Unpacking constructs: a network approach for studying war exposure, daily stressors and post-traumatic stress disorder

Conflict affected populations are exposed to stressful events during and after war, and it is well established that both take a substantial toll on individuals' mental health. Exactly how exposure to events during and after war affect mental health is a topic of considerable debate. Various hypotheses have been put forward on the relation between stressful war exposure (SWE), daily stressors (DS) and the development of post-traumatic stress disorder (PTSD). This paper seeks to contribute to this debate by critically reflecting upon conventional modeling approaches and by advancing an alternative model to studying interrelationships between SWE, DS, and PTSD variables. The network model is proposed as an innovative and comprehensive modeling approach in the field of mental health in the context of war. It involves a conceptualization and representation of variables and relationships that better approach reality, hence improving methodological rigor. It also promises utility in programming and delivering mental health support for war-affected populations

Influenza Vaccine Type-Dependent Antibody Response in Patients with Autoimmune Inflammatory Rheumatic Diseases

BACKGROUND: The study aimed to explore influenza antibody response in patients with autoimmune inflammatory rheumatoid diseases (AIIRDs) stratified by the different vaccine types applied in Denmark during the 2018-2019 influenza season.METHODS: Included patients were diagnosed with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis receiving biological disease-modifying antirheumatic drugs (bDMARDs) with or without conventional synthetic disease-modifying antirheumatic drugs. Influenza vaccination status in the 2018-2019 season and vaccine type received were reviewed in the Denmark. Blood samples were drawn ≥ 14 days post vaccination, and antibody titers were determined by the hemagglutinin inhibition (HAI) assay for the serotypes A/Michigan/H1N1, A/Singapore/H3N2, and B/Colorado included in the influenza vaccines in the 2018-2019 season. An overall serotype HAI geometric mean titer (GMT) was calculated from the 3 serotype-specific HAI titers. An overall serotype HAI GMT ≥ 40 was considered protective.RESULTS: Of the 205 included patients, 105 (51%) had received influenza vaccination. One-quarter of vaccinated patients achieved post-vaccination overall serotype HAI GMT ≥40. For patients vaccinated with Influvac, a significantly higher proportion had HAI titers ≥ 40 for 2 serotypes, namely, A/Michigan/H1N1 and A/Singapore/H3N2, than patients vaccinated with Vaxigrip or VaxigripTetra. The same applied to all serotypes HAI GMT, where significantly more patients who received Influvac achieved postvaccination HAI GMT≥40 versus patients who received Vaxigrip (p=0.02) or VaxigripTetra (p=0.002). The latter outcome was explored in a multivariable logistic regression analysis and remained significant when including the following variables: age, sex, treatment with methotrexate and/or prednisolone, type of influenza vaccine, time interval from vaccination to antibody measurement, and previous vaccination status.CONCLUSION: Influenza antibody levels following vaccination with Influvac in bDMARD-treated patients with AIIRDs were superior to Vaxigrip and VaxigripTetra. Treatment with methotrexate (MTX) did not reduce the antibody response.</p

Bibliotekarer som aktivister i Danmark og Sverige: Kompromis og konflikt

This article concerns differences in the types of conflicts related to librarians acting as activists in Denmark and Sweden. The conflicts in Denmark are limited and mainly of internal character while the conflicts in Sweden are debated in more broadly in the field. Through the Orders of Worth framework by Boltanski &amp; Thévenot the article analyses interviews with both Danish and Swedish librarians. The analysis shows that activism in Denmark is considered an appropriate description for library work that involves doing more than making materials available in working towards social justice. In Sweden, the understanding of activism is more problematic and the Swedish informants in the article do not see themselves as activists, nor the library’s work for social justice as activism. The article shows that Danish librarians work strategically with activism through partnerships. In contrast, the Swedish librarians justify their work by focusing on work done for the good of society or certain groups, since this is considered the best possible position in order to avoid conflict, as the library institution itself also is justified from this perspective. Finally, the article discusses the cultural policy-climate in both countries and shows, that libraries and the cultural field in general have been low on society’s agenda in Denmark, while there is an ongoing ideological conflict in Sweden between left- and rightwing political actors and between national and local levels of government. Overall, the article shows that the difference in the conflicts related to activism in libraries in Denmark and Sweden must take the cultural policy climate in each country in to account, but that it is important for the understanding of the conflict to discuss how actors justify their work for social change

Rekruttering til fiskeri i Lebesby kommune. Hvordan har reguleringssystemet påvirket sysselsettingssystemet i fiske i et lokalsamfunn i Lebesby?

Fiskeri har alltid vært viktig for lokalsamfunnene langs kysten og vært med på å skape levedyktige samfunn. Sysselsettingssystemet har lenge vært under endring og gått fra et tradisjonelt sysselsettingssystem til et mer moderne. Utviklingen med ny teknologi, adgangsbegrensninger og kvoter i fiskeriene har ført til effektivisering og bedre lønnsomhet. Det har også ført til færre fartøy og fiskere over hele landet. Sammen med generell samfunnsutvikling har endringene i fiskeflåten også vist seg å svekke tilknytningen lokalsamfunnene har til fiskeriene. Utfordringene har vært størst med tanke på fremtidig rekruttering, og forgubbing i fiskeflåten er en stor bekymring. Dette gjelder langt på vei for lokalsamfunnet i Lebesby som, i likhet med andre kystsamfunn, har blitt påvirket av denne utviklingen. Rekrutteringen blant de yngre var i en periode en stor utfordring, og kommunen opplevde en stadig økende gjennomsnittsalder blant fiskerne. Til tross for det ser det ut til at lokalsamfunnet har opplevd en positiv utvikling de siste årene. Det ser ikke ut til at lokalsamfunnet i dag har omfattende problemer knyttet til rekruttering til fiske. Det er derimot endringer i reguleringer som har ført til at det er vanskeligere å etablere seg i lukket gruppe, med fartøy og tilhørende rettigheter for unge. Utviklingen peker mot at det vil bli vanskeligere å etablere seg i lukket gruppe

Recent advances in understanding autoimmune thyroid disease:the tallest tree in the forest of polyautoimmunity

Autoimmune thyroid disease (AITD) is often observed together with other autoimmune diseases. The coexistence of two or more autoimmune diseases in the same patient is referred to as polyautoimmunity, and AITD is the autoimmune disease most frequently involved. The occurrence of polyautoimmunity has led to the hypothesis that the affected patients suffer from a generalized dysregulation of their immune system. The present review summarizes recent discoveries unravelling the immunological mechanisms involved in autoimmunity, ranging from natural autoimmunity to disease-specific autoimmunity. Furthermore, the clinical grounds for considering AITD in a setting of polyautoimmunity are explored. A better understanding of these may pave the way for designing new treatment modalities targeting the underlying immune dysregulation when AITD appears in the context of polyautoimmunity

Challenges in Interpretation of Thyroid Function Tests in Pregnant Women with Autoimmune Thyroid Disease

Physiological changes during gestation are important to be aware of in measurement and interpretation of thyroid function tests in women with autoimmune thyroid diseases. Thyroid autoimmune activity is decreasing in pregnancy. Measurement of serum TSH is the first-line screening variable for thyroid dysfunction also in pregnancy. However, using serum TSH for control of treatment of maternal thyroid autoimmunity infers a risk for compromised foetal development. Peripheral thyroid hormone values are highly different among laboratories, and there is a need for laboratory-specific gestational age-related reference ranges. Equally important, the intraindividual variability of the thyroid hormone measurements is much narrower than the interindividual variation (reflecting the reference interval). The best laboratory assessment of thyroid function is a free thyroid hormone estimate combined with TSH. Measurement of antithyroperoxidase and/or TSH receptor antibodies adds to the differential diagnosis of autoimmune and nonautoimmune thyroid diseases

Social inequalities in the provision of obstetric services in Norway 1967-2009: A population-based cohort study

Background: Socioeconomic (SE) inequalities have been observed in a number of adverse outcomes of pregnancy and many of the risk factors for such outcomes are associated with a low SE level. However, SE inequalities persist even after adjustment for these risk factors. Less well-off women are more vulnerable, but may also get less adequate health services. The objective of the present study was to assess possible associations between SE conditions in terms of maternal education as well as ethnic background and obstetric care. Methods: A population-based national cohort study from the Medical Birth Registry of Norway. The study population comprised 2 305 780 births from the observation period 1967–2009. Multilevel analysis was used because of the hierarchical structure of the data. Outcome variables included induction of labour, epidural analgesia, caesarean section, neonatal intensive care and perinatal death. Results: While medical interventions in the 1970s were employed less frequently in women of short education and non-western immigrants, this difference was eliminated or even reversed towards the end of the observation period. However, an excess perinatal mortality in both the short-educated [adjusted relative risk (aRR) ¼ 2.49] and the non-western immigrant groups (aRR ¼ 1.75) remained and may indicate increasing health problems in these groups. Conclusion: Even though our study suggests a fair and favourable development during the last decades in the distribution across SE groups of obstetric health services, the results suggest that the needs for obstetric care have increased in vulnerable groups, requiring a closer follow-up.publishedVersio