| 1. |
- Lindberg, Åsa, et al.
(författare)
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Pre-treatment health-related quality of life parameters have prognostic impact in patients >65 years with newly diagnosed mantle cell lymphoma : The Nordic Lymphoma Group MCL4 (LENA-BERIT) experience
- 2022
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Ingår i: Hematological Oncology. - : Wiley. - 0278-0232 .- 1099-1069. ; 40:1, s. 23-31
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Tidskriftsartikel (refereegranskat)abstract
- Mantle cell lymphoma (MCL) is a rare, often aggressive type of B-cell lymphoma with poor survival and no cure. Cancer and cancer treatment has a negative impact on health-related quality of life (HRQOL) both during active disease and in the long term, and improvement of HRQOL is a crucial objective of cancer therapy in older patients and no curative intent. Baseline HRQOL has in other lymphoma populations been shown to be predictive of outcome. Here, we explored HRQOL, and its association with survival, by the EORTC QLQ-C30 questionnaire, before, during and after chemotherapy in a patient cohort with MCL, treated within the NLG-MCL4 trial, designed to evaluate the addition of lenalidomide (LEN) to rituximab-bendamustine (R-B) as first-line treatment. Fifty-one patients were enrolled, median age was 71 years (range 62–84), 37 were men (73%). Pre-treatment HRQOL was similar to scores from the reference population with healthy individuals. During treatment, HRQOL deteriorated, but reverted to the same level as the reference population after treatment. There was a correlation between physical function (p = 0.001) and role function (p = 0.006) at baseline and WHO performance status, but not with other clinical or genetic prognostic factors. None of the baseline factors were predictive for treatment related to HRQOL in this cohort. Pre-treatment physical (p = 0.011) and role function (p = 0.032) were independent factors associated with overall survival, and physical function (p = 0.002) was also associated with progression free survival. These findings may possibly be used to design support during treatment and improve rehabilitation. Further investigations are needed for assessment of long-term HRQOL.
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| 2. |
- Andersson, Simon, 1980-
(författare)
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Skälig misstanke
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral dissertation studies the legal standard of proof called reasonable suspicion (skälig misstanke). This standard is central for criminal investigations as the majority of state criminal procedural actions (tvångsmedel) are tied to it, as well as the majority of a suspect’s rights. Despite the central role played by this standard, it has not to any significant extent been researched previously. What the standard entails cannot be seen from either the law or legislative history, and there are no published cases discussing it. As the meaning of the standard is not clear, there is much room for discretion in assessments as to whether the standard has been met. There consequently is a need to clarify what reasonable suspicion entails. What is required to fulfill the standard? How is reasonable suspicion to be assessed? These questions are answered in this dissertation.My investigation demonstrates that reasonable suspicion is a three-pronged standard:A requirement of preponderance of the evidenceReasonable suspicion entails a requirement of a preponderance of the evidence (sannolikhetsövervikt). This means, somewhat simplified, that it should be more probable that the suspect is guilty than innocent. The hypothesis underlying the reasonable suspicion of alleged guilt (gärningshypotesen) should be more probable than all other plausible hypotheses combined.A requirement of individualizationThe evidence must be sufficiently individualized in order to reach the level of reasonable suspicion. The requirement of individualization is in place to prevent that persons are suspected on the basis of group membership. The same is true with respect to persons belonging to groups where the probability of crime is generally high. In such situations, there must be a concrete circumstance pointing to just that person committing a certain crime. It can be, however, circumstances having very low evidentiary value. Group membership can still be of significance with respect to the suspect, but reasonable suspicion cannot be solely based on group membership. A generally applicable concept as to that distinguishing the general from the individual cannot however be articulated. All evidentiary evaluations are in some form based on generalizations. Consequently, the issue of whether the evidence is sufficiently individualized must be assessed from case to case. The main premise is that suspicion cannot be solely based on group belonging. This is a legal-political requirement. Legal-political aspects consequently must also be taken into consideration when evaluating evidence.A requirement of robustnessEven in cases where the evidence is evaluated so that a preponderance of the evidence exists and is sufficiently individualized, the evidence still needs to be sufficiently robust. Robustness is a measure of whether good grounds exist for the conclusion. It is not a question of how ”strong” the evidence is, but rather how thoroughly the situation has been investigated. Somewhat simplified, it is a question of ”how much” evidence exists rather than the strength of the individual pieces of evidence. This requirement of robustness varies depending upon time in that it is very low at the commencement of an investigation, but as time goes by, higher requirements are placed as to the ”completeness” of the investigation.
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| 3. |
- Anskär, Eva, 1957-
(författare)
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Time flies in primary care : a study on time utilisation and perceived psychosocial work environment
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks.Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study.Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks.Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration.This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible.
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| 4. |
- Baldanzi, Gabriel, et al.
(författare)
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OSA Is Associated With the Human Gut Microbiota Composition and Functional Potential in the Population-Based Swedish CardioPulmonary bioImage Study
- 2023
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Ingår i: Chest. - : Elsevier. - 0012-3692 .- 1931-3543. ; 164:2, s. 503-516
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-breathing disorder linked to increased risk of cardiovascular disease. Intermittent hypoxia and intermittent airway obstruction, hallmarks of OSA, have been shown in animal models to induce substantial changes to the gut microbiota composition and subsequent transplantation of fecal matter to other animals induced changes in blood pressure and glucose metabolism.RESEARCH QUESTION: Does obstructive sleep apnea in adults associate with the composition and metabolic potential of the human gut microbiota?STUDY DESIGN AND METHODS: We used respiratory polygraphy data from up to 3,570 individuals aged 50-64 from the population-based Swedish CardioPulmonary bioImage Study combined with deep shotgun metagenomics of fecal samples to identify cross-sectional associations between three OSA parameters covering apneas and hypopneas, cumulative sleep time in hypoxia and number of oxygen desaturation events with gut microbiota composition. Data collection about potential confounders was based on questionnaires, on-site anthropometric measurements, plasma metabolomics, and linkage with the Swedish Prescribed Drug Register.RESULTS: We found that all three OSA parameters were associated with lower diversity of species in the gut. Further, the OSA-related hypoxia parameters were in multivariable-adjusted analysis associated with the relative abundance of 128 gut bacterial species, including higher abundance of Blautia obeum and Collinsela aerofaciens. The latter species was also independently associated with increased systolic blood pressure. Further, the cumulative time in hypoxia during sleep was associated with the abundance of genes involved in nine gut microbiota metabolic pathways, including propionate production from lactate. Lastly, we observed two heterogeneous sets of plasma metabolites with opposite association with species positively and negatively associated with hypoxia parameters, respectively.INTERPRETATION: OSA-related hypoxia, but not the number of apneas/hypopneas, is associated with specific gut microbiota species and functions. Our findings lay the foundation for future research on the gut microbiota-mediated health effects of OSA.
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| 5. |
- Benedict, Christian, Docent, 1976-, et al.
(författare)
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Sex-specific association of the lunar cycle with sleep
- 2022
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Ingår i: Science of the Total Environment. - : Elsevier. - 0048-9697 .- 1879-1026. ; 804
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Tidskriftsartikel (refereegranskat)abstract
- Using one-night sleep recordings from 852 subjects all living in Uppsala, Sweden, the present study represents one of the largest polysomnography investigations into the association of the 29.53-day long lunar cycle with sleep among men and women and across a wide age range (22–81 years). Following the day after the new moon until the day of the full moon (also named the waxing period), the moon's illumination increases, and the timing of the meridian of the moon is gradually shifted from noontime toward midnight. In contrast, from the day after the full moon until the day of the new moon (also named the waning period), the moon's illumination decreases, and the timing of the meridian of the moon is gradually shifted from early night hours toward noontime. Thus, we focused on the contrast between the waxing and waning periods. Sleep duration was shorter on nights during the waxing period as compared to waning period (P < 0.001). In addition, a significant interaction effect of participants' sex with the lunar period on sleep was noted (P < 0.05). Men, but not women, exhibited lower sleep efficiency (P < 0.001 and P = 0.748, respectively) and were longer awake after sleep onset (P = 0.010 and P = 0.890, respectively) on nights during the waxing period. All associations were robust to adjustment for confounders (including regular sleep disturbances). Our findings suggest that the effects of the lunar cycle on human sleep are more pronounced among men. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.
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| 6. |
- Bergstrand, Ulrika
(författare)
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Styrning och re-kontextualisering av värden i utbildningspolicy på nationell och lokal nivå
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this study, governing as re-contextualization of values in Swedish educational policy has been described and analyzed. Two levels have been central to the study: the national level, in the form of the Swedish Schools Inspectorate's (SSI) survey to school personnel, and the municipal level, examined by interviews with superintendents in sparsely populated and rural areas. Three qualitative content analyses were performed, in two of which Rokeach’s theory of values as desirable actions and goals was used. The results presented that the dominant policy goal and the value expressed was that schools should promote students' knowledge, which is in line with the values underlying the PISA survey. The SSI survey expressed that schools should be quality assured to enhance students' knowledge development. Desirable actions to achieve this were: the principals evaluating, the teachers adapting to individual students, strengthening an environment conducive to learning with codes of conduct, and the guardians being informed about their children’s development. However, the superintendents expressed a lack of competence and qualified teachers for equivalent assessments, a need to upskill teachers, and that the information to the guardians did not always reach them. The study also showed an expressed value to include all students in teaching, which is in line with the values underlying the Salamanca statement. The SSI survey expressed this value as the students' participation in individualized teaching, an increased efficiency in special support, a socialization through codes of conduct, and that the students should know their rights. The superintendents expressed this value as motivating students, particularly boys, to study, adapting education for students in need of special support, preventing violations of newcomers, addressing girls' mental health, and the strengthening of democratic attitudes. In summary, the study shows that the values at the national level promoted increased individual rights, while at the local level, the values were expressed as a need to increase democratic values. Nonetheless, the values underlying the education of democratic citizens in sparsely populated and rural areas cannot be considered a closed chapter, even though policies at the national level continue to emphasize the values of promoting students' development of knowledge and their individual rights.
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| 7. |
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| 8. |
- Betancourt, Lazaro Hiram, et al.
(författare)
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The human melanoma proteome atlas-Defining the molecular pathology
- 2021
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Ingår i: Clinical and Translational Medicine. - : Wiley. - 2001-1326. ; 11:7, s. 1-20
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Tidskriftsartikel (refereegranskat)abstract
- The MM500 study is an initiative to map the protein levels in malignant melanoma tumor samples, focused on in-depth histopathology coupled to proteome characterization. The protein levels and localization were determined for a broad spectrum of diverse, surgically isolated melanoma tumors originating from multiple body locations. More than 15,500 proteoforms were identified by mass spectrometry, from which chromosomal and subcellular localization was annotated within both primary and metastatic melanoma. The data generated by global proteomic experiments covered 72% of the proteins identified in the recently reported high stringency blueprint of the human proteome. This study contributes to the NIH Cancer Moonshot initiative combining detailed histopathological presentation with the molecular characterization for 505 melanoma tumor samples, localized in 26 organs from 232 patients.
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| 9. |
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| 10. |
- Brue, Thierry, et al.
(författare)
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Diabetes in patients with acromegaly treated with pegvisomant : observations from acrostudy
- 2019
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Ingår i: Endocrine. - : SPRINGER. - 1355-008X .- 1559-0100. ; 63:3, s. 563-572
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo explore the effects of pegvisomant (PEGV) on glucose metabolism in patients with acromegaly within ACROSTUDY, an international, observational, prospective safety surveillance study.MethodsPatients were retrospectively divided into two cohorts, with (DM group) or without diabetes mellitus (no-DM). Parameters of glucose metabolism and IGF-I values were analyzed yearly both cross-sectionally for 4 years (yrs) and longitudinally at 1 and 4-5yrs of PEGV treatment.ResultsAmong 1762 patients, 510 (28.9%) had DM before PEGV start. At cross-sectional analyses, in the DM group mean blood glucose was 140.058.7mg/dl at baseline, 116.4 +/- 44.8mg/dl at year 1 and 120.0 +/- 44.3mg/dl at yr 4. Mean HbA1c was 6.6 +/- 1.2 % at yr 1 vs. 7.0 +/- 1.4 % at baseline. HbA1c was above 6.5% in 61.9% at baseline and ranged from 45.4 to 53.8% at subsequent yearly time points. At the 4-yr longitudinal analysis, in the DM group (n=109), mean blood glucose decreased by 20.2mg/dl at yr 4, mean HbA1c was 7.0 +/- 1.5% at baseline vs. 6.8 +/- 1.4%. Patients achieved IGF-I normalization in 52.1% and 57.4% of cases in the DM and no-DM groups, respectively at 1 year. The mean daily PEGV dose (mg/day) was higher in the DM group (18.2 vs. 15.3) while the absolute change of IGF-I values from baseline was similar in both groups. PEGV was well tolerated in both groups without any unexpected AEs.Conclusions p id=Par4 Patients with DM had a moderate decrease in mean fasting glucose values during PEGV treatment.
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