Aspects of Gestational Diabetes : Screening System, Maternal and Fetal Complications

The appropriateness of universal screening for gestational diabetes mellitus (GDM) has been strongly questioned, since it does not satisfy ethical principles for screening. The aims of these studies were to determine the prevalence of GDM, expressed in terms of impaired glucose tolerance (IGT) and diabetes mellitus (DM), to evaluate different screening models using traditional anamnestic risk factors and repeated random B-glucose, to determine whether GDM increases risks for maternal complications such as preeclampsia, and to determine whether IGT during pregnancy, if left untreated, is associated with increased maternal or neonatal morbidity. Of 4,918 pregnant non-diabetic women attending maternal health care, 73.5% agreed to have a 75 g oral glucose tolerance test (OGTT). GDM was diagnosed in 1.7%, IGT in 1.3% and DM in 0.4%. Traditional risk factor criteria were fulfilled by 15.8%. Prior GDM and a prior macrosomic infant showed the highest association with GDM. No selective or two-step universal screening model would have detected all cases of GDM. A constructed model comprising prior GDM, a prior LGA/macrosomic infant, or a cut-off random B-glucose level of 8 mmol/l as an indication for OGTT reduced the need for OGTT to 7.3% compared to the selective screening model with traditional risk factors. Such a universal two-step screening model had 100% sensitivity for DM, and 44.7% sensitivity for IGT. The Swedish Medical Birth Register was used to evaluate GDM as risk factor for preeclampsia. GDM occurred in 0.8% and preeclampsia in 2.9% of 430,852 singleton pregnancies. There is an independent and significant association between GDM and preeclampsia. Obesity is a major confounding factor, but cannot explain the total excess risk. In a prospective population-based case-control study 213 women with untreated IGT during pregnancy were identified. For each case, four controls were recruited from the same delivery department. The analyses confirmed that maternal and fetal morbidity were increased in the cases in terms of cesarean section rate, pre-term delivery, Erb’s palsy and admission to NICU. There was a marked, independent increase in the proportion of LGA infants (OR 7.3; 95% CI 4.1-12.7). To determine whether treatment has an effect when IGT is diagnosed during pregnancy, a randomized study is required

Dilemmas of participation in everyday life in early rheumatoid arthritis : a qualitative interview study (The Swedish TIRA Project)

Abstract Purpose: To explore the experiences of today's patients with early rheumatoid arthritis (RA) with respect to dilemmas of everyday life, especially regarding patterns of participation restrictions in valued life activities. Methods: A total of 48 patients, aged 20-63, three years post-RA diagnosis were interviewed using the Critical Incident Technique. Transcribed interviews were condensed into meaningful units describing actions/situations. These descriptions were linked to ICF participation codes according to the International Classification of Functioning, Disability and Health (ICF) linking rules. Results: Dilemmas in everyday life were experienced in domestic life, interpersonal interactions and relationships, community, social and civic life. Most dilemmas were experienced in domestic life, including participation restrictions in, e.g. gardening, repairing houses, shovelling snow, watering pot plants, sewing or walking the dog. Also many dilemmas were experienced related to recreation and leisure within the domain community, social and civic life. The different dilemmas were often related to each other. For instance, dilemmas related to community life were combined with dilemmas within mobility, such as lifting and carrying objects. Conclusions: Participation restrictions in today's RA patients are complex. Our results underline that the health care needs to be aware of the patients' own preferences and goals to support the early multi-professional interventions in clinical practice. Implications of Rehabilitation Today's rheumatoid arthritis (RA) patients experience participation restrictions in activities not included in International Classification of Functioning, Disability and Health (ICF) core set for RA or in traditionally questionnaires with predefined activities. The health care need to be aware of the patients' own preferences and goals to meet the individual needs and optimize the rehabilitation in early RA in clinical practice

Time to update the ICF by including socioemotional qualities of participation? : The development of a ‘patient ladder of participation’ based on interview data of people with early rheumatoid arthritis (The Swedish TIRA study)

Purpose: The aim of was to identify and illustrate in what situations and with what qualities people with early RA experience participation in every day’s life. Methods: 59 patients (age 18-63 years) were interviewed; 25 men and 34 women. Content analysis was used to identify meaning units which were sorted based on type of situations described and later on, categories based on quality aspects of participation were developed. Results: Participation was described as: 1. being part of a group, where a sense of belonging arose. 2. In doing activities with others for example at work or in leisure. 3. When sharing everyday chores and responsibilities for example in domestic duties. 4. When experiencing influence on actions such as when being asked for opinions on how to conduct a specific task. 5. When having the possibility to give direction of goals in rehabilitation, or elsewhere. 6. When sharing decision making and experiencing a high degree of influence in the situation. Conclusions: Participation from an individual’s perspective is about belonging and having influence that mediates a positive feeling of being included and that you matter as a person. The results are important when using participation as a goal in clinical care. It’s important to expand participation beyond the definitions in ICF and guidelines to include the patients’ socio-emotional participation in order to promote health.

Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis : a qualitative interview study (the Swedish TIRA project)

Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20-63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge.Funding Agencies|County Council of Ostergotland Research Foundations; Medical Research Council of South-East Sweden (FORSS); Norrbacka-Eugenia Foundation; Swedish Rheumatism Association</p

En beteende-ekologisk forskningsperiod på Klubbans biologiska station : Rapport från återträff med Doktorer som disputerade (1983-2001) på avhandlingar med fältarbete på Klubbans Biologiska station. I en värld av kantnålar, stubbar, spiggar och nudingar.

We had the fortune as PhD-students and scientists in Animal Ecology at Uppsala University, to spend joyful and creative field work summers at Klubban Biological Station, during the 1980-90’s. A reunion in June 2018 resulted in this report highlighting research on pipefishes, gobies, sticklebacks and nudibranchs. Our research on these animals have provided novel insights and knowledge of the process of sexual selection and paternal care. These animals have, in many aspects, now become model organisms in evolutionary behavioral ecology in marine environments. Our list of publications provides many examples of how environmental factors influence how sexual selection and mate choice operate, how predictors like potential reproductive rates, operational sex ratios work and how male parental care is prominent in influencing selection. This research, that started at Klubban, has broadened our understanding of the ecological importance of shallow marine areas. The evolutionary understanding of how males and females can behave and how adaptive traits are selected in interaction with social and an increasingly changing ambient environment is in focus in our continued scientific endeavors. We have happily compiled this report illustrating how science and scientist can stimulate each other at a wonderful place like Klubban Biological Station, with the access to amazing organisms like pipefishes, gobies, sticklebacks and nudibranchs

En beteende-ekologisk forskningsperiod på Klubbans biologiska station : Rapport från återträff med Doktorer som disputerade (1983-2001) på avhandlingar med fältarbete på Klubbans Biologiska station. I en värld av kantnålar, stubbar, spiggar och nudingar.

We had the fortune as PhD-students and scientists in Animal Ecology at Uppsala University, to spend joyful and creative field work summers at Klubban Biological Station, during the 1980-90’s. A reunion in June 2018 resulted in this report highlighting research on pipefishes, gobies, sticklebacks and nudibranchs. Our research on these animals have provided novel insights and knowledge of the process of sexual selection and paternal care. These animals have, in many aspects, now become model organisms in evolutionary behavioral ecology in marine environments. Our list of publications provides many examples of how environmental factors influence how sexual selection and mate choice operate, how predictors like potential reproductive rates, operational sex ratios work and how male parental care is prominent in influencing selection. This research, that started at Klubban, has broadened our understanding of the ecological importance of shallow marine areas. The evolutionary understanding of how males and females can behave and how adaptive traits are selected in interaction with social and an increasingly changing ambient environment is in focus in our continued scientific endeavors. We have happily compiled this report illustrating how science and scientist can stimulate each other at a wonderful place like Klubban Biological Station, with the access to amazing organisms like pipefishes, gobies, sticklebacks and nudibranchs

En beteende-ekologisk forskningsperiod på Klubbans biologiska station : Rapport från återträff med Doktorer som disputerade (1983-2001) på avhandlingar med fältarbete på Klubbans Biologiska station. I en värld av kantnålar, stubbar, spiggar och nudingar.

We had the fortune as PhD-students and scientists in Animal Ecology at Uppsala University, to spend joyful and creative field work summers at Klubban Biological Station, during the 1980-90’s. A reunion in June 2018 resulted in this report highlighting research on pipefishes, gobies, sticklebacks and nudibranchs. Our research on these animals have provided novel insights and knowledge of the process of sexual selection and paternal care. These animals have, in many aspects, now become model organisms in evolutionary behavioral ecology in marine environments. Our list of publications provides many examples of how environmental factors influence how sexual selection and mate choice operate, how predictors like potential reproductive rates, operational sex ratios work and how male parental care is prominent in influencing selection. This research, that started at Klubban, has broadened our understanding of the ecological importance of shallow marine areas. The evolutionary understanding of how males and females can behave and how adaptive traits are selected in interaction with social and an increasingly changing ambient environment is in focus in our continued scientific endeavors. We have happily compiled this report illustrating how science and scientist can stimulate each other at a wonderful place like Klubban Biological Station, with the access to amazing organisms like pipefishes, gobies, sticklebacks and nudibranchs

Impact of general anaesthesia on breast cancer survival : a 5-year follow up of a pragmatic, randomised, controlled trial, the CAN-study, comparing propofol and sevoflurane

Background: Anaesthesia may impact long-term cancer survival. In the Cancer and Anaesthesia study, we hypothesised that the hypnotic drug propofol will have an advantage of at least five percentage points in five-year survival over the inhalational anaesthetic sevoflurane for breast cancer surgery. Methods: From 2118 eligible breast cancer patients scheduled for primary curable, invasive breast cancer surgery, 1764 were recruited after ethical approval and individual informed consent to this open label, single-blind, randomised trial at four county- and three university hospitals in Sweden and one Chinese university hospital. Of surveyed patients, 354 were excluded, mainly due to refusal to participate. Patients were randomised by computer at the monitoring organisation to general anaesthesia maintenance with either intravenous propofol or inhaled sevoflurane in a 1:1 ratio in permuted blocks. Data related to anaesthesia, surgery, oncology, and demographics were registered. The primary endpoint was five-year overall survival. Data are presented as Kaplan-Meier survival curves and Hazard Ratios based on Cox univariable regression analyses by both intention-to-treat and perprotocol. EudraCT, 2013-002380-25 and ClinicalTrials.gov, NCT01975064. Findings: Of 1764 patients, included from December 3, 2013, to September 29, 2017, 1670 remained for analysis. The numbers who survived at least five years were 773/841 (91.9% (95% CI 90.1-93.8)) in the propofol group and 764/829 (92.2% (90.3-94.0)) in the sevoflurane group, (HR 1.03 (0.73-1.44); P = 0.875); the corresponding results in the per-protocol-analysis were: 733/798 (91.9% (90.0-93.8)) and 653/710 (92.0% (90.0-94.0)) (HR = 1.01 (0.71-1.44); P = 0.955). Survival after a median follow-up of 76.7 months did not indicate any difference between the groups (HR 0.97, 0.72-1.29; P = 0.829, log rank test). Interpretation: No difference in overall survival was found between general anaesthesia with propofol or sevoflurane for breast cancer surgery

Posttraumatic stress among women after induced abortion : a Swedish multi-centre cohort study

BACKGROUND: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers and little is known about the relationship between posttraumatic stress disorder (PTSD) and induced abortion. Thus, the aim of the study was to assess the prevalence of PTSD and posttraumatic stress symptoms (PTSS) before and at three and six months after induced abortion, and to describe the characteristics of the women who developed PTSD or PTSS after the abortion. METHODS: This multi-centre cohort study included six departments of Obstetrics and Gynaecology in Sweden. The study included 1457 women who requested an induced abortion, among whom 742 women responded at the three-month follow-up and 641 women at the six-month follow-up. The Screen Questionnaire-Posttraumatic Stress Disorder (SQ-PTSD) was used for research diagnoses of PTSD and PTSS, and anxiety and depressive symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS). Measurements were made at the first visit and at three and six months after the abortion. The 95% confidence intervals for the prevalence of lifetime or ongoing PTSD and PTSS were calculated using the normal approximation. The chi-square test and the Student's t-test were used to compare data between groups. RESULTS: The prevalence of ongoing PTSD and PTSS before the abortion was 4.3% and 23.5%, respectively, concomitant with high levels of anxiety and depression. At three months the corresponding rates were 2.0% and 4.6%, at six months 1.9% and 6.1%, respectively. Dropouts had higher rates of PTSD and PTSS. Fifty-one women developed PTSD or PTSS during the observation period. They were young, less well educated, needed counselling, and had high levels of anxiety and depressive symptoms. During the observation period 57 women had trauma experiences, among whom 11 developed PTSD or PTSS and reported a traumatic experience in relation to the abortion. CONCLUSION: Few women developed PTSD or PTSS after the abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Concomitant symptoms of depression and anxiety call for clinical alertness and support