| 1. |
- Hälleberg-Nyman, Maria, 1968-
(författare)
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Urinary catheter policies for short-term bladder drainage in hip surgery patients
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
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| 2. |
- Folkersen, Lasse, et al.
(författare)
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Genomic and drug target evaluation of 90 cardiovascular proteins in 30,931 individuals.
- 2020
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Ingår i: Nature metabolism. - : Springer Science and Business Media LLC. - 2522-5812. ; 2:10, s. 1135-1148
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Tidskriftsartikel (refereegranskat)abstract
- Circulating proteins are vital in human health and disease and are frequently used as biomarkers for clinical decision-making or as targets for pharmacological intervention. Here, we map and replicate protein quantitative trait loci (pQTL) for 90 cardiovascular proteins in over 30,000 individuals, resulting in 451 pQTLs for 85 proteins. For each protein, we further perform pathway mapping to obtain trans-pQTL gene and regulatory designations. We substantiate these regulatory findings with orthogonal evidence for trans-pQTLs using mouse knockdown experiments (ABCA1 and TRIB1) and clinical trial results (chemokine receptors CCR2 and CCR5), with consistent regulation. Finally, we evaluate known drug targets, and suggest new target candidates or repositioning opportunities using Mendelian randomization. This identifies 11 proteins with causal evidence of involvement in human disease that have not previously been targeted, including EGF, IL-16, PAPPA, SPON1, F3, ADM, CASP-8, CHI3L1, CXCL16, GDF15 and MMP-12. Taken together, these findings demonstrate the utility of large-scale mapping of the genetics of the proteome and provide a resource for future precision studies of circulating proteins in human health.
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| 3. |
- Tellgren, Britt, 1951-
(författare)
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Från samhällsmoder till forskarbehörig lärare : kontinuitet och förändring i en lokal förskollärarutbildning
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- From Mother of Society to a Teacher Qualified for Post-graduate Studies – Continuity and Change in a Local Pre-school Education. The aim of this thesis is to throw light upon the basic values and representations of knowledge within a local female teacher education tradition and identify what kind of expectations are held of a pre-school teacher over time. The main question concerns central values and notions in a local pre-school teacher education regarding what is expected of a recognised pre-school teacher between the beginning of the 20th century and the first decade of the 21st century. A key interest is how these underlying values and notions are maintained and how they are transformed over time. Another interest is how these values and notions are maintained and transformed when they meet other teacher education traditions and when they are confronted with traditional academic values. The preschool teacher education is deeply rooted in a female tradition and the study presented here also focuses on the role that gender plays in the formation, changes and continuity of the central values in pre-school teacher education. The empirical sources include in-depth-interviews with 22 lecturers and supervisors from a local pre-school education in addition to document studies of selected materials from the archives of the Department of Education at Örebro University and at the Örebro University Library. The historical context and the dimension of time have been analysed using James Wertsch’s (2002) conception of voices of collective remembering in addition to the concepts of knowledge cultures (Englund & Linné 2005, Nerland 2008) and communities of practice (Lave and Wenger 2003). The results presented in this dissertation indicate that major shifts have occurred in the collective memory of the local pre-school teacher education during the 20th century and the first years of the 21st century. I have distinguished seven historical periodic themes in the analysis. These are: Mother of society – formation of a new female activity system (ca 1902–1942), All-round kindergarten leader (ca 1942–1963), Personality development and child observation (ca 1963–1972), Developmental psychology and dialogue pedagogy (ca 1972–1977), Education in a university setting and a citizen of society (ca 1977–1983), Reflective child pedagogue (ca 1982 1993) and Teacher of younger children – qualified for a research tradition (ca 2001– 2007).
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| 4. |
- Thulin, Susanne, 1953-
(författare)
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Lärares tal och barns nyfikenhet : kommunikation om naturvetenskapliga innehåll i förskolan
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to generate new knowledge about how children and teachers communicate scientific contents in preschool. The general research question is formulated as: How do the object of learning and the act of learning appear in communication about scientific contents in preschool? This thesis is a collection of three (previously published) empirical studies and takes shape in the encounter between a projected knowledge acquisition task for preschool and the educational tradition of preschool.The research approach is based primarily on phenomenography focussing on developmental pedagogy. The results are discussed in relation to situated learning and the assumptions about the task of preschool characterising the social practice that is brought to light. The thesis is based on the assumption that teachers are bearers of taken-for-granted ideas about what the ‘good preschool’ is, and that these ideas affect the way they interpret new tasks.The empirical basis consists of video observations from two preschools working with different thematic projects: Life in the tree stump and How soil is formed. The analysis is delimited to the verbal communication occurring between children and teachers about the scientific content. The children are aged between three and six years. All observations have been transcribed to text and analysed according to the following research questions: Study I: (i) What is communicated as the object of learning in the theme work about natural scientific phenomena in the preschool studied? (ii) What acts of learning appear in the communication of the object of learning? Study II is a re-analysis of the linguistic usage in the empirical data from Study I. Research questions of Study II are: is there any systematic pattern in the use of anthropomorphic speech regarding (i) who uses this language, (ii) when it is used and (iii) what it is used for? Study III is delimited to children’s perspective, and the research questions are: (i) What do children ask about during theme work with a natural scientific process in preschool? (ii) Can any tendency towards change be discerned with regard to what kind of questions children ask in the course of the theme work?The results have thrown light on what natural science is in these preschools, a questioning teacher, an education ideal as an interpretative framework and children’s meeting with the object of learning. The results are discussed in relation to a feasible didactic perspective based on the educational ideal of preschool and in relation to a critical didactic perspective concerning teachers’ will, courage and competence to make the content visible. Finally, with the implementation of the raised knowledge task for preschool in mind, prominence is given to the need of critical reflection over the role of language as maintaining a discourse and the concepts established.
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| 5. |
- Anderbro, Therese
(författare)
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Behavior change intervention and fear of hypoglycemia in type 1 diabetes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions
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| 6. |
- Furukawa, Toshi A., et al.
(författare)
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Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual data
- 2021
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Ingår i: Lancet psychiatry. - London, United Kingdom : Elsevier. - 2215-0374 .- 2215-0366. ; 8:6, s. 500-511
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Forskningsöversikt (refereegranskat)abstract
- Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42.0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1.83 [95% credible interval (CrI) -2.90 to -0.80]) and that relaxation might be harmful (1.20 [95% CrI 0.17 to 2.27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0.32 [95% CrI 0.13 to 0.93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. 511
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| 7. |
- Johansson, Anna, 1965-
(författare)
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Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep. Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.
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| 8. |
- Rohlin, Malin
(författare)
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Att styra i namn av barns fritid : En nutidshistoria om konstruktionen av dagens fritidshem i samordning med skolan
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Governing in the name of children’s leisure time: A contemporary history of the construction of today’s school-age childcare (fritidshem) in coordination with the schools.The purpose of this study is to provide a perspective on the recent restructuring of the cooperation between schools and school-age childcare in Sweden. To achieve that goal the study also focuses on varying conceptions of school-age childcare through different time periods. The subject matter of the study is the reasoning embodied in various concepts of how school-age childcare and schools should cooperate, as well as their methods of coordination. The changing conceptions of school-age childcare over a period of time raise questions about its pedagogic identity. The actual focus of the study is on the ways of reasoning that guide school-age childcare now and have guided it in the past, and how this reasoning governs and exercises power in the name of children’s leisure time.The empirical basis of the study consists of various texts, most of which are official reports and propositions, professional texts, and earlier investigations on the coordination between school-age childcare the schools.At the end of the 1990s school-age childcare was transferred from the arena of social policy to that of educational policy. The change was emphasized in the discussion about a holistic view, which then produced the team as the logical tangible form for cooperation.The theoretical basis for the study is Michel Foucault’s and his followers’ analyses of the modern welfare state’s reasoning about governing. Foucault calls his perspective governmentality. This concept emphasizes the thinking and ideas in the name of which governing takes place. The object of governing is influenced, in other words, by the thinking that is the basis of the actual steering.The governing of school-age childcare is approached from three angles. These are costs/economy and the connections between compulsory school and voluntary afternoon activities. The third angle is about the relation between children’s social development and knowledge. The assumption is made that these angles provide a certain mode of thinking about today’s school-age childcare. Today’s governmentalities, which I call the pedagogical thought, emerged during the late 1970s. This mentality in turn appeared against the background of other historical figures of thought, e.g. the work mentality of the early 1900s as well as the recreation mentality of the 1930 and 1940s. The metaphors of the “child exempted from school attendance” and what I call the “village-child” show a strained relationship between what is stated in texts and the reasoning in pedagogical practice. In the 1970s the texts introduced a holistic view in childcare.The governmentalities that organize the school-age childcare of the 1990s are characterized by the discussion of holistic views and the team, and contain different aspects than the discussions of the early 1900s, the 1940s and -50s, and the1970s and -80s. The strategies and techniques developed aim at neutralizing the dichotomy of social development/knowledge. Assumptions about the child’s growth are not just a matter of an ambition to govern the whole child/pupil. Comprehensive control affects cognitive, emotional, and ethical values. Today’s reasoning also has an impact on the temporal aspects of the child’s existence – a life-long learning.Keywords: governmentality, leisure time, school-age childcare, school, social development, knowledge, developmental psychology, cooperation, holistic view, team
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| 9. |
- Skeppner, Elisabet [Elisabeth], 1962-
(författare)
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Penile carcinoma : from first symptom to sexual function and life satisfaction following organ-sparing laser treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe how patients with penile carcinoma experienced their symptoms, treatment seeking and the impact of the diagnosis and treatment on sexual function, sexual activity and life satisfaction. The thesis contains two studies of patients treated with organ-sparing laser therapy, a retrospective study (Papers II and III) of 46 patients treated between 1986-2000 and a prospective study (Papers I and IV) of 50 patients between 2005 and 2009 and additional 34 partners. In both studies face-to-face interviews were used with a structured questionnaire; and self-assessment instruments IIEF-5, LiSat-11, and HADS. An ad hoc comparator population of men aged 34–74 years from a nationally representative investigation of sexual life and life satisfaction in Swedes was chosen for some of the questions concerning sexuality and life satisfaction. We found a delay of more than 6 months in 37% of the patients in the retrospective study and 65% of the patients in the prospective study. The single most important reason for patients’ delay was embarrassment. Nine patients had a doctors’ delay of more than 3 months from first special visit until diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results (I, II). All patients younger than 75 years (34/46) in the retrospective study reported that they were sexual active before treatment, 80% of these had resumed their activity by the time of the interview. Furthermore, except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators were satisfied with life as a whole and with other domains of life including satisfaction with sexual life (III). We found that 21/29 couples were sexually active with intercourse before treatment and 17 couples resumed their activity. Two items differed markedly from the comparators; considerably fewer patients were satisfied with their somatic health, and satisfaction with sexual life (at 12 months follow-up). Couples with an active partner-related sexuality at 12 months follow-up, reported coherence in high satisfaction with life as a whole (IV).In conclusion, patients with penile carcinoma delay for a long time after identifying symptoms before seeking contact with the health care system. This delay is mainly caused by embarrassment in describing the symptom to health care personnel and deficient knowledge about the disease. Organ- sparing technique offers good, satisfying cosmetic results and the possibility of maintaining sexual activity and function to a great extent.
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| 10. |
- Windahl, Torgny, 1948-
(författare)
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Clinical aspect of laser treatment of lichen sclerosus and squamous cell carcinoma of the penis
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of these studies was to investigate the efficacy, complications and the long term results after laser treatment of lichen sclerosus et atrophicus and of squamous cell carcinoma of the penis.Patients and Methods: Paper I: In a prospective study from 1985-1991, 62 men with histologically verified lichen sclerosus et atrophicus were given carbon dioxide (CO2) laser treatment following the failure of local corticosteroid treatment. The study was subsequently updated at a median follow-up time of 14 years.Paper II-IV: Sixty-seven men aged 26 to 87 (mean 60 years) with newly diagnosed penile carcinoma were included in a prospective study. The patients were treated by a new combined laser method (CO2 and Nd:YAG) between 1986 and 2000. The median follow-up time was 42 months (range 12-186 months). All patients could be assessed for local recurrence, progression and survival at the end of 2001. Forty-six patients agreed to participate in face-to-face interviews addressing sexual activity, sexual function/dysfunction, satisfaction and cosmetic results.Results: Paper I: The laser treatment was successful in 47 patients (76%) with no local symptoms at a mean follow-up of 30 months. Fifty-three of the 62 men were alive when the update was carried out in February 2004, and we were able to get in contact with 50 of them. Forty of these patients (80%) had no local symptoms or visible lesion. We found concomitant squamous cell carcinoma of the penis in two patients and two further patients had died from anal cancer.Paper II-IV: Local recurrences appeared in 13 patients (19%) at a median follow up of 42 months, and 10 of these patients were successfully retreated with laser treatment. Two patients died from penile carcinoma. The disease-specific 5-years survival rate was 95%. Concomitant lichen sclerosus was found in 11 patients. All patients younger than 75 years reported that they were sexually active before the treatment, and 80% of them had resumed their sexual activity after the treatment. Ten patients (22%) reported decreased erectile function after the treatment, while 33 patients (72%) reported unaltered erectile function. The cosmetic result was regarded as satisfying or very satisfying in 78% of the patients.Conclusion: Carbon dioxide laser treatment is an efficient treatment for lichen sclerosus et atrophicus with excellent long-term results, and the side effects are few. One disadvantages of the treatment is a slow postoperative healing process. Combined CO2 and Nd:YAG laser treatment is effective for treatment of the primary tumour in patients with localized penile carcinoma. It can be safely carried out with good local tumour control and highly satisfactory results with respect to cosmetic aspects and sexual function.
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