Optic nerve hypoplasia: Risk factors and epidemiology.

OBJECTIVES: To study the epidemiology of optic nerve hypoplasia. DESIGN AND METHODS: Children with optic nerve hypoplasia and visual impairment were identified through the Swedish Register of Visually Impaired Children. Pre- and perinatal characteristics were obtained from the Medical Birth Registry and by scrutinizing pregnancy and delivery records. Clinical characteristics of children with optic nerve hypoplasia are described. The following risk factors were studied: maternal age, parity, maternal smoking, gestational duration, birth weight, delivery method, Apgar score, maternal disease during pregnancy, drugs used in early pregnancy. RESULTS: Young maternal age, first parity, maternal smoking, preterm birth and factors associated with preterm birth were risk factors for optic nerve hypoplasia. There was an indicated association with the use of fertility drugs and antidepressant drugs. CONCLUSIONS: Optic nerve hypoplasia is apparently associated not only with other anomolies, notably of the central nervous system, but also with signs of general disturbance in fetal development

Maternal Exposure to Air Pollution and Birth Outcomes

Background: The knowledge about air pollution effects on birth weight, prematurity and small for gestational age [SGA] in low-exposure areas is insufficient. Objectives: The aim of this birth cohort study was to investigate if low-level exposure to air pollution was associated with prematurity and foetal growth and if there are gender specific effects. Method: We combined high quality registry information on 81110 births with individually modeled exposure data at residence for nitrogen oxides [NOx] and proximity to roads with differing traffic density. The data were analyzed by using logistic and linear regression with and without potential confounders. Results: An increased risk for babies being SGA was observed when highest and lowest NOx quartiles were compared, adjusting for maternal age, smoking, gender and year of birth. After additional adjustment for maternal country of origin and parity (which were highly intercorrelated), the increase was no longer statistically significant. However, in subgroup analysis when highest and lowest NOx quartiles were compared, there was still an increased risk for SGA for baby girls Odds Ratio [OR] 1.12 (95% Confidence Interval [CI] 1.01, 1.24), and also if mothers had not changed residency during pregnancy OR 1.09 (95% CI 1.01, 1.18). The confounders with the greatest impact on SGA were parity and country of origin. Concerning prematurity, the prevalence was lower in the three higher NOx exposure quartiles compared to the lowest category. Conclusion: For future studies on air pollution effects on birth outcomes careful control of confounding is crucial

Didaktiska val inom svenskundervisningen i en mångspråkig och mångkulturell gymnasieklass / Didactic Choices within Swedish Teaching in a Multilingual and Multicultural High School Class

SAMMANFATTNINGDenna uppsats handlar om undervisningen i en mångkulturell och mångspråkig klass i den svenska gymnasieskolan. De didaktiska val som gjorts i undervisningen under ett par månader under höstterminen 2005 redogörs för och motiveras. De didaktiska valen analyseras mot bakgrund av ett kunskapsbegrepp inspirerat av kognitionsforskning. Vidare belyses valen från sociolingvistisk synpunkt och slutligen också ur en andraspråklig synvinkel.Syftet är att belysa de konsekvenser det mångspråkiga och mångkulturella samhället har för skolans praktik och då specifikt för svenskdidaktiken.Resultatet av undersökningen och analysen är att undervisningen påverkas av de mångspråkiga och mångkulturella särdragen. Dock kan stora delar av de didaktiska val som fungerar i denna grupp också tänkas kunna fungera i en traditionell modersmålssvensk undervisning. Däremot är det inte lika självklart att man kan vända på det och tro att den traditionellt modersmålssvenska didaktiken fungerar lika bra i en etniskt blandad grupp

Didaktiska val inom svenskundervisningen i en mångspråkig och mångkulturell gymnasieklass / Didactic Choices within Swedish Teaching in a Multilingual and Multicultural High School Class

SAMMANFATTNING Denna uppsats handlar om undervisningen i en mångkulturell och mångspråkig klass i den svenska gymnasieskolan. De didaktiska val som gjorts i undervisningen under ett par månader under höstterminen 2005 redogörs för och motiveras. De didaktiska valen analyseras mot bakgrund av ett kunskapsbegrepp inspirerat av kognitionsforskning. Vidare belyses valen från sociolingvistisk synpunkt och slutligen också ur en andraspråklig synvinkel. Syftet är att belysa de konsekvenser det mångspråkiga och mångkulturella samhället har för skolans praktik och då specifikt för svenskdidaktiken. Resultatet av undersökningen och analysen är att undervisningen påverkas av de mångspråkiga och mångkulturella särdragen. Dock kan stora delar av de didaktiska val som fungerar i denna grupp också tänkas kunna fungera i en traditionell modersmålssvensk undervisning. Däremot är det inte lika självklart att man kan vända på det och tro att den traditionellt modersmålssvenska didaktiken fungerar lika bra i en etniskt blandad grupp

201Thallium SPECT; accuracy in astrocytoma diagnosis and treatment evaluation

The aims of the studies included in this thesis were:• to investigate the reliability of 201thallium single photon emission computed tomography (201Tl SPECT) for preoperative diagnosis and histological staging of malignant astrocytomas in comparison with CT; • to develop a method for quantification of cerebral thallium uptake, and to evaluate the quantitative measurement in comparison with CT, for astrocytoma treatment follow-up purposes; • to compare quantitative 201Tl SPECT and proton magnetic resonance spectroscopy (1H-MRS) with conventional MR imaging for astrocytoma monitoring, and to evaluate associations between change of morphological tumour characteristics during treatment and changes of cerebral thallium uptake and metabolic ratios. Results and conclusions:• High 201Tl-index, calculated as a ratio comparing tumour uptake to uptake in the contralateral hemisphere, is an indicator of highly malignant astrocytoma. Differentiation between the high-grade astrocytomas, the low-grade astrocytomas, and infectious lesions is only partial, with an overlap of 201Tl-indexes between these groups. High-grade astrocytomas that do not show contrast enhancement on CT, and astrocytomas with central necrosis and moderate ring-enhancement, tend to be underestimated when evaluated by 201Tl-index calculation. 201Tl SPECT is not a reliable method for non-invasive tumour staging among the group of highly malignant astrocytomas. • Quantification of cerebral 201Tl-uptake, defining the volume of viable tumour tissue, is a new method for astrocytoma chemotherapy monitoring. Results suggest that the method provides prognostic information, and information of treatment efficacy, at an earlier stage than CT. • We did not find a higher accuracy of quantitative 201Tl SPECT than of MR for monitoring purposes and our results indicated that treatment induced MR changes were interrelated with 201Tl-uptake variations. • Multi-voxel 1H-MRS was difficult to apply for astrocytoma treatment monitoring, due to the anatomical and histological heterogeneity of astrocytomas

Recovery of cognitive and emotional functioning following withdrawal of topiramate maintenance therapy

The present investigation reports cognitive improvement following withdrawal of topiramate (TPM) maintenance therapy in two patients with intractable seizures. The first patient received a neuropsychological evaluation after 10 months of adjunctive TPM treatment and was reassessed after complete withdrawal. The second patient received a first evaluation without TPM therapy. A reassessment was conducted after 13 weeks of stable TPM add-on therapy, and a third evaluation was performed after TPM withdrawal. During TPM treatment, the first patient demonstrated dysfunction on both verbal and non-verbal measures, suggesting bilateral impairment. Reassessment yielded cognitive improvement, and was consistent with a lateralized lesion as supported by seizure semiology, magnetic resonance imaging (MRI), and electroencephalogram (EEG) data. The second patient showed cognitive and emotional declines during TPM therapy. Reassessment, without TPM, demonstrated recovery on a majority of variables. These results illustrate the risk for considerable cognitive side effects after TPM habituation and support good recovery after withdrawal. Attempting to withdraw TPM and conducting a re-evaluation may be especially justified in the presence of a deflated neuropsychological profile that is inconsistent with a patient's estimated level of cognitive functioning. Reducing the influence of medical effects that could mimic bilateral dysfunction is particularly important in presurgical evaluations