| 1. |
- Aro, Pertti, et al.
(författare)
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Use of tobacco products and gastrointestinal morbidity : an endoscopic population-based study (the Kalixanda study)
- 2010
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 25:10, s. 741-750
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Tidskriftsartikel (refereegranskat)abstract
- The impact of snus (smokeless tobacco or snuff) on gastrointestinal symptoms and pathological findings is largely unknown. The authors aimed to investigate whether the exposure to different forms of tobacco influences upper gastrointestinal symptoms, histology and frequency of Helicobacter pylori infection. A random sample (n = 2,860) of the adult population of two northern Swedish municipalities Kalix and Haparanda (n = 21,610) was surveyed between December 1998 and June 2001 using a validated postal questionnaire assessing gastrointestinal symptoms (response rate 74.2%, n = 2,122) (The Kalixanda Study). A random sub-sample (n = 1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%) including biopsies, Helicobacter pylori culture and serology and symptom assessment and exploration of present and past use of tobacco products. No symptom groups were associated with snus use. Snus users had a significantly higher prevalence of macroscopic esophagitis univariately but snus use was not associated with esophagitis in multivariate analysis. Snus use was associated with basal cell hyperplasia (OR = 1.74, 95% CI: 1.02, 3.00) and with elongation of papillae (OR = 1.79, 95% CI: 1.05-3.05) of the squamous epithelium at the esophago-gastric junction. Current smoking cigarettes was associated with overall peptic ulcer disease (OR = 2.32, 95% CI: 1.04, 5.19) whereas snus use was not. There were no significant association between current Helicobacter pylori infection and different tobacco product user groups. Snus significantly alters the histology of the distal esophagus but does not impact on gastrointestinal symptoms or peptic ulcer disease.
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| 2. |
- Bolinder, Gunilla
(författare)
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Long-term use of smokeless tobacco : cardiovascular mortality and risk factors
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Little is known about the risks of cardiovascular disease associated with the use of smokeless tobacco, which produces blood nicotine levels similar to those caused by cigarette smoking. There were 900 000 smokeless tobacco users in Sweden in 1996. Epidemiological studies of 136 036 construction workers (6 297 smokeless tobacco users, 28 501 smokers and 32 546 never-users of tobacco), surveyed through 1971-74, regarding the general health profile, blood pressure, sick leaves and disability pensions were conducted together with a 12-year follow-up study of all-cause mortality and cardiovascular mortality. Hypertension (blood pressure >160/90) was most common in smokeless tobacco users, particularly after the age of 45 (RR 1.8; 95% c.i. 1.5-2.1). Compared to never-users, respiratory, circulatory, musculoskeletal and mental disorders were slightly more common in smokeless tobacco users, but significantly more common in smokers. During follow-up, smokeless tobacco users, who were middle-aged at the start of follow-up, had a doubled relative risk of dying of cardiovascular disease (RR 2.1; 95% c.i. 1.5-2.9) and smokers had a triple risk (RR 3.2; 95% c.i. 2.6-3.9) compared with never-users. The risk of dying of cancer was similar in smokeless tobacco users and never-users, whereas smokers showed more than a doubled risk (RR 2.5; 95% c.i. 2.2-3.0). Clinical studies of 151 healthy middle-aged firemen (50 smokeless tobacco users, 33 smokers and 68 non-users) were made to evaluate the influence of long-term smokeless tobacco use on physical performance, cardiovascular metabolic risk factors, ultrasonographic signs of atherosclerosis and diurnal blood pressure variations. Both smokeless tobacco users and smokers had significantly elevated heart rates during the day time (p<0.05) compared with non-users. Daytime diastolic blood pressures were also significantly elevated in both smokeless tobacco users and smokers >45 years of age. The metabolic cardiovascular risk (based on serum lipids, lipoproteins, fibrinogen, PAI-I, insulin and glucose), calculated as the "atherogenic index", was significantly elevated (p<0.001) only in smokers and the 10-year future risk of cardiovascular events (Framingham CHD risk index) was 13.2% in smokers (p<0.001) and 4.6% in smokeless tobacco users (p=0.3) compared with 3.4% in never-users. Smokeless tobacco users did not exhibit any significant signs of accelerated atherosclerosis at ultrasonographic examination of the carotid artery, as did smokers. Smokeless tobacco users did not reveal any significant reduction in maximal physical capacity, whereas the performances of smokers were significantly poorer (p<0.001) compared with non-users. It is concluded that the use of smokeless tobacco involves as high exposure to nicotine as smoking, which causes the release of sympathoadrenergic stimuli. This seems to signify an elevated risk of cardiovascular stress involving higher heart rate and blood pressure levels, which might influence the risk of fatal cardiovascular events. However, it does not seem to involve the same high risk of accelerated atherosclerosis as smoking.
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| 3. |
- Ericson, Anne, et al.
(författare)
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Interprofessional clinical training for undergraduate students in an emergency department setting
- 2012
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 26:4, s. 319-325
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Tidskriftsartikel (refereegranskat)abstract
- Interprofessional education (IPE) for teams of undergraduate students has since 1999 been carried out at the orthopedic emergency department at the Karolinska University Hospital. During a 2-week period, teams of medical, nursing and physiotherapy students practice together. With the aim of training professional and collaboration skills, the teams take care of patients with varying acute complaints, under the guidance of supervisors from each profession. This study describes the educational model and compares the attitudes of the different student categories participating in this unique IPE model. All students who participated in this experience during the period 2008-2010 were asked to fill in a questionnaire on completion of their training period. Results showed that all three categories, with no significant difference, highly appreciated the setting and the team training. Results also showed that the training significantly increased the students' knowledge of their own professional role as well as their knowledge of the other professions. We conclude that training at an emergency department can provide excellent opportunities for interprofessional team training for undergraduate students. The teamwork enhances the students' understanding of the professional roles and can contribute to a more holistic approach to patient care.
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| 4. |
- Ericson, Anne, et al.
(författare)
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Interprofessional education in a student-led emergency department : A realist evaluation
- 2017
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Ingår i: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 31:2, s. 199-206
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Tidskriftsartikel (refereegranskat)abstract
- This article reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations, and questionnaires to study what worked, for whom, and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing, and physiotherapy students, their supervisors, and two members of the emergency department's management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors, and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team.
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| 5. |
- Nilsson, Mikael, et al.
(författare)
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Does individual learning styles influence the choice to use a web-based ECG learning programme in a blended learning setting?
- 2012
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 12, s. 5-
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Tidskriftsartikel (refereegranskat)abstract
- Background: The compressed curriculum in modern knowledge-intensive medicine demands useful tools to achieve approved learning aims in a limited space of time. Web-based learning can be used in different ways to enhance learning. Little is however known regarding its optimal utilisation. Our aim was to investigate if the individual learning styles of medical students influence the choice to use a web-based ECG learning programme in a blended learning setting. Methods: The programme, with three types of modules (learning content, self-assessment questions and interactive ECG interpretation training), was offered on a voluntary basis during a face to face ECG learning course for undergraduate medical students. The Index of Learning Styles (ILS) and a general questionnaire including questions about computer and Internet usage, preferred future speciality and prior experience of E-learning were used to explore different factors related to the choice of using the programme or not. Results: 93 (76%) out of 123 students answered the ILS instrument and 91 the general questionnaire. 55 students (59%) were defined as users of the web-based ECG-interpretation programme. Cronbach's alpha was analysed with coefficients above 0.7 in all of the four dimensions of ILS. There were no significant differences with regard to learning styles, as assessed by ILS, between the user and non-user groups; Active/Reflective; Visual/Verbal; Sensing/Intuitive; and Sequential/Global (p = 0.56-0.96). Neither did gender, prior experience of E-learning or preference for future speciality differ between groups. Conclusion: Among medical students, neither learning styles according to ILS, nor a number of other characteristics seem to influence the choice to use a web-based ECG programme. This finding was consistent also when the usage of the different modules in the programme were considered. Thus, the findings suggest that web-based learning may attract a broad variety of medical students.
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| 6. |
- Nilsson, Mikael, et al.
(författare)
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Evaluation of a web-based ECG-interpretation programme for undergraduate medical students
- 2008
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 8, s. 25-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Most clinicians and teachers agree that knowledge about ECG is of importance in the medical curriculum. Students at Karolinska Institute have asked for more training in ECG-interpretation during their undergraduate studies. Clinical tutors, however, have difficulties in meeting these demands due to shortage of time. Thus, alternative ways to learn and practice ECG-interpretation are needed. Education offered via the Internet is readily available, geographically independent and flexible. Furthermore, the quality of education may increase and become more effective through a superior educational approach, improved visualization and interactivity. METHODS: A Web-based comprehensive ECG-interpretation programme has been evaluated. Medical students from the sixth semester were given an optional opportunity to access the programme from the start of their course. Usage logs and an initial evaluation survey were obtained from each student. A diagnostic test was performed in order to assess the effect on skills in ECG interpretation. Students from the corresponding course, at another teaching hospital and without access to the ECG-programme but with conventional teaching of ECG served as a control group. RESULTS: 20 of the 32 students in the intervention group had tested the programme after 2 months. On a five-graded scale (1- bad to 5 - very good) they ranked the utility of a web-based programme for this purpose as 4.1 and the quality of the programme software as 3.9. At the diagnostic test (maximal points 16) by the end of the 5-month course at the 6th semester the mean result for the students in the intervention group was 9.7 compared with 8.1 for the control group (p = 0.03). CONCLUSION: Students ranked the Web-based ECG-interpretation programme as a useful instrument to learn ECG. Furthermore, Internet-delivered education may be more effective than traditional teaching methods due to greater immediacy, improved visualisation and interactivity.
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| 7. |
- Nilsson, Mikael, et al.
(författare)
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Why Medical Students Choose to Use or Not to Use a Web-Based Electrocardiogram Learning Resource : Mixed Methods Study
- 2019
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Ingår i: JMIR Medical Education. - : JMIR Publications Inc.. - 2369-3762. ; 5:2, s. e12791:1-e12791:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electrocardiogram (ECG) interpretation is a core competence and can make a significant difference to patient outcomes. However, ECG interpretation is a complex skill to learn, and research has showed that students often lack enough competence. Web-based learning has been shown to be effective. However, little is known regarding why and how students use Web-based learning when offered in a blended learning situation.Objective: The aim of this paper was to study students’ use of Web-based ECG learning resources which has not previously been studied in relation to study strategies.Methods: A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a Web-based ECG learning resource. Overall, 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final examination, all the students answered a questionnaire on study strategies and questions about internet access and estimated their own skills in ECG interpretation. Furthermore, study strategies and use patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course examination.Results: In total, 2 themes were central in the students’ reasoning about usage of Web-based ECG: assessment of learning needs and planning according to learning goals. Reasons for using the Web resource were to train in skills, regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and a lack of awareness of its availability. Usage data showed that 21 students (63%) used the Web resource. Of these, 11 were minimal users and 10 were major users based on usage activity. Large variations were found in the time spent in different functional parts of the resource. No differences were found between users and nonusers regarding the OSCE score, final examination score, self-estimate of knowledge, or favoring self-regulated learning.Conclusions: To use or not to use a Web-based ECG learning resource is largely based on self-regulated learning aspects. Decisions to use such a resource are based on multifactorial aspects such as experiences during clinical rotations, former study experiences, and perceived learning needs. The students’ own judgment of whether there was a need for a Web-based resource to achieve the learning goals and to pass the examination was crucial for their decisions to use it or not. An increased understanding of students’ regulation of learning and awareness of variations in their ECG learning needs can contribute to the improvement of course design for blended learning of ECG contexts for medical students.
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| 8. |
- Nohlert, Eva, 1955-
(författare)
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Smoking Cessation : Treatment Intensity and Outcome in Randomized Clinical Trials
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The primary aim was to compare the effectiveness of smoking cessation interventions of different intensities in a clinical dental and a telephone setting in Sweden.Methods: A total of 300 smokers were randomized to High or Low Intensity Treatment (HIT or LIT) at the Public Dental Service, County Council of Västmanland. Effectiveness (abstinence rate) was measured after 1yr (paper I) and 5-8yrs (paper III). A cost-effectiveness analysis was conducted, based on intervention costs, number of abstinent participants after 1yr, and a Markov modelling of future costs and health (in QALYs) consequences (paper II). In paper IV, 586 callers to the Swedish National Tobacco Quitline (SNTQ) were randomized to high-intensity proactive or low-intensity reactive service, and effectiveness was measured after 1 yr. Effectiveness measures were self-reported point prevalence, 6-month continuous abstinence, and sustained abstinence.Results: Absolute quit rates were 7% higher with HIT than with LIT on all measures and increased by 8% from 1yr to 5-8yrs. Point prevalence was 23% vs. 16% (p=.11) after 1yr and 31% vs. 24% (p=.16) after 5-8yrs. Six-month continuous abstinence was 18% vs. 9% (p =.02) after 1yr and 26% vs.19% (p=.18) after 5-8yrs. Sustained abstinence was 12% vs. 5% (p =.03) after 5-8yrs. Nicotine dependence was a strong predictor for abstinence at 1yr and achieved abstinence at 1yr was a strong predictor for abstinence at long-term follow-up. The cost-effectiveness analysis showed that both HIT and LIT were cost-effective, and LIT was even cost-saving compared with doing nothing. HIT was more costly and more effective than LIT, and the cost of each extra QALY gained by HIT was 100,000SEK, which is considered very cost-effective in Sweden. Proactice and reactive services were equally effective at the SNTQ. Point prevalence was 27% and 6-month continuous abstinence was 21% after 1yr. Being smoke-free at baseline was the strongest predictor for abstinence at 1yr.Conclusion: Support at high as well as low intensity in a clinical dental setting in Sweden and at the SNTQ was effective in achieving smoking cessation. Both high- and low-intensity interventions were very cost-effective in a clinical dental setting.
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| 9. |
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