Treatment and consequences of atopic dermatitis from childhood to adulthood

Background: Atopic dermatitis (AD) is a common, itching, chronic disease from childhood up to adulthood, which requires daily treatment. The treatment goal is to achieve as the longest symptom-free periods possible. In children with AD, parents are responsible for the treatment being carried out. During adolescence, there should be a transfer of responsibility to the young person themself. To achieve treatment goals and perform self-management of AD, young people need knowledge and support from healthcare. Aim: The overall research aim of this thesis was to investigate the prevalence, treatment, and consequences of living with AD in relation to sex and AD severity in adolescence and young adulthood. Method: All studies in this thesis were based on data from the prospective population-based birth cohort BAMSE ([Barn]/Child, Allergy, Milieu, Stockholm). At approximately 2 months of age, 4,098 infants were recruited to the study. Questionnaire data regarding AD and treatment were obtained at participant aged 1, 2, 4, 8, 12, 16, and 24 years. The questionnaire definition of AD was based on a modified version of William’s criteria. Health-related quality of life (HRQoL) was examined at age 12, 16, and 24 years. Clinical examinations were carried out at 4, 8, 16, and 24 years of age. Blood samples for study of immunoglobulin E sensitization, filaggrin gene mutations, and blood lipids were obtained from almost all participants. BAMSE data were linked to the Swedish Prescribed Drug Register and Region Stockholm’s Healthcare Data Warehouse regarding dispensed topical corticosteroid (TCS) and AD-related healthcare consultations. Results: In Study I, a quantitative study, the aim was to explore the use of emollients and TCS in adolescents with AD in relation to sex and disease severity, and to study dispensing patterns of TCS. The prevalence of AD among the adolescents at 16 years of age was 10% (n = 297). Of those, 73% reported mild AD, 17% moderate, and 10% severe AD. In total, 55% of the adolescents with AD had used TCS within the preceding 12 months, with no difference between sexes. The likelihood of being treated with TCS, emollients, or a combination of these increased in adolescents with symptoms of AD (adjusted odds ratio (adj. OR) 5.97, 95% confidence interval (CI) 1.90–18.9), but not in those with more severe AD compared with mild AD (adj. OR 1.57, 95% CI 0.58–4.25). In total, 24% (n = 297) of the adolescents reported any dispensed TCS in the preceding year. In the group with current/ongoing moderate to severe AD, 24% had been dispensed a potent TCS. In Study II, a qualitative interview study, the aim was to explore young adults’ perceptions of living with AD in relation to the concept of self-management. In total, 15 young adults with persistent AD, mild to very severe, described their perceptions of living with AD. The results revealed four categories: A part of life, Difficult to get help, Limited knowledge, and Impact on my body. The respondents expressed uncertainty regarding treatment with TCS, how to self-treat, and how it affected their bodies. They felt that it was difficult to get support from healthcare, with difficulties making an appointment or getting adequate instructions about how treatment should be performed. The young adults never felt completely symptom-free but stated that they did not allow the AD to affect their daily life. In Study III, a quantitative study, the aim was to determine whether AD affects HRQoL in adolescents and young adults in a population-based setting. A further aim was to determine if use of TCS or healthcare contacts affect HRQoL. The prevalence of AD was 17.7% (n = 542) among the young adults, and higher in females than in males (20.5% vs. 14.8%, p < 0.001). HRQoL values indicated that participants with AD at 12–24 years did not consider themselves completely healthy, with an overall increased adj. OR (1.50, 95% CI 1.30–1.73). Participants with persistent AD reported more pain/discomfort and anxiety/depression than those without AD. Moreover, healthcare contacts were limited among young people with AD and with persistent AD (mean number of consultations 0.57 and 0.96, respectively) during an eight-year period between 14 and 22 years of age. In Study IV, a quantitative study, the aim was to assess associations between AD in childhood and risk factors for cardiovascular disease in young adulthood. The prevalence of AD was 18.6% (n = 420) at 24 years. Males with AD had increased body mass index (βAdj. 0.81, 95% CI 0.15–1.47), body fat percentage (βAdj. 1.19, 95% CI 0.09–2.29), systolic blood pressure (βAdj. 1.92, 95% CI 0.02–3.82), total cholesterol (βAdj. 0.14, 95% CI 0.00–0.28), and low-density lipoprotein cholesterol (βAdj. 0.15, 95% CI 0.02–0.27) compared with males without AD. No statistically significant association was seen in females. In current AD with prepubertal onset, there was a positive association with increased BMI in both males and females (βAdj. 0.89, 95% CI 0.11–1.67 and βAdj. 0.72, 95% CI 0.11–1.33, respectively). Of those with AD, 23% (n = 97) fulfilled the criteria for severe AD. A positive association was found between severe AD and overweight, of similar size in males and females. Conclusion: Adolescents with AD and even those with severe AD are undertreated. Young adults with AD are unsure of how to manage their illness. Furthermore, AD has a negative effect on HRQoL from adolescence to adulthood. In addition, young adults with AD have few healthcare consultations. Moreover, it appears that AD, especially in males, is associated with risk factors for cardiovascular disease in young adulthood. However, the results indicate that both a long duration of AD and severe AD may be associated with obesity in both males and females

Nordic countries: Denmark, Norway and Sweden

The aims of the workpackage: The objective of WP3 is to provide an overview of policy formation and deliberation across a number of regions and across a relatively broad timeframe (late 1980s to the present). As a mapping exercise it is intended to provide an initial comparative framework for further elaboration in more detailed country and regional case studies. WP3 offers a ‗helicopter view‘ of global xenotransplantation (XTP) regulation and landmark policy events. It provides a history of the development and timeline of policy-making combined with an initial scoping of the place and purpose of consultative and deliberative processes. In so doing, the WP provides a means of initial orientation for future comparative work and more in depth case studies. The WP is in no sense intended to be comprehensive but instead provides an initial means of developing a more focussed comparative method and body of questions to be taken up in the project‘s future workpackages

Överväganden och effekter vid implementering av ny teknologi – en fallstudie av Anototeknologin

Avsikten med uppsatsen är att utvärdera och analysera implementeringen av en ny teknologi, vilken befinner sig i en nätverksdriven marknad. Studien ämnar se till de överväganden företag står inför vid implementering av Anototeknologi, förändringar som implementeringen medför samt de för- och nackdelar som uppleves. För att nå syftet med denna undersökning används kvalitativa intervjuer uppdelade i två fall med två slutkunder till företaget Anoto. Teorierna som används och ställs mot empirin är disruptiv, plattforms teori, nätverkseffekter, switching cost & TCO. Uppsatsens empiriska material består av kvalitativ data erhållen från intervjuer med två Anotopartner: Penboosts Solutions AB och Catrel AB, två slutkunder: Würth Svenska AB och Hemtjänsten i Sundbyberg, tre användare av Anotopennan: två Würthsäljare och en hemtjänstarbetare, samt sekundärdata erhållen från de undersökta företagens hemsidor och annat informationsmaterial. Överväganden vid implementering av en ny teknologi var bland annat användarvänlighet, teknologiska finesser, företagets verksamhet och kultur samt nätverkseffekter. Anototeknologin gav i ett fall upphov till ett extra arbetsmoment medan i det andra fallet tog bort ett arbetsmoment. Andra effekter är dess snabba informationsöverföring och positiva personliga vinster, dock är den digitala pennan lite ömtålig

Remote nocturnal bird classification by spectroscopy in extended wavelength ranges

We present optical methods at a wide range of wavelengths for remote classification of birds. The proposed methods include eye-safe fluorescence and depolarization lidar techniques, passive scattering spectroscopy, and infrared (IR) spectroscopy. In this paper we refine our previously presented method of remotely classifying birds with the help of laser-induced beta-keratin fluorescence. Phenomena of excitation quenching are studied in the laboratory and are theoretically discussed in detail. It is shown how the ordered microstructures in bird feathers induce structural "colors" in the IR region with wavelengths of around 3-6 mu m. We show that transmittance in this region depends on the angle of incidence of the transmitted light in a species-specific way and that the transmittance exhibits a close correlation to the spatial periodicity in the arrangement of the feather barbules. We present a method by which the microstructure of feathers can be monitored in a remote fashion by utilization of thermal radiation and the wing beating of the bird. (C) 2011 Optical Society of Americ

Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program

BACKGROUND: Today, there is a trend towards establishing the medical humanities as a component of medical education. However, medical humanities programs that exist within the context of a medical school can be problematic. The aim of this study was to explore problems that can arise with the establishment of a medical humanities curriculum in a medical school program. METHODS: Our theoretical approach in this study is informed by derridean deconstruction and by post-structuralist analysis. We examined the ideology of the Humanities and Medicine program at Lund University, Sweden, the practical implementation of the program, and how ideology and practice corresponded. Examination of the ideology driving the humanities and medicine program was based on a critical reading of all available written material concerning the Humanities and Medicine project. The practice of the program was examined by means of a participatory observation study of one course, and by in-depth interviews with five students who participated in the course. Data was analysed using a hermeneutic editing approach. RESULTS: The ideological language used to describe the program calls it an interdisciplinary learning environment but at the same time shows that the conditions of the program are established by the medical faculty's agenda. In practice, the "humanities" are constructed, defined and used within a medical frame of reference. Medical students have interesting discussions, acquire concepts and enjoy the program. But they come away lacking theoretical structure to understand what they have learned. There is no place for humanities students in the program. CONCLUSION: A challenge facing cross-disciplinary programs is creating an environment where the disciplines have equal standing and contribution