaptations.

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