Annual Report on Research in the County Council of Gävleborg

 Annual Report on Research in the County Council of Gävleborg 2010 www.lg.se/fou
Annual Report on Research in the County Council of Gävleborg 2010 This year we have combined the annual report with the research accounts for 2010 and called it the Annual Report on Research in the County Council of Gävleborg. The research accounts identify our researchers and their scientific production. Clinical research is a natural part of our work in the county council, a resource for creating stimulating and attractive workplaces, where researchers’ knowledge is used for meeting the needs of future health care. Gävle, 17 March 2011 Marieann Högman Director of Research & Development Professor
Inga‐Lill Stenlund Administrative Assistant Content Contract with Uppsala University .......................................................................................................................... 1
Centre for Research and Development ................................................................................................................. 2
The Goals of Activity............................................................................................................................................... 2
We undertake......................................................................................................................................................... 3
Important Events during 2010 ............................................................................................................................... 3
Research and Development Day, 29 April .......................................................................................................... 3
Study visit from Umeå University ....................................................................................................................... 4
Final Research Accounts 2009 ............................................................................................................................ 4
The Gävleborg County Research Council ............................................................................................................ 5
Regional Investment in Prevention of Pressure Ulcers ....................................................................................... 6
Dissemination of Information............................................................................................................................. 6
Regional Research Council.................................................................................................................................. 6
Specialist Medical Education .............................................................................................................................. 6
Scientific supervision and advising ..................................................................................................................... 7
Course in Basic Research Methods ..................................................................................................................... 7
Resources................................................................................................................................................................ 8
Staff......................................................................................................................................................................... 8
Summary of Research carried out in the County Council.................................................................................... 10
DIVISION BKPH ..................................................................................................................................................... 11
PhD‐exam ......................................................................................................................................................... 11
Researchers ...................................................................................................................................................... 12
PhD‐students .................................................................................................................................................... 14
DIVISION DIAGNOSTICS........................................................................................................................................ 16
Researchers ...................................................................................................................................................... 16
PhD‐students .................................................................................................................................................... 17
DIVISION MEDICINE.............................................................................................................................................. 18
PhD‐exam ......................................................................................................................................................... 18
Researchers ...................................................................................................................................................... 19
PhD exam in 2000 on the subject ” Hyperosmolality and the heart” at Institute of Physiology and Biomedical Technique, Norwegian University of Science and Technology, Trondheim........................................................... 20
PhD‐students .................................................................................................................................................... 23
DIVISION OPERATION........................................................................................................................................... 24
Researchers ...................................................................................................................................................... 24
PhD‐students .................................................................................................................................................... 29
Others............................................................................................................................................................... 31
DIVISION PRIMARY CARE ..................................................................................................................................... 32
PhD‐exam ......................................................................................................................................................... 32
Researchers ...................................................................................................................................................... 35
MANAGEMENT & ACTIVITIES SUPPORT .............................................................................................................. 38
PhD‐students .................................................................................................................................................... 38
CFUG AND COUNTY COUNCIL STAFF.................................................................................................................... 39
PhD‐exam ......................................................................................................................................................... 39
Researchers ...................................................................................................................................................... 40
DENTAL CARE, GÄVLE........................................................................................................................................... 42
Researchers ...................................................................................................................................................... 42
PhD‐students .................................................................................................................................................... 43
Others............................................................................................................................................................... 44
Contract with Uppsala University In May 2001, a formal agreement on collaboration was drawn up between Uppsala University and the Gävleborg County Council. This agreement entailed that the university‐
financed Centre for Clinical Research‐Gävleborg, abbreviated to CKF be connected to the county council’s unit for research and development, FoU. The director of CKF is Marieann Högman, who is also head of the research and development unit, FoU, and consultant professor at the Institution for the Medical Sciences, Lung Medicine and Allergology at Uppsala University. Professor Marianne Carlsson, Institution for Public Health and the Caring Sciences, has been deputy director of CKF since 2008. The contract with Uppsala University expired 31 December 2009, but a new one has been drawn up and applies until 31 December 2012. More information may be found at http://www.medfarm.uu.se/centrumbildningar/cfug.html. The purpose of this agreement is to facilitate in‐depth and long‐term collaboration between the medical and pharmaceutical science faculties of Uppsala University and the Gävleborg County Council. The intention is to expand and reinforce clinical research and development within medicine, pharmaceutics, the caring sciences and health care research. This broadens the university’s base and gives the county council access to the university’s resources as regards educational courses and scientific competence as well as financial support for PhD candidates who are registered at Uppsala University. CKF‐Gävleborg has a prominent place within Uppsala University, as is shown in Figure 1, and along with the directors of other collaborative partners, the director of CKF Gävleborg attends meetings of heads of departments within the university’s medical and pharmaceutical faculties. Figure 1. Position of CKF‐Gävleborg in the organization of Uppsala University 1
Centre for Research and Development The County Council of Gävleborg has had a county‐wide unit for research and development since 1991: FoU Forum (Forum for Research and Development). In 2001 Uppsala University established CKF‐Gävleborg at the County Council and since then both FoU and CKF have had a shared identity as “Centrum för Forskning och Utveckling, Uppsala Universitet/Landstinget Gävleborg” – CFUG (Centre for Research and Development, Uppsala University/County Council of Gävleborg). CFUG has been placed as an independent administrative unit directly under the Director of the County Council (Figure 2). This position, in combination with the organizational collaboration with Uppsala University outlined above, creates the best preconditions for achieving the goals of the administration as effectively as possible. Figure 2. Organization of the County Council of Gävleborg with the position of Centre for Research & Development. The Goals of Activity The purpose of CFUG is to highlight research and development questions within the Gävleborg County Council. We support and stimulate research and development within all divisions of the county council, help to achieve greater competence within research and development and raise the quality of the various activities undertaken under the auspices of the County Council. In addition, we cooperate with the University of Gävle and with Region Gävleborg and its R&D unit, Research and Development Welfare, and thereby contribute to local regional development. In time of national regionalisation it is important to collaborate 2
with the other Centres for Clinical Research at Uppsala University to get a similar view of the direction of the clinical research. A frequent collaboration with Uppsala University is of great importance for our researchers and PhD‐students. We undertake 
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to stimulate research and development scientific supervision to advise research and development projects supervision and advice on statistics IT support including training groups and individuals in systematic literature searches, referencing, presentations etc. seminars meetings with PhD students basic courses in research methods to disseminate information on research through informal meetings and newsletters to award research grants to organize a Research and Development Day for the county council every second year Important Events during 2010 Research and Development Day, 29 April A local Research and Development Day has been held for the Gävleborg County Council, with invitations to the University College in Gävle and Research & Development Welfare. This year’s activities attracted somewhat more participants than in 2008, partly because posters were distributed by hand. Ragnar Levi, doctor, editor and director of information at SBU, (Swedish Council on Health Technology Assessment) gave a lecture on “Evidence and Critical Thinking in Healthcare – A fundamental or exclusive requirement?” Björn Olsen, professor of Infectious diseases at the Institution for the Medical Sciences at Uppsala University lectured on “Resistant Bacteria and Medical Challenges”. The three doctors who received PhDs in 2009 discussed their theses. There were 26 lectures by county employees and two by lecturers from the University College in Gävle. The library, the University College, Research & Development Welfare and the Care Guides (Vårdvägvisarna) all had stands and information available. Picture 1: Students from Västerbergs Folkhögskola start off the Research and Development Day with music Photo: Anders Friberg 3
Study visit from Umeå University Umeå University came on a study visit to get inspiration from our way of working. They want to create a interconnected research area in the north of Sweden to promote clinical research. To present once own organisation was very fruitful and to recognise what is good and what needs to be improved. We got an excellent verdict, which is rewording in our future work. Picture 2. Visit from a delegation of Norrland and Umeå University. From left: Peter Naredi, Christina Reuterwall, Madelene Lundgren, Katrine Åhlström‐Riklund, Jonas Appelberg, Karin Zingmark, Jack Lysholm, Marieann Högman (CFUG), Hans Högberg (CFUG), Stefan Söderberg, Dag Rissén (CFUG), Anne Lindberg, Inga‐Lill Stenlund (CFUG) och Per Kristiansson. Photo: CFUG Final Research Accounts 2009 CFUG has had meetings throughout the year with all division managers and presented a final research account for 2009. The Swedish Association of Local Authorities and Regions (Sveriges Kommuner och Landsting – SKL) has invited discussions on this procedure, also for 2010, which they have entitled “Annual Report on Clinical Research in the County Councils”. The head of Research and Development, who is the representative of the County Council of Gävleborg, has agreed to participate in the annual report, which will be presented division by division to SKL.
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Table 1. Number of months reserved for research requested by PhD students. Less than half of this time could be financed by CFUG due to full compensation of their salary. 2006 2007 2008 2009 2010 Total number of months requested 75,5 81 66,5 63 80 Granted from the Gävleborg County Council 30 28,5 30 31 18 Granted from Uppsala University 9 9 8 13 18 The Gävleborg County Research Council The County Research Council has met and distributed funding for projects and PhDs in 2011, which amounted to around SEK 2 million. County employees applied for project and PhD financing for SEK 6 million, which meant that funding available for projects amounted to near half of what had been applied for. As Table 1 shows, the County Council of Gävleborg has drastically reduced the number of months available to PhD candidates. This reflects a new procedure as of 2010 whereby a whole month salary is allotted, and a salary ceiling of SEK 25,000 and the norm of 75% remuneration have been removed. The County Research Council is composed of Professor Marieann Högman (chairwoman), Uppsala University representatives, Professor Marianne Carlsson, Professor Martin Björck, Professor Lars Lind and Professor Johan Hallqvist; and Gävleborg County Council representatives, Ola Westin, Associate Professor Mats Hallman, Tomas Weitoft and Ulla I Johansson. Applied funds
3,0
Granted funds
2,5
Million Skr
2,0
1,5
1,0
0,5
2006
2007
2008
2009
2010
Figure 3. Funding earmarked for research and development projects amounts to just over one third of what was applied for. 5
Regional Investment in Prevention of Pressure Ulcers Initiatives have been taken for regional cooperation in research on the prevention of pressure sores. Three county councils (Gävleborg, Dalarna and Uppsala), university colleges in Gävle and Falun and Uppsala University have joined forces in a major effort to limit the incidence of pressure sores in both hospital care settings and municipal care facilities. During the autumn, Karlstad University and the Värmland County Council also joined the programme. Several research projects have been planned by the group. One project received financial support from the Regional Research Council. One PhD candidate is involved in the group and her research has shown that practical changes and more knowledge on the part of staff are needed. Her work provided the basis for a scientific development project to which the unit for the management of health services within the county council, HSL, allotted SEK 3 million over a period of two years. A working group has been assembled and produced a proposal for how to best raise levels of knowledge and motivation for working with pressure sore prophylaxis. A project has been commenced with the Computer Science department at Gävle University College to create an electronic device for measuring pressure sores. This prepares us for the national investment in increased patient safety, which was initiated by SKL, that aims at reducing the number of pressure sores caused in conjunction with care. Dissemination of Information CFUG’s intranet newsletter reaches many senior managers, researchers, PhD candidates and others interested in research within the county. A pdf version of this newsletter is available outside the county and is also on our home page www.lg.se/fou . Nine newsletters have been produced in 2010. Regional Research Council The Regional Research Council of the Uppsala/Örebro region, to which the county of Gävleborg contributes funding, granted SEK 1,749,000 to researchers working in the county. The funding is to be used in 2011. This should be seen in light of the fact that the county of Gävleborg contributes SEK 1.5 million annually to the regional council, an indication that our researchers’ work maintains high quality. Svante Lönnbark, County Director, represents Gävleborg on the Regional Research Council. Members from Gävleborg on the council’s prioritizing committee include consultant dentist, Ingalill Feldmann, research supervisor, Lennart Fredriksson and consultant physician, Gösta Ullmark. CFUG was represented at the Research Conference at Örebro. Specialist Medical Education In specialist medical education today it is mandatory that the student completes a research project. To support this, CFUG has restructured the course in basic research methods in order to satisfy the requirements laid down by the National Swedish Board of Health and Welfare. In cooperation with directors of studies, CFUG has produced a model for how the Board’s §19 can be carried out in Gävleborg. To this end, a half‐time post at CFUG has been designed and advertised. Initiatives have also been taken for a course aimed at scientific supervisors working within the county. 6
Scientific supervision and advising There is a great demand for supervision on the part of many people from various professional categories who find themselves in different phases in research, development and education. The total number of supervised projects is 289, and these include 135 research projects, 120 educational and 34 development projects ‐ somewhat fewer projects than in 2009 but more than in 2008. In addition to this supervision, CFUG offers help with how to organize references; how to use various computer programs in research (Word, Excel, SPSS, Power Point); presentation techniques; how to apply for funding, and other general tips and advice regarding research and development. Development
Research
12 %
Education
47 %
41 %
Figure 4. Supervision during 2010. The distribution shows an increasing proportion of research in comparison with education. Course in Basic Research Methods At its start in the autumn, the annual course in basic research methods had 19 participants, of whom 12 completed the exam during the year. The course was aimed at all professional categories, but as in the previous year, it was primarily composed of specialist doctors. This is due to changes in specialist education, where the National Board of Health and Welfare requires a methods course and evidence of work on a scientifically‐based research project. The course included an introduction to statistical methods, qualitative methods, instructions in how to apply for research funding; how to write an ethical application, search for literature in scientific data bases, organize literature references; and advice on what to consider when using questionnaires or interviews, and on how scientific articles are scrutinized, etc. As previously, the course exam consisted of a written project plan for a possible research or development project. This is then presented, opposed and discussed on the last day of the course. The course also requires written assignments, based on obligatory course literature. Course evaluations show that the participants have been largely satisfied. Since 2009, this course has been expanded to include an in‐depth study, which after passing the exam, gives 7.5 higher education credits. In this year’s course there were two participants who were successfully examined in an in‐depth study. Senior physician Stefan Bergström becomes Research Fellow/Associate Professor In June, Stefan Bergström, consultant physician at Division Operation, became Research Fellow in Oncology at Uppsala University. He held a lecture on his work towards becoming a research fellow in the Bröms Room on 2 October. The lecture was well attended (53 people). 7
Picture 3: Research Fellow, Stefan Bergström is congratulated by Inger Nordmark, Administrative Head of his department Foto:CFUG Resources CFUG receives SEK 1.5 million from the county council, which finances staff, premises, activities and other costs. In addition to direct supervision, advice and teaching, individual employees of the Gävleborg County Council have access to a place to work and computers with programs suitable for research and development. The goal is to offer a creative environment and quick access to help for those who have set aside time for research, education, or who are working with development projects. Staff There are five full‐time members of staff: a director, a chief secretary/administrator, a statistician and two research supervisors. Sick leave has been very low during the year – 0.56%, and hours worked have numbered 7,951. During staff reviews, questions of work environment have been brought up ‐ what works well and what less well. In part on the basis of staff questionnaires, discussions have been started, but the Research & Development Forum (FoU) is a small unit and therefore we have relied a great deal on wider results from the Gävleborg County Council. An action plan has been drawn up, focusing on competence and exchange of knowledge, and on creating a pleasant workplace, with a good spirit of cooperation and control of employees’ work load. During 2010, staff has included the following: Marieann Högman, Professor, Head of Department, Director of CKF (100%) Marianne Carlsson, Professor, Deputy Director of CKF (20%) Inga‐Lill Stenlund, Secretary, Administrative Assistant of CKF (100%) Lennart Fredriksson, PhD, Research Supervisor (100%) Hans Högberg, PhD, Statistician (100%) Dag Rissén, PhD, Research Supervisor (100%) 8
CFUG staff is represented in the priorizing committee of the Uppsala Örebro Regional Research Council, in the Research Council of Research and Development Welfare, the Educational Council for Doctors, and in the Education Council for Care, and on the Regional Ethics Board in Uppsala. Picture 4: CFUG Staff: top from left, Lennart Fredriksson, Dag Rissén, Hans Högberg. Bottom from left: Inga‐Lill Stenlund and Marieann Högman. Photo: CFUG 9
Summary of Research carried out in the County Council There is a base of researchers that can be involved in project initialized by the County Council if so desires. Nearly 50 persons have defended their thesis, two have reached professors level and one assistant professor. During 2010 there were about 20 PhD‐students, level slightly lower than pervious years. Personnel from different professions perform research. There is however a majority of male physicians even though amoung PhD‐students it has leveled out. The scientific production has been satisfactory and has remained on a high level compared to previous years. After completing a final research account for 2009, we discovered how to best assemble the relevant facts. Each researcher and PhD‐student have a research activity card to fill in. They also have individual accounts for internal and external fundings. When research time is granted it will burden this accounts. In this way we get to know how much money the County Council of Gävleborg allocates to research. After an active campaign in the county council, research has been recognized and those who have research as part of their post have received a formal contract stipulating this. There is also an agreement on economic reimbursement for research education. The short summary of research is presented by Division in Table 2. Number of researcher, PhD‐students, research funding and scientific publications as referee reviewed articles. Table 2. Statistic of the research in the County Council of Gävleborg. Division BKPH *) Diagnostics Medicine Operation Primary Care Dental Care Other Summary 1 623 1 329 Reseacher 6 2 10
16
- Male/Female 5/1 2/0 7/3
12/4
- Physician 5 2 8
14
- RN 0 0 1
1
- Other 0 0 1 1 PhD‐student 3 1 3
8
- Male/Female 1/2 1/0 0/3
3/5
- Physician 1 1 2
6
- RN 0 0 1
2
- Other 2 0 0 0 Researcher without 1 1 0 3 diploma Research time in 1 775 0 2 302 4 305 tkr Internal account tkr 1 062 55 1 266 1 494 External account 190 0 1840 1424 tkr Scientific production 6 2 6
18
- articles 1 0 4
5
- book chapters 1 0 1
0
- thesis 7 2 11 11 - conferences *) Children’s and Woman’s Health Care, Psychiatry and Habilitation
6
4/2
5
0
1 1
0/1
1
0
0 3 2/1 0 0 3 1 1/0 0 0 1 4 3/1 1 1 2 4 2/2 0 2 1 6 400 47
35/12
35
3
8 21
8/13
11
5
4 1 3 2 11 1 218 1 510 11 790 Employee 963 411 798 10
680 445 1 276 182 115 416 4 590 2250 300 217 6 221 14
0
2
6 6 0 0 3 1 6 1 9 53
16
5
49
DIVISION BKPH PhD‐exam Author: Amini Hashem Title: Fetal Anomalies: Surveillance and Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging Institution: Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa Keyword: Pregnancy termination, fetal anomalies, antenatal diagnosis, ultrasound, second trimester, fetal MRI, CNS anomalies, pregnancy management, non‐CNS anomalies, fetal autopsy, birth defects registry, ascertainment, spina bifida, cleft lip/palate Dissertation: 2010‐05‐07, Rudbeck auditorium, Rudbeck Laboratory, entrance C11, Uppsala, 09:15 (Swedish) Opponent: Lindqvist, Pelle, Ass Prof (Karolinska Institution) Abstract: The aims were to investigate the accuracy of ultrasound in diagnosis of structural fetal anomalies with special focus on false positive findings (I), to evaluate the additional value of second trimester fetal MRI on pregnancy management (II‐III) and to estimate the ascertainment in the Swedish Birth Defects Registry and incidence of spina bifida and cleft lip/palate (IV). Retrospectively, 328 fetal autopsies were identified where pregnancies were terminated due to ultrasonographically diagnosed fetal anomalies. In 175 (53.4 %) cases ultrasound and fetal autopsy were identical, in 124 (37.8 %) ultrasound was almost correct, in 23 (7.0 %) ultrasound diagnoses could not be verified, but fetal autopsy showed other anomalies with at least the same prognostic value and in six (1.8 %) ultrasound diagnosis could not be verified and autopsy showed no or less severe anomalies (I). Prospectively, 29 pregnancies with CNS‐ (II) and 63 with non‐CNS‐anomalies (III) were included. In the CNS study MRI provided no additional information in 18 fetuses (62 %), additional information without changing the management in 8 (28 %) and additional information altering the pregnancy management in 3 (10%). In the non‐CNS study the corresponding figures were 43 (68 %), 17 (27 %) and three (5 %), respectively. MRI in the second trimester might be a clinically valuable adjunct to ultrasound for the evaluation of CNS anomalies, especially when the ultrasound is inconclusive due to maternal obesity (II) and in non‐CNS anomalies in cases of diaphragmatic hernia or oligohydramnios (III). In newborns, the ascertainments of birth defects are relatively high and assessable, but in pregnancy terminations they are lower or unknown. The incidence of newborns with spina bifida has decreased because of an increased rate of pregnancy terminations (>60%). There is room for improvement concerning the reporting of anomalies from terminated pregnancies (IV). 11
Picture 5. Hashem Amini nails his thesis according to the tradition of CFUG. Photo: CFUG Researchers Bengt Andraé, senior physician, Gynaecology Development and effectuation of amodel for Routine National Audit for Cancer prevention. Research area: Cervix cancer Keywords: Cervical cancer screening, audits, adenocarcinoma Litterature: SFOG, ARG rapport nr 63: Cervixcancerprevention. Riktlinjer för handläggning av interaepitelial dysplasi 2010. Scientific articles: Silfverdal L, Kemetli L, Sparén P, Andrae B, Strander B, Ryd W, Dillner J, Törnberg S. Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: A population‐based case‐control study. Int J Cancer. 2010 Epub Nov 9 Participation in national and international conferenses: Speaker at EUROGIN Monaco 2010 European Federation for Colposcopy Berlin 2010 ECCG‐ECN‐EUROCOURSE Pan‐European Network Neeting (IARC) "Prospects for improvement in cancer screening and prevention" Warsaw 2010 Equalis Expert Groupe for cervix cancer prevention SKL Expert Groupe for HPV vaccination and cervix cancer screening 12
Hashem Amini, senior physician, Gynaecology PhD exam in 2010 on the subject ”Fetal Anomalies – Surveillance and Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging” at Uppsala University. Research area: Obstetrik och gynekologi Keywords: fetal anomalies, fetal MRI, ultrasound, fetakl autopsy Scientific articles: Amini H, Axelsson O, Raiend M, Wikström J. The clinical impact of fetal magnetic resonance imaging on management of CNS anomalies in the second trimester of pregnancy. Acta Obstet Gynecol Scand. 2010; 89(12): 1571‐81. Participation in national and international conferenses: SFOG Gotland Carl Lindgren, senior physician, Children‐ and Adolescent Health Care PhD exam in 1996 on the subject “Respiratory tract infections, reflex apnea and sudden
infant death : experimental and epidemiological studies with special reference to Respiratory
syncytial virus, Bordetella pertussis and infant sleep position” at Karolinska Institutet. Research area: Pediatrics Scientific articles: Lindgren C Lindblad F, The Enigma of the welfare state, Acta Paediatr. 2010; 99(6): 803‐7. Lindgren C. Pediatric interviewing. A Practical, Relationship‐Based Approach. Acta Paediatr. 2010; 99(11): 1750‐1751 Sten Jagell, senior physician, Children‐ and Adolescent Psychiatry PhD exam in 1981 on the subject “Sjögren‐Larsson syndrome in Sweden : an epidemiological, genetic, clinical and biochemical study” at Umeå University. Research area: Not active Gunilla Norrman, senior physician, Children‐ and Adolescent Health Care 13
PhD exam in 2007 on the subject ”Eczema in young children: aspects of clinical investigation and treatment” at Linköping University. Research area: Atopic dermatitis in children Keywords: allergy, eczema, skin prick test, asthma, food allergy Ragnar Sidenvall, senior physician, Children‐ and Adolescent Habilitation PhD exam in 2000 on the subject ” Epidemiology of seizure disorders: population‐based studies in Swedish children” at Umeå University. Research area: Not active Peter Smith, senior physician, Gynaecology PhD exam in 1993 on the subject ”Estrogens and the urogenital tract : studies on steroid hormone receptors and a clinical study on a new estradiol‐releasing vaginal ring” at Uppsala University Research area: Obstetrics and gynaecology Keywords: hysterctomi, analgesia, pain Henning Thejls, senior physician, Gynaecology PhD exam in 1995 on the subject “Silent chlamydia infections : aspects of diagnosis and considerations concerning treatment” at Uppsala University. Research area: Gynaecology Keywords: CRP, sectio, infection PhD‐students Registered at Uppsala University Maria Palm Gynaecologist Department of Women's and Children's Health Scientific focus: Oxidative stress, inflammation och angiogenes under normal graviditet samt under normal menstruationscykel Time of dissertation: 2011 14
Scientific articles: Larsson A, Palm M, Hansson LO, Axelsson O. Cystatin C and modification of diet in renal disease (MDRD) estimated glomerular filtration rate differ during normal pregnancy. Acta Obstet Gynecol Scand. 2010; 89(7): 939‐44. Larsson A, Palm M, Pentraxin 3 values during normal pregnancy Inflammation 2010 Sept Epub Ylva Strömbom Psycologist Department of Psychology Scientific focus: Frequent attainders in Primary Health Care Time of dissertation: study recess Gölin Wikstrand Gynaecologist Department of Women's and Children's Health Scientific focus: Occurence of risk factors of becoming ill in cardiovascular disease after pregnacy induced hypertension Time of dissertation: 2014 Registered at Karolinska Institutet Kristina Nordstrand Vroland Occupational Therapist Department of Women's and Children's Health Scientific focus: Goal setting and skills achievement in children with disabilities Time of dissertation: 2016 Registered at Örebro University Patrik Arvidsson Psycologist Depatement of Health and Sciencis Scientific focus: Factors related to positive functioning and participation in people with mild intellectual disability Time of dissertation: 2011 15
DIVISION DIAGNOSTICS Researchers Olov Haller, senior physician, Diagnostics Research area: X‐ray diagnostics Keywords: Abdominal pain, computed tomography, radiation dosage Scientific articles: Haller O, Karlsson L, Nyman R. Can low‐dose abdominal CT replace abdominal plain film in evaluation of acute abdominal pain? Ups J Med Sci. 2010; 115(2): 113‐20 Leif Jansson, senior physician, Clinical Chemistry PhD exam in 1974 on the subject ” Studies on the macromolecular properties and metabolism of heparin‐like glycosaminoglycans” at Uppsala university. Research area: inflammatory biomarkers, reference values for children Keywords: procalcitonin, CRP Erik Wilander, senior physician, Clinical pathology/Cytology PhD exam in 1974 on the subject “On the development of diabetes mellitus in Chinese hamsters given streptozotocin and N‐nitrosomethylurea” at Uppsala university. Research area: HPV Keywords: HPV, testing Scientific articles: Gyllensten U, Lindell M, Gustafsson I, Wilander E. HPV test shows low sensitivity of Pap screen in older women. Lancet Oncol. 2010; 11(6): 509‐10 Participation in national and international conferenses: Speaker at EUROGIN Monaco 2010, European Federation for Colposcopy Berlin 2010 16
PhD‐students Registered at Uppsala University Olli Leppänen Physician Ludwig Institute for Cancer Research, Uppsala Scientific focus: Arterial Response to Injury and Inhibition of Ligand‐induced Platelet‐derived Growth Factor Beta‐receptor Activation. Time of dissertation: 2011 17
DIVISION MEDICINE PhD‐exam Author: Magnus Lindberg Title: Excessive Fluid Overload Among Haemodialysis Patients: Prevalence, Individual Characteristics and Self‐regulation of Fluid Intake Department: Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg Keywords: Behavioural medicine, fluid overload, adherence, haemodialysis, self‐efficacy, attentional style, depressive symptomatology, cluster analysis, tailored treatment, quasi‐experimental single‐case design, Fluid Intake Appraisal Inventory (FIAI), renal nursing Dissertation: 2010‐05‐19, Sal IV, Universitetshuset, Övre Slottsgatan 2, Uppsala, 13:00 (Swedish) Opponent: Wredling, Regina, Professor emirita (Karolinska Institute, Dept of Neurobiology)
Abstract: This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self‐regulation of fluid allotment from a bio‐psychosocial and behavioural medicine perspective. The extent of non‐adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self‐
administered scale to measure situation‐specific self‐efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self‐efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self‐efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. 18
This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced. Picture 6. Professor emirita Regina Wredling, Institutionen för neurobiology, Karolinska Institutet, and Magnus Lindberg. Photo: CFUG Researchers Eva Brandén, , senior physician, Lung Medicine, 20% research time PhD exam in 2005 on the subject ” Chronic Infection with Chlamydia Pneumoniae in COPD and Lung Cancer” at Karolinska institutet. Research area: Lung cancer and diagnostics Keywords: Carcinoma, non‐small‐cell lung cance, prognosis, differential diagnosis, apoptosis Scientific articles: De Petris L, Brandén E, Herrmann R, Sanchez BC, Koyi H, Linderholm B, Lewensohn R, Linder S, Lehtiö J. Diagnostic and prognostic role of plasma levels of two forms of cytokeratin 18 in patients with non‐small‐cell lung cancer. Eur J Cancer. 2010 Sep 3 Epub Participation in national and international conferenses: 2010 02 18 – 19 Critical Issues in Lung Cancer Research: The Swedish approach and the International Standards, Nobel Forum, Stockholm 2010 03 06 – 07 Perspectives in Lung Cancer, Amsterdam, Holland 2010 06 03 – 08 ASCO, Chicago, USA 2010 09 18 – 22 European Respiratory Society, Barcelona Spanien 19
2010 12 01 Moderator at Lung cancer symposium, Swedish Conference of Medicine, Göteborg Geir Falck, senior physician, Cardiology PhD exam in 2000 on the subject ” Hyperosmolality and the heart” at Institute of Physiology and Biomedical Technique, Norwegian University of Science and Technology, Trondheim Research area: Not active Ulla Johansson, senior physician, Gastroenterology, R&D position PhD exam in 1993 on the subject ” Glucose metabolism and insulin resistance in patients with cirrhosis ” at Karolinska institutet. Research area: carcinoid of the ileus – malnutrition and metabolism Keywords: mid‐gut carcinoid tumours, disease‐related malnutrition, loss of bone mass, nutritional assessment, metabolism Ulla I Johansson, Occupational Therapist, R&D position PhD exam in 2004 on the subject ”Long‐term outcome after brain injury with focus on work re‐entry, life satisfaction and participation” at Umeå University. Research area: Rehabilitation after brain injury Keywords: rehabilitation, stroke, workability Participation in national and international conferenses: World Federation of Occupational Therapy, Santiago, Chile, 2010. Hirsh Koyi, senior physician, Lung Medicine, 20% research time PhD exam in 2001 on the subject “Lung cancer in the county of Gaevleborg : Epidemiology and importance of infection with Chlamydia pneumoniae” at Karolinska insitutet. Research area: Lung cancer, chronic obstructive pulmonary disease Keywords: Lung cancer, COPD, proteonomix Scientific articles: De Petris L, Brandén E, Herrmann R, Sanchez BC, Koyi H, Linderholm B, Lewensohn R, Linder S, Lehtiö J. Diagnostic and prognostic role of plasma levels of two forms of cytokeratin 18 in patients with non‐small‐cell lung cancer Eur J Cancer. 2010 Sep 3 Epub 20
Participation in national and international conferenses: ERS, 18‐22 September, 2010, Bercelona, Spanien, ASCO, 4‐8 Jun, 2010, Chicago, USA Magnus Lindberg, RN, R&D position PhD exam in 2010 on the subject ” Excessive Fluid Overload Among Haemodialysis Patients : Prevalence, Individual Characteristics and Self‐regulation of Fluid Intake” at Uppsala University. Research area: Renal Medicine Keywords: Haemodialysis, Renal nursing, Self‐efficacy, Self‐care, Patient adherence, Questionnaires, Psychometrics, Patient safety, Quality of care, Behavioural medicine Scientific articles: Lindberg M, Fernandes MA. Self‐efficacy in relation to limited fluid intake amongst Portuguese haemodialysis patients. J Ren Care. 2010; 36(3): 133‐8 Lindberg M, Wikström B, Lindberg P Subgroups of haemodialysis patients in relation to fluid intake restrictions: a cluster analytical approach. J Clin Nurs. 2010; 19(21‐22): 2997‐3005. Participation in national and international conferenses: EANS Scholar meeting Witten‐Herdecke, Germany 6‐8/7 Thomas Olsson, senior physician, Cardiology PhD exam in 2004 on the subject “Risk prediction at the emergency department” at Uppsala University. Research area: Myocardial infarction Keywords: BNP, troponin, ECG Litterature: Akutmedicin Liebers förlag.#:E nyreviderande upplagan Erik Torell, senior physician, Infection Disease PhD exam in 2003 on the subject “Epidemiology of Enterococci with Acquired Resistance to Antibiotics in Sweden: Special emphasis on Ampicillin and Vancomycin” at Uppsala University. Research area: Antibiotica resistence and infektion epidemiology 21
Keywords: Antimicrobial resistance, ESBL, VRE Scientific articles: Lytsy B, Lindbäck J, Torell E, Sylvan S, Velicko I, Melhus A. A case‐control study of risk factors for urinary acquisition of Klebsiella pneumoniae producing CTX‐M‐15 in an outbreak situation in Sweden. Scand J Infect Dis. 2010; 42(6‐7): 439‐44 Tomas Weitoft, senior physician, Rheumatology, 20% research time PhD exam in 2005 on the subject ” Intra‐articular Glucocorticoid Treatment: Efficacy and Side Effects” at Uppsala University. Research area: Rheumatology Keywords: arthritis, intra‐articular glucocorticoid, triamcinolone hexacetonide, arthrocentesis, bone metabolism, cartilage, cortisol, ACTH, joint infection Scientific articles: Weitoft T, Forsberg C. Importance of immobilization after intraarticular glucocorticoid treatment for elbow synovitis: a randomized controlled study. Arthritis Care Res (Hoboken). 2010; 62(5): 735‐7. Participation in national and international conferenses: EULAR Rom Lars Wesslén, senior physician, Infection Disease PhD exam in 2001 on the subject ” Sudden Cardiac Death in Swedish Orienteers” at Uppsala University. Research area: Infections in sports Keywords: bartonella, cricetinae, risk factors Litterature English version of FYSS 2010 ‐ Capter " Infections and Sport" http://www.fhi.se/Publikationer/Alla‐publikationer/Physical‐Activity‐in‐the‐Prevention‐and‐
Treatment‐of‐Desease/ Participation in national and international conferenses: Speaker at the Annual Congress for Veterinarians 2010. Subject: Trikinos 22
PhD‐students Registered at Uppsala University Marianne Lannsjö Senior physician Department of Neuroscience Scientific focus: Prognostic factors after head trauma Time of dissertation: 2011 Lindberg, Maria RN Department of Public Health and Caring Sciences Scientific focus: Experiences in patients colonized with Methicillin Resistant Staphylococcus Aureus and knowledge, attitudes and behaviour of healthcare workers Time of dissertation: 2011 Scientific articles: Mamhidir AG, Lindberg M, Larsson R, Fläckman B, Engström M Deficient knowledge of multidrug‐resistant bacteria and preventive hygiene measures among primary healthcare personnel J Adv Nurs. 2010 Dec 28 Epub Registered at Karolinska Institutet Amanda Häggblom Physician Department of Medicine, Huddinge Scientific focus: Antivetroviral drug resistance and treatment outcome of HIV‐1 infection Time of dissertation: 2016 23
DIVISION OPERATION Researchers Johan Ahlgren, senior physician, Oncology, R&D position PhD exam in 2002 on the subject” Studies on Prediction of Axillary Lymph Node Status in Invasive Breast Cancer” at Uppsala Univesity. Research area: Breast Cancer Keywords: breat cancer, metastasis, treatment Litterature National Guidelines for Breast Cancer Treatment Scientific articles: Malmström A, Hansen J, Malmberg L, Carlsson L, Svensson JH, Ahlgren J, Ahlin C, Jansson T, Westberg R. Gemcitabine and capecitabine in combination for advanced anthracycline and taxane pre‐
treated breast cancer patients: A phase II study. Acta Oncol. 2010; 49: 35‐41. Lambe M, Wigertz A, Holmqvist M, Adolfsson J, Bardage C, Fornander T, Karlsson P, Odlind V, Persson I, Ahlgren J, Bergkvist L. Reductions in use of hormone replacement therapy: effects on Swedish breast cancer incidence trends only seen after several years Breast Cancer Res Treat. 2010; 121(3): 679‐83 Stefan Bergström, senior physician, Oncology, R&D position, Ass Prof PhD exam in 1989 on the subject ”On mast‐cell‐mediated miltogenesis in rat mesenteric windows. Influence olf long‐standing strepozotin‐diabetes and related features such as age and hyperplasia” at Göteborg University. Research area: Cancer Keywords: cancer, CT, PET, larynx, oesophagus, prostat Scientific articles: Ekman S, Frödin JE, Harmenberg J, Bergman A, Hedlund A, Dahg P, Alvfors C, Ståhl B, Bergström S, Bergqvist M. Clinical Phase I study with an Insulin‐like Growth Factor‐1 Receptor Inhibitor: Experiences in patients with squamous non‐small cell lung carcinoma. Acta Oncol. 2010 Epub Aug. 24
Bergström S, Holgersson G, Bergqvist JE, Bergqvist M, Ekman S, Stenström M. Dual‐headed coincidence PET vs. dedicated PET/CT in the evaluation of thoracic malignancies. In Vivo. 2010; 24(2): 235‐8. Tinge B, Molin D, Bergqvist M, Ekman S, Bergström S. Mast cells in squamous cell esophageal carcinoma and clinical parameters. Cancer Genomics Proteomics. 2010; 7(1): 25‐9. Holgersson G, Ekman S, Reizenstein J, Bergqvist M, Pontén F, Uhlén M, Magnusson K, Jonnalagadda P, Asplund A, Strömberg S, Linder A, Blomquist E, Liljeholm M, Lödén B, Hellström K, Bergström S. Molecular profiling using tissue microarrays as a tool to identify predictive biomarkers in laryngeal cancer treated with radiotherapy. Cancer Genomics Proteomics. 2010; 7(1): 1‐7. Hallqvist A, Wagenius G, Rylander H, Brodin O, Holmberg E, Lödén B, Ewers SB, Bergström S, Wichardt‐Johansson G, Nilsson K, Ekberg L, Sederholm C, Nyman J. Concurrent cetuximab and radiotherapy after docetaxel‐cisplatin induction chemotherapy in stage III NSCLC: Satellite‐A phase II study from the Swedish Lung Cancer Study Group. Lung Cancer. 2010 Jun 10 Epub. Ekman S, Bergqvist M, Tell R, Bergström S, Lennartsson J. Hsp90 as a therapeutic target in patients with oesophageal carcinoma. Expert Opin Ther Targets. 2010; 14(3): 317‐28. Reizenstein JA, Bergström SN, Holmberg L, Linder A, Ekman S, Blomquist E, Lödén B, Holmqvist M, Hellström K, Nilsson CO, Brattström D, Bergqvist M. Impact of age at diagnosis on prognosis and treatment in laryngeal cancer. Head Neck. 2010; 32(8): 1062‐8. Participation in national and international conferenses: Perspectives in Lung Cancer Amsterdam, 1st national conference in palliative care, Stockholm Eva Boström Lindberg, RN PhD exam in 2003 on the subject “ Continuous Quality Development by Means of New Understanding” at Uppsala University. Research area: Not active Scientific articles: 25
Boll M, Boström‐Lindberg E. Physiotherapists' understanding and approach to health promotion work in compulsory school: perceiving and supporting coherence. Physiother Theory Pract. 2010; 26(5): 318‐26 Eva Funseth Åhs, Physician PhD exam in 1999 on the subject “ Interactions between the environmental pollutant 2,3,7,8‐ tetrachlorodibenzo‐p‐dioxin and coxsackievirus infection : experimental studies in mice” at Uppsala University. Research area: Not active Håkan Hedstrand, senior physician, Dermatology, 20% research time PhD exam in 2000 on the subject ”Alopecia and vitiligo in autoimmune polyendocrine syndrome type 1” at Uppsala University. Research area: Skin diseases Keywords: Vitiligo, melanom, serum, markörer, SOX10, antigen Scientific articles: Agnarsdóttir M, Sooman L, Bolander A, Strömberg S, Rexhepaj E, Bergqvist M, Ponten F, Gallagher W, Lennartsson J, Ekman S, Uhlen M, Hedstrand H SOX10 expression in superficial spreading and nodular malignant melanomas Melanoma Res. 2010; 20(6): 468‐78 Hagforsen E, Hedstrand H, Nyberg F, Michaëlsson G Novel findings of Langerhans cells and interleukin‐17 expression in relation to the acrosyringium and pustule in palmoplantar pustulosis Br J Dermatol. 2010; 163(3): 572‐9 Johan Hansson, senior physician, Surgery PhD exam in 2009 on the subject” Loco‐regional Treatment of Peritoneal Carcinomatosis: Survival, Morbidity and Quality of Life” at Uppsala University. Research area: Peritoneal Cancer Keywords:Peritoneal carcinomatosis, cytoreductive surgery, intraperitoneal chemotherapy, Participation in national and international conferenses: National meeting, Surgery 26
Mary Hägg, Dentist, 20 % research time PhD exam in 2007 on the subject ”Sensorimotor Brain Plasticity in Stroke Patients with Dysphagia. A Methodological Study on Investigation and Treatment” at Uppsala University. Research area: Stroke Keywords: Brain plasticity, dysphagia, facial palsy, lip force Scientific articles: Hägg M, Anniko M. Influence of lip force on swallowing capacity in stroke patients and in healthy subjects. Acta Otolaryngol. 2010; 130(11): 1204‐8. Participation in national and international conferenses: Speaker 1) 20‐22/1 for dentist, Tällberg; 2) 16/2 Regional R&D‐day, Falun; 3) Teaching 27,28/5 for speach therapist, ENT‐physicians, Örebro University; 4) 28/9 Umeå University; 5) 18/11 Odontologists National Congress, Göteborg. Lars Karlsson, senior physician, Surgery PhD exam in 2009 on the subject ”The role of Chlamydophila pneumoniae in the inflammatory response and expansion of abdominal aortic aneurysms” at Uppsala University. Research area: Aorta Aneurysm Keywords: Abdominal aortic aneurysm, Chlamydophilia pneumoniae, expansion, inflammation Scientific articles: Haller O, Karlsson L, Nyman R. Can low‐dose abdominal CT replace abdominal plain film in evaluation of acute abdominal pain? Ups J Med Sci. 2010; 115(2): 113‐20. Karlsson L, Björck M, Pärsson H, Wanhainen A. The Association Between Serological Markers for Chlamydophila pneumoniae and the Development of Abdominal Aortic Aneurysm. Ann Vasc Surg. 2010 Nov 30 Epub. Susanne Ledin Eriksson, senior physician, Anaesthesia PhD exam in 2004 on the subject “Central‐block techniques for relief of labour pain” at Karolinska institutet. Research area: Not active 27
Anders Moberg, senior physician, Orthopedics PhD exam in 1996 on the subject “Legg‐Calvé‐Perthes disease: an epidemiological, clinical and radiological study” at Uppsala University. Research area: Not active Joel Olsson, senior physician, Surgery PhD exam in 1995 on the subject ”Irrigating Fluid Absorption during Transcervical Endometrial Resection” at Karolinska institutet. Research area: Not active Per Törnquist, senior physician, Eye Medicine PhD exam in 1979 on the subject” Aspects of retinal nutrition” at Uppsala Univesity. Research area: Not active Gösta Ullmark, senior physician, Orthopedics, 20 % research time PhD exam in 2000 on the subject “Morcelised Impacted Cortico‐Cancellous Bone Allografts in Revision Surgery for Endoprosthetic Loosening with Osteolysis” at Uppsala University. Research area: Bone metabolism Keywords: bone metabolism, hip replacement Participation in national and international conferenses: Speaker at EFORT congress, Madrid , SICOT congress Göteborg , and European Hip Society congress Aten. Henrik Wallander, senior physician, Orthopedics, 20 % research time PhD exam in 2009 on the subject “Congenital clubfoot. Aspects on epidemiology, residual deformity and patient reported outcome” at Uppsala University. Research area: Congenital clubfoot Keywords: Congenital clubfoot, incidens, ultra sound, life quality Participation in national and international conferenses: Speaker at International Pediatric Orthopaedic Think Tank, Stockholm 3‐5 Sept, 28
SBOF:s annual meeting( Swedish Children Orthopedic Association) in arrangement with London Pediatric Orthopaedic Club, Göteborg 20‐22 okt. Bengt Wallner, senior physician, Surgery, 20 % research time PhD exam in 2001 on the subject ”Endoscopic and morphologic characterization of the gastroesophageal junction : with special emphasis on Barrett's esophagus” at Umeå University. Research area: Epidemiology and gastro‐esophaegal difficulties Litterature: Acute upper gastrointestinal bleeding. 7th edition of Book of Surgery, Liber AB. Participation in national and international conferenses: National meeting, Surgery Ulf Öhrvall, senior physician, Surgery PhD exam in 1998 on the subject “Intraoperative scintigraphic detection of abdominal endocrine tumors : development and evaluation of hand held gamma sensitive probes for” at Uppsala University. Research area: Not active PhD‐students Registered at Uppsala University Catrine Björn RN, surgery Department of Public Health and Caring Sciences Department of Public Health and Caring Sciences Identifcation of attractive working environment in health care Time of dissertation: 2014 Khatereh Djavani Gidlund Seniro physician Department of Surgical Sciencies Scientific focus: Colonic ischemia and intra‐abdominal hypertention after operation for abdominal aorticaneurysm Time of dissertation: 2011 29
Per Fessé RN, oncology Department of Oncology, Radiology and Clinical Immunology Scientific focus: Description of early/acute and late skin reaction (toxicity) after radiotherapy Time of dissertation: 2011 Gustaf Hedström Physician Department of Oncology, Radiology and Clinical Immunology Scientific focus: Inflammatoriska komponenter kopplade till diffusa storcelliga B‐cellslymfom Time of dissertation: Hella Hultin Physician Department of Surgical Sciences, Endocrinology Scientific focus: Calcium and vitamin D‐turnover in pre‐eclampsia and obesity Time of dissertation: 2011 Scientific articles: Hultin H, Edfeldt K, Sundbom M, Hellman P. Left‐Shifted Relation between Calcium and Parathyroid Hormone in Obesity. J Clin Endocrinol Metab. 2010; 95(8): 3973‐81. Karin Sanner Physician Department of Women's and Children's Health Scientific focus: Significance of Human Papilloma Virus (HPV) analysis for the detection of precancerous cervical cancer‐impact of self sampling. Time of dissertation: Mattias Karlqvist Senior physician Department of Medical Sciencies, Dermatology and venereology Scientific focus: Botulinumtoxin i behandling av i hyperhidros och epidermolytiska gendermatoser. Time of dissertation: 2016 Scientific articles: Swartling C, Karlqvist M, Hymnelius K, Weis J, Vahlquist A. Botulinum toxin in the treatment of sweat‐worsened foot problems in patients with epidermolysis bullosa and pachyonychia congenita. Br J Dermatol. 2010; 163(5): 1072‐6 30
Registered at Umeå University Benny Holmström Senior physician Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Scientific focus: Evaluation of PSA as a biomarker and the effects of prostate‐specific antigen testing in a population based survey. Time of dissertation: 2011 Scientific articles: Holmström B, Holmberg E, Egevad L, Adolfsson J, Johansson JE, Hugosson J, Stattin P. Outcome of Primary Versus Deferred Radical Prostatectomy in the National Prostate Cancer Register of Sweden Followup Study. J Urol. 2010; 184(4): 1322‐7. Holmström B, Johansson M, Bratt O, Stattin P. PSA‐testet håller inte för screening. Bra ‐ men inte tillräckligt bra. Läkartidningen 2010; 7: 436‐39. Others Matilda Andersson, RN Nina Saunamäki, RN Scientific articles: Saunamäki N, Andersson M, Engström M. Discussing sexuality with patients: nurses' attitudes and beliefs. J Adv Nurs. 2010; 66(6): 1308‐16. 31
DIVISION PRIMARY CARE PhD‐exam Author: Kristina Bröms Title: A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, , Prevalence, Co‐ocurrence and Incidence Department: Uppsala University, Faculty of Medicine, Department of Public Health and Caring Sciences. Keywords: Asthma, rhinitis, eczema, allergy, indoor environment, daycare centre, prevalence, incidence epidemiology Dissertation: 2010‐05‐07, Brömssalen, ingång 11, Länssjukhuset, Gävle, 13:15 (Swedish) Opponent: Åberg, Nils, Ass Prof (Department of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg) Abstract: Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non‐atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre‐school children. Methods: All 70 allergen avoidance day‐care centres (AADC) with 84 sections and 140 matched ordinary day‐care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow‐up questionnaire. Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co‐occurrence between all asthma‐
atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co‐occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%. Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co‐occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co‐occurrence conditions. 32
Picture 7. Kristina Bröms in the middle cheering the opponent, ass prof Nils Åberg, ass prof Margareta Emtner and ass prof Lennart Bråbäck to the left and to the right professor Kjell Larsson. Photo: CFUG. Author: Monica Uddenfeldt Title: A Longitudinal Study of Asthma: Risk Factors and Prognosis Department: Uppsala University, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine
Keywords: asthma epidemiology, longitudinal studies, obstructive airway symptoms, risk factors, BMI, diet, smoking, allergic sensitization, atopy Dissertation: 2010‐12‐16, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:15 (Swedish) Opponent: Larsson, Kjell, Professor (Department of Environmental Medicine, Lung‐ and allergy research , Karolinska Institutet) Abstract: The aim of this thesis was to identify risk factors for the onset of adult asthma. Other objectives were to study determinants of smoking habits and the association between sensitization and outcome of asthma. In 1990, a questionnaire was distributed to 12,732 individuals from three age groups (16, 30‐39 and 60‐69 years) in two counties of Sweden. In a second phase, 2538 subjects who had reported respiratory symptoms and 600 controls were invited to clinical investigations, 81% participated. At the follow‐up in 2003 subjects of the remaining cohort (11,282) were re‐invited. Analyses are based on the 67% (n=7563) who responded to both questionnaires 1990 and 2003. In 2003, 17.2% of the young adults, 11.4% of the middle‐aged and 10.3% of the elderly reported having, or having had, asthma. A total of 791 subjects reported onset of asthma during the 13‐year study period. Lifestyle factors such as smoking, obesity, hard physical training and a low consumption of fruit and fish were constant risk factors for onset of asthma after adjusting for socioeconomic group. A smoker’s risk of asthma onset was increased by 37%. The impact of 33
risk factors differed between the age‐groups. BMI had a significantly higher impact in the middle‐aged and elderly. In subjects participating in the clinical investigations in 1990, sensitization to pets, were determinants of both persistent asthma and onset of asthma in 2003. The risk for persistent asthma was threefold. The risk for onset of asthma was more than doubled. Smoking at baseline in 1990 was the strongest determinant of being a smoker in 2003. Allergic sensitization and clinically verified asthma were not associated with smoking habits in 2003. No differences in changing smoking habits could be identified between smokers with or without asthma. In conclusion, modifiable lifestyle factors are important risk factors for adult onset asthma. The co‐occurrence and interplay between asthma and cigarette smoking is still puzzling. Picture 8. Monica Uddenfeldt nails her thesis for the public eye at the University in Uppsala. Photo: Anna Rask‐Andersen. 34
Researchers Kristina Bröms, senior physician, 20% research time PhD exam in 2010 on the subject “A Nationwide Study of Asthma and Allergy in Swedish Preschool Children‐ with Special Reference to Environment, Daycare, Prevalence, Co‐
ocurrence and Incidence” at Uppsala University. Research area: Asthma and allergy in preschool children Keywords: Asthma, rhinit, atopy, children, preschool Jamal Fadul, senior physician PhD exam in 1997 on the subject “Clinical and Haemorheological Effects of Extracorporeal Plasma Purification Therapy” at Uppsala University. Research area: Not active Monica Uddenfeldt, senior physician PhD exam in 2010 on the subject “A Longitudinal Study of Asthma‐ Risk factors and Prognosis” at Uppsala University. Research area: Asthma and Epidemiology Keywords: asthma, mortality, BMI, Scientific articles: Leander M, Janson C, Uddenfeldt M, Cronqvist A, Rask‐Andersen A. Associations Between Mortality, Asthma, and Health‐Related Quality of Life in an Elderly Cohort of Swedes. J Asthma. 2010; 47(6): 627‐32. Uddenfeldt M, Janson C, Lampa E, Leander M, Norbäck D, Larsson L, Rask‐Andersen A. High BMI is related to higher incidence of asthma, while a fish and fruit diet is related to a lower‐ Results from a long‐term follow‐up study of three age groups in Sweden. Respir Med. 2010; 104(7): 972‐80. Per Uddenfeldt, senior physician PhD exam in 1990 on the subject “Primary biliary cirrhosis : an epidemiological and clinical study based on patients from northern Sweden “ vid Umeå universitet. Research area: Not active 35
Per Wiklund, psychologist PhD exam in 2007 on the subject” Kampen för människovärdet: om identitet i ett föränderligt arbetsliv” at Karolinska institutet. Research area: Not active Anders Wimo, senior physician, professor PhD exam in 1992 on the subject ”Dementia care alternatives in the Sundsvall‐region, Sweden. Studies on symptoms, costs and quality of life” at Umeå University. Research area: Dementia in the elderly person Keywords: Demens, health economy, geriatric care, epidemiologi Scientific articles: Wimo A, Winblad B, Jönsson L. The worldwide societal costs of dementia: Estimates for 2009. Alzheimers Dement. 2010; 6(2): 98‐103. Jedenius E, Wimo A, Strömqvist J, Jönsson L, Andreasen N. The cost of diagnosing dementia in a community setting. Int J Geriatr Psychiatry. 2010; 25(5): 476‐82. Gustavsson A, Jönsson L, McShane R, Boada M, Wimo A, Zbrozek AS. Willingness‐to‐pay for reductions in care need: estimating the value of informal care in Alzheimer's disease. Int J Geriatr Psychiatry. 2010; 25(6): 622‐32. Mesterton J, Wimo A, By A, Langworth S, Winblad B, Jönsson L. Cross sectional observational study on the societal costs of Alzheimer's disease. Curr Alzheimer Res. 2010; 7(4): 358‐67. Bergvall N, Brinck P, Eek D, Gustavsson A, Wimo A, Winblad B, Jönsson L. Relative importance of patient disease indicators on informal care and caregiver burden in Alzheimer's disease. Int Psychogeriatr. 2010 Jul 12 Epub. Érsek K, Kovács T, Wimo A, Kárpati K, Brodszky V, Péntek M, Jönsson L, Gustavsson A, McDaid D, Kenigsberg PA, Valtonen H, Gulácsi L. Costs of dementia in Hungary. J Nutr Health Aging. 2010; 14(8): 633‐9 Wimo A, Jonsson L, Zbrozek A. The Resource Utilization in Dementia (RUD) instrument is valid for assessing informal care 36
time in community‐living patients with dementia J Nutr Health Aging. 2010; 14(8): 685‐90. Anders Gustavsson, L. Jonsson, T. Rapp, E. Reynish, P. J. Ousset, S. Andrieu, C. Cantet, B. Winblad, B. Vellas, A. Wimo Differences in resource use and costs of dementia care between European countries: Baseline data from the ictus study J Nutr Health Aging. 2010; 14(8): 648‐54. Gustavsson A, Jonsson L, Fillit H, Johansson G, Wimo A, Winblad B. IPECAD5‐‐Fifth International Pharmaco‐Economic Conference on Alzheimer's Disease. J Nutr Health Aging. 2010; 14(5): 358‐60. Wimo A. The art of cost of illness. J Alzheimers Dis. 2010; 19(2): 617‐9. Wimo A, Jönsson L, Gustavsson A, McDaid D, Ersek K, Georges J, Gulácsi L, Karpati K, Kenigsberg P, Valtonen H. The economic impact of dementia in Europe in 2008‐cost estimates from the Eurocode project. Int J Geriatr Psychiatry. 2010 Oct 28 Epub. Sjölund BM, Nordberg G, Wimo A, von Strauss E. Morbidity and physical functioning in old age: differences according to living area. J Am Geriatr Soc. 2010; 58(10): 1855‐62 Participation in national and international conferenses: Wimo A. Future dementia care costs – a time bomb?KNDD & DZNE Kongress 16‐17 März 2010 in Berlin Wimo A. Formell och Informell omsorg. Nationell SNAC konferens: Det är personen som räknas 7 juni 2010 Wimo A. World Alzheimer Report 2010 The Global Economic Impact of Dementia, King´s college, London, UK, Sept 21, 2010 Wimo A. Health Economy, Primary care. Swedish Brain Power konferens,Edsviken, 2010‐09‐
23/24 Wimo A. The worldwide costs of dementia. Round table, Council on Foreign Relations, New York City, 28 Oct 2010 Wimo A . Cost analysis of using pure AD patients versus AD with mixed pathologies in clinical trials. CTAD, Toulouse, November 4, 20 37
MANAGEMENT & ACTIVITIES SUPPORT PhD‐students Registered at Uppsala University Sevek Engström Dentist/Administrator Department of Public Health and Caring Sciences Scientific focus: Tandvården som en resurs i tidig case finding av diabetes‐ och hypertonipatienter. Time of dissertation: 2012 Sving, Eva RN Department of Public Health and Caring Sciences Scientific focus: Pressure Ulcer Prevention – How is it done in hospital care situations? Time of dissertation: 2014 Boll Madeleine Physiotherapist Department of Public Health and Caring Sciences Licentiatexamen 2009‐11‐06 Scientific articles: Boll M, Boström‐Lindberg E. Physiotherapists' understanding and approach to health promotion work in compulsory school: perceiving and supporting coherence. Physiother Theory Pract. 2010; 26(5): 318‐26 38
CFUG AND COUNTY COUNCIL STAFF PhD‐exam Author: Hans Högberg Title: Some Properties of Measures of Disagreement and Disorder in Paired Ordinal Data Department: Örebro University, Swedish Business School Keywords: Agreement; augmented ranks; categorical data; disorder; jackknife; paired ordinal data; rating scales; sample size; sampling distribution; simulation; U‐
statistics; variance; Statistics; Dissertation: 2010‐12‐17, Örebro universitet, Hörsal M,13.15(Svenska) Opponent: Sture Holm, prof em, Mathematica Statistics, University of Gothenburg Abstract: The measures studied in this thesis were a measure of disorder, D, and a measure of the individual part of the disagreement, the measure of relative rank variance, RV, proposed by Svensson in 1993. The measure of disorder is a useful measure of order consistency in paired assessments of scales with a different number of possible values. The measure of relative rank variance is a useful measure in evaluating reliability and for evaluating change in qualitative outcome variables. In Paper I an overview of methods used in the analysis of dependent ordinal data and a comparison of the methods regarding the assumptions, specifications, applicability, and implications for use were made. In Paper II an application, and a comparison of the results of some standard models, tests, and measures to two different research problems were made. The sampling distribution of the measure of disorder was studied both analytically and by a simulation experiment in Paper III. The asymptotic normal distribution was shown by the theory of U‐statistics and the simulation experiments for finite sample sizes and various amount of disorder showed that the sampling distribution was approximately normal for sample sizes of about 40 to 60 for moderate sizes of D and for smaller sample sizes for substantial sizes of D. The sampling distribution of the relative rank variance was studied in a simulation experiment in Paper IV. The simulation experiment showed that the sampling distribution was approximately normal for sample sizes of 60‐100 for moderate size of RV, and for smaller sample sizes for substantial size of RV. In Paper V a procedure for inference regarding relative rank variances from two or more samples was proposed. Pair‐wise comparison by jackknife technique for variance estimation and the use of normal distribution as approximation in inference for parameters in independent samples based on the results in Paper IV were demonstrated. Moreover, an application of Kruskal‐Wallis test for inde‐
pendent samples and Friedman’s test for dependent samples were conducted. 39
Picture 9. Hans Högberg´s act of dissertation was both educational, interesting and as can be seen fun Photo: Anders Högberg. Researchers Marieann Högman, professor, R&D‐director, 20% research time PhD exam in 1994 on the subject “Bronchial reactivity in rabbits and humans. Modulation with nitric oxide and hypertonic saline” at Uppsala University. Research area: Respiration Physiology and Patophysiology Keywords:exhaled biomarkers, nitric oxide, lung function,rhinit, asthma, lung cancer, COPD Participation in national and international conferenses: European respiratory society, Annual Meeting Barcelona. (Chairperson) ERS 2010 Research Seminar on :“The Role of Small Airways in Obstructive Pulmonary Diseases”, Amsterdam, The Netherlands – October 15‐16, 2010 (Invited) Visit at Dr. Simona M. Cristescu, Life Science Trace Gas Facility, Molecular and Laser Physics, Institute of Molecules and Materials, Radboud University , Holland. (Invited) Is Medical Ethics Really in the Best Interest of thePatient? Uppsala Lennart Fredriksson, research advisor, 20% research time PhD exam in 2003 on the subject ” Det vårdande samtalet” at Åbo Akademi University, Finland. Research area: Health in and living with psychological disorders Keywords: Health, scizofrenia, psycosis, communication 40
Litterature: Fredriksson, L. (2010). Att vårda i samtal‐kommunikativa aspekter på lidande och vårdande. I: Wiklund Gustin, L. (red) Vårdande vid psykisk ohälsa‐på avancerad nivå. Lund: Studentlitteratur. Participation in national and international conferenses: Nordic College of Caring Science konferens Metodologiska innovationer på vårdvetenskapens villkor. Hermeneutik och metasyntes av kvalitativa studier‐ett vårdvetenskapligt perspektiv. Vasa, 14‐16 april 2010. QMSH 10, 6th Nordic Interdisciplinary Conference on Qualitative Methods in the Service of Health. Hermeneutics and qualitative meta‐synthesis – a way to develop concepts and models for health care research. Uppsala, 3‐4 maj 2010. Is Medical Ethics Really in the Best Interest of thePatient? Uppsala Hans Högberg, statistician, 20% research time PhD exam in 2010 on the subject “Some properties of measures of disagreement and disorder in paired ordinal data” at Örebro university. Research area: Medical statistics Keywords: agreement, augmented ranks, categorical data, disorder, jackknife, paired ordinal data, rating scales, U‐statistics Dag Rissén, research advisor, 20% research time PhD exam in 2006 on the subject “Repetitive and monotonous work among women: Psychophysiological and subjective stress reactions, muscle activity and neck and shoulder pain” at Stockholm University. Research area: Occupational injury Keywords: muscle‐skeleton injury, psycosocial stress, work environment Participation in national and international conferenses: 8th Congress at the Stress Research Institute, May 2010 Per Forsgren, senior physician PhD exam in 1989 on the subject “Pulmonary function, ventilation/perfusion relationships and aerosol therapy in early adult respiratory distress syndrome: experimental studies in the pig” at Uppsala University. Research area: Not active 41
DENTAL CARE, GÄVLE Researchers Ingalill Feldmann, senior dentist, 20% research time PhD exam in 2007 on the subject ”Orthodontic anchorage – Evidence‐based evaluation of anchorage capacity and patients´ perceptions” at Faculty of Odontology, Malmö University. Research area: Tooth movement efficiency and patients perceptions of different orthodontic Keywords: orthodontisc, anchorage, pain and discomfort Mats Hallman, senior dentist/surgeon, ass prof, 20% research time PhD exam in 2002 on the subject” On Healing of Titanium Implants in Xenografts” vid Umeå universitet. Research area: Experimental and clinical biomaterial research Keywords: Dental implantation, graft survivial,bone substitute, bone density Scientific articles: Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone. Clin Oral Implants Res. 2010; 21(9): 961‐70. Lindgren C, Hallman M, Sennerby L, Sammons R. Back‐scattered electron imaging and elemental analysis of retrieved bone tissue following sinus augmentation with deproteinized bovine bone or biphasic calcium phosphate. Clin Oral Implants Res. 2010; 21(9): 924‐30 Lindgren C, Mordenfeld A, Hallman M. A Prospective 1‐Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone. Clin Implant Dent Relat Res. 2010 May 11, Epub. Participation in national and international conferenses: 42
Annual meeting of Swedish Association of Oral and Maxillofacial Surgeons Congress of Implant at Barcelona. Anders Holmlund, senior dentist/surgeon, 20% research time PhD exam in 2008 on the subject” Oral inflammation and cardiovascular disease” vid Uppsala universitet. Research area: Oral inflammation and cardiovascular disease Keywords: immune response, cardiavacular disease, dental, infection Scientific articles: Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol. 2010; 81(6): 870‐6. Brage M, Holmlund A, Johansson A. Humoral immune response to Aggregatibacter actinomycetemcomitans leukotoxin. J Periodontal Res. 2010 Dec 1, Epub Participation in national and international conferenses: Odontologic national meeting. Europeen association of oseo integration PhD‐students Registered at Göteborgs University Arne Mordenfeld Senior dentist/surgeon Medical Faculty Scientific focus: On tissue reactions and resorption of bone substitutes Time of dissertation: 2013 Scientific articles: Mordenfeld A, Hallman M, Johansson CB, Albrektsson T. Histological and histomorphometrical analyses of biopsies harvested 11 years after maxillary sinus floor augmentation with deproteinized bovine and autogenous bone. Clin Oral Implants Res. 2010; 21(9): 961‐70 43
Lindgren C, Mordenfeld A, Hallman M. A Prospective 1‐Year Clinical and Radiographic Study of Implants Placed after Maxillary Sinus Floor Augmentation with Synthetic Biphasic Calcium Phosphate or Deproteinized Bovine Bone. Clin Implant Dent Relat Res. 2010 May 11, Epub. Others Agneta Candell, dental hygienist, FTV Slottstorget Candell A, Engström M. Dental hygienists' work environment: motivating, facilitating, but also trying. Int J Dent Hyg. 2010; 8(3): 204‐12. 44