KI News

The Parliamentary Ombudsman (JO) has dropped the inquiry that it launched last spring following the report filed by Paolo Macchiarini against Karolinska Institutet. In November 2016, Paolo Macchiarini reported KI to the Parliamentary Ombudsman, accusing the university of having made serious mistakes in its investigation into allegations of scientific misconduct concerning articles published in scientific journals, including Nature Communications and The Lancet. According to Macchiarini, this caused considerable damage to his and his co-authors’ professional reputation. The Parliamentary Ombudsman has now announced that he is closing the investigation after having obtained documents from KI and spoken to one of the university’s lawyers. “The facts as presented give me no reason to continue the investigation,” he writes.

The effects of corticosteroid treatments on pregnant women facing preterm delivery to prevent infant death and morbidity have been thought to develop gradually over days. However, a new study by researchers at Karolinska Institutet and colleagues in the European EPICE project – published in JAMA Pediatrics – suggests that survival and health gains for very preterm infants may occur within hours. Hundreds of thousands of pregnant women in Europe deliver preterm every year. Even if survival nowadays is the most probable outcome, preterm birth is still one of the major causes of death in children under the age of 5. To prepare the foetus for breathing air and increase chances of survival after birth, corticosteroid treatment is given to pregnant women at risk of preterm delivery. So far, the protective effect of corticosteroids before birth has been thought to develop gradually over days. A large European study provides new knowledge, however, indicating an immediate effect. Significant effect after 3 hours “Our study finds that antenatal (before birth) corticosteroids given to pregnant women only hours before delivery were associated with a survival advantage for their infants”, says Mikael Norman, lead author, neonatologist and professor at Karolinska Institutet’s Department of Clinical Science, Intervention and Technology in Stockholm, Sweden. Mikael Norman and colleagues on the EPICE (Effective Perinatal Intensive Care in Europe) research project have studied outcomes in over 4,500 very preterm infants, born at 24 to 31 weeks of gestation (excluding multiple pregnancies and severe congenital malformations) in 11 countries across Europe. In this cohort, 15 per cent of the pregnant women were not exposed to antenatal corticosteroids. 21 per cent of the unexposed infants died after birth. Infants born already 3 hours after corticosteroid administration to the mother had significantly lower mortality than those not exposed to the treatment, and corticosteroid administration 6 to 12 hours before birth was associated with halved risks of infant death. “Given the current concept of a slow effect, pregnant women at immediate risk of preterm delivery may not receive corticosteroid treatment because it is considered futile”, says Dr Norman. “Also our results can provide reassurance for clinicians or parents in situations where it is not possible to wait a day or two to reach the full effect of corticosteroid treatment because of the need for action to reduce or stop ongoing morbidity in the pregnant woman and her foetus”, he continues. Substantial survival and health gains In the study, antenatal corticosteroid treatment was also associated with a lower risk of severe neonatal morbidity such as bleedings in the brain. This reduction in the risk was associated with longer administration-to-birth intervals. “Our findings challenge current beliefs that very short exposures to antenatal steroids before delivery have no effect, and suggest that encouraging the administration of antenatal corticosteroids to pregnant women when delivery is very imminent could result in substantial survival and health gains for very preterm infants” says Jennifer Zeitlin, principal investigator of the EPICE study and researcher at Inserm (French National Institute of Health and Medical Research), Paris, France. The research received funding from the European Union's Seventh Framework Program, the French Institute of Public Health Research/Institute of Public Health and its partners, the National Research Agency through the French Equipex Program of Investments in the Future, the PremUp Foundation in France, the Polish Ministry of Science and Higher Education, regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet, and Karolinska University Hospital in Sweden. Publication 'Association of short antenatal corticosteroid administration-to-birth intervals with survival and morbidity in very preterm infants – results from the EPICE cohort' Mikael Norman, Aurelie Piedvache, Klaus Børch, Lene Drasbek Huusom, Anna-Karin Edstedt Bonamy, Elizabeth A. Howell, Pierre-Henri Jarreau, Rolf F. Maier, Ole Pryds, Liis Toome, Heili Varendi, Tom Weber, Emilija Wilson, Arno VanHeijst, Marina Cuttini, Jan Mazela, Henrique Barros, Patrick Van Reempts, Elizabeth Draper, Jennifer Zeitlin on behalf of the EPICE Research Group JAMA Pediatrics, online 15 May 2017, doi:10.1001/jamapediatrics.2017.0602

With a nod to Norway, this year’s spring conferment ceremony took place in Stockholm City Hall on 12 May to the tune of “En liten Fuggel” sung by Adolf Fredrik’s boys’ choir. The doctors and honorary doctors then donned their hats to the canon salute from the City Hall waterfront. Karolinska Institutet’s vice-chancellor-elect Ole Petter Ottersen comes from Oslo University, and even though he did not attend the ceremony was welcomed in his absence by the choir and in the speeches. Acting Vice-Chancellor Karin Dahlman-Wright, who spoke for the last time in this capacity during a conferment ceremony, advised the new vice-chancellor that the student ushers, who make the ceremony run so smoothly, are a key to success. The ushers also guided each of the 150 new doctors, leading them to the marble stairway in the Blue Hall where the conferrer, Dean of Doctoral Education Marianne Schultzberg, had the privilege of presenting them with their hats and diplomas in celebration of their achievements in having successfully defended their theses. Tribute was also paid during the evening to the two new honorary doctors of medicine at Karolinska Institutet: Professor Francis L. Demonico, a champion of ethical organ donation and opponent of human donor trafficking; and doctor and researcher Margaret A. Liu, who was involved in fundamental discoveries in gene activity and the immune system that are important to the development of vaccines and immunotherapy. Their honorary doctorates were conferred by Dean of Research Anders Gustafsson. Soprano Saara Rauvala, mezzo Karin Osbeck, tenor Willian Davis Lind and baritone Caspar Engdahl accompanied by Majsan Dahling at the piano provided the entertainment during the ceremony and ensuing banquet in the Golden Hall. The ceremony concluded with a parade, with the assembled doctors and standard bearers exiting the hall to the tune of the Star Wars theme. Text: Madeleine Svärd Huss Translation: Neil Betteridge Photo: Ulf Sirborn and Stefan Zimmerman

While it is well known that smoking while pregnant can damage the fetus, the effects of using Swedish snus (oral moist snuff) have been more mooted. Now, a new thesis from Karolinska Institutet in Sweden shows that using snus while pregnant carries the same level of risk as smoking as regards to stillbirth, preterm birth, cleft lip and palate, and neonatal apnea. However, it pays off to quit using snus early in the pregnancy, before the first visit at the antenatal care, as doing so gives no observable increase in risk. Anna Gunnerbeck at Karolinska Institutet’s Department of Women’s and Children’s Health has recently defended her thesis on how the nicotine consumption of pregnant women affects their unborn babies. Cigarettes contain some 4,000 substances, while Swedish snus contains almost only nicotine. Basing research on women who use snus provides unique information about what kind of damage nicotine does to the fetus. Her doctoral thesis is based on data from the National Board of Health and Welfare’s Medical Birth Register, which provides information on the health of mother and baby for effectively all pregnancies in Sweden from the point of entry into antenatal care to a month after birth.  Not a healthier alternative Snus gives even higher doses of nicotine than cigarettes and can be taken more frequently. By charting the tobacco habits of pregnant women and the state of health of their babies, Anna Gunnerbeck’s research group found that using snus carried an equally high risk of stillbirth, preterm birth, cleft lip and palate and neonatal apnea. “Snus is often promoted as a healthier alternative to smoking, and it may be for adult users,” says Dr Gunnerbeck. “But the nicotine in the snus can damage fetuses. Young women who start using snus are unaware of the risk they subject their unborn babies to when they use snus while pregnant.” Important to reach out to young women Anna Gunnerbeck's research also shows that the health risk to the fetus is significantly reduced if the mother stops using snus very early in her pregnancy. “If you stop using snus as soon as you find out you’re pregnant, the risk of fetal damage doesn’t increase,” continues Dr Gunnerbeck. “So it’s important that we reach out with this health message to young people. Ideally before they start using tobacco, since the nicotine in snus, like that in cigarettes, is highly addictive and very hard to give up.” Sweden is uniquely placed to study the effects of nicotine in pregnancy given that snus has been in widespread use here for such a long time. The results are, however, of global interest since e-cigarettes and nicotine patches are often marketed as healthy alternatives to smoking, and the use of the former is increasing in many countries.   The research was financed by Karolinska Institutet and Stockholm County Council. Anna Gunnerbeck defended her thesis "Prenatal nicotine exposure and effects on the health of the newborn" on 21 April 2017.

Resistance to malaria drugs means that pregnant women are unable to overcome the anaemia caused by the malaria parasite – and their babies are born undersized. A study carried out at Karolinska Institutet, however, exposes the effects of malaria in pregnant women and shows how the PTEF protein is central to the infection. The study, which is published in the scientific journal Nature Microbiology, opens the way for new malaria drugs. Some 50 million pregnant women contract malaria every year. The most common and most dangerous parasite, “Plasmodium falciparum”, affects both female carriers of the malaria parasite and their unborn babies. The parasite retards fetal growth by consuming vital nutrients and the babies are born undersized. The women are also affected by anaemia when the parasite infects the placenta. When the parasite sends a 'glue protein' to the infected red blood membrane, tens, even hundreds of thousands of parasites can accumulate in the placental vessel wall and cause inflammation. First-time mothers, who have not built up immunity to the glue molecule, develop serious, chronic infections unless given prophylactic treatment. Due to growing resistance to modern malaria drugs, the treatments are not always that efficacious. An alternative to antibiotics The team behind the study found a certain protein in the parasite, PTEF, that is vital to the synthesis of the glue molecule to which the parasites attach themselves. The researchers show how PTEF binds direct to the cell’s protein-manufacturing ribosome, where it speeds up the production of new glue molecules. “However, we can now stop this happening, and will one day be able to develop drugs that prevent the accumulation of parasites in the placenta,” says Professor Mats Wahlgren at Karolinska Institutet’s Department of Microbiology, Tumor and Cell Biology who was involved in the study. “We think that it will be possible in the future to deliver small molecules rather than traditional antibiotics to prevent pregnant women and the babies they are carrying from contracting malaria.” The researchers also collaborated with Professor Suparna Sanyal at Uppsala University, who examined how the PTEF protein affected the ribosomes in E. coli bacteria models and found that it could stimulate protein synthesis in bacteria too. The study was financed by several bodies, including the Swedish Research Council, the Swedish Foundation for Strategic Research and the Torsten Söderberg Foundation. Publication 'Regulation of PfEMP1-VAR2CSA Translation by a Plasmodium Translation- Enhancing Factor' Sherwin Chan, Alejandra Frasch, Chandra Sekhar Mandava, Jun-Hong Ch’ng, Maria del Pilar Quintana, Mattias Vesterlund, Mehdi Ghorbal, Nicolas Joannin, Oscar Franzén, Jose-Juan Lopez-Rubio, Sonia Barbieri, Antonio Lanzavecchia, Suparna Sanyal and Mats Wahlgren Nature Microbiology, online 8 May 2017

  “Student representation is the most important tool we have for influencing our education, our current study situation and our future as colleagues,” says Pontus Dannberg, deputy chair of the Medical Students’ Association in Stockholm (MF). MF and the Student Union of Odontology organised a joint meeting on Thursday to inform students about what student influence means, how to become a student representative and what such a position can give in return. “Apart from the influence aspect, it’s also a good way to get experience of board work and how meetings are structured and a plus on your CV,” says Pontus Dannberg. There are currently some 100 student representatives on many of KI’s various bodies, including the University Board (konsistoriet), the boards of Research, Doctoral Education and Higher Education, the Working Environment Committee and the Education Committee. “Some representatives are on more than one body, which means that at the moment we’re raising the student perspective in over 200 contexts at KI,” he continues. “We hope that today’s meeting will encourage even more people to get on board.”

There is a clear correlation between the number of registered nurses working at an acute hospital, the amount of nursing care that is left undone and the number of patients who die, a new thesis from Karolinska Institutet in Sweden shows. Moreover, the higher death rate associated with low nurse staffing levels does not decline if the nurses are replaced by support workers. Research conducted since the 1980s has established an inverse correlation between nurse staffing levels and the rate of patient deaths at acute hospitals, but no studies have yet been done to show what it is attributable to or whether there is a causal relationship. In her thesis from Karolinska Institutet, Jane Ball has interrogated the relationship between nurse staffing levels, missed care and risk of patient death in over 300 acute hospitals in nine European countries, including Sweden and the UK. 10 per cent missed care linked to a 16 per cent higher risk of death Nurses were asked to answer a questionnaire on how much and what type of care they did not provide owing to lack of time during their latest work shift. These responses were then related to reports of nurse staffing during the same work shift. The results show a clear correlation between fewer nurses, more missed care and higher patient mortality. In patients who had undergone common, non-life threatening surgical procedures, 10 per cent missed care was linked to a 16 per cent higher risk of death within 30 days of surgery. “We found a significant association between mortality rates and the volume of missed care owing to lack of nursing time, which supports the inference of a causal connection between registered nurse staffing and patient mortality,” says Jane Ball, registered nurse, doctoral student at Karolinska Institutet’s Department of Learning, Informatics, Management and Ethics (LIME) and researcher at University of Southampton, England. In Sweden, 74 per cent of the surveyed nurses reported that they had left necessary care undone due to lack of time; in the UK the corresponding figure was 86 per cent. Ms Ball’s thesis also shows that low levels of registered nurse staffing cannot be compensated for by other healthcare staff – the volume of omitted necessary care remains unchanged. The problem deserves more attention “What surprised me most while working on my thesis is that staffing levels differ a great deal between different departments and hospitals,” says Ms Ball. “It also surprises me that even more attention isn’t given to low nurse staffing levels given that short-staffing jeopardises patient safety and put lives at risk.” Ms Ball will now go on to analyse the correlation further with the help of electronic data instead of questionnaires, and examine in more detail the role of patient surveillance on patient survival. Most of the data in the thesis derives from the EU 7th framework financed RN4CAST project. Vårdförbundet and Forte have also supported the research. On 5 May 2017 Jane Ball defends her thesis ”Nurse staffing levels, care left undone & patient mortality in acute hospitals” at Karolinska Institutet.

A new study in Science from Karolinska Institutet maps out how different DNA-binding proteins in human cells react to certain biochemical modifications of the DNA molecule. The scientists report that some ‘master’ regulatory proteins can activate regions of the genome that are normally inactive due to epigenetic changes. Their findings contribute to a better understanding of gene regulation, embryonic development and the processes leading to diseases such as cancer. The DNA molecule carries information in the form of a sequence of four nucleotide bases, adenine (A), cytosine (C), guanine (G) and thymine (T), which can be thought of as the letters of the genomic language. Short sequences of the letters form ‘DNA words’ that determine when and where proteins are made in the body. Almost all of the cells in the human body contain the letters in precisely the same order. Different genes are however active (expressed) in different cell types, allowing the cells to function in their specialised roles, for example as a brain cell or a muscle cell. The key to this gene regulation lies in specialised DNA-binding proteins – transcription factors – that bind to the sequences and activate or repress gene activity. Two variants of the same letter The DNA letter C exists in two forms, cytosine and methylcytosine, which can be thought of as the same letter with and without an accent (C and Ç). Methylation of DNA bases is a type of epigenetic modification, a biochemical change in the genome that does not alter the DNA sequence. The two variants of C have no effect on the kind of proteins that can be made, but they can have a major influence on when and where the proteins are produced. Previous research has shown that genomic regions where C is methylated are commonly inactive, and that many transcription factors are unable to bind to sequences that contain the methylated Ç. By analysing hundreds of different human transcription factors, researchers at Karolinska Institutet in Sweden have now found that certain transcription factors actually prefer the methylated Ç. These include transcription factors that are important in embryonic development, and for the development of prostate and colorectal cancers. “The results suggest that such ‘master’ regulatory factors could activate regions of the genome that are normally inactive, leading to the formation of organs during development, or the initiation of pathological changes in cells that lead to diseases such as cancer”, says Professor Jussi Taipale at Karolinska Institutet’s Department of Medical Biochemistry and Biophysics who led the research. Helps us interpret the genetic language The results pave the way for cracking the genetic code that controls the expression of genes, and will have broad implications for the understanding of development and disease. The availability of genomic information relevant to disease is expanding at an exponentially increasing rate. “This study identifies how the modification of the DNA structure affects the binding of transcription factors, and this increases our understanding of how genes are regulated in cells and further aids us in deciphering the grammar written into DNA”, says Professor Taipale. The study was supported by the Academy of Finland Center of Excellence in Cancer Genetics and the ERA SynBio project MirrorBio, Karolinska Institutet’s Center for Innovative Medicine, Knut and Alice Wallenberg Foundation, Göran Gustafsson Foundation, and the Swedish Research Council. Publication Yimeng Yin, Ekaterina Morgunova, Arttu Jolma, Eevi Kaasinen, Biswajyoti Sahu, Syed Khund-Sayeed, Pratyush K. Das, Teemu Kivioja, Kashyap Dave, Fan Zhong, Kazuhiro R. Nitta, Minna Taipale, Alexander Popov, Paul A. Ginno, Silvia Domcke, Jian Yan, Dirk Schübeler, Charles Vinson, and Jussi Taipale ‘Impact of cytosine methylation on DNA binding specificities of human transcription factors' Science, 5 May 2017

Laws and regulations concerning work environment and chemicals are largely adhered to as a major study of laboratory environments commissioned by Karolinska Institutet has revealed. There are, however, some shortcomings. Not all research group leaders take their responsibility for the work environment. Research groups at fourteen different departments at Karolinska Institutet and SciLifeLab underwent unannounced inspections by an external consultancy firm. The results from the inspections have now been complied in a report, “Inspections of Karolinska Institutet’s Laboratory Environments”. The primary focus was on activities where KI shares the workplace with other organisations and where research groups share premises. The report is part of the work being done to follow up the external investigation of the Macchiarini case and the internal audit of CLINTEC, the Department of Clinical Science, Intervention and Technology. Those who were present at the inspections were interviewed for three to four hours. The premises were inspected and among other things storage of chemicals and flammable products, signage, and security systems were checked. Local chemical registers, emergency procedures and documented risk assessments were studied. The inspections were made between November 2016 and February 2017 by consultancy firm Goodpoint. Knowledge is lacking According to the report, adherence to laws and regulations is relatively good at Karolinska Institutet. But there are some shortcomings. Knowledge is lacking in many departments of how to use the KLARA chemicals database to search for CMR (Carcinogenic, mutagenic and reprotoxic) classified products. Nor is the form that by law is to be used for these products used as required. Understanding of what delegated responsibility for the work environment involves also varies. Many research group leaders rely on their lab manager or other key person to take this responsibility, which in fact lies with them. “We have found that the person who signed a delegation of responsibility for the work environment has not always understood their responsibility,” says KI’s Main Health and Safety Delegate Anna-Lee Cöster Jansén. “The department head is not only supposed to give someone a piece of paper to sign, but must also make sure that the person accepting the responsibility, for example a research group leader, understands what it means. If a research group leader feels that he or she does not have the knowledge or resources needed, they can in fact return the delegation of responsibility”, Anna-Lee Cöster Jansén goes on. Follow-up feedback sessions The unannounced inspections were followed up with feedback sessions that were compulsory for the research group leaders. For 5 of the 35 areas inspected, someone other than the research group leader attended the session and for another 5 no one at all turned up, which according to the report shows the low priority that work environment and lab safety have in these areas. University Director Per Bengtsson has been thinking about why not everyone attended the sessions. “In some cases, absence was probably justified and some people might feel that the unannounced inspections are a violation of integrity. But it’s important not to see this as a threat. It’s a system check that is to everyone’s benefit.” Per Bengtsson believes that it is good to know where there are shortcomings. “Even if things by and large function well, there are non-conformances that we need to address by improving people’s knowledge. Now we can work with the issue on system level so that everyone understands what lies within their area of responsibility. There is a strong connection between work environment and safety. People can be injured if safety is not adequate.” Shortcomings in work environment The report also points out a connection between leadership where work environment matters are not distinctly prioritised and shortcomings in the work environment and safety. Anna-Lee Cöster Jansén has noticed this when she has gone along on safety inspections. “If the person who is responsible comes along and has used KI’s checklist, the picture in the lab is usually better. The checklist (link) makes people aware of any deficiencies and they can then be included in an action plan for rectifying non-conformities.” “KI should now strive for greater awareness of why it is necessary to, for example, make risk assessments,” says Anna-Lee Cöster Jansén. “They are made to prevent people being injured or in the worst case killed at the workplace and to know how to act if an emergency occurs. I wish that work environment and lab safety, actually making statutory risk assessments and CMR investigations before the experiments, were considered part of day-to-day work, as well as carrying out the experiments themselves.” Good research results above all Another thing criticised in the report is that research group leaders feel that KI turns a blind eye to shortcomings in leadership, work environment and lab safety as long as good research results are delivered. Per Bengtsson says that he cannot answer for what the situation was like in the past, but that the present management team feels it is important to prevent things going wrong. “The vast majority of the mistakes are caused by not having the necessary knowledge, but it is also a matter of how we view mistakes. Good quality comes from feeling secure in one’s role and daring to point out things that have gone wrong. It is a management responsibility to deal with mistakes without stigmatising individual employees,” Per Bengtsson says.   Text: Ann Patmalnieks   These aspects work satisfactorily in most areas: Handling and storing chemicals Handling chemical waste Procedures for purchase of and information management concerning products for which a permit is required Rules and procedures concerning flammable products Transportation of liquid nitrogen Adherence to laws and regulations concerning radioactive substances Procedures for use and waste management of pharmaceuticals, narcotics and cytostatic substances   Improvements are needed in many areas: Implementation and follow-ups of safety inspections Appointment of an inspector for flammable products (flammable products were not put away at the end of the working day in some areas) Correct labelling of one’s own preparations Warning notices when chemicals with different properties are kept in the same cupboard Knowledge to be able to identify CMR (Carcinogenic, mutagenic and reprotoxic) classified products in the KLARA database Use the new CMR identification form to if possible replace the products Knowledge to be able to search for allergenic products in KLARA Local knowledge of permits, notifications and conditions concerning bacteria, viruses and human samples Procedures in emergency situations

The Medical Students’ Union’s building needs renovation. Karolinska Institutet recently decided to contribute 4.5 million kronor to get planning of the modernisation off the ground. But funds are still lacking. Last autumn the Medical Students’ Union launched an appeal to raise money for the renovation, which will cost an estimated 40 million. Karolinska Institutet has now contributed 4.5 million. In conjunction with the Medical Students’ Union’s 140th anniversary, Karin Dahlman-Wright, acting Vice-Chancellor, and Annika Östman Wernersson, Dean of Higher Education, presented the union with a symbolic cheque for the promised amount. “We have understood that if external donors are to be persuaded to contribute funds, then we also need to show that we think it’s important. KI needs a students’ union that drives issues actively and without a union building the union’s work will be restricted,” says Karin Dahlman-Wright. More than a meeting point for students “A union building that runs as it should is not only important for the students; it can also be a place where teachers, researchers and others can come together,” she goes on. The 4.5 million will go towards planning, meaning the studies and preparatory work that need to be done before modernisation can begin. “When the building has been completed, we will be contributing a further half a million a year for five years for its long-term upkeep,” says Karin Dahlman-Wright. Daniel Holl, Deputy Chair of the Medical Students' Union’s Union Building Foundation, is happy. “It’s extremely important that KI show that they support our plans. It’s also important from the point of view of future fundraising. We have contacts who are prepared to make substantial donations provided KI donates too. It’s not the university’s job to fully finance the students’ union; we’re supposed to be independent of KI.” The renovation appeal has so far raised 1.3 million, in addition to KI’s donation. The Medical Students’ Union and the Union Building Foundation have already invested 3.9 million, among other things to cover renovation of the ventilation system and toilets and external consultants’ costs. But, as said, there is some way to go to 40 million. Will have to prioritise “The goal is to raise as much as possible, but if we don’t reach the target we will have to prioritise. Windows in the old part of the building need to be replaced as an energy-save measure. Some parts of the building need to be redesigned to improve work with student influence. The auditorium, which is from 1985, is in sore need of renovation,” says Daniel Holl. “The idea is then to rent out the auditorium for conferences during the day, which will be less wearing for the premises and require less work on the part of the union than renting them out in the evening. “But we’ll still be holding our own functions,” Daniel Holl promises.   Text: Ann Patmalnieks

Hello, Stefan Eriksson. You’re the new Vice-Dean of Infrastructure at Karolinska Institutet, focusing on research infrastructure. What does your new appointment involve? “In general terms, it concerns the new research settings that are being set up, animal experiments, imaging activities with heavy, expensive equipment and bio-banks, and not least research data and how such data is managed, and KI’s activities at SciLifeLab. It also means assisting and contributing to any national applications that KI participates in, where support can be provided for infrastructure. At the moment we’re also planning to establish an infrastructure council that is to draw up a strategy for KI’s overall research infrastructure. The rapid changes in health and medical care will have a drastic impact on how we access clinical data and process it.” Why is a vice-dean needed for this? “An overarching, well-considered plan is required for KI to be able to prioritise and finance the future research infrastructure – an increasing focus has come to be placed on the university’s own responsibility and possibilities to finance research infrastructure.” How does it contribute to research? “Extremely advanced equipment is needed in many cases. And keeping pace with developments in different areas with different kinds of equipment requires highly specialised skills that need to be coordinated between the various sites Bioclinicum, Neo – the Ana 8 laboratory of the future and Biomedicum, and the other departmental activities and operations at KI, and the different needs that researchers have. We also need to constantly improve interaction with the health and medical care sector.” What is your mandate as Vice-Dean? “I’m not allowed to make decisions about things. Decisions are made by the Board of Research but it is my and the infrastructure council’s task to draw up underpinning information, prepare matters and create prerequisites for the board to make well-considered decisions and prioritise on the basis of the information we daw up.”  How difficult will it be? “It’s a challenging task – but an interesting one. And it’s of course a complex task that is to cover operations with a turnover of seven billion kronor.”   Text: Stina Moritz

Comment: On 28 April the newspaper Dagens Nyheter, DN, published an article about a preliminary investigation by the prosecutor, following suspected economic misconduct at a KI department reported to the police by KI. The article contains an incorrect photo of Professor Martin Ingvar. Professor Ingvar is not subject to any police investigation, nor is he in any way involved in the case described in the DN article. DN has admitted to the error and has published a correction of error and a public excuse in the 29 April edition of the paper. 

On 27 April, the government decided to appoint Ole Petter Ottersen Vice-Chancellor at Karolinska Institutet. He will take office on 1 August 2017. "I am honored to be appointed rector of Karolinska Institutet - a university that I have looked up to throughout my career. It is a great privilege to be able to lead such a prominent institution," Ole Petter Ottersen says. "I look forward to getting started and to work together with KI’s many talented researchers, board members, staff, students and multiple collaborative partners nationally and internationally. Together we will strengthen public trust and internal enthusiasm and pride," he continues. Ole Petter Ottersen is currently rector of the University of Oslo, where he has held several leading positions, including dean of research for the medical faculty. He is also a professor of medicine.  The appointment as vice-chancellor of the Karolinska Institute applies from 1 August 2017 until 28 February 2022.

The cessation of breathing during sleep caused by enlarged tonsils is common in preschool-age children and can cause serious complications, but the methods normally used to diagnose the condition are subjective and unreliable. The finding is reported in a thesis from Karolinska Institutet by Anna Borgström, who has also evaluated different surgical treatments. Obstructive sleep apnoea affects 5 to 6 per cent of all children of preschool age, causing the repeated cessation of breathing during sleep. If the condition remains untreated, it can interfere with brain development and cause complications such as learning difficulties and behavioural disorders with ADHD-like symptoms. In extreme cases it can even lead to heart failure. The diagnostic method currently seen as the best for obstructive sleep apnoea in children is polysomnography, but it is a resource-heavy examination that has to be carried out in a sleep laboratory. Because of this, doctors have often relied on the combination of clinical examination and questionnaire (OSA-18) to make their diagnoses. However, as Dr Borgström – ear, nose and throat specialist and researcher at Karolinska Institutet’s Department of Clinical Science, Intervention and Technology – demonstrates in her thesis, the questionnaire has no diagnostic value. Symptoms are easily missed “What we need are better and cheaper diagnostic methods,” she says. “Since the symptoms are unspecific and breathing often stops late at night, the diagnosis is probably often missed.” Childhood obstructive sleep apnoea is usually caused by enlarged tonsils, in which case an operation is the conventional answer. Tonsil surgery is one of the most common forms of surgery performed on children, with thousands of operations every year in Sweden alone. Dr Borgström’s thesis shows that the number of such operations has risen over the past few decades and that ever younger children are having them. Two main surgical methods compared There are two main methods used: tonsillectomy and tonsillotomy, which involve, respectively, the complete and partial removal of the tonsils. Despite the lack of randomised studies comparing the two, the latter method has begun to dominate. One such study is included in Dr Borgström’s thesis and has recently been published in the esteemed periodical Pediatrics. It shows that the methods give similar outcomes for the treatment of obstructive sleep apnoea in preschool children, but also that tonsillotomy carries a risk of tonsil regrowth and the consequent need for renewed surgery. “I want my thesis to show that obstructive sleep apnoea and enlarged tonsils are common conditions that can have serious ramifications,” says Dr Borgström. “What I hope is that my research will mean better treatment for preschool children suffering from such problems.” Anna Borgström defended her thesis “Pediatric obstructive sleep apnea – evaluation of questionnaire and surgical treatment” on 24 March 2017.

Commentary: Dagens Nyheter has published an article on an internal investigation at Karolinska Institutet into the sale of an IT platform within the Programme 4D concept. The KI management decided to have the internal audit office look into any impropriety in the sale following internal criticism of the Programme 4D steering group chairperson. The chairperson has chosen to take time out in the mean time.

Around 180 guests came to celebrate the 140 years of the Medical Students’ Association during the anniversary banquet on 22 April. Karolinska Institutet was happy to congratulate with a donation of 4.5 million SEK for the renovation of the student union building.

A crowd of more than 2,500 people showed up for the March for Science in Stockholm on Saturday on 22 April. The global manifestation for research, science and peer review was held simultaneously in 605 places around the world. Among the participants were staff and students from Karolinska Institutet.

A large-scale analysis of Swedish registry data suggests that there are fewer risks than previously thought from exposure to antidepressants in early pregnancy. Exposed children had no increased risk of developing autism or attention deficit hyperactivity disorder. The study, published in JAMA, was a collaboration between researchers at Indiana University, Karolinska Institutet and Harvard T.H. Chan School of Public Health. The research found significant evidence for only a slight increase in risk for premature birth in the infants of mothers who used antidepressants during the first trimester of pregnancy. After controlling for multiple other risk factors, the researchers did not find any increased risk of autism, ADHD or reduced fetal growth among exposed offspring. The risk for premature birth was about 1.3 times higher for exposed offspring compared to unexposed offspring. The analysis included data on all live births in Sweden from 1996 to 2012, over 1.5 million infants. It also incorporated data reporting the country's antidepressant prescriptions in adults, autism and ADHD diagnoses in children, genetic relationships between parents and children, parents' age and education levels, and other factors. Family factors influence the outcomes The majority of the antidepressants examined in the study – 82 percent – were selective serotonin reuptake inhibitors, or SSRIs, the most common type of antidepressants. Commonly used SSRIs include fluoxetine (Prozac), sertraline (Zoloft) and citalopram (Celexa). In addition to the use of these medications during early pregnancy, the study looked at concurrent antidepressant use in fathers, as well as mothers' use of antidepressants before but not during pregnancy. These uses were associated with increased risk for autism, ADHD and poor fetal growth – providing evidence that family factors, such as genetics or environmental factors, influence these outcomes, as opposed to antidepressant use during pregnancy. Contributors from Karolinska Institutet were Sara Öberg, Catarina Almqvist, Paul Lichtenstein and Henrik Larsson at the Department of Medical Epidemiology and Biostatistics. The study was supported in part by the National Institutes of Health's National Institute of Mental Health and National Institute on Drug Abuse, the Indiana Clinical and Translational Sciences Institute and the Swedish Research Council. This news article is an edited version of a press release from Indiana University. Publication Ayesha C. Sujan, Martin E. Rickert, A. Sara Öberg, Patrick D. Quinn, Sonia Hernández-Díaz, Catarina Almqvist, Paul Lichtenstein, Henrik Larsson, Brian M. D’Onofrio ‘Associations of Maternal Antidepressant Use During the First Trimester of Pregnancy With Preterm Birth, Small for Gestational Age, Autism Spectrum Disorder, and Attention-Deficit/Hyperactivity Disorder in Offspring’ JAMA, online 18 April 2017. doi:10.1001/jama.2017.3413

Someone takes their own life every six hours in Sweden. But despite suicide touching so many people we rarely talk about it. In the new documentary on Swedish public service television, researchers from Karolinska Institutet contribute knowledge about suicide research and how the number of suicides can be reduced. Swedish Television’s documentary series “30 liv i veckan” [30 lives a week] will begin in April. The series’ title refers to the fact that some 1,500 people committed suicide in Sweden in 2015. This is roughly equivalent to 30 lives a week, or one suicide every six hours. But despite suicide touching so many people we rarely talk about it. Journalists have often refrained from naming the cause of death when someone has taken their own life. This has contributed to a stigmatisation of suicide according to Anne Lundberg, one of the series’ two presenters. “Society’s message has been ‘we don’t talk about this’. Society has labelled both the suicide, the relatives and anyone who survives an attempted suicide as shameful. Our intention is to talk about suicide and, alleviate the shame and inspire hope instead. Because research shows that there is no danger in talking about suicide and that there are many ways to prevent it,” Anne Lundberg says. Over the course of three programmes, Anne Lundberg and her co-presenter actress Sofia Helin talk to people who in various ways have been affected by suicide. They also interview experts in the field, among them researchers at Karolinska Institutet. “Involving research both before and during production of the series went without saying,” Anne Lundberg says. “These are sensitive issues and we wanted to help bring them out in the right way together with the people who know the subject best. The researchers were an invaluable resource and we would not have been able to make the series without them,” she goes on. Mental disorder a common cause Danuta Wasserman is professor of psychiatry and suicidology at Karolinska Institutet and one of the researchers interviewed. She is also head of NASP, the National Centre for Suicide Research and Prevention of Mental Ill-Health. NASP is an expert function for suicide prevention nationally and internationally and is connected to the World Health Organization, WHO. “The majority of those who take their own lives are suffering from some mental disorder, normally severe depression,” says Danuta Wasserman. “At the same time, depression is a fairly common condition and most people who are depressed do not take their own lives. But people suffering from severe depression need treatment,” she goes on. “I hope the series will increase awareness of depression and show that help is in fact available. The people around them must also understand that they might need to act – the individual concerned does not always seek help him- or herself or even be aware of their poor condition,” Danuta Wasserman says. More men than women commit suicide Two thirds of all suicides are committed by men. “Men are more violent than women and consume more alcohol, which can both increase the risk of suicide. Men’s seeking help for mental problems also differs from women’s,” says Gergö Hadlaczky, who is a researcher at NASP and also appears in the programmes. “Men more rarely tell the people around them that they are feeling down or depressed. Men seek help for mental problems to a lesser extent and focus on physical symptoms if they do go to a doctor, not on the fact that they feel depressed. This is why it is easier to miss that they depressed or liable to take their own life,” he says. Gergö Hadlaczky hopes that the series will help increase knowledge about suicide, put it higher on society’s agenda and make it less stigmatised. “It’s important to be able to ask for help if you don’t feel good, not least for men. We must also care about people who don’t feel good. It’s a myth that you induce suicide if you talk about it. Asking about how someone feels and taking the time to listen and getting them the help they need can instead have a preventive effect,” Gergö Hadlaczky says. The documentary series will begin on 20 April on Swedish Television.   Text: Sara Nilsson Photo: Ulf Sirborn, SVT

Hans Rosling, professor of international health at Karolinska Institutet until his death earlier this year, has won the 2017 United Nations Population Award. Established by the General Assembly in 1981, the award recognizes outstanding achievements in population and health.