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- Berglund, Erik, 1980-
(författare)
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Adherence to drug treatment and interpretation of treatment effects
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Suboptimal adherence to medical treatments is prevalent across several clinical conditions and can lead to treatment failure. Adherence is a far from fully explored phenomenon and there is little knowledge about how patients interpret treatment effects. Commonly used treatment evaluation measures are often relative measures, which may be difficult for lay people and patients to understand.The overall aim of this thesis was to investigate factors with relevance to adherence, to estimate treatment effects with the time-based Delay of Event (DoE) measure in anticoagulant preventive treatments, and to explore how lay people responded to the DoE measure, as compared with established measures, regarding treatment decisions and effect interpretation.A quantitative population-based cross-sectional design was used for Study I. Study II used data from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) clinical trial and estimated effects as DoEs. Studies III and IV were carried out as randomised survey experiments.The results showed that general adherence behaviour was associated with both environmental and social factors. Estimations of DoE showed that stroke or systemic embolism was delayed 181 (95% CI 76 to 287) days through twenty-two months of apixaban use, as compared with warfarin use. The delay of major and intracranial bleeding was 206 (95% CI 130 to 281) and 392 (95% CI 249 to 535) days, respectively, due to apixaban use for twenty-two months, as compared with warfarin use. Presenting preventive treatment effects as DoEs to lay people was associated with high willingness to initiate treatment and positive views on treatment benefits and willingness to pay for treatment.Non-optimal adherence was partly associated with modifiable factors and it might be possible to increase adherence by managing these factors. Estimations of DoEs in preventive treatments gave information on effects regarding delay of different outcomes; the estimation also provides tools that might be useful for interpreting and communicating treatment effects in clinical decision-making. Lay people seemed to react rationally to variations in DoE magnitude; a higher proportion accepted treatment when the magnitude was greater.
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- Fridén, Michael, et al.
(författare)
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Effects of a low-carbohydrate high polyunsaturated fat diet or a healthy Nordic diet versus usual care on liver fat content and cardiometabolic risk factors in people with type 2 diabetes and prediabetes: a randomized controlled trial (NAFLDiet)
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Previous trials have shown that plant-derived polyunsaturated fatty acids (PUFA) in place of saturated fat reduces liver fat, a prerequisite for non-alcoholic fatty liver disease (NAFLD). The effect on liver fat from a novel “anti-lipogenic diet” replacing carbohydrates with PUFA or a healthy Nordic diet (HND) higher in whole-grains but lower in saturated fat has not yet been examined. Objectives: To investigate the effects on changes in liver fat (primary outcome) and other cardiometabolic risk factors after 12 months of follow-up in individuals with prediabetes or T2D from three different diet comparisons: a low carbohydrate high PUFA (LCPUFA) diet versus a HND, a LCPUFA diet versus usual care (UC) and a HND versus UC. Methods: A three-arm parallel ad libitum randomized trial was conducted. Adult men and women (n=148) were randomized to one of the three diet groups. Participants in all groups received key food items on a monthly/bimonthly basis. Liver fat and cardiometabolic risk factors were assessed at baseline and after 12 months. Dietary adherence was assessed using weighed food diaries and objective biomarkers. General linear models were employed to estimate the intention-to-treat (ITT) effect. Results: Dietary adherence was high for all diet groups. Liver fat was reduced to a similar extent in the LCPUFA and the HND group compared to UC (-1.46% (95% CI: -2.42, -0.51)) and -1.76 % (95% CI: -2.96, -0.57), respectively. No difference in liver fat between LCPUFA and HND was observed. Body weight and HbA1c decreased more in the HND compared to the other diet groups whereas no differences were observed between LCPUFA and UC. Similar reductions in LDL-cholesterol were observed for the HND and the LCPUFA group compared to UC, but only the HND reduced triglycerides and C-reactive protein (CRP) compared with UC. No differences were observed for any other secondary outcomes.Conclusions: A LCPUFA diet and a HND both reduced liver fat as compared with UC. Given the sustained weight loss after the HND compared to the other groups, together with improvements in other cardiometabolic markers, the HND in particular seems to be useful for the treatment of T2D and NAFLD.
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- Johansson, Birgitta, et al.
(författare)
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Uppsalastudie av 20 husläkares roll i vården av cancerpatienter : Lättare att bedöma behovet av stöd om utförlig specialistinformation ges
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99:8, s. 771-773
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to describe the role of the GP in the care of one specified cancer patient per GP and to explore the GP’s knowledge about that patient’s disease and treatments. A further aim was to evaluate the effects of an extended information routine, including increased information from the specialist clinic to the GP. Twenty GPs were selected for a semi-structured interview about a patient randomised either to an extended GP information routine or to standard information. The results suggest that GPs are commonly involved in the care of cancer patients, particularly in the diagnosis of the disease but also during the period of treatments and follow-up. The information from the specialist clinic to the GP is insufficient in standard care. The extended information routine increased the GPs’ knowledge about the disease and treatments and facilitated their possibilities to determine patients’ need for support. However, this did not affect the extent of contacts with the patient.
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- Modén, Carl S., 1979-
(författare)
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Micromechanics of softwoods in the transverse plane : effects on cell and annual ring scales
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Transverse mechanical properties of wood are important in many practial applications and an interesting scientific subject. A very low transverse shear modulus has been identified in spruce, which causes large strain concentrations in wood structures. In this thesis, experimental characterization of local density variations as well as local strain fields are carried out using the SilviScan apparatus and digital speckle photography, respectively. This is combined with micromechanical modeling based on hexagonal wood cells in combination with finite element analysis. Problems addressed include the moduli in the transverse plane, including variations at the scale of individual annual rings. The relative importance of cell wall bending and stretching deformation mechanisms is analysed as a function of wood cell geometry, relative density and direction of loading (radial, tangential and shear). Transverse anisotropy is also analyzed, including its dependency of earlywood and latewood characteristics. The wood cell shape angle variation and density effects are sufficient to explain transverse anisotropy in softwoods (no ray effects), and the influence of earlywood/latewood ratio is explained. As a practical test method for shear modulus measurements, an off-axis compression test with full-field strain determination is proposed. The advantage is a simple fixture and large region of representative strain required for a heterogeneous material such as wood. As an alternative, the single cube apparatus (SCA) for shear tests is evaluated. The SCA is used to determine the shear strain distribution within the annual rings. Based on the density distribution of the shear test specimen and a micromechanics model, a finite element model is developed, and predictions are compared with the measured shear strains. The agreement between predicted and measured shear strains at the annual ring scale are remarkably good. It shows that the low GRT of spruce is due to the low earlywood density and the large cell wall bending deformation resulting from shear loading. Furthermore, it illustrates the need for improved understanding of annual ring scale effects. For example, fairly low transverse global loads will lead to lage local shear strains.
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