A Genome-Wide Association Study of Diabetic Kidney Disease in Subjects With Type 2 Diabetes

dentification of sequence variants robustly associated with predisposition to diabetic kidney disease (DKD) has the potential to provide insights into the pathophysiological mechanisms responsible. We conducted a genome-wide association study (GWAS) of DKD in type 2 diabetes (T2D) using eight complementary dichotomous and quantitative DKD phenotypes: the principal dichotomous analysis involved 5,717 T2D subjects, 3,345 with DKD. Promising association signals were evaluated in up to 26,827 subjects with T2D (12,710 with DKD). A combined T1D+T2D GWAS was performed using complementary data available for subjects with T1D, which, with replication samples, involved up to 40,340 subjects with diabetes (18,582 with DKD). Analysis of specific DKD phenotypes identified a novel signal near GABRR1 (rs9942471, P = 4.5 x 10(-8)) associated with microalbuminuria in European T2D case subjects. However, no replication of this signal was observed in Asian subjects with T2D or in the equivalent T1D analysis. There was only limited support, in this substantially enlarged analysis, for association at previously reported DKD signals, except for those at UMOD and PRKAG2, both associated with estimated glomerular filtration rate. We conclude that, despite challenges in addressing phenotypic heterogeneity, access to increased sample sizes will continue to provide more robust inference regarding risk variant discovery for DKD.Peer reviewe

Odorous and pungent attributes of mixed and unmixed odorants

In order to explore functional properties of the olfactory and common chemical senses as well as their relation to the total nasal sensation experienced, various concentrations of two pungent odorants were presented alone and in the presence of different backgrounds of the other irritant. Stimuli comprised formaldehyde (at 1.0, 3.5, 6.9, and 16.7 ppm), ammonia (at 210, 776, 1,172, and 1,716 ppm), and their 16 possible binary mixtures. Subjects were asked to estimate the total nasal perceived intensity, and then to assess the olfactory (odor) and common chemical (pungency) attributes of the evoked sensations. The results showed that stimulus-response functions for pungency are steeper than those for odor. Furthermore, odor was always hypoadditive in mixtures (i.e., mixtures were perceived as less intense than the sum of their components), whereas pungency was, mainly, additive, and even suggested hyperadditivity. Total perceived intensity of the stimuli, alone and in mixtures, followed the stimulus-response patterns for pungency, which, therefore, emerged as the dominating attribute used by subjects in scaling the explored range of concentrations. The relationship between total nasal perceived intensity of the mixtures and that of their components reflected hypoaddition, resembling the outcome for the odor attribute

Interprofessional Collaboration in Swedish health and social care from a care manager’s perspective : [Interprofessionell samverkan i svensk hälso- och sjukvård och social omsorg ur biståndshandläggares perspektiv]

The aim of this study was to study interprofessional collaboration in health and social care for older people and persons with disabilities from a care manager's perspective. The empirical data was collected at a workshop held during a national conference for care managers and through focus group interviews in two Swedish municipalities. The results showed that the care managers collaborated in different ways with many different professionals from different organisations. The care and discharge planning meetings emerged as the most typical situation where care managers collaborated with different health care professionals. Interprofessional collaboration was seen as a means for care managers to fulfil their assignment and carry out their work. The care manager role encompassed role strain, a relatively weak professional identity, and differences in professional status among those involved in interprofessional collaboration.Syftet med studien var att studera interprofessionell samverkan i hälso- och sjukvård och social omsorg för äldre personer och personer med funktionsnedsättningar ur biståndshandläggares perspektiv. Empiriska data samlades in vid en workshop i samband med en nationell konferens för biståndshandläggare samt genom fokusgruppsintervjuer i två kommuner i Sverige. Resultatet visade att biståndshandläggare samverkar på flera varierande sätt och med olika yrkesgrupper från flera organisationer. Vård- och omsorgsplaneringsmöten framträdde som den mest typiska situationen där biståndshandläggare samverkar med andra yrkesgrupper inom vård och omsorg. Interprofessionell samverkan sågs som viktig för att biståndshandläggarna skulle kunna fullfölja sin uppgift och utföra sitt arbete. Biståndshandläggarrollen kännetecknas av motstridiga rollförväntningar och en relativt svag professionell identitet. Skillnader i professionell status bland de involverade påverkade samverkan