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Hagerup A, Wijk H, Lindahl G, Olausson S. Toward a Future Orientation: A Supportive Mental Health Facility Environment. HERD 2024:19375867231221151. [PMID: 38259241 DOI: 10.1177/19375867231221151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND The provision of supportive environments is essential in clinical and environmental psychology. Mental health disorders are a major issue, and the experience of being at a mental health facility is affected by numerous factors related to the building's design. AIM The aim of this study is to explore the expectations of a mental health facility planning group regarding the potential impact of a supportive design on patients' mental health and staff's therapeutic practices when planning and designing a new mental health facility. METHODS The new mental health facility is a case study and data were collected through qualitative in-depth interviews with nine participants and analyzed using a thematic analysis. The participants came from a mental health facility planning group in a new mental health facility in Norway. RESULTS The overall expectation of the new building was related to a future orientation to support patients' mental health and therapeutic practices. Three main themes were identified: toward a future orientation, supportive building design, and work environment. CONCLUSIONS Supportive environments are expected to influence patients' mental health and staff's therapeutic practices, including providing options for novel treatment needs in contrast to older and more outdated buildings that are perceived as hindering appropriate treatment conditions.
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Affiliation(s)
- Anne Hagerup
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Inland School of Business and Social Sciences, Inland Norway University of Applied Sciences, Inland Norway
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Quality strategies, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Center for Healthcare Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- Division of Construction Management/Center for Healthcare Architecture, Department of Architecture and Civil Engineering, Chalmers University of Technology, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anesthesiology and Intensive Care/Sahlgresnka, Sahlgrenska University Hospital, Gothenburg, Sweden
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Nolbeck K, Olausson S, Lindahl G, Thodelius C, Wijk H. Be prepared and do the best you can: a focus group study with staff on the care environment at Swedish secure youth homes. Int J Qual Stud Health Well-being 2023; 18:2168234. [PMID: 36727536 PMCID: PMC9897801 DOI: 10.1080/17482631.2023.2168234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study examined staff members' experiences of the institutional care environment within secure youth homes. METHODS Data were collected through three focus group discussions with 17 staff members at two secure youth homes. Subsequently, a thematic analysis was conducted. RESULTS The analysis indicated two main themes: risk management and damage control in a restricted environment and compensating and reconstructing ordinariness-trying to make the best of it; each theme had three subthemes. The care environment seems to be experienced by staff as characterized by conflicting demands, thus constituting a gap between needs and what is possible to achieve-a balancing act that constitutes a constant struggle. CONCLUSIONS The staff members' constant struggle could be interpreted as conflicting moral and instrumental demands; they know what the youths need, but the environment of the secure youth homes demands the decorous behaviour of sociomaterial control practices-rather than care practices.
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Affiliation(s)
- Kajsa Nolbeck
- Institute of Social Work, University of Gothenburg, Gothenburg, Sweden,CONTACT Kajsa Nolbeck University of Gothenburg, Institute of Social Work, Sprängkullsgatan 23-25, Box 720, 405 30, Gothenburg, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Lindahl
- Department of Architecture and Civil Engineering, Division of Building Design, Chalmers University of Technology, and Centre for Healthcare Architecture, Gothenburg, Sweden
| | | | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Division of Building Design, Chalmers University of Technology, and Centre for Healthcare Architecture, Gothenburg, Sweden
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Corrigendum to "Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial" [Sex. Reprod. Healthc. 32 (2022) 100731]. Sex Reprod Healthc 2023; 37:100883. [PMID: 37399758 DOI: 10.1016/j.srhc.2023.100883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, DR Congo
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Goldkuhl L, Gyllensten H, Begley C, Nilsson C, Wijk H, Lindahl G, Uvnäs-Moberg K, Berg M. Impact of Birthing Room Design on Maternal Childbirth Experience: Results From the Room4Birth Randomized Trial. HERD 2023; 16:200-218. [PMID: 36239523 PMCID: PMC9755691 DOI: 10.1177/19375867221124232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the effect of the birthing room design on nulliparous women's childbirth experience up to 1 year after birth. BACKGROUND Although it is known that the birth environment can support or hinder birth processes, the impact of the birthing room design on maternal childbirth experience over time is insufficiently studied. METHODS The Room4Birth randomized controlled trial was conducted at a labor ward in Sweden. Nulliparous women in active stage of spontaneous labor were randomized (n = 406) to either a regular birthing room (n = 202) or a new birthing room designed with more person-centered considerations (n = 204). Childbirth experiences were measured 2 hr, 3 months, and 12 months after birth by using a Visual Analogue Scale of Overall Childbirth Experience (VAS-OCE), the Fear of Birth Scale (FOBS), and the Childbirth Experience Questionnaire (CEQ2). RESULTS Women randomized to the new room had a more positive childbirth experience reported on the VAS-OCE 3 months (p = .002) and 12 months (p = .021) after birth compared to women randomized to a regular room. Women in the new room also scored higher in the total CEQ2 score (p = .039) and within the CEQ2 subdomain own capacity after 3 months (p = .028). The remaining CEQ2 domains and the FOBS scores did not differ between the groups. CONCLUSIONS These findings show that a birthing room offering more possibilities to change features and functions in the room according to personal needs and requirements, positively affects the childbirth experience of nulliparous women 3 and 12 months after they have given birth.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden,Lisa Goldkuhl, MSc, RN, RM, Arvid Wallgrens backe, Box 457, 405 30 Gothenburg, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Ireland
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Region Västra Götaland, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden,Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture, CVA, Chalmers University of Technology, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Gothenburg, Sweden
| | | | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden,Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, D. R. Congo
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Goldkuhl L, Gyllensten H, Begley C, Wijk H, Nilsson C, Lindahl G, Ringqvist AK, Uvnäs-Moberg K, Berg M. Room4Birth - The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial. Sex Reprod Healthc 2022; 32:100731. [PMID: 35500476 DOI: 10.1016/j.srhc.2022.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. METHODS A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. RESULTS A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90-2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71-0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). CONCLUSIONS The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden.
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Blå stråket 5, 413 45, Region Västra Götaland, Gothenburg, Sweden; Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Munkebäckstorg 6, 416 73 Gothenburg, Region Västra Götaland, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden; Department of Architecture and Civil Engineering, Building Design, Chalmers University of Technology, Chalmersplatsen 4, 412 96 Gothenburg, Sweden
| | - Anna-Karin Ringqvist
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden
| | - Kerstin Uvnäs-Moberg
- University of Agriculture (SLU), Almas Allé 8, 750 07, Uppsala University, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Arvid Wallgrens backe, Box 457, 405 30, University of Gothenburg, Gothenburg, Sweden; Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Diagnosvagen 11, 41685 Gothenburg, Region Västra Götaland, Sweden; Faculty of Medicine and Community Health, Evangelical University of Africa, Bukavu, Democratic Republic of the Congo, The
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Abstract
Aim: To explore women’s experiences of physical features in a birthing room
designed to be adaptable to personal wishes and needs during labor and
birth. Background: Childbirth is a central life event influenced by numerous factors, including
the healthcare environment; however, there is insufficient knowledge on how
the physical design affects women during birth. Methods: This study was part of a randomized controlled trial in the Room4Birth
research project, including women randomized to receive care in a new
birthing room designed with physical features changeable according to
personal wishes. Data consisted of responses to two questions analyzed with
descriptive statistics (n = 202) and semi-structured
interviews analyzed for content (n = 19). Results: A total of 93.6% (n = 189) assessed the physical features in
the birthing room as meaningful to a very high or high extent. The overall
impression of the room was positive and exceeded women’s expectations. They
felt welcomed and strengthened by the room, which shifted the focus to a
more positive emotional state. The room differed from traditional hospital
birthing rooms, contained familiar features that maintained integrity, and
had space for companions. The variety of physical features was appreciated.
Of nine listed physical features, the bathtub was ranked most important,
followed by the projection of nature scenery, and dimmable lighting, but the
room as a whole appeared most important. Conclusions: When planning and designing hospital-based birthing rooms, it is crucial to
offer possibilities to adapt the room and physical features according to
personal wishes.
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Affiliation(s)
- Lisa Björnson Skogström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Vithal
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.,Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture (CVA), Chalmers University of Technology, Gothenburg, Sweden.,Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Brambilla A, Sun TZ, Elshazly W, Ghazy A, Barach P, Lindahl G, Capolongo S. Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation. Int J Environ Res Public Health 2021; 18:ijerph182111478. [PMID: 34769993 PMCID: PMC8583089 DOI: 10.3390/ijerph182111478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022]
Abstract
Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.
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Affiliation(s)
- Andrea Brambilla
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Center for Healthcare Architecture (CVA), Division of Building Design, Department Architecture and Civil Engineering (ACE), Chalmers University of Technology, SE-412 96 Goteborg, Sweden
- Correspondence: ; Tel.: +39-0223995140
| | - Tian-zhi Sun
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
| | - Waleed Elshazly
- School of Architecture and Urban Planning (AUIC), Politecnico di Milano, 20133 Milan, Italy; (W.E.); (A.G.)
| | - Ahmed Ghazy
- School of Architecture and Urban Planning (AUIC), Politecnico di Milano, 20133 Milan, Italy; (W.E.); (A.G.)
| | - Paul Barach
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
- School of Medicine and Law, Sigmund Freud University, 1020 Vienna, Austria
| | - Göran Lindahl
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
- Center for Healthcare Architecture (CVA), Division of Building Design, Department Architecture and Civil Engineering (ACE), Chalmers University of Technology, SE-412 96 Goteborg, Sweden
| | - Stefano Capolongo
- Design and Health Lab, Department of Architecture, Built Environment and Construction Engineering (DABC), Politecnico di Milano, 20133 Milan, Italy; (T.-z.S.); (P.B.); (G.L.); (S.C.)
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Brambilla A, Lindahl G, Capolongo S. Evidence-informed health care infrastructures: test of SustHealthv2 tool on hospital pilot cases. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Healthcare facilities are important node of health systems and several scholars from Public Health and health service field highlighted that high quality and sustainable built environment is fundamental in providing high quality health care services. Nevertheless, most hospital buildings are obsolete, not adequate to contemporary organizational models; additionally, none of the existing quality improvement tools systematically evaluate the built environment. Therefore, the study develops an evidence-informed weighted multicriteria tool and tested it on two pilot case study.
Methods
Starting from previous literature reviews and scenario analysis, different indicators for hospital quality assessment have been grouped in 17 criteria and 3 macro areas, validated through semi-structured interviews and weighted with Multicriteria Simon Roy Figueras (MCDA-SRF) and Deck Card Method (DCM). The weighted tool SustHealthv2 has been tested on two medium sized hospital pilot case studies (H1 and H2) in northern Italy.
Results
The tool is composed by three macro areas: Social, Environmental and Organizational qualities respectively accounting for 22%, 29% and 49%. The application and test of the tool highlighted transversal criticalities such as Sustainable Accessibility (H1=0.04/0.16; H2=0.11/0.16), Sensitization and Education (H1=0.06/0.18; H2=0.10/0.18). The most recent case study (H1) was able to achieve higher scores in energy (0.15/0.0.19), waste management (0.07/0.07), as well as future proofing characteristics (0.20/0.23) compared to the older one. Overall H1 scored higher in all the macro areas reaching a total fulfillment of 72/100, while H2 scored 52/100.
Conclusions
The application of SustHealth v2 on operating health care facilities can support hospital management in defining strategic area of improvements and investments for hospital building renovation providing higher level of services to patients, users and staff.
Key messages
Built environment for healthcare needs systematic evaluation frameworks to improve and contribute to health service quality. SustHealth v2 is an evidence-informed multicriteria framework for hospital built environment sustainability and quality assessment from social, environmental and organizational perspective.
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Affiliation(s)
- A Brambilla
- Design & Health Lab, Department ABC, Politecnico di Milano, Milan, Italy
| | - G Lindahl
- Center for Healthcare Architecture, Department ACE, Chalmers University of Technology, Goteborg, Sweden
| | - S Capolongo
- Design & Health Lab, Department ABC, Politecnico di Milano, Milan, Italy
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Wedin M, Stålberg K, Marcickiewicz J, Ahlner E, Åkesson Å, Lindahl G, Wodlin NB, Kjølhede P. Impact of lymphadenectomy and lymphoedema on health-related quality of life 1 year after surgery for endometrial cancer. A prospective longitudinal multicentre study. BJOG 2021; 129:450-460. [PMID: 34437763 DOI: 10.1111/1471-0528.16870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of lymphadenectomy and lymphoedema of the lower limbs (LLL) on health-related quality of life (HRQoL) 1 year after surgery for endometrial cancer (EC). DESIGN Prospective longitudinal cohort multicentre study. SETTING Departments of obstetrics and gynaecology at four university hospitals, six central hospitals and four county hospitals in Sweden. POPULATION Two-hundred-and-thirty-five women with early stage EC were included; 116 with high-risk EC underwent surgery including lymphadenectomy (+LA), and 119 with low-risk EC had surgery without lymphadenectomy (-LA). METHODS The generic SF-36 and EQ-5D-3L and the lymphoedema-specific LYMQOL questionnaire were used to assess HRQoL. LLL was assessed by systematic circumferential measurements of the legs enabling volume estimation, clinical evaluation and patient-reported perception of leg swelling. All assessments were carried out on four occasions; preoperatively, and 4-6 weeks, 6 months and 1 year postoperatively. MAIN OUTCOME MEASURE HRQoL scores. RESULTS No significant differences were seen in HRQoL between the +LA and -LA groups 1 year postoperatively. Irrespective of method of determining LLL, women with LLL were significantly more affected in the LYMQOL domains Function, Appearance/body image and Physical symptoms, but not in the domain Emotion/mood, than women without LLL. No such differences were seen in the generic HRQoL or in the LYMQOL global score between the groups with and without LLL. CONCLUSIONS Lymphadenectomy did not seem to affect generic HRQoL adversely. Irrespective of the method of measuring, LLL affected the lymphoedema-specific HRQoL negatively, mainly in physical domains, but had no impact on the generic HRQoL. TWEETABLE ABSTRACT Lymphoedema has impact on lymphoedema-specific, but not on generic, HRQoL, 1 year after surgery for EC.
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Affiliation(s)
- M Wedin
- Department of Obstetrics and Gynaecology in Linköping, Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | - K Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - J Marcickiewicz
- Department of Obstetrics and Gynaecology, Varberg Hospital, Varberg, Sweden
| | - E Ahlner
- Department of Oncology, Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | - Å Åkesson
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - G Lindahl
- Department of Oncology, Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | - N B Wodlin
- Department of Obstetrics and Gynaecology in Linköping, Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
| | - P Kjølhede
- Department of Obstetrics and Gynaecology in Linköping, Department of Biomedical and Clinical Science, Linköping University, Linköping, Sweden
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10
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Miedema E, Lindahl G, Elf M. The Swedish Health Promoting Healthcare network and the built environment. Health Promot Int 2021; 37:6318106. [PMID: 34244726 PMCID: PMC8851404 DOI: 10.1093/heapro/daab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Health Promoting Hospitals (HPH) networks, founded by the World Health Organisation, support the introduction of health promotion in healthcare. This development involves the creation of a health promoting built environment. However, few studies have explored the HPH in relation to the built environments, and it is unclear how HPH-networks incorporate the built environment in their work. The study therefore examined the Swedish HPH-Network in relation to the built environment. The mixed-method study included data from (i) key online material from the Swedish network, (ii) a survey with open-ended questions of representatives of the networks’ workgroups and (iii) semi-structured interviews with the built environment workgroup. The study showed that the built environment is unevenly and incoherently incorporated in the network. Moreover, there is more attention for healing and healthy rather than health-promotive strategies, indicating a knowledge gap. Descriptions of the health promoting built environment are diverse, and address design features, design strategies or indicate places for health promotion interventions. The descriptions of the built environment are combined with various HPH goals and population groups. To utilize the built environment as a resource for HPHs, the networks should consider incorporating the built environment in documents and action plans at all organizational levels.
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Affiliation(s)
- Elke Miedema
- Division of Architectural Theory and Method, Department of Architecture and Civil Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Göran Lindahl
- Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Marie Elf
- School of Health and Welfare, Department of Nursing and Midwifery, Dalarna University, 791 88 Falun, Sweden
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11
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Brambilla A, Lindahl G, Dell'Ovo M, Capolongo S. Validation of a multiple criteria tool for healthcare facilities quality evaluation. F 2020. [DOI: 10.1108/f-06-2020-0070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Several healthcare quality assessment tools measure the processes and outcomes of the care system. The actual physical infrastructure (buildings and organizational) aspects are, however, rarely considered. The purpose of this paper is to describe the process of validation and weighting of an evidence-informed framework for the quality assessment of hospital facilities from social, environmental and organizational perspectives to complement other assessments.
Design/methodology/approach
Sustainable High-quality Healthcare version 2 (SustHealth v2) is the updated version of an existing framework composed of three domains (social, environmental and organizational quality). To validate and establish a relevant weighting, interviews were conducted with 15 professionals within the field of healthcare planning, design, research and management. The study has been conducted through semi-structured interviews and the application of the Simon Roy Figueras (SRF) procedure for the elicitation of weights criteria. The data collected have been processed through the DecSpace web platform.
Findings
Among the three domains, the organizational qualities appear to be the most important (W = 49%), followed by the environmental (W = 29%) and social aspects (W = 22%). Relevant indicators such as future-proofing, wayfinding and users’ space control emerged as the most important within each macro-area. Those results are confirmed by the outcome of the interviews that highlight user/patient-centeredness, wayfinding strategies and space functionality as the most important concepts to foster in existing healthcare facilities improvement.
Practical implications
The study highlights important structural and organizational aspects that hospital managers and planners can consider when dealing with healthcare facilities’ quality improvement.
Originality/value
The use of the SRF multicriteria method is novel in this context when used to weight an assessment tool with a focus on hospital built environment.
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12
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Nolbeck K, Wijk H, Lindahl G, Olausson S. "If you don't behave, you're in real shit, you don't get outside the doors"-a phenomenological hermeneutic study of adolescents' lived experiences of the socio-spatial environment of involuntary institutional care. Int J Qual Stud Health Well-being 2020; 15:1726559. [PMID: 32049605 PMCID: PMC7034456 DOI: 10.1080/17482631.2020.1726559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In Sweden, according to law, adolescents with extensive psychosocial problems, substance abuse or criminal behaviour can be cared for in institutions. The two-fold aim of these institutions (to rehabilitate and incarcerate) puts special demands to their socio-spatial context. Purpose: To elucidate adolescents’ lived experiences of the socio-spatial environment at special youth homes run by the Swedish National Board of Institutional Care (SiS) in Sweden. Methods: Data collected through Photovoice and analysed employing a phenomenological hermeneutical method. Fourteen adolescents (age 15–19) were asked to photograph their environment, and this was followed up by in-depth interviews. Results: Two themes emerged from the material: the dense walls of institutional life and create and capture the caring space. The socio-spatial environment can be seen as an additional “other” that distances the adolescents and the staff from one another. Negotiating with their behaviour, the adolescents strive to present themselves as worthy of increased degrees of freedom and ultimately access to the desired outside life. Conclusions: In an institutional setting dominated by a security and criminal justice logic, words appear to have less impact than the environment. The adolescents appear to understand themselves through the socio-spatial other, causing reinforced feelings of social exclusion.
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Affiliation(s)
- Kajsa Nolbeck
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department for Quality Assurance, Sahlgrenska University Hospital, Gothenburg, Sweden.,Centre for Healthcare Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- Department of Architecture and Civil Engineering, Division of Building Design, Chalmers University of Technology, Gothenburg, Sweden.,Centre for Healthcare Architecture, Chalmers University of Technology, Gothenburg, Sweden
| | - Sepideh Olausson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Ethics, Law and Mental Health, Rågården Forensic Psychiatry Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Berg M, Goldkuhl L, Nilsson C, Wijk H, Gyllensten H, Lindahl G, Uvnäs Moberg K, Begley C. Room4Birth - the effect of an adaptable birthing room on labour and birth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden. Trials 2019; 20:629. [PMID: 31744523 PMCID: PMC6862754 DOI: 10.1186/s13063-019-3765-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden. Methods/design Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms. Discussion The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care. Trial registration ClinicalTrials.gov NCT03948815. Registered 13 May 2019—retrospectively registered.
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Affiliation(s)
- Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden. .,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-416 50, Gothenburg, Sweden.
| | - Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, SE-416 50, Gothenburg, Sweden
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Quality and Patient Safety Unit, Sahlgrenska University Hospital of Gothenburg, SE-413 45, Gothenburg, Sweden.,Centre for Healthcare Architecture , CVA, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Box 457, SE-405 30, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Box 457, SE-405 30, Gothenburg, Sweden
| | - Göran Lindahl
- Centre for Healthcare Architecture , CVA, Chalmers University of Technology, SE-412 96, Gothenburg, Sweden.,Building Design, Architecture and Civil Engineering, Chalmers University of Technology, SE 412 96, Gothenburg, Sweden
| | | | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 24 D'Olier St, Dublin 2, Ireland
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Elf M, Lindahl G, Anåker A. A Study of Relationships Between Content in Documents From Health Service Operational Plans and Documents From the Planning of New Healthcare Environments. HERD 2018; 12:107-118. [PMID: 30205707 DOI: 10.1177/1937586718796643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim was to investigate the content and quality of the governing documents created in the planning and design phase of new healthcare environments and in the related healthcare strategic and operational plans. BACKGROUND Quality deficits in buildings can often be traced back to the initial stages in the planning and design phase. Although large investments have been made to improve the process of planning new healthcare environments and linking the requirements to health service strategies, healthcare organizations rarely relate their strategy goals to the built environment. METHOD A retrospective review of documents created in the planning and design stages of new healthcare environments and the operational plans of the target organizations was conducted. RESULTS The organizational operational plans did not contain any statements or information about the built environment or how a building could or should support the organization's goals. Important information was frequently absent from the documents governing the planning and design of buildings. The documents lacked information about what and how to follow-up and what to measure once a construction project had been completed. There were no references to evidence. CONCLUSIONS Poor documentation might undermine the quality of the planning and design phase and ultimately the opportunity to create environments that support health outcomes. Therefore, more emphasis must be placed on the importance of documentation but above all to strengthen and clarify the relationship between the healthcare organization strategy to achieve an effective and efficient care process and the intention made in the planning and design process.
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Affiliation(s)
- Marie Elf
- 1 Department of Nursing, School of Education, Health and Society, Dalarna University, Falun, Sweden.,2 Department of Architecture and Civil Engineering, Chalmers University of Technology, Göteborg, Sweden.,3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Göran Lindahl
- 2 Department of Architecture and Civil Engineering, Chalmers University of Technology, Göteborg, Sweden
| | - Anna Anåker
- 3 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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15
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Abstract
OBJECTIVE: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design. BACKGROUND: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design. METHOD: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged. RESULTS: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions. CONCLUSIONS: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.
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Affiliation(s)
- Elke Miedema
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marie Elf
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.,2 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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16
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Bak KH, Bolumar T, Karlsson AH, Lindahl G, Orlien V. Effect of high pressure treatment on the color of fresh and processed meats: A review. Crit Rev Food Sci Nutr 2017; 59:228-252. [DOI: 10.1080/10408398.2017.1363712] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- K. H. Bak
- University of Copenhagen, Faculty of Science, Department of Food Science, Frederiksberg C, Denmark
| | - T. Bolumar
- CSIRO, Agriculture and Food, Meat Science Team, Coopers Plains, Queensland, Australia
| | - A. H. Karlsson
- Department of Animal Environment and Health, Swedish University of Agricultural Sciences, Skara, Sweden
| | | | - V. Orlien
- University of Copenhagen, Faculty of Science, Department of Food Science, Frederiksberg C, Denmark
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17
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De Lauretis A, Ward S, Murray C, Clayman C, Ong V, Denton C, Bikov A, Visca D, Lindahl G, Chetta A, Aiello M, Wuyts W, Kreuter M, Maher T, Stock C, Wells AU, Renzoni E. P32 Role of non acid and proximal reflux in scleroderma-associated interstitial lung disease. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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18
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Elf M, Fröst P, Lindahl G, Wijk H. Shared decision making in designing new healthcare environments-time to begin improving quality. BMC Health Serv Res 2015; 15:114. [PMID: 25888922 PMCID: PMC4373305 DOI: 10.1186/s12913-015-0782-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 03/09/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. DISCUSSION This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users' perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.
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Affiliation(s)
- Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
| | - Peter Fröst
- Department of Architecture, Chalmers University of Technology, Göteborg, Sweden.
| | - Göran Lindahl
- Department of Civil and Environmental Engineering, Chalmers University of Technology, Göteborg, Sweden.
| | - Helle Wijk
- Sahlgrenska Academy, Health and Caring Sciences, University of Gothenburg, Göteborg, Sweden.
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19
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Meding B, Lindahl G, Alderling M, Wrangsjö K, Anveden Berglind I. Is skin exposure to water mainly occupational or nonoccupational? A population-based study. Br J Dermatol 2014; 168:1281-6. [PMID: 23413840 DOI: 10.1111/bjd.12275] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin exposure to water is considered to contribute to hand eczema. Knowledge about total water exposure during a day is scanty. OBJECTIVES To investigate self-reported water exposure at work as well as throughout the day. METHODS Skin exposure to water was assessed from two questionnaire-based health surveys: the nationwide Environmental Health Survey 2007 (EHS), which enquired about water exposure throughout the day, and the Stockholm Public Health Survey 2006 (PHS), which probed water exposure at work. Answers from 19,667 individuals (EHS) and 18,318 individuals (PHS) were available for analysis. RESULTS In total, 22% of respondents (women 30%, men 12%) reported skin exposure to water more than 20 times during an entire day (EHS) compared with 6% (women 8%, men 4%) at work (PHS). In a univariate analysis, using a merged file comprising data from the EHS and the PHS, water exposure more than 20 times a day was more common in the EHS (prevalence proportion ratio 3·570, 95% confidence interval 3·353-3·802). In multivariate models the variables studied did not fulfil the criteria for being confounders. Water exposure at work declined with increasing age in both women and men (P < 0·0001) as did water exposure during the entire day in men (P < 0·0001). However, women were equally exposed during the entire day across age groups (P = 0·205). CONCLUSIONS High water exposure over the entire day was found to be considerably more frequent than exposure at work. Thus, a significant proportion of water exposure seems to occur outside work. This should be considered in prevention of hand eczema and when counselling patients with hand eczema in clinical practice.
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Affiliation(s)
- B Meding
- Unit of Occupational and Environmental Dermatology, Institute of Environmental Medicine, SE-17177, Stockholm, Sweden.
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20
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21
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Dabrosin C, Lindahl G, Abrahamsson A, Saarinen N. Abstract P1-02-06: Tamoxifen, Flaxseed and the Lignan Enterolactone Increase Stroma and Cancer Cell Derived IL-1Ra, Decrease Tumor Growth and Angiogenesis in Estrogen Dependent Breast Cancer Explants. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p1-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The proinflammatory cytokines IL-1α and IL-1β have been shown to promote tumor angiogenesis, which may be counteracted by the IL-1 receptor antagonist (IL-1Ra). A diet with high amounts of phytoestrogens such as flaxseed (Flax), genistein (GEN), and the mammalian lignan enterolactone (ENL) may affect breast cancer progression possibly in a similar fashion as the anti-estrogen tamoxifen. Both cancer cells and the tumor stroma may be targets for cancer therapy. Therefore, we set up a model with species-specific components of the microenvironment by establishing human breast cancers in nude mice and sampled released proteins by microdialysis. We show that tumors of mice treated with tamoxifen, fed Flax or ENL exhibited decreased in vivo release of IL-1β derived from the murine stroma and decreased microvessel density whereas dietary GEN had no effects compared to controls. Cancer cells released IL-1Ra were approximately five times higher compared with stroma derived and tamoxifen, Flax, and ENL increased these levels significantly whereas GEN did not. In vitro, estradiol decreased released IL-1Ra of breast cancer cells. ENL completely reversed this whereas tamoxifen further increased IL-1Ra levels. IL-1Ra had no effect on breast cancer cell proliferation in presence of E2 in vitro whereas endothelial cell proliferation was significantly decreased by IL-1Ra in a dose dependent manner. Finally, IL-1Ra therapy of tumor bearing mice opposed estrogen dependent breast cancer growth and decreased tumor angiogenesis. These data may provide insights into tumor-stroma mechanisms involved in estrogen effects on breast cancer progression and tamoxifen and dietary interventions against this disease.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-02-06.
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Affiliation(s)
- C Dabrosin
- Linköping University, Sweden; Turku University, Finland
| | - G Lindahl
- Linköping University, Sweden; Turku University, Finland
| | - A Abrahamsson
- Linköping University, Sweden; Turku University, Finland
| | - N. Saarinen
- Linköping University, Sweden; Turku University, Finland
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22
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Lindahl G. Studies on the Immunohistopathology of the Lip Salivary Glands in Connective Tissue Diseases. Scand J Rheumatol 2009. [DOI: 10.3109/03009748909099939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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24
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Larsson C, Lindroth M, Nordin P, Stålhammar-Carlemalm M, Lindahl G, Krantz I. Association between low concentrations of antibodies to protein alpha and Rib and invasive neonatal group B streptococcal infection. Arch Dis Child Fetal Neonatal Ed 2006; 91:F403-8. [PMID: 17056838 PMCID: PMC2672751 DOI: 10.1136/adc.2005.090472] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Infection with group B streptococci (GBS) is a serious neonatal disease. The GBS cell surface proteins alpha and Rib elicit protective immunity in animal models and have been suggested as potential antigens in a vaccine against human GBS disease. AIMS To test the hypothesis that transplacentally transferred maternal antibodies to GBS proteins contribute to the protection of the neonate from GBS infection. METHODS Thirty neonates with invasive infection were included in a case-control study. IgG antibody concentrations were measured in sera from these neonates, their mothers, and from 60 non-infected controls, neonates as well as mothers. RESULTS A clear association was found between concentrations of antibody to proteins alpha and Rib in neonatal and maternal sera, indicating that transplacental transfer had occurred. Moreover, low concentrations of antibodies to alpha and Rib in neonatal sera were associated with invasive GBS infection caused by strains expressing the Rib protein. The odds ratio was 0.0007 (95% confidence interval 0.000 to 0.54) for antibodies to alpha and 0.002 (95% confidence interval 0.000 to 0.57) for antibodies to Rib. CONCLUSION These findings support the notion that antibodies to GBS surface proteins contribute to the protection against neonatal infection.
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Affiliation(s)
- C Larsson
- Department of Medical Microbiology, Lund University, Lund, Sweden.
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25
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André I, Persson J, Blom AM, Nilsson H, Drakenberg T, Lindahl G, Linse S. Streptococcal M protein: structural studies of the hypervariable region, free and bound to human C4BP. Biochemistry 2006; 45:4559-68. [PMID: 16584191 DOI: 10.1021/bi052455c] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Streptococcus pyogenes is a Gram-positive bacterium that causes several diseases, including acute tonsillitis and toxic shock syndrome. The surface-localized M protein, which is the most extensively studied virulence factor of S. pyogenes, has an approximately 50-residue N-terminal hypervariable region (HVR) that plays a key role in the escape of the host immunity. Despite the extensive sequence variability in this region, many HVRs specifically bind human C4b-binding protein (C4BP), a plasma protein that inhibits complement activation. Although the more conserved parts of M protein are known to have dimeric coiled-coil structure, it is unclear whether the HVR also is a coiled coil. Here, we use nuclear magnetic resonance (NMR) to study the conformational properties of HVRs from M4 and M22 proteins in isolation and in complex with the M protein binding portion of C4BP. We conclude that the HVRs of M4 and M22 are folded as coiled coils and that the folded nucleus of the M4 HVR has a length of approximately 27 residues. Moreover, we demonstrate that the C4BP binding surface of M4-N is found within a region of four heptad repeats. Using molecular modeling, we propose a model for the structure of the M4 HVR that is consistent with our experimental information from NMR spectroscopy.
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Affiliation(s)
- I André
- Department of Biophysical Chemistry, Lund University, Chemical Center, S-221 00 Lund, Sweden
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26
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Karlskov-Mortensen P, Bruun CS, Braunschweig MH, Sawera M, Markljung E, Enfält AC, Hedebro-Velander I, Josell A, Lindahl G, Lundström K, von Seth G, Jørgensen CB, Andersson L, Fredholm M. Genome-wide identification of quantitative trait loci in a cross between Hampshire and Landrace I: carcass traits. Anim Genet 2006; 37:156-62. [PMID: 16573530 DOI: 10.1111/j.1365-2052.2005.01405.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report the identification of quantitative trait loci (QTL) affecting carcass composition, carcass length, fat deposition and lean meat content using a genome scan across 462 animals from a combined intercross and backcross between Hampshire and Landrace pigs. Data were analysed using multiple linear regression fitting additive and dominance effects. This model was compared with a model including a parent-of-origin effect to spot evidence of imprinting. Several precisely defined muscle phenotypes were measured in order to dissect body composition in more detail. Three significant QTL were detected in the study at the 1% genome-wide level, and twelve significant QTL were detected at the 5% genome-wide level. These QTL comprise loci affecting fat deposition and lean meat content on SSC1, 4, 9, 10, 13 and 16, a locus on SSC2 affecting the ratio between weight of meat and bone in back and weight of meat and bone in ham and two loci affecting carcass length on SSC12 and 17. The well-defined phenotypes in this study enabled us to detect QTL for sizes of individual muscles and to obtain information of relevance for the description of the complexity underlying other carcass traits.
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Affiliation(s)
- P Karlskov-Mortensen
- Division of Genetics, Department of Animal and Veterinary Basic Sciences, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark
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27
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Abstract
The aim of this project was to study the long-term prognosis of occupational skin diseases in Sweden. In 1999, a questionnaire was sent to 623/655 individuals who in 1987 reported occupational skin disease to the Social Insurance Office. 394 answered the questionnaire, and 123 non-responders were interviewed by telephone, giving 517 participants (83%), 323 females and 194 males. 85% reported skin symptoms after 1987, 70% during the previous year. 28% considered themselves recovered, of those with nickel allergy only 12%. In a logistic regression model, skin atopy was the strongest unfavourable factor for the prognosis followed by contact allergy and female sex. 66% had consulted a doctor after 1987 and the majority, 82%, had performed occupational changes - most common was change of jobs, 44%. Those who had changed jobs reported less sick leave. The conclusion is that occupational skin diseases have a clear tendency to end up as chronic conditions with a majority reporting symptoms at a 12-year follow-up. The skin disease had influenced the occupational situation for the majority (82%) and for 15% resulted in exclusion from the labour market through unemployment or disability pension.
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Affiliation(s)
- B Meding
- Occupational Dermatology, National Institute for Working Life, Stockholm, Sweden.
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28
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Young J, Bertram H, Rosenvold K, Lindahl G, Oksbjerg N. Dietary creatine monohydrate affects quality attributes of Duroc but not Landrace pork. Meat Sci 2005; 70:717-25. [DOI: 10.1016/j.meatsci.2005.03.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2004] [Revised: 03/15/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
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29
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Lindahl G. Gene Regulation: A Eukaryotic Perspective. Int J Biochem Cell Biol 2003. [DOI: 10.1016/s1357-2725(02)00174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Lindahl G. Global compact to leverage world development. Water Sci Technol 2002; 45:xvii-xviii. [PMID: 12402961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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31
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Morfeldt E, Berggård K, Persson J, Drakenberg T, Johnsson E, Lindahl E, Linse S, Lindahl G. Isolated hypervariable regions derived from streptococcal M proteins specifically bind human C4b-binding protein: implications for antigenic variation. J Immunol 2001; 167:3870-7. [PMID: 11564804 DOI: 10.4049/jimmunol.167.7.3870] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antigenic variation in microbial surface proteins represents an apparent paradox, because the variable region must retain an important function, while exhibiting extensive immunological variability. We studied this problem for a group of streptococcal M proteins in which the approximately 50-residue hypervariable regions (HVRs) show essentially no residue identity but nevertheless bind the same ligand, the human complement regulator C4b-binding protein (C4BP). Synthetic peptides derived from different HVRs were found to retain the ability to bind C4BP, implying that the HVR corresponds to a distinct ligand-binding domain that can be studied in isolated form. This finding allowed direct characterization of the ligand-binding properties of isolated HVRs and permitted comparisons between different HVRs in the absence of conserved parts of the M proteins. Affinity chromatography of human serum on immobilized peptides showed that they bound C4BP with high specificity and inhibition experiments indicated that different peptides bound to the same site in C4BP. Different C4BP-binding peptides did not exhibit any immunological cross-reactivity, but structural analysis suggested that they have similar folds. These data show that the HVR of streptococcal M protein can exhibit extreme variability in sequence and immunological properties while retaining a highly specific ligand-binding function.
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Affiliation(s)
- E Morfeldt
- Department of Medical Microbiology, Dermatology, and Infection, Lund University, Sölvegatan 23, SE-22362 Lund, Sweden
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32
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Berggård K, Johnsson E, Morfeldt E, Persson J, Stålhammar-Carlemalm M, Lindahl G. Binding of human C4BP to the hypervariable region of M protein: a molecular mechanism of phagocytosis resistance in Streptococcus pyogenes. Mol Microbiol 2001; 42:539-51. [PMID: 11703674 DOI: 10.1046/j.1365-2958.2001.02664.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The amino-terminal hypervariable region (HVR) of streptococcal M protein is required for the ability of this virulence factor to confer phagocytosis resistance. The function of the HVR has remained unknown, but the finding that many HVRs with extremely divergent sequences bind the human complement regulator C4b-binding protein (C4BP) has suggested that this ligand may play a role in phagocytosis resistance. We used the M22 system to study the function of bound C4BP and provide several lines of evidence that C4BP indeed contributes to phagocytosis resistance. First, the ability of anti-HVR antibodies to cause opsonization correlated with their ability to inhibit binding of C4BP. Secondly, a short deletion in the HVR eliminated C4BP binding and also reduced the ability of M22 to confer phagocytosis resistance. Thirdly, the addition of an excess of pure C4BP to a phagocytosis system almost completely blocked the effect of opsonizing anti-HVR antibodies. Together, our data indicate that binding of C4BP to the HVR of M22 plays an important role in phagocytosis resistance, but other properties of M22 also contribute. This study provides the first molecular insight into the mechanisms by which the HVR of an M protein confers phagocytosis resistance.
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Affiliation(s)
- K Berggård
- Department of Medical Microbiology, Dermatology and Infection, Lund University, Sölvegatan 23, SE-223 62 Lund, Sweden
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33
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Abstract
Human complement regulators are important targets for pathogenic microorganisms. In one such interaction, Bordetella pertussis binds human C4b-binding protein (C4BP), a high-molecular-weight plasma protein that acts as inhibitor of the classical pathway of complement activation. At least two different B. pertussis surface components, one of which is the virulence factor filamentous hemagglutinin (FHA), contribute to the binding. We used a set of C4BP mutants and monoclonal antibodies to characterize the region in C4BP that binds B. pertussis and analyzed the salt sensitivity of the interaction. These studies indicated that positively charged residues at the interface between complement control protein modules 1-2 in the C4BP alpha-chain are important for binding, and that the site in C4BP that binds B. pertussis is very similar, but not identical, to the C4b-binding site. Bacteria-bound C4BP retained its complement regulatory function and B. pertussis selectively bound C4BP in human plasma, indicating that binding occurs also in vivo. Together, these findings indicate that B. pertussis exploits a site in C4BP, resembling that used by the natural ligand C4b.
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Affiliation(s)
- K Berggård
- Department of Medical Microbiology, Dermatology and Infection, Lund University, Lund, Sweden
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34
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Blom AM, Rytkönen A, Vasquez P, Lindahl G, Dahlbäck B, Jonsson AB. A novel interaction between type IV pili of Neisseria gonorrhoeae and the human complement regulator C4B-binding protein. J Immunol 2001; 166:6764-70. [PMID: 11359834 DOI: 10.4049/jimmunol.166.11.6764] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
C4b-binding protein (C4BP) is an important plasma inhibitor of the classical pathway of complement activation. Several bacterial pathogens bind C4BP, which may contribute to their virulence. In the present report we demonstrate that isolated type IV pili from Neisseria gonorrhoeae bind human C4BP in a dose-dependent and saturable manner. C4BP consists of seven identical alpha-chains and one beta-chain linked together with disulfide bridges. We found that pili bind to the alpha-chain of C4BP, which is composed of eight homologous complement control protein (CCP) domains. From the results of an inhibition assay with C4b and a competition assay in which we tested mutants of C4BP lacking individual CCPs, we concluded that the binding area for pili is localized to CCP1 and CCP2 of the alpha-chain. The binding between pili and C4BP was abolished at 0.25 M NaCl, implying that it is based mostly on ionic interactions, similarly to what have been observed for C4b-C4BP binding. Furthermore, the N-terminal part of PilC, a structural component of pili, appeared to be responsible for binding of C4BP. Membrane cofactor protein, previously shown to be a receptor for pathogenic N. gonorrhoeae on the surface of epithelial cells, competed with C4BP for binding to pili only at high concentrations, suggesting that different parts of pili are involved in these two interactions. Accordingly, high concentrations of C4BP were required to inhibit binding of N. gonorrhoeae to Chang conjunctiva cells, and no inhibition of binding was observed with cervical epithelial cells.
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MESH Headings
- Antigens, CD/genetics
- Antigens, CD/metabolism
- Bacterial Proteins/metabolism
- Binding, Competitive/genetics
- Carrier Proteins/genetics
- Carrier Proteins/metabolism
- Cell Line
- Complement C4b/metabolism
- Complement Inactivator Proteins
- Epithelial Cells/metabolism
- Epithelial Cells/microbiology
- Fimbriae Proteins
- Fimbriae, Bacterial/classification
- Fimbriae, Bacterial/metabolism
- Glycoproteins
- HEPES/pharmacology
- Humans
- Maltose-Binding Proteins
- Membrane Cofactor Protein
- Membrane Glycoproteins/genetics
- Membrane Glycoproteins/metabolism
- Neisseria gonorrhoeae/metabolism
- Peptide Fragments/metabolism
- Polysorbates/pharmacology
- Protein Binding/drug effects
- Receptors, Complement/blood
- Receptors, Complement/isolation & purification
- Receptors, Complement/metabolism
- Receptors, Complement/physiology
- Serum Albumin, Bovine/pharmacology
- Sodium Chloride/pharmacology
- Sodium Hydroxide/pharmacology
- Tromethamine
- Tumor Cells, Cultured
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Affiliation(s)
- A M Blom
- Department of Clinical Chemistry, The Wallenberg Laboratory, Floor 6, Lund University, University Hospital Malmö, S-205 02 Malmö, Sweden.
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35
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Pleass RJ, Areschoug T, Lindahl G, Woof JM. Streptococcal IgA-binding proteins bind in the Calpha 2-Calpha 3 interdomain region and inhibit binding of IgA to human CD89. J Biol Chem 2001; 276:8197-204. [PMID: 11096107 DOI: 10.1074/jbc.m009396200] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Certain pathogenic bacteria express surface proteins that bind to the Fc part of human IgA or IgG. These bacterial proteins are important as immunochemical tools and model systems, but their biological function is still unclear. Here, we describe studies of three streptococcal proteins that bind IgA: the Sir22 and Arp4 proteins of Streptococcus pyogenes and the unrelated beta protein of group B streptococcus. Analysis of IgA domain swap and point mutants indicated that two loops at the Calpha2/Calpha3 domain interface are critical for binding of the streptococcal proteins. This region is also used in binding the human IgA receptor CD89, an important mediator of IgA effector function. In agreement with this finding, the three IgA-binding proteins and a 50-residue IgA-binding peptide derived from Sir22 blocked the ability of IgA to bind CD89. Further, the Arp4 protein inhibited the ability of IgA to trigger a neutrophil respiratory burst via CD89. Thus, we have identified residues on IgA-Fc that play a key role in binding of different streptococcal IgA-binding proteins, and we have identified a mechanism by which a bacterial IgA-binding protein may interfere with IgA effector function.
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Affiliation(s)
- R J Pleass
- Department of Molecular and Cellular Pathology, University of Dundee Medical School, Ninewells Hospital, Dundee DD1 9SY, United Kingdom
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36
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Stâlhammar-Carlemalm M, Areschoug T, Larsson C, Lindahl G. Cross-protection between group A and group B streptococci due to cross-reacting surface proteins. J Infect Dis 2000; 182:142-9. [PMID: 10882591 DOI: 10.1086/315693] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/1999] [Revised: 03/20/2000] [Indexed: 11/03/2022] Open
Abstract
The R28 protein of group A streptococcus (GAS) and the Rib protein of group B streptococcus (GBS) are surface molecules that elicit protective immunity to experimental infection. These proteins are members of the same family and cross-react immunologically. In spite of extensive amino acid residue identity, the cross-reactivity between R28 and Rib was found to be limited, as shown by analysis with highly purified proteins and specific antisera. Nevertheless, immunization of mice with purified R28 conferred protection against lethal infection with Rib-expressing GBS strains, and immunization with Rib conferred protection against R28-expressing GAS. Thus, R28 and Rib elicited cross-protective immunity. Characterization of many clinical GAS and GBS isolates expressing R28 or Rib, respectively, indicated that most of them expressed proteins similar to those of the reference strains. Analysis of these data suggests that cross-protection may influence the outcome of natural infections with R28-expressing GAS and Rib-expressing GBS.
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37
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Blom AM, Berggârd K, Webb JH, Lindahl G, Villoutreix BO, Dahlbäck B. Human C4b-binding protein has overlapping, but not identical, binding sites for C4b and streptococcal M proteins. J Immunol 2000; 164:5328-36. [PMID: 10799895 DOI: 10.4049/jimmunol.164.10.5328] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many strains of Streptococcus pyogenes bind C4b-binding protein (C4BP), an inhibitor of complement activation. The binding is mediated by surface M proteins in a fashion that has been suggested to mimic the binding of C4b. We have previously shown that a positively charged cluster at the interface between complement control protein domains 1 and 2 of C4BP alpha-chain is crucial for the C4b-C4BP interaction. To extend this observation, and to investigate the interaction with M proteins, we constructed and characterized a total of nine mutants of C4BP. We identified a key recognition surface for M proteins that overlaps with the C4b binding site because substitution of R64 and H67 by Gln dramatically reduces binding to both ligands. However, the analysis of all mutants indicates that the binding sites for C4b and M proteins are only overlapping, but not identical. Furthermore, M proteins were able to displace C4BP from immobilized C4b, whereas C4b only weakly affected binding of C4BP to immobilized M proteins. We found that the molecular mechanisms involved in these two interactions differ because the binding between M proteins and C4BP is relatively insensitive to salt in contrast to the C4BP-C4b binding. In addition, six mAbs directed against the alpha-chain interfered with C4b-C4BP interaction, whereas only two of them efficiently inhibited binding of C4BP to M proteins. Collectively, our results suggest that binding between C4b and C4BP is governed mostly by electrostatic interactions, while additional noncovalent forces cause tight binding of C4BP to streptococcal M proteins.
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Affiliation(s)
- A M Blom
- Department of Clinical Chemistry, Lund University, University Hospital Malmö, Malmö, Sweden
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38
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Abstract
The C3 convertases of the human complement system are controlled by fluid-phase and membrane proteins in the RCA (regulators of complement activation) family. Accumulated data show that many pathogenic microorganisms interact with these complement regulators. Recent advances in this field include determination of the crystal structure of the binding domains in the measles virus receptor CD46 and identification of a CD46 transgenic mouse line that is sensitive to measles virus. Moreover, recent findings support the hypothesis that pathogenic bacteria binding fluid-phase RCA proteins exploit these proteins to escape complement attack. These studies provide novel insight into the interplay between pathogens and the innate immune system and may have implications for the plans to use animals expressing an RCA protein for xenotransplantation.
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Affiliation(s)
- G Lindahl
- Department of Laboratory Medicine, Lund University, Lund, 223 62, Sweden.
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39
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Abstract
Group A streptococcal M proteins are type-specific virulence factors that inhibit phagocytosis. We used two M proteins, M5 and Emm22, to analyze the influence of genetic background on the properties of M proteins. Mutant strains, engineered to lack these M proteins, were complemented with genes encoding the homologous or heterologous M protein, and the complemented strains were analyzed for phagocytosis resistance. Neither the M5 nor the Emm22 protein conferred phagocytosis resistance in the heterologous background, but they did do so in the homologous background. This was not due to lack of surface expression in the heterologous background. Moreover, the M5 and Emm22 proteins expressed in heterologous background appeared to have normal structure, since they were not affected in their ability to bind different human plasma proteins. In particular, M5 or Emm22 had normal ability to bind human complement inhibitors, a property that has been implicated in phagocytosis resistance. Results similar to those obtained with M5 and Emm22 were obtained in experiments with the M6 and Emm4 proteins. Together, these data suggest that the surface expression of M protein alone may not be sufficient to confer phagocytosis resistance and consequently that strain-specific factors other than M and Emm proteins may contribute to the ability of group A streptococci to resist phagocytosis.
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Affiliation(s)
- H Kotarsky
- Institute for Laboratory Medicine, Lund University, Lund, Sweden
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40
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Areschoug T, Stålhammar-Carlemalm M, Larsson C, Lindahl G. Group B streptococcal surface proteins as targets for protective antibodies: identification of two novel proteins in strains of serotype V. Infect Immun 1999; 67:6350-7. [PMID: 10569749 PMCID: PMC97041 DOI: 10.1128/iai.67.12.6350-6357.1999] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Strains of group B streptococcus (GBS) express surface proteins that confer protective immunity. In particular, most strains of the four classical capsular serotypes (Ia, Ib, II, and III) express either of the Rib and alpha proteins, two members of the same protein family. Here, we report a study of surface proteins expressed by strains of serotype V, which has recently emerged as an important serotype among GBS strains causing serious disease. Two novel GBS proteins were identified, purified, and characterized. One of these proteins, designated Fbs, was immunologically unrelated to other GBS surface proteins. This approximately 110-kDa protein was found in 15 of 49 (31%) type V isolates but in few strains of other serotypes. The Fbs proteins expressed by different strains showed limited variation in size. The most common surface protein among type V strains, found in 29 of 49 (59%) isolates, was designated Rib-like, since it cross-reacted with Rib but was not immunologically identical to Rib. Characterization of this Rib-like protein showed that the N-terminal sequence (12 residues) was identical to that of alpha, although these two proteins lacked cross-reactivity. The biochemical and immunological properties of the Rib-like GBS protein indicate that it is closely related to the R28 protein of Streptococcus pyogenes. Importantly, passive and active immunization experiments with mice showed that the Fbs and Rib-like proteins are targets for protective antibodies. These two proteins are therefore of interest for analysis of pathogenic mechanisms and for vaccine development.
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Affiliation(s)
- T Areschoug
- Department of Laboratory Medicine, Lund University, S-22362 Lund, Sweden
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41
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Burova LA, Nagornev VA, Pigarevskii PV, Gladilina MM, Molchanova IV, Seliverstova VG, Tern A, Lindahl G, Totolyan AA. Streptococcal IgG Fc-binding proteins are factors initiating experimental glomerulonephritis. Bull Exp Biol Med 1999. [DOI: 10.1007/bf02433421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Burova LA, Nagornev VA, Pigarevskiĭ PV, Gladilina MM, Molchanova IV, Selivestrova VG, Tern A, Lindahl G, Totolian AA. [Streptococcal IgG Fc-binding proteins--initiation factors of experimental glomerulonephritis]. Biull Eksp Biol Med 1999; 128:548-52. [PMID: 10640245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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43
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Lindahl G, Perman E. [Influenza vaccine caused problems in joints. Compensation from the drug insurance authority]. Lakartidningen 1999; 96:3912-4. [PMID: 10522100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- G Lindahl
- Reumatologiska kliniken, Karolinska sjukhuset/Danderyds sjukhus
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44
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Affiliation(s)
- J R Johansen
- Department of Paediatrics, The National Centre for Epilepsy, Sandvika, N-1307, Norway
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45
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Stålhammar-Carlemalm M, Areschoug T, Larsson C, Lindahl G. The R28 protein of Streptococcus pyogenes is related to several group B streptococcal surface proteins, confers protective immunity and promotes binding to human epithelial cells. Mol Microbiol 1999; 33:208-19. [PMID: 10411737 DOI: 10.1046/j.1365-2958.1999.01470.x] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The R28 protein is a surface molecule expressed by some strains of Streptococcus pyogenes (group A streptococcus). Here, we present evidence that R28 may play an important role in virulence. Sequence analysis demonstrated that R28 has an extremely repetitive sequence and can be viewed as a chimera derived from the three surface proteins Rib, alpha and beta of the group B streptococcus (GBS). Thus, the gene encoding R28 may have originated in GBS. The R28 protein promotes adhesion to human epithelial cells, as shown by experiments with an R28-negative mutant and by the demonstration that antibodies to highly purified R28 inhibited adhesion. In a mouse model of lethal intraperitoneal S. pyogenes infection, antibodies to R28 conferred protective immunity. However, the virulence of an R28-negative mutant was similar to that of the parental strain in the intraperitoneal infection model. Together, these data indicate that R28 represents a novel type of adhesin expressed by S. pyogenes and that R28 may also act as a target for protective antibodies at later stages of an infection. We consider the hypothesis that R28 played a pathogenetic role in the well-known epidemics of childbed fever (puerperal fever), which were caused by S. pyogenes. A role for R28 in these epidemics is suggested by epidemiological data.
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46
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Abstract
Surface proteins that bind to the Fc part of human IgA are expressed by many strains of Streptococcus pyogenes, a major human pathogen. Studies of these proteins have been complicated by their size and by their ability to bind human plasma proteins other than IgA. Here, we describe a synthetic 50-residue peptide, derived from streptococcal protein Sir22, that binds human IgA but not any of the other plasma proteins known to bind to Sir22. The peptide binds serum IgA and secretory IgA and binds IgA of both subclasses. Evidence is presented that the peptide folds correctly both in solution and when it is immobilized and that it readily renatures after denaturation. Together, these data indicate that the peptide corresponds to a protein domain that binds IgA with high specificity. This is the first report of an IgA-binding domain that retains its properties in isolated form.
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Affiliation(s)
- E Johnsson
- Department of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
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47
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Affiliation(s)
- J E Bishop
- Centre for Cardiopulmonary Biochemistry and Respiratory Medicine, University College London Medical School, Rayne Institute, UK.
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48
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Larsson C, Stålhammar-Carlemalm M, Lindahl G. Protection against experimental infection with group B streptococcus by immunization with a bivalent protein vaccine. Vaccine 1999; 17:454-8. [PMID: 10073723 DOI: 10.1016/s0264-410x(98)00218-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Group B streptococcus (GBS), a bacterium with polysaccharide capsule, is the major cause of sepsis and meningitis in early infancy. Recent work has indicated that immunity to GBS infection can be elicited by the surface proteins Rib and alpha, either of which is expressed by most GBS strains causing invasive infections. Here we show that a bivalent vaccine, composed of purified Rib and alpha mixed with aluminum hydroxide (alum), an adjuvant accepted for human use, elicits an antibody response to each of the two antigens. Moreover, the bivalent vaccine was found to protect against experimental infection with GBS strains representing the four classical serotypes. Our results represent an encouraging step towards the development of a human GBS vaccine based on pure protein antigens.
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Affiliation(s)
- C Larsson
- Department of Medical Microbiology, Lund University, Sweden
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49
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Shankar V, Baghdayan AS, Huycke MM, Lindahl G, Gilmore MS. Infection-derived Enterococcus faecalis strains are enriched in esp, a gene encoding a novel surface protein. Infect Immun 1999; 67:193-200. [PMID: 9864215 PMCID: PMC96296 DOI: 10.1128/iai.67.1.193-200.1999] [Citation(s) in RCA: 322] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/1998] [Accepted: 10/08/1998] [Indexed: 01/06/2023] Open
Abstract
We report the identification of a new cell wall-associated protein of Enterococcus faecalis. Studies on the distribution of the gene encoding this novel surface protein, Esp, reveal a significant (P < 0.001) enrichment in infection-derived E. faecalis isolates. Interestingly, the esp gene was not identified in any of 34 clinical E. faecium isolates or in 4 other less pathogenic enterococcal species tested. Analysis of the structural gene among various E. faecalis isolates reveals the existence of alternate forms of expression of the Esp protein. The deduced primary structure of the Esp protein from strain MMH594, inferred to be 1,873 amino acids (aa) with a predicted mass of approximately 202 kDa, reveals a core region consisting of repeat units that make up 50% of the protein. Esp bears global organizational similarity to the Rib and C alpha proteins of group B streptococci. Identity among Esp, Rib, and C alpha proteins is strikingly localized to a stretch of 13 aa within repeats of similar length. The high degree of conservation of this 13-residue sequence suggests that it plays an important role in the natural selection for this trait among infection-derived E. faecalis and group B streptococcal isolates.
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Affiliation(s)
- V Shankar
- Department of Medicinal Chemistry and Pharmaceutics, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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50
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Johnsson E, Berggård K, Kotarsky H, Hellwage J, Zipfel PF, Sjöbring U, Lindahl G. Role of the hypervariable region in streptococcal M proteins: binding of a human complement inhibitor. J Immunol 1998; 161:4894-901. [PMID: 9794423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Antigenic variation allows pathogenic microorganisms to evade the immune system of the infected host. The variable structure must play an important role in pathogenesis, but its function is in most cases unknown. Here, we identify a function for the surface-exposed hypervariable region of streptococcal M5 protein, a virulence factor that inhibits phagocytosis. The hypervariable region of M5 was found to bind the human complement inhibitor FHL-1 (factor H-like protein 1), a 42-kDa plasma protein. Plasma absorption experiments with M5-expressing bacteria showed that the interaction with FHL-1 occurs also under physiologic conditions. Studies of another extensively characterized M protein, M6, indicated that this protein also has a binding site for FHL-1 in the hypervariable region. The complement-inhibitory function of FHL-1 was retained after binding to streptococci, suggesting that bound FHL-1 protects bacteria against complement attack. All available data now indicate that FHL-1, or another human complement inhibitor, binds to the hypervariable region of M proteins. These findings provide insights into the forces that drive antigenic variation and may explain why the hypervariable region of M protein is essential for phagocytosis resistance. Moreover, these data add to a growing body of evidence that human complement inhibitors are major targets for pathogenic microorganisms.
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Affiliation(s)
- E Johnsson
- Department of Medical Microbiology, Lund University, Sweden
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