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S Westin

Publications and source records attributed to S Westin.

At least 19 recordsLinked to original sources
PubMed2006

Poor oral nutrition after allogeneic stem cell transplantation correlates significantly with severe graft-versus-host disease.

It has previously been shown that enteral nutrition has several advantages compared to parenteral nutrition (PN) in critically ill patients. The nutritional history was studied in 231 patients after allogeneic stem cell transplantation (SCT). Parenteral nutrition was given for a median of 10 (0-74) days. Patients with graft-versus-host disease (GVHD) grades III-IV received more PN (median 20, range 0-67) than patients with GVHD grades 0-II (10, 0-74, P=0.016). Eighty-five (37%) patients were not able to eat anything for a median of 4 days (1-37). We found a correlation between the number of days with no oral intake (before the diagnosis of acute GVHD) and the incidence of acute GVHD grades III-IV. In patients with 1-4 days of no oral intake, the incidence of grades III-IV acute GVHD was 6%, in those with 5-9 days it was 17%, and in those with >9 days it was 38%. On multivariate analysis, we found that more than 9 days with no oral intake was associated with acute GVHD grades III-IV (odds ratio 7.66, confidence interval 1.44-40.7, P=0.016). Poor oral intake early after SCT may be associated with an increased risk of developing severe acute GVHD.

Acute Disease↗
PubMed2002

Trends in health inequalities by educational level in a Norwegian total population study.

OBJECTIVE: To describe levels of inequality and trends in self reported morbidity by educational level in a total Norwegian county population in the mid-1980s and mid-1990s. DESIGN: Two cross sectional health surveys at an interval of 10 years in the Nord-Trøndelag Health Study, HUNT I (1984-86) and HUNT II (1995-97). SETTING: Primary health care, total county population study. PARTICIPANTS: Men and women, 25-69 years. MAIN RESULTS: There was a consistent pattern of increasing self reported health problems with decreasing educational level for three health variables: perceived health, any longstanding health problem, and having a chronic condition. A stable or slight decrease in inequalities over time was found. The prevalence odds ratio for perceived health less than good were 2.71 for men (95% confidence intervals (CI): 2.39 to 3.09) and 2.13 for women (95% CI: 1.85 to 2.46) in the first survey, 2.51 for men (95% CI: 2.27 to 2.78) and 2.06 for women (95% CI: 1.88 to 2.26) 10 years later. CONCLUSIONS: The magnitude of the socioeconomic gradients in health in this population seemed somewhat lower than in Norway as a whole and close to the average in studies from other European countries. There was a slight trend towards smaller differences despite rapid structural changes in working life, turbulence in economy, and more people experiencing unemployment.

Adult↗
PubMed2000

[Is there a place for humanistic dimension in medical education?].

Inspired by the concept of "two cultures", coined by C.P. Snow, this paper discusses the role of the humanities in relation to the natural sciences in a recently (since 1993) revised medical curriculum at the Faculty of Medicine in Trondheim, Norway. A concept of a "third culture" is identified as well: community medicine in a broad sense, disciplines dealing with health, illness and disease in the context of society and the environment. The implementation of the new curriculum was affected by intended and unintended social forces. The result was a hybrid model rather than the planned "pure" problem-based model. The humanities and "third culture" disciplines tended to yield to the pressure from the basic sciences when numbers of formal lectures were strictly limited, while the basic sciences themselves felt cut short by clinical disciplines. Problem-based learning in groups did seem efficient in basic sciences and clinical subjects, but not for the humanities or third culture disciplines. This apparent limitation in the problem-based approach was probably due to contextual factors, rather than inherent in the method itself.

Concept Formation↗
PubMed2000

[The problem-based medical curriculum in Trondheim--did it turn out as planned?].

BACKGROUND: A problem-based (PBL) medical curriculum was implemented in 1993 at the Medical School of the Norwegian University of Science and Technology. The objective of this study was to examine how the planned reduction in scheduled activities, the emphasis on student-centred learning, and the integration of disciplines have been implemented. MATERIAL AND METHODS: The schedules in the old and new programmes were the main sources of data. Each scheduled activity was coded according to discipline taught and chosen learning method. RESULTS: The number of hours spent on scheduled activities was much higher in the new programme (n = 4,009) than in the intended (n = 2,974), and it was even slightly higher than in the old programme (n = 3,785). In contrast to plans there was less student-centered learning, and basic science was mainly taught during the two first years. INTERPRETATION: Contrary to plans, the new curriculum in Trondheim has not become a pure PBL curriculum. It is a hybrid model involving a number of learning methods. A high degree of autonomy of the individual faculty members in the planning, and resistance to change among faculty members may have caused less radical changes. This is not necessarily negative; the new model may be a pragmatic synthesis between new and traditional medical education.

Curriculum↗
PubMed2000

Ligand-dependent interactions of coactivators steroid receptor coactivator-1 and peroxisome proliferator-activated receptor binding protein with nuclear hormone receptors can be imaged in live cells and are required for transcription.

Members of the nuclear receptor superfamily are thought to activate transcription by recruitment of one or more recently identified coactivator complexes. Here we demonstrate that both peroxisome proliferator-activated receptor binding protein (PBP) and steroid receptor coactivator-1 (SRC-1) are required for ligand-dependent transcription of transiently transfected and chromosomally integrated reporter genes by the estrogen receptor (ER) and retinoic acid receptor (RAR). To examine ligand-dependent interactions between nuclear receptors and specific coactivators in living cells, these proteins were tagged with cyan (CFP) and yellow (YFP) mutants of the green fluorescent protein. Fluorescence resonance energy transfer (FRET) from the CFP to the YFP indicated interaction between the receptor and coactivator. CFP fusions to RAR or its ligand-binding domain exhibited rapid ligand-dependent FRET to YFP-tagged nuclear receptor interaction domains of the coactivators SRC-1 and PBP. The ER-ligand-binding domain, unlike RAR, also exhibited some basal interaction with coactivators in unstimulated cells that was abolished by the receptor antagonists tamoxifen or ICI182,780. Inhibition of FRET by tamoxifen but not ICI182,780 could be reversed by estradiol, whereas estradiol-enhanced FRET could not be inhibited by either antagonist, indicating that ligand effects can show varying degrees of hysteresis. These findings suggest that ligand-dependent transcriptional activities of the RAR and ER require concurrent or sequential recruitment of SRC-1 and PBP-containing coactivator complexes.

Carrier Proteins↗
PubMed1999

[Welfare and health in the century of social security].

Great achievements for public health in this century include penicillin, oral contraception, vaccination and transplantation, but the greatest contribution to the health of Norwegians may have been made by social security and the welfare state policies. The beneficial effects of social security include: less social inequality, a factor which in itself makes for better health, some degree of financial security for people who are ill and unable to support themselves or their families, universal availability of medical and health services. This paper explores the ideas and sources from which present-day social security legislation stems. The emergence of state based welfare legislation was inspired by developments in Germany under Bismarck; accident insurance for industrial workers was the first to be introduced in 1894. Several periods of active social security legislation followed at times when labour unions and socialist ideas were strong, supported, to some degree, by radical clergy and public health doctors. Social democratic governments, inspired by the British Beveridge plan towards the end of World War II, took the lead during the long post-war period until the mid 1970s. The Scandinavian model of social security is based on universal coverage and a single payer system. However, since the 1980s, as in other countries of Northern Europe, the social security system has come under pressure from market liberalism. Now at the turn of the century, increasing social inequalities cause some concern for the future of the welfare state.

Europe↗
PubMed1999

[Equality and brotherhood--values worth preserving in the health services].

This article is the last in a series on virtues and values in medicine and health care. Its point of departure relates to the heritage of the great French 1789 revolution. Equality in society is hardly attainable, but equity in health care, providing health care according to need rather than according to wealth, has been a highly valued aim for the post-war Norwegian health services. The political ideas of this development came from the socialist labour movement as well as from Christian ideas of charity, merging to form the institutions of the post-war welfare states. Fraternity, brotherhood, or in its modern version solidarity, is based on the very nature of man as a social being, but has also been a tool to create political power necessary to achieve equity. Mounting research evidence on inequality and health shows that what makes a difference to health is more a matter of people's relative income and status in society rather than their absolute material standard of living. The values of equity and solidarity are challenged by recent neo-liberalist and populist movements. Market models in the health services tend to turn health services into commodities and patients into consumers. This has implications for medicine beyond the financial impact. Utilitarian arguments tend to favour more user fees for medical services and drugs, the emergence of private services and health insurance, the result being a drift towards greater inequality in health and access to health services. However, recent research on value preferences suggests that issues related to equality are gaining support in several European countries.

Civil Rights↗
PubMed1999

Transcriptional activation by NF-kappaB requires multiple coactivators.

Nuclear factor-kappaB (NF-kappaB) plays a role in the transcriptional regulation of genes involved in inflammation and cell survival. In this report we demonstrate that NF-kappaB recruits a coactivator complex that has striking similarities to that recruited by nuclear receptors. Inactivation of either cyclic AMP response element binding protein (CREB)-binding protein (CBP), members of the p160 family of coactivators, or the CBP-associated factor (p/CAF) by nuclear antibody microinjection prevents NF-kappaB-dependent transactivation. Like nuclear receptor-dependent gene expression, NF-kappaB-dependent gene expression requires specific LXXLL motifs in one of the p160 family members, and enhancement of NF-kappaB activity requires the histone acetyltransferase (HAT) activity of p/CAF but not that of CBP. This coactivator complex is differentially recruited by members of the Rel family. The p50 homodimer fails to recruit coactivators, although the p50-p65 heterodimeric form of the transcription factor assembles the integrator complex. These findings provide new mechanistic insights into how this family of dimeric transcription factors has a differential effect on gene expression.

Acetyltransferases↗
PubMed1998

[Who were the healers in medieval Trondheim?].

When Trondheim celebrated its millenium in 1997, this also marked a 1000 year-old medical tradition. In medieval times, sick and disabled people made their pilgrimage to the Nidaros cathedral and the grave of Saint Olav (995-1030). Working from the assumption that every organized society develops rituals and rules to deal with disease and death, we have looked for evidence of what kind of healers one would expect there were in medieval Trondheim up to the reformation in 1537. Sources include reports from archaeological excavations, written material of both medieval and more recent origin, buildings and objects, and living traditions. Three kinds of healer traditions can be identified: The popular and "wise" folk healers were based on traditional pre-Christian mythology and belief in natural forces. The charitable clerics emerged with Christianity. The "professional" wound healers evolved from the needs of the military, later to merge with the early barber surgeons. Traces of scientific traditions, the Salerno school and early European university medicine can be found in local texts, but there is no evidence of any university educated doctor practising in Trondheim before the 17th century.

Barber Surgeons↗