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| 2. |
- Nugin, Hampus, et al.
(författare)
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Work-up and treatment of prostate cancer before and after publication of the first national guidelines on prostate cancer care in Sweden
- 2018
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Ingår i: Scandinavian journal of urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 52:4, s. 277-284
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: In 2007, the Swedish National Board of Health and Welfare published the first Swedish guidelines on prostate cancer (PCa) to improve care and decrease geographical and social inequalities. The aim of this analysis was to assess how these guidelines affected PCa care.Materials and Methods: Work-up and treatment for men diagnosed with PCa between 1998 and 2014 were assessed by use of data in the Prostate Cancer data Base Sweden (PCBaSe) with information from the National Prostate Cancer Register (NPCR) and other healthcare registries and demographic databases.Results: Overall, there were modest improvements in the performance for 14 selected quality indicators, with some notable exceptions. There was a strong increase in the use of active surveillance for very low-risk PCa, up from 56% in 2009 to 92% in 2014, and use of bone imaging for high-risk PCa up from 50% in 2008 to 77% in 2014. There were large differences in work-up and treatment of PCa between healthcare providers with modest decreases over time. The differences between counties were larger than differences according to socioeconomic status with one exception: use of curative treatment for high-risk PCa was more common in men with high income, highest versus lowest tertile, OR 2.74 (95% CI, 1.85-4.06).Conclusion: The modest improvements in PCa care after the publications of national guidelines indicate that if these are to make an impact on care, feedback to each point of care on their performance as well as local quality improvement programs implementing the guidelines are needed.
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| 4. |
- Adolfsson, Carl-Henrik, Fil doktor, 1976-, et al.
(författare)
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Evaluating School Improvement Efforts : Pupils as Silent Result Suppliers, or Audible Improvement Resources?
- 2018
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Ingår i: International Journal of Learning, Teaching and Educational Research. - Flacq : Society for Research and Knowledge Management. - 1694-2493 .- 1694-2116. ; 17:6, s. 34-50
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Tidskriftsartikel (refereegranskat)abstract
- This article contributes to a perspective of school development, where pupils‟ experiences of the teaching they encounter are regarded as a result of improvement work. In a three-year research collaboration with four nine-year compulsory schools in a large Swedish municipality, researchers have continuously conducted group interviews with different actors, collected relevant documentation and reported their preliminary analyses to the schools. In the light of previous research, the results show that the development areas that have been in focus in the schools have in some cases had an impact on the teaching. However, no homogenous change is evident. Rather, the variation between classrooms, teachers and subjects is great, especially if the pupils‟ perspectives are taken into consideration. The pupils‟ experiences and voices on how the improvement work materialises in the classroom contribute to explaining the connections, or lack of them, between the school and classroom levels.
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| 5. |
- Adolfsson, Carl-Henrik, Fil doktor, 1976-, et al.
(författare)
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Evaluating teacher and school development by learning capital : a conceptual contribution to a fundamental problem
- 2019
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Ingår i: Improving Schools. - : Sage Publications. - 1365-4802 .- 1475-7583. ; 22:2, s. 130-143
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Tidskriftsartikel (refereegranskat)abstract
- In light of an international policy movement to increase focus on students’ academic achievement, the question of how to improve schools has become an important issue at all levels in the school system. Substantial resources have been invested in reforms to improve conditions for pupils’ learning. Great expectations and responsibility are often placed on teachers in terms of their professional development (PD), the aim being to improve their teaching practices. Consequently, the question of how to evaluate the results of school improvement programmes, including teachers’ PD, has arisen. However, there is a lack of theoretical concepts that can capture the outcomes of such development in a qualified way. Taking inspiration from the research on teachers’ PD and theories relating to teachers’ knowledge and capabilities, the aim of this study is to outline a conceptual framework that can serve as an analytical tool when evaluating both school improvement initiatives in general and school actors’ learning in particular. Four types of learning capital that are intended to reflect the central aspects of teachers’ and school organisations’ learning and the capabilities linked to teaching practice and its development are outlined. This conceptual framework is applied and exemplified based on the results of a three-year research project evaluating a school improvement programme in a Swedish municipality. Finally, some conclusions are drawn regarding the different types of analysis possible with the current conceptual framework related to the evaluation of school improvement efforts.
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| 7. |
- Adolfsson, Carl-Henrik, Fil doktor, 1976-, et al.
(författare)
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The Local Education Authority’s Implementation of a Capacity-building model for school improvement – obstacles and possibilities
- 2019
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Ingår i: Presented at ECER 2019.
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Konferensbidrag (refereegranskat)abstract
- General description on research questions, objectives and theoretical framework (600 words)In school systems around the world, there is an increasing focus on pupils’ academic achievements and school results. This has resulted in an intensified control of pupils’ levels of achievement (cf. PISA) and increasing demands for school actors and decision-makers to improve schools. In this respect, Sweden is no exception. Ages of declining student achievement, decreased equality between schools have spurred an intensive critique against the Swedish school system and triggered a more state-regulated governing of the school system in terms of several national reforms, which altogether aim to take control over the schools’ outcome (Wahlström & Sundberg, 2017; Adolfsson, 2018). In light of such a policy movement the Local Education Authorities (LEA) and schools’ responsibility for pupils’ achievement and equality have been highlighted and strengthened in Swedish policy. In addition, to ensure the quality of the teaching and the professionalism of the teachers, a revision of the Swedish Education Act was carried out in 2010. This revision stipulated, among other things, that all schools and local school authorities must conduct a systematic improvement work. This had led to a discussion of how school on a local basis can build capacity to improve themselves. In this context, LEA, in the Swedish municipalities, have become important policy actors (Wahlström & Sundberg, 2017b). To strengthen the schools own capacity for improvement, but also to increase the control over the schools’ processes and outcomes, the construction and implementation of different quality systems has been an important strategy for the local education authorities (Adolfsson & Alvunger, 2017; Håkansson & Sundberg, 2016).In this paper, we will put this ‘meso-level’, i.e. the relationship between LEA and the schools, in focus. We mean that this is an important, but many times overlooked, relationship when it comes to understand processes and outcomes related to the implementation of local quality systems and school improvement initiatives (Rorrer, Skrla & Scheurich, 2008). Based on an ongoing three-year research project in a major municipality in Sweden, the overall aim is to investigate a LEA: s attempt to implement a new quality system at the schools in the municipality, as a way to control and strengthen the schools’ improvement work. The following research questions are addressed in the paper:1. How and which central aspects of the schools’ improvement work tries LEA control and strengthened through the implementation of a new quality system?2. In what w ay do school actors respond to LES’s attempt to implement the quality system?3. Which different factors can be distinguished as notably important for the outcome of the implementation process?The relationship between the LED and the current schools are understood and analysed from a neo-institutional theoretical perspective (Scott, 2008). From this perspective, three dimensions can be highlighted regarding how institutions (in this case the LED and the current schools) seek to control and affect other institutions, respond to external pressure and seek legitimacy: regulative (rules and sanctions), normative (prevalent norms, expectations and ideals ), and cognitive-cultural/discursive (shared conceptions and frames of meaning-making). This perspective enable us to elucidate the character of the different strategies and actions that LED undertake in the implementation of the new quality model. To understand the implementation processes that occurred at the different schools, theoretical inspiration is acquired from implementation theory (Fixen et al. 2005; Lundquist, 1987; Lipsky, 1980). This theory put analytical focus on central implementation factors such as clarity, school actors knowledge, legitimacy, time, leadership, organisation, school culture etc, which thus help us to understand the result of the implementation processes of the different schools. Methods/methodology (400 words)The overall research project, which this specific study is conducted within, has a mixed-method inspired design. The aim with such an approach is to deepening the understanding of the current research questions being addressed through obtaining different, but complementary data on the phenomenon that stand in focus for the study (Cresswell, 2010; Cresswell and Clark, 2007). In this specific sub-study, we have followed the education authority’s implementation process at six different schools in the current municipality. The current schools are located in areas with differences in socioeconomic and ethnic backgrounds and each school was followed for a school year, which made it possible to contextually place and understand the implementation process within the structure, organization and culture of the schools.In line with the theoretical points of departure and the general aim to elucidate patterns of the local school authority’s implementation of the new quality system and school actors’ understanding and response of the quality system, following methods and empirical data have been used. i) content analysis of central policy documents ii) observations (n=xx) iii) 24 semi-structured interviews with key actors at the different schools (n=50). Accordingly, an extensive empirical material have been collected. To conduct a contextual understanding of each school, central documents regarding the local schools’ organisation, policy and vision, leading and management structure, pupils’ achievement, school improvement strategies were at a first step analysed. This contextual understanding was important for the next step, when data related to LEA implementation of the new quality system at the single schools were collected. This was carried out through participating observations at the different kinds of meetings that occurred amongst LEA and the current schools. Finally, as a way to deepen the understanding of the school actors’ response to the new quality system, semi-structured interviews with central key actors at the single school were carried out. Expected outcomes (300 words)The relationship between the LEA and the schools will finally be discussed and problematized in light of the following preliminary results:- The implementation of the quality system occurred through a number of steps: 1. an introduction meeting between represents from the LEA and key actors from the schools 2. a quality dialogue two months later and 3. a quality seminary arranged by the LEA where the principals from the involving schools were participating. In contrast to a more traditional ‘regulative’ strategy of governing the schools, the LEA’s implementation of the current quality system, in terms of these different activities, was characterized by a more normative and discursive way of controlling the schools’ improvement work (i.e. soft governance).- We could distinguish a variety in the initial stage of the implementation process regarding in what degree the school actors consider the LEA’s quality system as legitimate. The same variety between the schools was notably concerning how they perceived the idea and the purpose behind the new quality system but also how LEA’s system should be incorporated with their own local quality systems.- Factors that may explain these differences in the implementation process is firstly, a notably ‘knowledge-gap’, that existed between the schools. That is, principals and other key actors’ knowledge and competencies about local systematic quality work in terms of, for example, data collection, interpretation and using different methods of analysis, seem to be crucial for the implementation process. A second crucial factor seems to be how the principals organized his or her school improvement work, including delegation of responsibility and how different school actors’ knowledge and competencies were used in an appropriate way.
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| 8. |
- Adolfsson, Lisa, 1984, et al.
(författare)
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Enhanced Secondary- and Hormone Metabolism in Leaves of Arbuscular Mycorrhizal Medicago truncatula.
- 2017
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Ingår i: Plant physiology. - : Oxford University Press (OUP). - 1532-2548 .- 0032-0889. ; 175:1, s. 392-411
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Tidskriftsartikel (refereegranskat)abstract
- Arbuscular mycorrhizas (AM) are the most common symbiotic associations between a plant's root compartment and fungi. They provide nutritional benefit (mostly inorganic phosphate [Pi]), leading to improved growth, and nonnutritional benefits, including defense responses to environmental cues throughout the host plant, which, in return, delivers carbohydrates to the symbiont. However, how transcriptional and metabolic changes occurring in leaves of AM plants differ from those induced by Pi fertilization is poorly understood. We investigated systemic changes in the leaves of mycorrhized Medicago truncatula in conditions with no improved Pi status and compared them with those induced by high-Pi treatment in nonmycorrhized plants. Microarray-based genome-wide profiling indicated up-regulation by mycorrhization of genes involved in flavonoid, terpenoid, jasmonic acid (JA), and abscisic acid (ABA) biosynthesis as well as enhanced expression of MYC2, the master regulator of JA-dependent responses. Accordingly, total anthocyanins and flavonoids increased, and most flavonoid species were enriched in AM leaves. Both the AM and Pi treatments corepressed iron homeostasis genes, resulting in lower levels of available iron in leaves. In addition, higher levels of cytokinins were found in leaves of AM- and Pi-treated plants, whereas the level of ABA was increased specifically in AM leaves. Foliar treatment of nonmycorrhized plants with either ABA or JA induced the up-regulation of MYC2, but only JA also induced the up-regulation of flavonoid and terpenoid biosynthetic genes. Based on these results, we propose that mycorrhization and Pi fertilization share cytokinin-mediated improved shoot growth, whereas enhanced ABA biosynthesis and JA-regulated flavonoid and terpenoid biosynthesis in leaves are specific to mycorrhization.
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| 9. |
- Beckmann, Kerri, et al.
(författare)
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Androgen Deprivation Therapies and Changes in Comorbidity : A Comparison of Gonadotropin-releasing Hormone Agonists and Antiandrogen Monotherapy as Primary Therapy in Men with High-risk Prostate Cancer
- 2019
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Ingår i: European Urology. - : ELSEVIER SCIENCE BV. - 0302-2838 .- 1873-7560. ; 75:4, s. 676-683
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Tidskriftsartikel (refereegranskat)abstract
- Background: Some studies suggest that gonadotropin-releasing hormone (GnRH) agonists are associated with higher risk of adverse events than antiandrogens (AAs) monotherapy. However, it has been unclear whether this is due to indication bias.Objective: To investigate rates of change in comorbidity for men on GnRH agonists versus AA monotherapy in a population-based register study.Design, setting, and participants: Men with advanced nonmetastatic prostate cancer (PCa) who received primary AA (n = 2078) or GnRH agonists (n = 4878) and age- and area-matched PCa-free men were selected from Prostate Cancer Database Sweden 3.0. Increases in comorbidity were measured using the Charlson Comorbidity Index (CCI), from 5 yr before through to 5 yr after starting androgen deprivation therapy (ADT).Outcome measures and statistical methods: Multivariable linear regression was used to determine differences in excess rate of CCI change before and after ADT initiation. Risk of any incremental change in CCI following ADT was assessed using multivariable Cox regression analyses.Results and limitations: Men on GnRH agonists experienced a greater difference in excess rate of CCI change after starting ADT than men on AA monotherapy (5.6% per yr, p < 0.001). Risk of any new CCI change after ADT was greater for GnRH agonists than for AA (hazard ratio, 1.32; 95% confidence interval, 1.20-144).Conclusions: Impact on comorbidity was lower for men on AA monotherapy than for men on GnRH agonists. Our results should be confirmed through randomised trials of effectiveness and adverse effects, comparing AA monotherapy and GnRH agonists in men with advanced nonmetastatic PCa who are unsuitable for curative treatment.Patient summary: Hormone therapies for advanced prostate cancer can increase the risk of other diseases (eg, heart disease, diabetes). This study compared two common forms of hormone therapy and found that the risk of another serious disease was higher for those on gonadotropin-releasing hormone agonists than for those on antiandrogen monotherapy.
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| 10. |
- Beckmann, Kerri, et al.
(författare)
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Chronic inflammatory diseases, anti-inflammatory medications and risk of prostate cancer : a population-based case-control study
- 2019
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Ingår i: BMC Cancer. - : BioMed Central. - 1471-2407. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whether chronic inflammation increases prostate cancer risk remains unclear. This study investigated whether chronic inflammatory diseases (CID) or anti-inflammatory medication use (AIM) were associated with prostate cancer risk.Methods: Fifty-five thousand nine hundred thirty-seven cases (all prostate cancer, 2007–2012) and 279,618 age-matched controls were selected from the Prostate Cancer Database Sweden. CIDs and AIMs was determined from national patient and drug registers. Associations were investigated using conditional logistic regression, including for disease/drug subtypes and exposure length/dose.Results: Men with a history of any CID had slightly increased risk of any prostate cancer diagnosis (OR: 1.08; 95%CI: 1.04–1.12) but not ‘unfavourable’ (high-risk or advanced) prostate cancer. Generally, risk of prostate cancer was highest for shorter exposure times. However, a positive association was observed for asthma > 5 years before prostate cancer diagnosis (OR: 1.21; 95%CI: 1.05–1.40). Risk of prostate cancer was increased with prior use of any AIMs (OR: 1.26; 95%CI: 1.24–1.29). A positive trend with increasing cumulative dose was only observed for inhaled glucocorticoids (p < 0.011).Conclusion: Detection bias most likely explains the elevated risk of prostate cancer with prior history of CIDs or use of AIMs, given the higher risk immediately after first CID event and lack of dose response. However, findings for length of time with asthma and dose of inhaled glucocorticoids suggest that asthma may increase risk of prostate cancer through other pathways.
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