Pharyngeal surgery and epidemiology in sleep apnea

Obstructive sleep apnea syndrome (OSAS) occurs frequently among adults and children. The first-line treatments in adults are continuous positive airway pressure (CPAP) or mandibular retaining devices (MRDs), but the long-term efficacy is only around 60%. Uvulopalatopharyngoplasty (UPPP) has been criticized for lack of efficacy and a high degree of complications. In children the first-line treatment is adenotonsillectomy. This thesis evaluates two major aspects of OSAS: firstly, UPPP in adult OSAS patients with failing CPAP and MRD treatment regarding efficacy, safety, satisfaction and side effects in Papers I and II. Secondly, the relationship between sleep disordered breathing (SDB) in children and adolescents, defined as first hospital diagnoses of OSAS, tonsillar and adenotonsillar hypertrophy (ATH), and parental diagnoses of OSAS, occupation and family socioeconomic status (SES) in Papers III and IV. In paper I, we measured changes in numbers of oxygen desaturations 4% (ODI4) with home based sleep apnea registrations and daytime sleepiness with validated questionnaires (Epworth sleepiness scale, ESS), as well as complication and satisfaction rate, before and 1 year after UPPP in 158 patients. There was a significant decrease in the ODI4 from median 23 (range 6-100) to 8 (range 0-60). The criteria of success (50% reduction and ODI<20), was 64% and UPPP reduced the nightly respiratory disturbances to a mean of 60 %. The ESS value decreased significantly from median 12 (range 0-21) to 6 (0-22). Four of 158 patients (2.5%) had serious postoperative complications, 88% of the patients were satisfied and there was no mortality. In Paper II, a pilot study without previous power calculation, 47 of the patients in Paper I answered a questionnaire before and one year after UPPP, as well as 15 non-snoring controls. The median score of the patients was unchanged from 5 (range 0–17) to 5 (0–19), compared to 1 (0–3) for controls. In Paper III we estimated the standardized incidence ratio (SIR) of hospitalization, 1997–2007, for OSAS and SDB caused by ATH in children (aged 0–18 years) with a parent affected by OSAS and compared this risk with that of children with OSAS and SDB without a parent affected by OSAS. We used the MigMed2 database which includes the Swedish Hospital Discharge Register. After accounting for SES, age, and geographic region, the SIRs of OSAS in boys and girls with a parent affected by OSAS were 3.09 (95% CI 1.83–4.90) and 4.46 (95% CI 2.68–6.98), respectively. The SIRs of ATH in boys and girls with a parent affected by OSAS were 1.82 (95% CI 1.54–2.14) and 1.56 (95% CI 1.30–1.87), respectively. In Paper IV we analyzed the odds ratio (OR) in individuals aged 0–18 years, 1997–2007, for first hospital diagnoses of OSAS and ATH by family SES and parental occupation. The MigMed2 database was linked to the Swedish census. There were a total of 34 933 children with a first hospital diagnosis of OSAS and ATH. The ORs were increased in individuals with low family SES, defined as family income and maternal education. Increased ORs were found among 14 maternal and 13 paternal occupational groups. Decreased ORs were found for 10 paternal occupational groups. In paper III and IV there was no data available for individual risk factors and confounders such as BMI or passive smoking. In summary, UPPP reduced the nightly respiratory disturbances to a mean of 60%, halved the daytime sleepiness, did not change the median scores of pharyngeal disturbances, and may be a safe alternative in selected OSAS patients. Swedish children with a parent affected by OSAS had a significantly higher risk of hospitalization for OSAS and SDB defined as ATH. Children with a low family SES and in some occupational groups were associated with an increased OR for hospitalization for OSAS and SDB

Parental poverty and occupation as risk factors for pediatric sleep-disordered breathing.

Previous studies have found associations between pediatric sleep-disordered breathing (SDB) and socioeconomic status (SES), as well as a neighborhood-related disadvantage. This study analyzes the association among familial SES, parental occupation, and SDB in Swedish offspring

A Model System for In Vitro Studies of Bank Vole Borne Viruses

The bank vole (Myodes glareolus) is a common small mammal in Europe and a natural host for several important emerging zoonotic viruses, e.g. Puumala hantavirus (PUUV) that causes hemorrhagic fever with renal syndrome (HFRS). Hantaviruses are known to interfere with several signaling pathways in infected human cells, and HFRS is considered an immune-mediated disease. There is no in vitro-model available for infectious experiments in bank vole cells, nor tools for analyses of bank vole immune activation and responses. Consequently, it is not known if there are any differences in the regulation of virus induced responses in humans compared to natural hosts during infection. We here present an in vitro-model for studies of bank vole borne viruses and their interactions with natural host cell innate immune responses. Bank vole embryonic fibroblasts (VEFs) were isolated and shown to be susceptible for PUUV-infection, including a wild-type PUUV strain (only passaged in bank voles). The significance of VEFs as a model system for bank vole associated viruses was further established by infection studies showing that these cells are also susceptible to tick borne encephalitis, cowpox and Ljungan virus. The genes encoding bank vole IFN-β and Mx2 were partially sequenced and protocols for semi-quantitative RT-PCR were developed. Interestingly, PUUV did not induce an increased IFN-β or Mx2 mRNA expression. Corresponding infections with CPXV and LV induced IFN-β but not Mx2, while TBEV induced both IFN-β and Mx2

Molecular characterization of highly pathogenic H5N1 avian influenza viruses isolated in Sweden in 2006

<p>Abstract</p> <p>Background</p> <p>The analysis of the nonstructural (NS) gene of the highly pathogenic (HP) H5N1 avian influenza viruses (AIV) isolated in Sweden early 2006 indicated the co-circulation of two sub-lineages of these viruses at that time. In order to complete the information on their genetic features and relation to other HP H5N1 AIVs the seven additional genes of twelve Swedish isolates were amplified in full length, sequenced, and characterized.</p> <p>Results</p> <p>The presence of two sub-lineages of HP H5N1 AIVs in Sweden in 2006 was further confirmed by the phylogenetic analysis of approximately the 95% of the genome of twelve isolates that were selected on the base of differences in geographic location, timing and animal species of origin. Ten of the analyzed viruses belonged to sub-clade 2.2.2. and grouped together with German and Danish isolates, while two 2.2.1. sub-clade viruses formed a cluster with isolates of Egyptian, Italian, Slovenian, and Nigerian origin. The revealed amino acid differences between the two sub-groups of Swedish viruses affected the predicted antigenicity of the surface glycoproteins, haemagglutinin and neuraminidase, rather than the nucleoprotein, polymerase basic protein 2, and polymerase acidic protein, the main targets of the cellular immune responses. The distinctive characteristics between members of the two subgroups were identified and described.</p> <p>Conclusion</p> <p>The comprehensive genetic characterization of HP H5N1 AIVs isolated in Sweden during the spring of 2006 is reported. Our data support previous findings on the coincidental spread of multiple sub-lineage H5N1 HPAIVs via migrating aquatic birds to large distance from their origin. The detection of 2.2.1. sub-clade viruses in Sweden adds further data regarding their spread in the North of Europe in 2006. The close genetic relationship of Swedish isolates sub-clade 2.2.2. to the contemporary German and Danish isolates supports the proposition of the introduction and spread of a single variant of 2.2.2. sub-clade H5N1 avian influenza viruses in the Baltic region. The presented findings underline the importance of whole genome analysis.</p

70 лет научно-исследовательскому институту охраны материнства и детства Минздрава Беларуси

НАУЧНО-ИССЛЕДОВАТЕЛЬСКИЕ ИНСТИТУТЫМАТЕРИ И РЕБЕНКА ОХРАНЫ ЗДОРОВЬЯ ЦЕНТРЫ /ИСТМЕДИЦИНСКИЕ ИНСТИТУТЫ /ИСТНАУЧНО-ИССЛЕДОВАТЕЛЬСКАЯ РАБОТАИСТОРИЯ МЕДИЦИН

Dissemination of Spotted Fever Rickettsia Agents in Europe by Migrating Birds

Migratory birds are known to play a role as long-distance vectors for many microorganisms. To investigate whether this is true of rickettsial agents as well, we characterized tick infestation and gathered ticks from 13,260 migratory passerine birds in Sweden. A total of 1127 Ixodes spp. ticks were removed from these birds and the extracted DNA from 957 of them was available for analyses. The DNA was assayed for detection of Rickettsia spp. using real-time PCR, followed by DNA sequencing for species identification. Rickettsia spp. organisms were detected in 108 (11.3%) of the ticks. Rickettsia helvetica, a spotted fever rickettsia associated with human infections, was predominant among the PCR-positive samples. In 9 (0.8%) of the ticks, the partial sequences of 17kDa and ompB genes showed the greatest similarity to Rickettsia monacensis, an etiologic agent of Mediterranean spotted fever-like illness, previously described in southern Europe as well as to the Rickettsia sp.IrITA3 strain. For 15 (1.4%) of the ticks, the 17kDa, ompB, gltA and ompA genes showed the greatest similarity to Rickettsia sp. strain Davousti, Rickettsia japonica and Rickettsia heilongjiangensis, all closely phylogenetically related, the former previously found in Amblyomma tholloni ticks in Africa and previously not detected in Ixodes spp. ticks. The infestation prevalence of ticks infected with rickettsial organisms was four times higher among ground foraging birds than among other bird species, but the two groups were equally competent in transmitting Rickettsia species. The birds did not seem to serve as reservoir hosts for Rickettsia spp., but in one case it seems likely that the bird was rickettsiemic and that the ticks had acquired the bacteria from the blood of the bird. In conclusion, migratory passerine birds host epidemiologically important vector ticks and Rickettsia species and contribute to the geographic distribution of spotted fever rickettsial agents and their diseases

Chambers i teori och praktik

AbstractThis is an essay about Chambers book talk, how Chambers describes them and how they beenpracticed in reality, that´s my purpose. In Chamber´s book Tell me – Children, Reading andTalk, I look specific for Chambers arguments for this kind of literary education and comparethis with teacher’s description of book conversations. I finally compare this result withactually scientific arguments that supported Chambers arguments.Sten-Olof Ullström proclaims the meaning of social interactions as a prerequisite forreading and writing development. He says that the reading education must offer various formsof interaction for pupils to challenge each other. Ullström´s theoretical discussion is mytheoretical point of departure in this essay.I found out that book conversation is a reprehensible method to reach a literarycompetence. I also find out that the interviewed teacher work in an experienced based way,where their educations are founded from pupils experience and conditions.Keywords: book conversation, literary education, reading competence, social interactio

Intryck och avtryck : Elevers upplevelser av skapande aktiviteter i en landsortsskola

Sammandrag  Syftet med detta arbete har varit att undersöka elevers uppfattning om sina möjligheter att vara skapande i skolan, vilka förutsättningar som finns för skapande verksamhet och kulturupplevelser samt hur man uppfyller det styrdokumenten säger gällande estetisk verksamhet i en landsortsskola.  Kvantitativ metod i form av enkätundersökningar har använts tillsammans med strukturerade observationer. Undersökningen har genomförts på mellanstadiet i en landsortsskola i västra Värmland och omfattats av 151 elever och åtta lärare. Det empiriska materialet visar att eleverna har störst möjlighet att vara skapande i de ämnen där observationerna pekade på god måluppfyllelse, där eleverna var delaktiga i sitt eget lärande samt då lokalerna var ändamålsenliga. Materialet visar även att man i liten omfattning erbjuder kulturupplevelser i skolan.  Arbetets forskningsavsnitt stödjer den skapande verksamhetens betydelse i skolan genom att behandla styrdokument, utveckling och lärande, skapandeprocessen samt betydelsen av upplevelser och intryck.Abstract  The aim of this study has been to examine students' perception of their ability to be creative in school, what conditions that exist for creative activities and cultural experiences, and how to the school comply with the steering documents regarding arts in school.  Quantitative method in the form of questionnaires has been used along with structured observations. The research has taken place in a primary school in western Värmland and involved 151 pupils and eight teachers. The empirical data indicates that students have the greatest opportunity to be creative in subjects where the observations pointed towards good target achievement, where students were involved in their own learning as well as were the physical premises were appropriate. The material also indicates that the pupils are offered cultural experiences only to a very limited extent in school.  This study’s research section supports that the creative activities are highly relevant to school by discussing policy documents, development and learning research, creative process and the importance of experiences and impressions