Publications from KI

Public health economics of chlamydia and other STIs : aspects of risk, prevention and resources

Wed, 22 May 2013 00:00:00 GMT

Public health economics of chlamydia and other STIs : aspects of risk, prevention and resources

Deogan, Charlotte

2013-06-14

10.00

Inghe-salen, Widerströmska Huset, Tomtebodavägen 18A, Solna

Inst för molekylär medicin och kirurgi / Dept of Molecular Medicine and Surgery

The overall aim of this thesis was to increase the knowledge of the public health economic aspects of chlamydia and other STIs, in terms of risk, prevention and resources. In Study I, we examined the association between demographic, socioeconomic and lifestyle factors and the risk of self-reported chlamydial infection among young adults in the Stockholm public health cohort. We found that the risk of self-reported chlamydia infection among young adults in Sweden was associated with lower age, high alcohol consumption, lower educational level and being employed or unemployed, on sick leave or pre-retired compared to being a student. In Study II, we identified potential key factors for successful regional prevention of chlamydia and other STIs by a case study including seven Swedish counties. We found that potential key factors include adequate programme- and county council investments, suitable organizational structure, strong leadership, management of regional networks, research connection, multiple local collaborations, high testing coverage and a strategic risk approach. In Study III, we analyzed the cost-effectiveness of the intervention Chlamydia Monday by estimating costs, savings and health gains generated by the intervention and analyzed whether the cost-effectiveness varied between men and women. We found that this testing intervention of a self-selected sample of individuals was cost-effective for both sexes with a discounted average cost of €8,346 per QALY. Sensitivity analyses showed consistent results for changes in parameters, and all scenarios except exclusion of contact tracing for males, generated a cost per QALY below the established threshold. In Study IV, we estimated the additional resources required to scale up adolescent- friendly health services to universal coverage in 74 low-and middle-income countries. We found that the financial costs for scaling up key adolescent-friendly health services was US$ 15.4 billion through 2015. The cost for STI management was approximately US$ 226.97 million of which approximately 20% constituted management of chlamydia. The estimated required resources illustrate a substantial investment gap in relation to current expenditure. In conclusion, the thesis illustrates a public health economic approach to studying STI- prevention. The findings show that chlamydia in young adults in Stockholm is associated with social and lifestyle factors, that greater consideration should be taken to the structural factors of prevention, that one of the common testing interventions implemented in many parts of Sweden is cost-effective and finally that considerable investment is required to improve quality and expand reproductive health care services to universal coverage for adolescents in the least developed countries in the world.

A novel inhibitor of proteasome deubiquitinating activity renders tumor cells sensitive to TRAIL-mediated apoptosis by natural killer cells and T cells

Wed, 22 May 2013 00:00:00 GMT

A novel inhibitor of proteasome deubiquitinating activity renders tumor cells sensitive to TRAIL-mediated apoptosis by natural killer cells and T cells

Sarhan, Dhifaf; Wennerberg, Erik; D'Arcy, Padraig; Gurajada, Deepthy; Linder, Stig; Lundqvist, Andreas

Inst för onkologi-patologi / Dept of Oncology-Pathology

The proteasome inhibitor bortezomib simultaneously renders tumor cells sensitive to killing by natural killer (NK) cells and resistant to killing by tumor-specific T cells. Here, we show that b-AP15, a novel inhibitor of proteasome deubiquitinating activity, sensitizes tumors to both NK and T cell-mediated killing. Exposure to b-AP15 significantly increased the susceptibility of tumor cell lines of various origins to NK (p<0.0002) and T cell (p=0.02) –mediated cytotoxicity. Treatment with b-AP15 resulted in increased TRAIL [tumor necrosis factor-related apoptosis-inducing ligand] receptor-2 expression (p=0.03) and decreased cFLIP expression in tumor cells in vitro. In tumor-bearing SCID/Beige mice, treatment with b-AP15 followed by infusion of either human NK cells or tumor-specific T cells resulted in a significantly delayed tumor progression compared with mice treated with NK cells (p=0.006), T cells (p<0.0001), or b-AP15 alone (p=0.003). Combined infusion of NK and T cells in tumor-bearing BALB/c mice following treatment with b-AP15 resulted in a significantly prolonged long-term survival compared with mice treated with b-AP15 and NK or T cells (p≤0.01). Our findings show that b-AP15-induced sensitization to TRAIL-mediated apoptosis could be used as a novel strategy to augment the anti-cancer effects of adoptively infused NK and T cells in patients with cancer.

Negative experiences of encounters in healthcare

Wed, 22 May 2013 00:00:00 GMT

Negative experiences of encounters in healthcare

Wessel, Maja

2013-06-13

10.00

Inghesalen, Widerströmska huset, Tomtebodavägen 18A.

Inst för lärande, informatik, management och etik / Dept of Learning, Informatics, Management and Ethics

A positive encounter is essential to the provision of qualitative healthcare. Experiences of negative encounters in healthcare may affect the patient’s wellbeing and health, and have a negative effect on the patient’s trust in the healthcare system. The overall aim of this thesis was to gain new knowledge about negative experiences of encounters in Swedish healthcare and, based on this knowledge, suggest potential measures to reduce or prevent such experiences. The thesis consists of four different studies: STUDY 1 Aim: To investigate patients’ experiences of not being treated well in medical healthcare in Stockholm County, Sweden. Methods: Systematic review of complaints of negative encounters to Patientnämnden in Stockholm registered in 2006 and 2007. The complaints were subjected to qualitative content analysis by categorization, and a complementary snapshot review of complaints on medical treatment was conducted. Results: The most common types of complaints were “rude, aggressive or arrogant behaviour”, followed by “being ignored, not listened to, or being taken seriously”. One third of the complaints about “medical treatment” also contained complaints about negative encounters. Women were found to complain on negative encounters more frequently than men. STUDY II Aim: To examine how long-term sick-listed persons perceive healthcare encounters, with special emphasis on negative encounters and feeling wronged. Methods: Postal questionnaire to 10 042 long-term sick-listed persons. Statistical analysis of Attributable Risk (AR) with 95% CI. Results: Response rate 58%. 1 628 of the respondents had experiences of negative encounters in healthcare, and of these 1 036 reported also having felt wronged. Types of negative encounters with highest AR for feeling wronged were “nonchalant behaviour” and “treated me with disrespect”. Men reported higher AR for feeling wronged than women, as did respondents with psychiatric diagnoses compared to other patients. Feeling wronged seems to be an outcome based on accumulated experiences of negative encounters. STUDY III Aim: To gain an improved understanding of experiences of negative healthcare encounters in the general population. Methods: Postal questionnaire to a sample of 1 484 inhabitants of Stockholm County. Conventional content analysis of data from open-ended questions. Results: Response rate 62.1%. 17 different types of complaints about negative encounters were identified and two comprehensive explanatory factors were established: “structure and allocation of healthcare” and “the staff’s attitudes and professional practice”. STUDY IV Aim: To investigate the hypothesis that complaints of adverse events related to encounters with healthcare personnel are underreported, and to identify barriers to filing such complaints. Methods: Postal questionnaire to a sample of 1 484 inhabitants of Stockholm County. Statistical analysis of proportions and OR with CI: 95%, and minor qualitative content analysis by categorization. Results: Response rate 62.1%. Patient complaints about negative encounters were found to be under-reported. The main barriers for filing complaints were “did not have the strength” or “did not know where to turn”, or that “it makes no difference anyway”. Experiences of negative encounters were also found to have a negative impact on people’s trust in healthcare.

Go with the flow : to facilitate learning in laparoscopic gynecology

Wed, 22 May 2013 00:00:00 GMT

Go with the flow : to facilitate learning in laparoscopic gynecology

Ahlborg, Liv

2013-06-14

09.00

Föreläsningssal B 64, Karolinska Universitetssjukhuset, Huddinge

Inst för klinisk vetenskap, intervention och teknik / Dept of Clinical Science, Intervention and Technology

Background. Education in medicine, particularly in surgical disciplines, is crucial since it affects patient safety. The learning process is dependent on individual abilities, prior knowledge and the learning environment. Evidence of simulators’ positive impact on actual laparoscopic performance is mounting. However, less attention has been given to non-technical factors that might have direct effect on both simulated and real laparoscopic performance. Aims of the thesis. 1. To evaluate if visiospatial ability, as measured by the mental rotation test A, correlates with gynecological simulated laparoscopic performance (paper I) 2. To examine if self-efficacy and flow are associated with simulated laparoscopic performance (paper II) 3. To investigate if visiospatial ability, self-efficacy, flow and simulator training in LapSimGyn®, with or without mentorship with feedback influence performance in laparoscopic tubal occlusion (paper III) 4. To evaluate the effect of mentorship with feedback on simulated laparoscopic performance using both quantitative and qualitative methods (paper IV) Materials and methods. The participants in the studies were consultants or residents in obstetrics and gynecology or medical students. Validated tests, questionnaires and scales assessed visiospatial ability, self-efficacy and flow. Simulator training was conducted in LapSimGyn®. Laparoscopic performance was measured as duration of surgery in the laparoscopic tubal occlusions. Group interviews and inductive thematic analyses were used to evaluate mentorship. Results. This thesis demonstrates that visiospatial ability correlated with duration of surgery in early gynecological laparoscopic simulator performance (r: Q0.64, p<0.05) as well as in early laparoscopic performance (rho: Q0.98, p<0.05) , Papers I-III. Simulator training appeared to enhance both selfQefficacy and flow, Papers II &III. Moreover, the findings suggested that laparoscopic performance was improved by simulator training with, or without, structured mentorship and by increased flow and self-efficacy among the trainees. Duration of surgery was significantly shorter in the trained groups (median 340 s, IQR: 285Q537), as compared to the control group (median 760 s, IQR: 573Q1218) , Paper III. Mentorship with feedback influenced laparoscopic simulator performance. Right instrument path length was shorter in the mentor group (median 3.9 m, IQR: 3.3Q4.9) as compared to the control group (median 5.9 m, IQR: 5.0Q8.1) . Students in the mentor and nonQmentor groups expressed the importance of getting support and being acknowledged, Paper IV.