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Exploring Nurse Responses to Spontaneous Breastfeeding Episodes During Routine Infant Health Checks in Finland: A Multimodal Conversation Analytic Approach
No full textSupport for mothers' uptake and longevity in breastfeeding is a global health priority. The benefits of breastfeeding are well documented, ranging from immediate health benefits for the infant that include provision of the best nutrition, to longer-term impacts such as reducing the risk of future digestive complications and obesity in adulthood. We analyze how impromptu breastfeeding might be supported by health-care nurses in Finnish maternity and child health clinics during routine infant health checks. The video data analyzed explore naturally occurring breastfeeding during these clinic encounters, using the analysis of ethnomethodology and conversation analysis (EMCA) approach to explore breastfeeding interactions between mothers, infants, and nurses. Findings demonstrate that, in extract 1 the nurse makes herself freely available, offering verbal and physical support when needed, and in extract 2 the mother manages a close intimate interaction feeding her baby whilst also engaging in knowledge exchange regarding important information with the nurse. We discuss how spontaneous breastfeeding interactions during routine clinic visits provide opportunities for nurses to support breastfeeding, where they are acknowledged as rather complex activities requiring focus. Considerations for professional practice are made by exploring how these early perinatal visits provide opportunities for nurses to observe and converse with mothers about how they are managing breastfeeding. A further conclusion suggests that an EMCA methodological exploration of breastfeeding interactions can inform future nurse practice in Finland and other countries.Funding Agencies|Finnish Academy, project "Touch and Affect in Health Care" [339827]</p
Volumetrisk Rendering Av Heterogena Media Med Användning Av Approximerade Taylor Utvecklingar
No full textThere have been interesting strides made in the frontier of path tracing solutions for global illumination of volumes. Within global illumination of participating media, it is of- ten preferable to stochasticaly sample the volume and how a photon would interact within it in order to generate unbiased and performance efficient renderers. The sampling is done by transmittance estimators. This work examines the performance difference of several state of the art transmittance estimation algorithms. The new Poisson trackers are based on sampling the participating media directly according to a Poisson probability distribu- tion. This is afforded by a theoretic derivation that rephrases transmittance estimation as sampling the terms of the optical depth’s Taylor expansion representation. This derivation also left room to theorize about potential estimators using alternative distributions than Poisson. The Poisson class of estimators are performance tested along with the contem- porary methods to determine scenarios in which one method would be more performant over an other. To do this, the software Inviwo was extended to support compute shader. This extension allows for more general deployment of the GPU not tied to rendering. The potential for new transmittance methods built around the geometric distributions is also discussed. This work confirms that the new Poisson Estimators, especially the one based on Residual-Ratio Tracking, outperform all other estimators in the general case. The discussed geometric transmittance estimators is shown to require a tricky optimization equation to be solved
Anti-FHL1 autoantibodies in adult patients with myositis: a longitudinal follow-up analysis
No full textObjectives: To determine prevalence and clinical associations of anti-Four-and-a-half-LIM-domain 1 (FHL1) autoantibodies in patients with idiopathic inflammatory myopathies (IIM) and to evaluate autoantibody levels over time. Methods: Sera at the time of diagnosis from patients with IIM (n = 449), autoimmune disease controls (DC, n = 130), neuromuscular diseases (NMDs, n = 16) and healthy controls (HC, n = 100) were analysed for anti-FHL1 autoantibodies by enzyme-linked immunosorbent assay (ELISA). Patients with IIM FHL1+ and FHL1- were included in a longitudinal analysis. Serum levels were correlated to disease activity. Results: Autoantibodies to FHL1 were more frequent in patients with IIM (122/449, 27%) compared with DC (autoimmune DC and NMD, 13/146, 9%, P &lt; 0.001) and HC (3/100.3%, P &lt; 0.001). Anti-FHL1 levels were higher in IIM [median (IQR)=0.62 (0.15-1.04)] in comparison with DC [0.22 (0.08-0.58)], HC [0.35 (0.23-0.47)] and NMD [0.48 (0.36-0.80)] P &lt; 0.001. Anti-FHL1+ patients with IIM were younger at the time of diagnosis compared with the anti-FHL1- group (P = 0.05) and were seronegative for other autoantibodies in 25%.&lt;br /&gt; In the first follow-up, anti-FHL1+ sample 20/33 (60%) positive at baseline had turned negative for anti-FHL1 autoantibodies. Anti-FHL1 autoantibodies rarely appeared after initiating treatment. Anti-FHL1 autoantibody levels correlated with CK (r = 0.62, P= 0.01), disease activity measured using the Myositis Disease Activity Assessment Tool (MYOACT) (n = 14, P = 0.004) and inversely with Manual Muscle Test-8 (r = -0.59, P = 0.02) at baseline. Conclusion: Anti-FHL1 autoantibodies were present in 27% of patients with IIM; of these, 25% were negative for other autoantibodies. Other autoimmune diseases had lower frequencies and levels. Anti-FHL1 levels often decreased with immunosuppressive treatment, correlated with disease activity measures at diagnosis and rarely appeared after start of treatment.Funding Agencies|Swedish Research Council [2020-01378]; Swedish Rheumatism Association; King Gustaf V 80 Year Foundation; Konung Gustaf V: s och Drottning Victorias Frimurarestiftelse, Region Stockholm</p
Plasma interferon-alpha protein levels during pregnancy are associated with lower birth weight in systemic lupus erythematosus
No full textObjectives Adverse pregnancy outcomes are more common in women with SLE compared with healthy women, but we lack prognostic biomarkers. Plasma IFN-alpha protein levels are elevated in a subgroup of pregnant women with SLE, but whether this is associated with pregnancy outcomes is unknown. We investigated the relationship between IFN-alpha, adverse pregnancy outcomes and the presence of autoantibodies in SLE pregnancy.Methods We followed 76 women with SLE prospectively. Protein levels of IFN-alpha were quantified in plasma collected in the second and third trimester with single-molecule array. Positivity for ANA and aPL antibodies was assessed during late pregnancy with multiplexed bead assay. Clinical outcomes included the adverse pregnancy outcomes small for gestational age (SGA), preterm birth and preeclampsia.Results During SLE pregnancy, women with SGA infants compared with those without had higher levels of plasma IFN-alpha protein, and IFN-alpha positivity was associated with lower birth weight of the infant. Preterm birth was associated with autoantibodies against chromatin. IFN-alpha protein levels associated positively with autoantibodies against chromatin, Smith/RNP (SmRNP) and RNP, but negatively with aPL antibodies.Conclusion Elevated IFN-alpha protein in plasma of women with SLE is a potential risk factor for lower birth weight of their infants. The association between IFN-alpha and lower birth weight warrants further investigation regarding the pathophysiological role of IFN-alpha during SLE pregnancy. Graphical AbstractFunding Agencies|County councils; Swedish government; ALF agreement [ALFGBG-970938, ALFGBG-71320, ALFGBG-773381, ALF-GBG-717541]; Swedish Rheumatism Association; Swedish Research Council for Medicine and Health [2019-01035, 2018- 02399, 2023-00356, 2022-01018, 2023-02256, 2019-02397]; European Union's Horizon Europe research and innovation programme [101053962]; Rune and Ulla Amlov; Frimurare Barnhusdirektionen; Irisstipendiet; King Gustav V's 80-year Foundation; Swedish Society of Medicine; Ingegerd Johansson donation; Gustafsson Foundation; Cornell Foundation</p
Early-Life Diet Diversity and the Subsequent Risk of Inflammatory Bowel Disease: Findings From Two Scandinavian Birth Cohorts
No full textBackground Diet diversity in early childhood promotes microbial diversity, influences the developing immune system, and has been linked to a reduced risk of immune-mediated diseases. This study aimed to determine the association between childhood diet diversity and later inflammatory bowel disease (IBD), for which data are limited.Methods Questionnaire data from the population-based birth cohorts All Babies in Southeast Sweden (ABIS) and the Norwegian Mother, Father, and Child Cohort (MoBa), including participants from Southeast Sweden and Norway, were used to estimate a diet diversity score at ages 1 and 3 years. This score represents the diversity of intakes across 5 food groups comprising 11 subgroups. A higher score signifies higher diet diversity. We used linked health registry data to identify IBD diagnoses up to the year 2021. Cox regression and random-effect models were used to estimate pooled hazard ratios (aHRs) adjusted for sociodemographics, breastfeeding, and early-life antibiotic use.Results Among 81 272 children with 1 304 325 person-years of follow-up, 307 developed IBD. Diet diversity at ages 1 and 3 years was in pooled analyses not associated with later IBD (per one-unit increase, aHR = 0.96 [95% CI = 0.81-1.14] and aHR = 0.96 [95% CI = 0.83-1.11]). In MoBa, but not ABIS, a higher diet diversity at 1 and 3 years of age was inversely associated with ulcerative colitis (UC) (per one-unit increase, aHR = 0.78 [95% CI = 0.66-0.94] and aHR = 0.78 [95% CI = 0.65-0.95]). Still, pooled aHRs for UC as well as Crohn's disease approximated one.Conclusions In this prospective study of 2 Scandinavian birth cohorts, no association was observed between early-life diet diversity and the subsequent risk of IBD. In this prospective study of over 80 000 children followed in 2 Scandinavian birth cohorts, early-life diet diversity was not associated with the subsequent risk of inflammatory bowel disease.Funding Agencies|Swedish Society for Medical Research [DNR S20-0007]; Swedish Research Council [2020-01980, K2005-72X-11242-11A, KS2008-g9X-20826 01-4, K2008-69X-20826-01-4]; Birgitta and Goeran Karlsson Foundation; ALF; Swedish Child Diabetes Foundation; Swedish Council for Working Life and Social Research [FAS2004-1775]; OEstgoeta Brandstodsbolag; Medical Research Council of Southeast Sweden (FORSS); JDRF Wallenberg Foundation [K 98-99D-12813-01A]; Region OEstergoetland; Linkoeping University; Joanna Cocozza Foundation; Norwegian Ministry of Health and Care Services; Ministry of Education and Research</p
Parent-child interaction after home-visiting intervention for children born extremely preterm-A randomised clinical trial
No full textAim: To determine whether a strength-based home-visiting program enhances parent-child interaction during the first year at home for children born extremely preterm (gestational age &lt; 28). Methods: A randomised controlled trial of 130 infants born extremely preterm 2018-2021 in Stockholm, allocated to either the Stockholm preterm interaction-based intervention (SPIBI) (n = 66) or an extended follow-up program (n = 64). The intervention group received ten home visits during the first year by a trained interventionist following SPIBI guidelines: an interaction-based intervention supporting sensitive parental responses to infants' signals. The primary outcome of emotional availability was assessed at 12 months corrected age (CA) using the emotional availability scales (EAS). Results: At 1-year CA, data were collected from 115/130 (89%) of the included children. There were no significant group differences in emotional availability at 12 months CA. A secondary analysis showed an effect modifier in families with mothers self-rated as depressed at discharge, with the outcome favouring intervention in the EAS dimension of child involvement. Conclusion: The SPIBI had no significant main effect on emotional availability at 12 months CA. Children of self-reported depressed mothers displayed superior involvement behaviour in the intervention group, prompting further research on risk groups and potential modifications of post-discharge interventions.Funding Agencies|Stiftelsen Clas Groschinskys Minnesfond; ALF-agreement; Drottning Silvias Jubileumsfond; Sallskapet Barnavard; H.K.H. Kronprinsessan Lovisas Forening foer Barnasjukvard; Stiftelsen Sven Jerrings Fond; Stiftelsen Promobilia; Philipson foundation; Hjarnfonden; Region Stockholm; Stockholm University [SU-SLLno.20160881|SU/RSno.2019-0843]</p
Sex-stratified mortality estimates in people with schizophrenia: A systematic review and meta-analysis of cohort studies of 2,700,825 people with schizophrenia
No full textThe differential influence of sex on premature mortality in schizophrenia is unclear. This study assessed differences in all-cause and specific cause mortality risks in people with schizophrenia compared to several control groups stratified by sex. We conducted a PRISMA 2020-compliant systematic review and random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) for people with schizophrenia, comparing by sex. We measured publication bias and conducted a quality assessment through the Newcastle-Ottawa scale. We meta-analyzed 43 studies reporting on 2,700,825 people with schizophrenia. Both males and females with schizophrenia had increased all-cause mortality vs. comparison groups (males, RR=2.62, 95%CI 2.35-2.92; males, RR=2.56, 95%CI 2.27-2.87), suicide (males, RR=9.02, 95%CI 5.96-13.67; females, RR=12.09, 95%CI 9.00-16.25), and natural cause mortality (males, RR=2.11, 95%CI 1.88-2.38; females, RR=2.14, 95%CI 1.93-2.38). No statistically significant differences in sex-dependent mortality risk emerged. There was an age group-dependent increased mortality risk in females &lt; 40 years vs. &gt;/=40 years old (RR=4.23/2.17), significantly higher risk of death due to neurological disorders (dementia) in males vs. females (RR=5.19/2.40). Increased mortality risks were often associated with specific modifiable risk factors. The increased mortality did not improve over time, calling for more studies to identify modifiable factors, and for better physical healthcare for males and females with schizophrenia
Engaging stakeholders in construction transport policy: A mass-participation framework
No full textIn the complex landscape of social decision making, multi-criteria decision making (MCDM) provides decision makers with a structured approach to evaluate multiple alternatives based on multiple conflicting criteria. Numerous multi-criteria group decision making (MCGDM) frameworks have been developed to engage stakeholders like citizens on a large scale and to capture their diverse preferences. Real-World Application in Construction Logistics: The framework’s utility and effectiveness are empirically validated through its application in a construction logistics project. This application involved gathering preferences from residents near the construction site and using these inputs to guide policy decisions, demonstrating the framework’s practical impact on urban planning and development. However, current frameworks exhibit certain limitations. In recognition of this, we present the mass-participation framework for MCGDM. This innovative framework combines data collection of criterion weights via survey with representative workshops for a more holistic evaluation of alternatives. Key features of our approach include the tailored adaptation of the Revised Simos Method for surveys, which ensures intuitive weight elicitation. In addition, we introduce a clustering algorithm rooted in priority-based K-medoids techniques and employ a comprehensive set of metrics for optimal cluster number determination. The methodology is then empirically illustrated in the context of a real-world construction logistics project. The research highlights the importance of extensive stakeholder engagement for robust and inclusive construction transport and urban planning policies. Our mass-participation framework moves beyond traditional consultation by actively involving stakeholders in decision-making, allowing them to contribute both preferences and solutions. Empirical validation in the Brussels-Capital Region involved over 150 residents, whose preferences were clustered into distinct groups based on their concerns, such as noise pollution, air quality, and traffic accessibility. The majority of stakeholders favored sustainable logistics solutions, particularly electric concrete trucks, due to their potential to reduce environmental impacts. These findings demonstrate the framework’s ability to capture diverse perspectives and inform sustainable policy development.Funding Agencies|MIMIC project under the JPI Urban Europe research programme [438.15.403]</p
Parametric Digital Twins for Preserving Historic Buildings: A Case Study at Löfstad Castle in Östergötland, Sweden
No full textThis study showcases the digitalization of Löstad Castle in Sweden to contribute to preserving its heritage values. The castle and its collections are deteriorating due to an inappropriate indoor climate. To address this, thirteen cloud-connected sensor boxes, equipped with 84 sensors, were installed throughout the main building, from the basement to the attic, to continuously monitor various indoor environmental parameters. The collected extensive multi-parametric data form the basis for creating a parametric digital twin of the building. The digital twin and detailed data analytics offer a deeper understanding of indoor climate and guide the adoption of appropriate heating and ventilation strategies. The results revealed the need to address high humidity problems in the basement and on the ground floor, such as installing vapor barriers. Opportunities for adopting energy-efficient heating and ventilation strategies on the upper floors were also highlighted. The digitalization solution and findings are not only applicable to Löfstad Castle but also provide valuable guidance for the conservation of other historic buildings facing similar challenges.Funding Agencies|Swedish Innovation Agency (Vinnova); Swedish Energy Agency (Energimyndigheten)</p
Växjö's Fossil Fuel-Free Ambition : A Case Study on the Challenges of Achieving Carbon Neutrality in a Small City
No full textThe Swedish municipality of Växjö has set the ambitious climate goal of becoming a fossil fuel-free city by 2030. Växjö has long strived to become an eco-smart, green and healthy, growing and inclusive city, and create a community that stops causing any negative climate impacts by 2030. The study uses the qualitative research method of case study. The policy document and municipal published reports from Växjö municipality provide the empirical data. Four online interviews were conducted to provide the first-hand data. This thesis aims to critically analyze the challenges and constraints that Växjö faces in its process of fossil fuel-free ambition achievement. And answering three research questions: the current strategies, challenges (in technology, policies, and social aspects), and solutions implemented by Växjö Municipality. The conclusion shows that Växjö has fall behind in achieving carbon neutrality by other Swedish peer cities, and there are gaps between symbolic actions (e.g. green branding) and real sustainable practices. The transition to a just and inclusive framework is needed to reconcile the rhetoric with reality for Växjö. This research fills the gap of a deeper understanding of complex dynamics in a small municipality like Växjö to achieve carbon neutrality and fossil fuel-free ambition, contributes to understanding the complex dynamics of local sustainability efforts, and contributes to the growing literature on energy transition theory in a specific city. It also offers practical insights for other municipalities, especially the small cities that pursue the similar climate goals.