Att göra eller icke göra, det är frågan! – En studie av Socialstyrelsens hantering av upplevd kontra kalkylerad risk i samband med fågelinfluensan

Modernitet är ett vanligt förekommande begrepp i den samhällsvetenskapliga diskursen och Anthony Giddens med flera talar om det risksamhälle som uppkommit till följd av moderniteten. Risksamhällets oöverskådlighet leder till behovet av expertgrupper och en ökande betydelse av vetenskaperna. I risksamhället råder det delade meningar om olika riskers hotfullhet och en divergens mellan allmänhetens upplevda risk och experternaskalkylerade dito verkar vara ett problem för många organisationer. Uppsatsen tar avstamp i hur organisationer hanterar ovan nämnda divergens och använder sig av en fallstudie av Socialstyrelsens hantering av fågelinfluensan för att besvara frågan. Den teoretiska utgångspunkten är nyinstitutionalismen och då främst begreppen frikoppling och beslutsrationalitet. Antagandet är att när organisationer ställs inför dilemmat att antingen framstå som effektiva eller rationella i sitt beslutsfattande blir lösningen att, omedvetet, frikoppla dessa från varandra. Slutsatserna av uppsatsen mynnar ut i ett konstaterat behov av frikoppling och att den, teorierna till trots, till viss del är medveten. Det ter sig oundvikligt att organisationen agerar på det viset eftersom omvärlden ställer helt oförenliga krav vilka bottnar i divergensen mellan upplevd och kalkylerad risk. Tolkningen av studien är att den situation med divergens som Socialstyrelsen ställts inför troligtvis är ett dilemma som mångaandra organisationer också måste hantera vare sig de är expertgrupper eller inte. Studien kan därför även underlätta förståelsen av andra organisationers handlande. Uppsatsen visar på ett samband mellan risk och frikoppling. Kärnan i problematiken är det klassiska dilemmat mellan att göra eller att inte göra

Preserved periprosthetic bone stock at 5 years post-operatively with uncemented short hip stem in both collared and collarless version

Introduction: Previous bone density studies have generally shown bone resorption around both cemented and uncemented total hip arthroplasty (THA) stems. This is presumed to be due to stress shielding. Short stems have been introduced partly to preserve bone in the proximal femur by a more physiological loading of the bone. The purpose of this study was to evaluate bone remodeling around a short, fully hydroxyapatite-coated titanium stem that comes in a collared and collarless version. Patients and methods: A prospective cohort of 50 patients included in a study evaluating the Furlong Evolution stem has been followed for 5 years. Examination was done with dual energy X-ray absorptiometry (DXA) postoperatively, at 1, 2 and 5 years. Clinical outcome was followed with radiography and both general and hip specific outcome measures. Results: The two versions of the stem behaved similarly regarding bone remodeling. After an initial decrease up to 1 year, bone mineral density (BMD) increased in all Gruen zones up to 2 years and at 5 years bone stock was still preserved compared with postoperatively (net BMD + 1.2% (95% CI − 0.4 to 2.8)). Increase in BMD occurred mainly in the greater trochanter and distally around the stem with a decrease in the calcar area. Both versions showed excellent clinical outcome up to 5 years. Conclusion: This short stem seems to preserve proximal bone stock up to 5 years, exhibiting similar behaviour both with and without a collar. Trial registration number and date of registration: ClinicalTrials.gov, (identifier: NCT01894854). July 10, 2013

Insulin induced phosphorylation and activation of the cGMP-inhibited cAMP phosphodiesterase in human platelets

Insulin induced phosphorylation and activation of the cGMP inhibited cAMP phosphodiesterase (cGI-PDE) in human platelets were demonstrated after isolation of the enzyme with specific polyclonal cGI-PDE antibodies. The demonstration of this insulin effect required suppression of basal cGI-PDE phosphorylation, through the use of the protein kinase inhibitor H-7 (1-(5-isoquinolinylsulfonyl)-2-methylpiperazine). The human platelet insulin receptor beta-subunit, previously identified as a 97 kDa polypeptide, was detected with the use of wheat germ agglutinin chromatography and anti-phosphotyrosine antibodies. These results suggest that insulin, through phosphorylation/activation of cGI-PDE, could decrease cAMP/cAMP dependent protein kinase (cAMP-PK) activity and thereby make the platelets more sensitive towards aggregating agents

Purification and properties of the cGMP-inhibited cAMP phosphodiesterase from bovine aortic smooth muscle

Pure cGMP-inhibited cAMP phosphodiesterase (cGI-PDE) in micrograms quantities was isolated from bovine aortic smooth muscle after more than 5000-fold purification using DEAE ion-exchange and affinity chromatography with a derivative of the specific cGI-PDE inhibitor cilostamide conjugated as a ligand to aminoethyl agarose (CIT-agarose). The cGI-PDE, which constituted about half of the high affinity cAMP-PDE activity of a tissue homogenate, was identified with a 105-kDa protein on SDS-PAGE through use of antibodies towards the human platelet, bovine cardiac and bovine adipose tissue cGI-PDE in Western blot and immunoprecipitation/immunoinactivation analysis. As observed during purification of the enzyme from other tissues the enzyme protein was exquisitely sensitive to proteolytic nicking during purification, resulting in several 30-77-kDa polypeptide fragments. Rapid immunoprecipitation from fresh tissue extracts was the only was found to partially prevent the proteolysis. The native enzyme had apparent molecular sizes of approx. 100,000 or, mainly approx. 220,000 by gel chromatography, presumably indicating the presence of monomeric and dimeric forms. The enzyme hydrolyzed cAMP and cGMP with normal Michaelis-Menten kinetics with Km of 0.16 and 0.09 microM, respectively, with Vmax for hydrolysis of cAMP of 0.3 compared to 3.1 mumol/min per mg protein for cAMP. The enzyme was potently and selectively inhibited by cGMP (IC50 approximately 0.25 microM) and the cardiotonic/vasodilatory drugs OPC-3911 (a cilostamide derivative), milrinone and CI-930 (IC50 approximately 0.05, 0.40 and 0.25 microM, respectively). The cGI-PDE was phosphorylated by cAMP-dependent protein kinase as has been reported for the analogous enzymes in heart, adipose tissue and platelets. The identification of a cGI-PDE in the aortic smooth muscle and its inhibitor specificity is consistent with the hypothesis that inhibition of this enzyme is important in the mechanism through which these drugs produce vasorelaxation

Long-term pattern of HIV-1 RNA load in perinatally infected children

The objective of this study was to describe the natural history of HIV-1 RNA load in vertically HIV-1-infected children. HIV-1 RNA in 156 plasma or serum samples (1-14, median 4 from each child) from 32 vertically HIV-1-infected children was detected with the NASBA® technique (Organon Teknika, The Netherlands). Twenty-one children were prospectively followed from birth, and 11 were identified and included at the age of 7-89 (median 61) months. The highest numbers of HIV-1 RNA copies were seen at 1.5-3 months of age. A quadratic curve model showed a reduction of HIV-1 RNA with increasing age up to approximately 8 years, and thereafter increasing numbers, p(age) = 0.002, p(age2) = 0.008, This pattern was not typical for individual children in whom a great variation in HIV-1 RNA numbers was seen over time. The interval from birth to the first HIV-1 RNA peak ranged from 1.5 months to more than 2 years. The HIV-1 RNA levels remained relatively high and fluctuating over the years in symptomatic as well as in long-term symptomatic children. This makes HIV-1 RNA determination in children more difficult to use than in adults, as the only tool for prediction of disease progression and for initiation of therapy

Prophylaxis and treatment of HIV-1 infection in pregnancy: Swedish Recommendations 2010

Prophylaxis and treatment with antiretroviral drugs and the use of elective caesarean section have resulted in a very low mother-to-child transmission of human immunodeficiency virus (HIV) during recent years. The availability of new antiretroviral drugs, updated general treatment guidelines and increasing knowledge of the importance of drug resistance, have necessitated regular revisions of the "Prophylaxis and treatment of HIV-1 infection in pregnancy" recommendations. For these reasons, The Swedish Reference Group for Antiviral Therapy (RAV) updated the 2007 recommendations at an expert meeting that took place on 25 March 2010. The most important revisions from the previous recommendations are: (1) it is recommended that treatment during pregnancy starts at the latest at gestational week 14-18; (2) ongoing efficient treatment at confirmed pregnancy may, with a few exceptions, be continued; (3) lopinavir/r and atazanavir/r are equally recommended protease inhibitors; (4) if maternal HIV RNA is >50 copies/ml close to delivery, a planned caesarean section, intravenous zidovudine, oral nevirapine for the mother and post-exposure prophylaxis for the infant with 3 antiretroviral drugs are recommended; (5) for delivery at <34 gestational weeks, intravenous zidovudine and oral nevirapine for the mother and at 48-72 h for the infant is recommended, in addition to other prophylaxis; (6) intravenous zidovudine is not recommended when HIV RNA is <50 copies/ml and a caesarean section is performed; (7) it is recommended that prophylaxis for the infant is started within 4 h; (8) prophylactic zidovudine for the infant may be administered twice daily instead of 4 times a day, as was the case previously; and (9) the number of sampling occasions for the infant has been decreased

Hospitalization of children born to human immunodeficiency virus- infected women in Europe

Objective. To describe the pattern of inpatient hospital service use in the first 5 years of life of all children born to HIV-infected women in 10 pediatric centers of the European Collaborative Study. Background. Little information is available on the need for hospitalization of children born to HIV-infected women, especially those uninfected, despite the fact that they may be at risk of social deprivation and poor health because of family cicumstances. Methods. Data on 1189 children enrolled between 1986 and 1997 and followed prospectively since birth according to a standard protocol were analyzed. Results. This analysis included 151 HIV-infected and 811 uninfected children. One hundred forty (12%) infants had delayed postnatal discharge, mainly for drug withdrawal symptoms and prematurity. Uninfected children had 0.5 admission per 5 child years compared with 2.4 for infected children. From life table analysis, an estimated 48% of infected and 17% of uninfected children will have been admitted by age 12 months. Nearly 60% (3304 of 5604) of the total inpatient days of infected children occurred after AIDS diagnosis. Infected children were 4 times more likely to be hospitalized than uninfected children of the same age, and children with symptomatic mothers were 13 times more likely to be admitted for a nonmedical reason. Conclusions. Whereas hospitalization of infected children poses an expected burden on the health care system, the use of such services by uninfected children is largely explained by their social background and provides an argument for better support for families affected by HIV.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

CD4 cell response to antiretroviral therapy in children with vertically acquired HIV infection: Is it associated with age at initiation?

Background. Considerable uncertainty remains as to whether early initiation of antiretroviral therapy (ART) in children with vertically acquired human immunodeficiency virus (HIV) infection increases the benefit in terms of immunological response. Methods. The association between immunological outcome and early initiation of and/or more-potent ART was investigated, using age-standardized z scores for CD4 cell counts (hereafter, "CD4 z scores"), in 131 HIV-infected children enrolled in the European Collaborative Study, a birth cohort study. Results. Median age at initiation of the most-potent ART was 4 years (range, 0.1-15.5 years). Initiation of treatment after 5 months of age resulted in nonsignificantly lower CD4 z scores 6 months after initiation. Time to a 20% increase in CD4 z score was associated with age at initiation of the most-potent ART (adjusted hazard ratios [AHRs], 0.37 [P5 years of age, respectively, compared with <5 months of age), ethnicity (AHR, 0.48 [P = .01], for black vs. white), and highly active ART (HAART) with or without prior ART (AHRs, 3.16 [P<.01] and 3.95 [P<.001], vs. mono or dual ART, respectively). The risk of subsequent deterioration of CD4 z score was similar for children who initiated ART in different age groups (χ2 = 0.824; P = .82). Conclusions. We confirm the effectiveness of HAART with respect to the recovery of CD4 cell count and suggest a benefit of initiating ART before the age of 5 months. Age at initiation of the most-potent ART was not associated with the likelihood of sustaining the recovery of CD4 cell count. © 2006 by the Infectious Diseases Society of America. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe