Type 1 diabetes in children - risk factors and prediction.

Susceptibility genes and environmental factors are important for development of Type 1 diabetes (T1D). Increased birth weight (BW), increased linear growth and gestational infections are among the reported risk factors. T1D is predictable by analysis of HLA genotypes and islet cell autoantibodies. In this thesis risk factors and prediction of T1D were studied as part of the Diabetes Prediction in Skåne (DiPiS) study. In paper I, an analysis of the association between T1D high-risk HLA genotypes, cord blood autoantibodies and BW indicated an increased risk for high relative BW (HrBW) in children with high-risk HLA. Presence of cord blood autoantibodies decreased this risk. In paper II the effect of gestational infections on BW was studied. Infections with fever and/or gastroenteritis during pregnancy increased the risk for HrBW. Furthermore, infections aggravated, but could not fully explain, the association between high-risk HLA and HrBW. The presence of cord blood autoantibodies decreased the risk for HrBW only when occurring together with infections. In paper III, intrauterine and childhood growth, corrected for mid-parental height, in children developing T1D were studied in relation to HLA genotypes. HLA genotypes were associated with SDS of birth length, confirming their interaction with intrauterine growth. T1D children were taller, but not heavier, at birth than non-HLA matched controls, but not compared to HLA matched ones. T1D children showed increased height development during the first 18 months compared to both non-HLA and HLA matched controls. Thus, other factors than HLA-genotypes are concluded to be responsible for the increased linear growth before T1D onset. In paper IV parental reactions to DiPiS was studied. Most parents were not worried by participation in our study

Baseline heterogeneity in glucose metabolism marks the risk for type 1 diabetes and complicates secondary prevention.

Non-diabetic children with multiple islet autoantibodies were recruited to a secondary prevention trial. The objective was to determine the predictive value of baseline (1) HbA1c and metabolic variables derived from intravenous (IvGTT) and oral glucose tolerance tests (OGTT), (2) insulin resistance and (3) number, type and levels of islet autoantibodies, for progression to type 1 diabetes

Childcare competency - an area under development : nurses selfperceived competency in emegency pediatrics

Background: Caring for children with acute illness or injury is one of the most stressful and terror-inspiring scenarios for hospital staff. Yet it is often that nurses who care for these patients feel that they lack the proper competency and training to care for them in the best way related to experience and scientific method. Aim and Method: This study hoped to illustrate how nurses at a hospital close to Mälaren, Sweden perceived their own competence in meeting and caring for a child with acute illness/injury with the use of self-assessment questionnaires. The study included the nurses at a hospital close to Mälaren, Sweden who cared for children with a need for emergency care. The answers were illustrated through descriptive statistical analysis to show nurses self-perceived competence related to their clinical experience in paediatric care. Results: There was a clear correlation and significance between years of clinical experience and parts of the competency of pediatric nurses. There was also a strong need for more pediatric education. Conclusion: The results of this study show that there was a clear correlation between the number of years that the nurses were in clinical practice and the selfperceived competence in care of acute sickness/ injured children. The areas showing the least selfperceived competence were in the areas of medication and handling acute situation. All of the nurses felt that there was a need for more emergency pediatic care.Bakgrund: Att vårda akut sjuka och skadade barn är en av de svåraste situationer som personal i sjukvården ställs inför, ett skräckscenario. Ändå är det ofta sjuksköterskor upplever att de möter akut sjuka/skadade barn utan att ha tillräcklig kompetens och utbildning för att vårda dem på bästa sätt utifrån vetenskap och beprövad erfarenhet. Syfte och Metod: Denna studies syfte var att genom självskattningsformulär undersöka hur sjuksköterskor vid ett sjukhus i Mälartrakten uppfattade den egna kompetensen i mötet med ett akut sjukt/skadat barn. Studien innefattade sjuksköterskor verksamma inom barn och akutsjukvård som mötte barn i behov av akut vård. Svaren analyserades genom deskriptiv statistisk analys för att synliggöra sjuksköterskornas självskattade kompetens relaterat till deras kliniska erfarenhet inom vård av barn. Resultat: Det sågs ett tydligt samband med signifikant korrelation mellan respondenternas kliniska erfarenhet och delar av barnsjuksköterskans kompetensbeskrivning. Även ett stort behov av pediatrisk utbildning framkom i resultatet. Slutsats: Resultatet visade att det fanns en tydlig korrelation mellan antal år som kliniskt verksam sjuksköterska inom barn och ungdomsvård och den självskattade kompetensen. Brister i sjuksköterskornas självskattade kompetens fanns främst i att medicinera barn och hantera akuta situationer. Samtliga sjuksköterskor upplevde att det fanns ett behov av utbildning kring vård av akut sjuka/skadade barn

Off-Road and On-Road Driving Assessments Methods, What Do They Say? A Clinical Sample

Driving assessments are carried out in various ways, and diverse methods and tests are used. The British Stroke Driver Screening Assessment (SDSA) is a cognitive test, developed to evaluate driving fitness in stroke patients. For Sweden, Denmark and Norway, there is a Nordic version, the Nordic Stroke Driver Screening Assessment (NorSDSA). This cognitive test has become commonly used by driving assessors and is sometimes the only test used to evaluate driving fitness regardless of a client’s diagnoses. The objective of the study was thus to compare the off-road NorSDSA test outcome, expressed as a global pass or fail result, with an on-road driving test outcome. The results showed that 52 out of 63 patients were correctly classified in the drivers-fail group and 24 of 57 in the pass group. In total, 63% were correctly classified, (sensitivity 42% and specificity 83%). The NorSDSA is thus not a valid predictor for pass or fail on the on-road test. However, only a few neuropsychological tests are made for driving assessments. The NorSDSA is one of them, but driving assessors should know its apparent limitations. The recommendation is thus not to solely rely on the NorSDSA to assess fitness to drive

Importance Of The Segmentation On Time-Rich And Time-Poor For Development And Marketing Of Computer Games

ICT (Information Communication Technology) development has already changed many aspects of our life. One of the most successful industries in using ICT as a means for development of new products as well as marketing and sales activities, is the entertainment industry. The games industry is developing rapidly and has penetrated every layer of society. In 1998 video and electronic game revenues reached USD 5.5bn in North American markets alone. The annual increase has been approximately 25% during a number of years. The success of ICT based entertainment products depends to a high degree on the penetration of PCs and Internet connections. Many governments all over the world have strategies and programs in order to reduce the digital divide and to offer all citizens Internet access. In the not so distant future Internet access will be as natural as water, electricity, radio or telephone. Time is more and more becoming an important variable for market segmentation. Everybody has 24 hours per day and night at his or her disposal. However, the perception of time varies. Some feel they have too much time and they are time-rich. Some feel that they have too little time and they are time-poor. Traditionally, time-rich people were also money-rich, but the big majority was both time-poor and money-poor. This is completely turned upside down in the Information society. Nowadays people are equally divided between time-rich and money-poor, and time-poor and money-rich. Both time-rich and time-poor need entertainment and are potential consumers of entertainment especially games as e-services but in different ways. This is a conceptual paper and its purpose is to investigate the importance of the division on time-rich and time-poor for the entertainment industry and practical implications with a special focus on computer games as products and e-services

Immune therapy in type 1 diabetes mellitus.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder directed against the β cells of the pancreatic islets. The genetic risk of the disease is linked to HLA-DQ risk alleles and unknown environmental triggers. In most countries, only 10-15% of children or young adults newly diagnosed with T1DM have a first-degree relative with the disease. Autoantibodies against insulin, GAD65, IA-2 or the ZnT8 transporter mark islet autoimmunity. These islet autoantibodies may already have developed in children of 1-3 years of age. Immune therapy in T1DM is approached at three different stages. Primary prevention is treatment of individuals at increased genetic risk. For example, one trial is testing if hydrolyzed casein milk formula reduces T1DM incidence in genetically predisposed infants. Secondary prevention is targeted at individuals with persistent islet autoantibodies. Ongoing trials involve nonautoantigen-specific therapies, such as Bacillus Calmette-Guérin vaccine or anti-CD3 monoclonal antibodies, or autoantigen-specific therapies, including oral and nasal insulin or alum-formulated recombinant human GAD65. Trial interventions at onset of T1DM have also included nonautoantigen-specific approaches, and autoantigen-specific therapies, such as proinsulin peptides. Although long-term preservation of β-cell function has been difficult to achieve in many studies, considerable progress is being made through controlled clinical trials and animal investigations towards uncovering mechanisms of β-cell destruction. Novel therapies that prevent islet autoimmunity or halt progressive β-cell destruction are needed

Values underlying farmers' business development decisions: evidence from Swedish agriculture using Zaltman metaphor elicitation technique

Purpose: This study aimed to uncover the values that underlie farmers' strategic choices for business development. In particular, we uncovered farmers' values related to business development through farm diversification and compared these with values regarding business development through non-diversified farm activities.Methodology: We considered diversified and non-diversified farm activities as two possible strategic orientations related to farm development. For each strategic orientation, the study systematically uncovered its values grounded on in-depth interviews with 23 farmers in Sweden, using the Zaltman metaphor elicitation technique. We analyzed values in terms of use- and non-use values related to the choice of strategic orientation.Findings: The results suggested that a heterogeneous set of use- and non-use values guide choices for farm strategic orientation. Particularly, for non-diversified farm activities, we identified eight values, of which three were categorized as use values and five as non-use values. For diversified farms, we found four values, all of which were categorized as non-use values.Practical Implications: Our results highlight that policymakers need to approach farm development differently for each strategic orientation, considering that the underlying values between these two groups differ. Also, for farm advisors, results can be useful for improving and adapting the communication and interaction with farmers, which can further improve the content and influence of advisory services.Theoretical Implications: The Zaltman metaphor elicitation technique expands the methodology of eliciting farmers' values and especially regarding farmers' strategic choices.Originality: This paper extends the knowledge of the driving forces that underlie farmers' choices for farm business development

Literature Review Comparing Laparoscopic and Percutaneous Endoscopic Gastrostomies in a Pediatric Population

Objective. This study compares laparoscopic and percutaneous endoscopic gastrostomy (PEG) in a paediatric population to test the hypothesis that there is a difference in the frequency of serious gastrointestinal complications between the two methods. Methods. All reports published between 1995 and 2009 on laparoscopic gastrostomy and PEG in children was included. Prospective and retrospective trials, comparing the two methods or dealing with one of them only were included. Endpoints were accidentally performed gastrointestinal fistula causing an emergency re-operation. The frequency of inadvertent gastroenteric fistulas using the two different techniques was calculated. Results. 822 publications were found when using the search terms: gastrostomy, gastrointestinal complications, and all child: 0–18 years. From these, 54 studies were extracted for this investigation. These studies reported a total of 4331 children undergoing gastrostomy operation, 1027 by using the laparoscopic technique and 3304 using the PEG technique. The number of serious gastrointestinal fistulas to colon or small bowel was 0% and .27%, respectively, P < .05. Conclusions. The results suggest that by performing laparoscopic gastrostomy in children it is possible to avoid the serious intestinal fistula complications caused by a blind puncture through the abdominal cavity when performing the PEG

The all-intracellular order Legionellales is unexpectedly diverse, globally distributed and lowly abundant

Legionellales is an order of the Gammaproteobacteria, only composed of host-adapted, intracellular bacteria, including the accidental human pathogens Legionella pneumophila and Coxiella burnetii. Although the diversity in terms of lifestyle is large across the order, only a few genera have been sequenced, owing to the difficulty to grow intracellular bacteria in pure culture. In particular, we know little about their global distribution and abundance. Here, we analyze 16/18S rDNA amplicons both from tens of thousands of published studies and from two separate sampling campaigns in and around ponds and in a silver mine. We demonstrate that the diversity of the order is much larger than previously thought, with over 450 uncultured genera. We show that Legionellales are found in about half of the samples from freshwater, soil and marine environments and quasi-ubiquitous in man-made environments. Their abundance is low, typically 0.1%, with few samples up to 1%. Most Legionellales OTUs are globally distributed, while many do not belong to a previously identified species. This study sheds a new light on the ubiquity and diversity of one major group of host-adapted bacteria. It also emphasizes the need to use metagenomics to better understand the role of host-adapted bacteria in all environments. The all-intracellular bacterial order of Legionellales is much more diverse, prevalent and globally distributed than previously thought