För att möta dagens och morgondagens samhällsutmaningar krävs kunskap ur ett bredare och större perspektiv. På Linnéuniversitetet samlar vi därför framstående forskning, utbildning och samverkan i något vi kallar kunskapsmiljöer. Våra kunskapsmiljöer är tvärvetenskapliga för att ta ett mångsidigt grepp om utmaningarna.

Inom kunskapsmiljön Hållbar hälsa arbetar vi för att främja hälsa och välbefinnande för alla människor i alla åldrar. Några av de utmaningar som vi tar oss an är:

·        Demografiska förändringar

·        Ändrade mönster för funktionshinder och sjukdomar

·        Traumatiska händelser 

·        Brist på delaktighet 

·        Organisatoriska utmaningar

Men med en åldrande befolkning och fler personer som lever länge med kroniska sjukdomar både ökar och förändras vårdbehoven samtidigt. Dessa faktorer, tillsammans med ökad migration, globalisering samt förändrade behov av hälsovård, är de demografiska utmaningar vi behöver inrikta oss mot. De förändringar i livsstilar som vi ser idag, till exempel näringsbrist på grund av mindre hälsosamma matvanor och en ökande psykisk ohälsa måste också adresseras. 

Den digitala utvecklingen ger oss helt nya möjligheter till en mer effektiv global hälsovård. Men även här finns utmaningar; ökad digitalisering kan leda till att människor stängs ute på grund av att de saknar kompetens eller den digitala utrustningen som krävs.

För att svara upp mot dessa utmaningar arbetar vi inom kunskapsmiljön brett med forskning, utbildning och samverkan inom en rad olika forskningsområden såsom:

·        e-Hälsa 

·        Palliativ vård 

·        Livsmedelsvetenskap

·        Ögon, syn och optometri

·        Humaniora, hälsa och medicin

·        Åldrande och handikapp

Vanligtvis kommunicerar vi i kunskapsmiljön vår forskning genom artiklar i vetenskapliga tidskrifter, på konferenser eller genom pressmeddelande till media. Denna bok tar ett annorlunda grepp och använder konstens metoder för att illustrera kunskapsmiljöns arbete. Boken har kommit till genom ett samarbete med Det kulturella universitetet som arbetar med att koppla samman konst och vetenskap för en fördjupad förståelse av komplex komplexa och ibland motsägelsefulla förhållanden

Clinical relevance: Investigation of refractive errors amongst Swedish schoolchildren will help identify risk factors associated with myopia development.Background: Genetic and hereditary aspects have been linked with the development of myopia. Nevertheless, in the case of ‘school myopia’ some authors suggest that environmental factors may affect gene expression, causing school myopia to soar. Additional understanding about which environmental factors play a relevant role can be gained by studying refractive errors in countries like Sweden, where prevalence of myopia is expected to be low.Methods: Swedish schoolchildren aged 8-16 years were invited to participate. Participants underwent an eye examination, including cycloplegic refraction and axial length (AL) measurements. Predictors such as time spent in near work, outdoor activities and parental myopia were obtained using a questionnaire. Myopia was defined as spherical equivalent refraction (SER) ≤ −0.50D and hyperopia as SER ≥ +0.75D.Results: A total of 128 children (70 females and 58 males) participated in this study with mean age of 12.0 years (SD = 2.4). Based on cycloplegic SER of the right eye, the distribution of refractive errors was: hyperopia 48.0% (CI95 = 38.8-56.7), emmetropia 42.0% (CI95 = 33.5-51.2) and myopia 10.0%. (CI95 = 4.4-14.9). The mean AL was 23.1 mm (SD = 0.86), there was a correlation between SER and AL, r = −0.65 (p < 0.001). Participants with two myopic parents had higher myopia and increased axial length than those with one or no myopic parents. The mean time spent in near work, outside of school, was 5.3 hours-per-day (SD = 3.1), and mean outdoor time reported was 2.6 hours-per-day (SD = 2.2) for all the participants. The time spent in near work and outdoor time were different for different refractive error categories.Conclusion: The prevalence of myopia amongst Swedish schoolchildren is low. Hereditary and environmental factors are associated with refractive error categories. Further studies with this sample are warranted to investigate how refractive errors and environmental factors interact over time.

Poster display 2: TRENDS IN SWEDISH CONTACT LENS PRESCRIBING 2017

Presenter: Oskar Johansson

Authors: OSKAR JOHANSSON¹ , PHILP MORGAN² , PETER GIEROW¹

Affiliation:1) Linnaeus University 2) University of Manchester

Key words: Contact lens, fitting, lens type

Purpose: The purpose was to evaluate the trends of contact lens prescribing among Swedish optometrists in 2017.

Methods: A standardized survey form developed by Morgan er al. was distributed to Swedish optometrists usingtheir professional organizations, optometry chains, direct email, and by hand directly. They were asked to fill out theform for the next ten contact lens patients after receiving the survey. Information was collected regarding the dayof fitting, age, sex, lens material, design, frequency of replacement, wear frequency, modality and type of caresystem. A weighting system is employed to account for the volume of activity undertaken by the respondents,calculated by the time period required to achieve 10 fits. All the forms and data were analyzed at the University of Manchester.

Results: 57 forms were returned, including 562 fits. The mean age of the patients was 37 yrs, and 65 % were female.83 % were fitted for full-time wear and 27 % were managed as new fits. Soft contact lenses is the most fitted modalityand represents 97.8 % of all new fits and 93.6 % of all refits. Rigid contact lens fits represents therefore in grand total5.3 % with 2.2 % of the new fits and 6.4 % of the refits. About two-thirds of soft lenses prescribed were siliconehydrogels. Of the different designs, spherical lenses were most widely fitted, with toric lenses on at least one eyecoming right after. Extended wear accounts for 10.6 % of the fittings. Multi-purpose solutions were the most popularregimen prescribed at 99.4 %.

Conclusions: When compared with data from Norway and Denmark, it is evident that daily disposables are morepopular in these countries (74 %), whereas in Sweden it is monthly replacements (58 %). Otherwise, the results aresimilar to what has been reported from other parts of the world.

Background: The purpose was to evaluate the trends of contact lens prescribing among Swedish optometrists in 2017.

Materials and Methods: A standardized survey form was distributed to Swedish optometrists using their professional organisations, optometry chains, direct email, and by hand directly. They were asked to fill out the form for the ten contact lens fits performed after receipt of the survey form. Information was collected regarding age and sex of patient, fit/refit, lens design and material, modality and solution prescribed.

Results: 57 forms were returned detailing 562 fits. The mean age of the patients was 37 yrs, and 65 % were female. 83 % were fitted for full-time wear and 27 % were managed as new fits. 94.7 % were soft contact lens fits and silicone hydrogel was the dominating material.

Conclusions: When compared with data from Norway and Denmark, it is evident that daily disposables are more popular in these countries (74 %), whereas in Sweden it is monthly replacements (58 %). Otherwise, the results are similar to what has been reported from other parts of the world.

Purpose: An accurate estimation of the anterior chamber depth (ACD) and anterior chamber angle (ACA) is essential when assessing angle-closure glaucoma. An underestimation of ACD or ACA may result in unnecessary clinical procedures being performed, burdening the healthcare system. An overestimation on the other hand, will lead to the misdiagnosis of individuals at risk of angle-closure glaucoma, and as such treatment which could prevent irreversible blindness may not be provided. The aim of this study was to evaluate the relationship between Smith’s Method and Sirius when measuring the ACD, as well as between the van Herick method and Sirius for measuring the ACA.

Methods: The study included 56 healthy subjects, 14 males and 42 females, aged from 8 to 60 years. Three consecutive measurements on the right eye of each subject were measured using Smith’s method, van Herick’s method and Sirius; in that specific order to avoid bias. Smith’s method measured the ACD in millimeters; van Herick’s method measured the ACA according to Shaffer’s grading-system. Sirius measured the ACD in millimeters and the ACA in degrees.

Results: All three methods showed good intra-observer repeatability (Sirius ICC = 0.997, van Herick ICC = 0.902, Smith ICC = 0.849). Sirius overestimated the ACD by 0.31 ± 0.20 mm compared to Smith’s method. To compensate for this difference, a constant of 1.11 was calculated by linear regression. Sirius and Smith correlates well (r = 0.73, p < 0.001) but Sirius and van Herick’s method correlates less (r = 0.31, p = 0.019). After converting the Sirius angles (in degrees) to Shaffer’s grading-system, Sirius overestimates the anterior chamber angle grade by 0.79 ± 0.87 compared to van Herick.

Conclusions: There is a good correlation between Smith’s method and Sirius when measuring ACD so long as the values are initially corrected by adding approximately 10 % to the value obtained by Smith’s method. On the other hand there were significant differences between Sirius and van Herick’s method when measuring the ACA; this indicates that these two should not be used interchangeably when evaluating ACA.

Purpose. The tear film lipid layer holds an important role in maintaining the integrity and health of the anterior surface of the eye. The meibomian glands found in eyelids are responsible for producing most of the lipids of the tear film. Dysfunction of the meibomian glands leads to increased evaporation of tears, which may lead to dry eye. Meibography is a method used for assessing the drop out of meibomian glands. The aim of this study was to evaluate the reliability between two different examiners when rating meibography images. Methods. The Sirius 3D scheimpflug camera (C.S.O., Florence, Italy) was used to photograph the everted upper and lower eyelids of the right and left eye of 52 subjects. The grade of meibomian gland loss was subjectively graded using the five-grade Meiboscale (Pult, 2012) and the percentage of gland loss was calculated using Phoenix Meibography software (version 3.0.1.021, bon Optic VertriebsGmbH, Lübeck, Germany). Data was analyzed using MedCalc for Windows (version 16.4.3, MedCalc Software, Ostend, Belgium). Results. The inter-rater reliability for the Meiboscale grade of meibomian gland loss was calculated using weighted Cohen’s kappa (linear weights). The result for all 208 images was Kw = 0.542 (95 % CI 0.454 to 0.630), which indicates a moderate agreement. The inter-rater reliability for the percentage of meibomian gland loss was calculated using intraclass correlation coefficient. The result for all 208 images was ICC = 0.794 (95 % CI 0.737 to 0.839), which indicates a substantial agreement. Conclusions. Imaging is an invaluable tool when managing patients in clinical practice. When performing meibography to evaluate meibomian gland loss, using software to calculate the percentage of gland loss gives a better inter-rater agreement than subjective grading of the images.

The lacrimal gland (LG) is an exocrine gland important for secretion of the tear film. The kinase p38 has important signal transduction functions, e.g. in gene transcription, but has previously not been known to modulate exocrine secretion. The aim of the current study was to investigate the role of p38 in carbachol (Cch)-induced LG secretion in LG acinar cells in vitro. Western blotting was used to determine the phosphorylation status of p38 and p42/44 and determine expression of p38 isoforms. To determine the effect of p38 inhibition on LG secretion, PD 169316, a general p38 inhibitor, and SB 239063, an inhibitor of p38α and β, were added to the cells prior to secretion measurements. The results revealed activation of p38 mediated by Cch stimulation and inhibition of Cch-induced secretion as a result of p38 inhibition. The inhibition was observed with PD 169316 isoforms, but not with SB 239063. The p38δ isoform was shown to have robust expression both by Western blotting of acinar cells and immunofluorescence of the whole gland. In conclusion, p38 activation mediates secretion in cholinergic stimulation of rabbit LG cells.

PURPOSE: Secretion from the lacrimal gland is an important part of the well-being of the eye, and a central part in the search for treatment of dry eye syndrome. Adenosine has stimulatory effects on the lacrimal gland, and can potentiate the effect of the cholinergic agonist carbachol (Cch). The aim of the present study is to investigate the presence of the adenosine A(2) receptor subtypes A(2A) and A(2B) in the rabbit lacrimal gland, and to characterize their role in regulated acinar cell secretion.

METHODS: Expression of the receptors was investigated using reverse transcriptase-PCR (RT-PCR) and immunofluorescence, and secretion effects were studied using a secretion assay in isolated lacrimal gland acinar cells.

RESULTS: Presence of both receptors was detected by RT-PCR and immunofluorescence. The secretion assay revealed a minor effect of stimulation of the A(2) receptors, and a strong synergistic effect with the cholinergic agonist Cch. The synergistic effect was significantly reduced by the A(2B) antagonist PSB 1115, but not by the A(2A) antagonist SCH 58261, indicating that A(2B) is the receptor responsible for this potentiation.

CONCLUSIONS: The study reveals the presence of the adenosine A(2) receptor subtypes as well as a role for them in lacrimal gland secretion, and especially in the synergy with purinergic and cholinergic stimulation.