Children with long-gap esophageal atresia (LGEA) risk living with aerodigestive morbidity and mental health difficulties. No previous study has investigated their experiences of schooling, despite ...the importance of schools in children's development, learning and social relationships. We aimed to describe experiences of schooling in children with LGEA in Sweden in comparison with children with EA who had primary anastomosis.
Children with LGEA aged 3-17 were recruited nationwide in Sweden. One parent completed a survey on their child's school-based supports (according to definitions from the Swedish National Agency for Education), school absence, school satisfaction, school functioning (PedsQL 4.0), mental health (Strength and Difficulties Questionnaire) and current symptomatology. School data were compared between 26 children with LGEA to that from 95 children with EA who had PA, a hypothesized milder affected group. Mental health level was determined using validated norms; abnormal ≥ 90 percentile. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05.
Formal school-based support was reported in 17 (65.4%) children with LGEA and concerned support with nutritional intake (60%), education (50%) and medical/special health needs (35%). The prevalence of school-based support was significantly higher compared to children with PA overall (36.8%, p = 0.013) and regarding nutritional intake support (20%, p < 0.001). In children with LGEA, school-based support was related to low birth weight (p = 0.036), young child age (p = 0.014), height ≤ -2SD for age/sex (p = 0.024) and an increased number of aerodigestive symptoms (p < 0.05). All children with LGEA who had abnormal mental health scores had school-based support, except for one child. Nine children with LGEA (36%) had school absence ≥ 1times/month the past year, more frequently because of colds/airway infections (p = 0.045) and GI-specific problems compared to PA (p = 0.003). School functioning scores were not significantly different from children with PA (p = 0.34) but correlated negatively with school-based support (< 0.001) and school absence (p = 0.002). One parent out of 26 reported their child's school satisfaction as "not good".
Children with LGEA commonly receive school-based support, reflecting multifaceted daily needs and disease severity. School absence is frequent and related to poorer school functioning. Future research focusing on academic achievement in children with EA is needed.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
In recruitment, promotion, admission, and other forms of wealth and power apportion, an evaluator typically ranks a set of candidates in terms of their perceived competence. If the evaluator is ...prejudiced, the resulting ranking will misrepresent the candidates’ actual ranking. This constitutes not only a moral and a practical problem, but also an epistemological one, which begs the question of what we should do – epistemologically – to mitigate it. The article is an attempt to begin to answer this question. I first explore the presuppositions that must obtain for individual interventions to likely yield positive epistemological effects in ranking situations. I then compare these with the corresponding presuppositions of a novel, ‘post hoc’ approach to deprejudicing due to Jönsson and Sjödahl (Episteme 14(4):499–517, 2017), which does not attempt to change evaluators but attempts to increase the veracity of the rankings they produce after the fact (but before the rankings give rise to discriminatory effects) using statistical methods. With these two sets of presuppositions in place, I describe the limitations imposed by each presupposition on its intervention, compare presuppositions across the two kinds of interventions, and conclude that the two kinds of interventions importantly complement each other by having fairly disjoint, but non–conflicting, presuppositions. The post hoc intervention can thus complement an individual intervention (and vice versa) in situations where both are applicable (by adding further increases in veracity), but also by applying to situations where that intervention is not applicable (and thereby increase veracity in situations beyond the reach of that intervention).
There has been much interest in group judgment and the so-called ‘wisdom of crowds’. In many real world contexts, members of groups not only share a dependence on external sources of information, but ...they also communicate with one another, thus introducing correlations among their responses that can diminish collective accuracy. This has long been known, but it has—to date—not been examined to what extent different kinds of communication networks may give rise to systematically different effects on accuracy. We argue that equations that relate group accuracy, individual accuracy, and group diversity (see Hogarth, 1978; Page, 2007) are useful theoretical tools for understanding group performance in the context of research on group structure. In particular, these equations may serve to identify the kind of group structures that improve individual accuracy without thereby excessively diminishing diversity so that the net positive effect is an improvement even on the level of collective accuracy. Two experiments are reported where two structures (the complete network and a small world network) are investigated from this perspective. It is demonstrated that the more constrained network (the small world network) outperforms the network with a free flow of information.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the ...consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
•The fast-growing hybrid had poorer health status than the slower-growing hybrid.•Health status decreased with age for both hybrids.•Slower-growing hybrids should be used when rearing exceeds 6 ...weeks.
Animal welfare is an important aspect of organic broiler (OB) production which involves e.g. up to twice the rearing period compared with conventional production and feedstuffs without prophylactic additives or synthetic amino acids. As market demand for organic broiler meat increases, the formerly modest OB production in Sweden is now rapidly increasing and research is needed to support this development. It is essential to use genotypes that adapt well to the rearing environment, in order to achieve satisfactory animal welfare. Health problems related to fast growth rate are a common animal welfare issue in modern broilers and this applies to systems with long rearing periods. In this study, the Welfare Quality® assessment protocol for poultry was used for assessment of lameness, contact dermatitis, cleanliness, thermal comfort, litter quality and the human-animal relationship in two modern broiler genotypes; the fast-growing Ross 308 (R) and the slower-growing Rowan Ranger (RR). In total, 645 day-old chicks (328 R and 317 RR) were reared until 10 weeks of age, which is the rearing period formerly used in organic production in Sweden, and fed a low-protein (L), high-protein (H) or mussel-meal (M) diet containing 14.5%, 17.0% or 15.6% crude protein, respectively. Broiler welfare was assessed on three occasions (at weeks 2, 6 and 9). The results showed rapid deterioration in welfare for fast-growing broilers when kept beyond 6 weeks. Mortality rate and incidence of lameness and contact dermatitis increased and litter quality, thermal comfort and plumage cleanliness decreased. Indications of poor welfare were also observed in the slower-growing hybrid, but to a lesser extent and later during rearing. Diet type only had minor effects on bird welfare, although R birds grew faster on the M diet. Thus the slower-growing RR hybrid is preferable to the fast-growing broiler type in production systems with a long rearing period. However, the RR growth rate can be regarded as moderate and, to avoid health problems related to fast growth rate, hybrids that grow even more slowly should be considered for OB production systems with a long rearing period.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.Design Cost ...effectiveness study alongside a single blind randomised controlled trial.Setting Memory clinic, day clinic of a geriatrics department, and participants’ homes.Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers.Intervention 10 sessions of occupational therapy over five weeks, including cognitive and behavioural interventions, to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision.Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment (that is, a combined patient and care giver outcome measure of clinically relevant improvement on process, performance, and competence scales) at three months after randomisation. Bootstrap methods used to determine confidence intervals for these measures.Results The intervention cost €1183 (£848, $1738) (95% confidence interval €1128 (£808, $1657) to €1239 (£888, $1820)) per patient and primary care giver unit at three months. Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were €1748 (£1279, $2621) lower in the intervention group, with the main cost savings in informal care. There was a significant difference in proportions of successful treatments of 36% at three months. The number needed to treat for successful treatment at three months was 2.8 (2.7 to 2.9).Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective, especially in terms of informal care giving.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Background
Reliable, widely accessible and affordable biomarkers for predicting Alzheimer’s disease (AD) brain pathology status are a necessity to aid development of prevention strategies in ...cognitively healthy at-risk older adults, at the right timepoint. Measurements of the key neuropathological hallmark beta-amyloid (Aβ) by PET neuroimaging or cerebrospinal fluid measures reflect its accumulation in the brain, yet recent methodological advancements now enable blood-based measures reflecting cerebral amyloid burden.
Objectives
The current study validated the capacity of plasma Aβ42/Aβ40 measured using six different assays to predict amyloid positivity in a subgroup of cognitively unimpaired (CU) participants in the ADNI study and assessed its ability to discriminate CU from AD cases. We also explored economic viability of using two different plasma amyloid assays for pre-screening in AD prevention trials and as routine clinical diagnostic tool, versus amyloid PET alone.
Design
A cross-sectional analysis of plasma and brain amyloid data, including comparative cost analysis of the plasma biomarkers in relation to brain amyloid PET.
Setting
Alzheimer’s Disease Neuroimaging Initiative (ADNI).
Participants
ADNI participants consisting of 115 CU, mild cognitive impairment and AD cases who had plasma Aβ42/ Aβ40 measured with six platforms.
Measurements
Plasma Aβ42/Aβ40 was measured via six different platforms: three immunoassays (Roche, Quanterix and ADx Neurosciences) and three mass spectrometry (MS) based assays (WashU, Shimadzu and Gothenburg). Aβ-PET imaging was conducted within three months of plasma sampling using 18Fflorbetapir.
Results
There was a weak to moderate correlation of plasma Aβ42/Aβ40 ratio between platforms. The MS-based WashU test had the highest capacity to discriminate between CU and AD (area under the curve, AUC = 0.734, 95% CI: 0.613–0.854; P = 0.008). Within the CU group, the WashU plasma amyloid test had the best discriminative capacity to distinguish Aβ+ from Aβ- (AUC = 0.753, 95% CI: 0.601–0.905; P = 0.003) closely followed by the immunoassay from Roche (AUC = 0.737, 95% CI: 0.597–0.877; P = 0.006). The exploratory economic analyses showed that the use of Roche or WashU plasma amyloid assay as a pre-screening tool prior to Aβ-PET scans for clinical trial recruitment significantly reduced total screening cost (saving up to $5882 per recruited patient) expected in an AD prevention trial.
Conclusions
With few available treatment strategies, dementia prevention is a global priority. CU individuals at risk for AD are the target population for dementia prevention but have been poorly studied. Our findings confirming diagnostic value of ultrasensitive immunoassays and high-performance immunoprecipitation coupled with MS for measurement of plasma Aβ42/β40 to detect PET amyloid positivity in CU participants allude to potential clinical utility of this biomarker. Plasma Aβ42/Aβ40 could be optimal for pre-selecting at-risk candidates for more invasive and expensive investigations across AD prevention clinical trials and clinical care for a rapidly ageing population.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
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