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- Bergström, Göran, 1964, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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Ingår i: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 2. |
- Bergström, Göran, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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Ingår i: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 5. |
- Fransson, Göran, 1968-, et al.
(författare)
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On the Swedish National Grade School for Digital Technologies in Education – GRADE : Expectations and experiences of doctorial students and supervisors
- 2018
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Ingår i: ICERI2018 Proceedings. - Sevilla : IATED. - 9788409059485 ; , s. 769-774
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Konferensbidrag (refereegranskat)abstract
- The Swedish National Graduate School for Digital Technologies in Education (GRADE) is a cooperative venture between six Swedish universities established during 2018. Within the field of educational sciences and in the area of digital technologies in education, GRADE aims to strengthen the expertise in the area and to increase national and international cooperation in research training activities.Over a number of years, and from multitude of sources (cf. Brown & Davis, 2004; Fisher, Higgins & Loveless, 2006; Kafai & Resnick 1996), research has stressed that increased digitalization in schools leads to a complexity that needs to be taken into account on different levels, from different perspectives and with different designs, methodologies and theoretical perspectives (cf. Olofsson, Lindberg, Fransson & Hauge, 2015; Price, Jewitt & Brown, 2013; Tondeur, Valcke & van Braak, 2008). At a micro-level, the learning situation of students, teachers and school-leaders changes and it becomes important to deepen the knowledge about the impact digital technologies has on the fundamental conditions for teaching and learning of different school subjects (cf. Chun, Kern & Smith 2016; Leung & Baccaglini-Frank, 2017). On a macro-level, conditions for education as such changes and digital technologies becomes an important object of study as agents of change (Wong & Li, 2008). The digitalization of K-12 schools has long been highlighted in policy as a necessity (cf. Kirkman et al, 2002; OECD, 2010). However, research and evaluations (cf. Fransson et al, 2012; OECD, 2015; Wastiau et al, 2013) show that many substantial challenges remain. One of the fundamental pillars of GRADE is the interdisciplinary approach. Several disciplines are present (Applied IT, Curriculum studies, Education, Informatics, Technology and Learning, Educational work, Work-interated Learning) in researching digital technologies in K-12 schools with the ambition to contribute to the continued implementation, integration and use of digital technologies in Swedish K-12 schools that stems from the evidence-based knowledge produced within the activities of GRADE. The research within GRADE will be characterized by close cooperation with stakeholders from school practice, with the aim to contribute to concrete school development. In GRADE, a multi-level approach that involves multiple layers or levels of school activities will be encouraged. When possible, studies will be longitudinal. This will imply studies from an organizational and management perspective, e.g. studies of school leaders and other members of senior management positions responsible for digital technology use and implementation. Also implied are studies of teachers' teaching practices and didactical considerations, as well as studies of the students in classrooms and their learning using digital technologies. This will also imply that several issues with a bearing on the digitalization of education, for example regarding school policy, teaching, learning, assessment and professional development will be researched from different perspectives and with different methodological approaches. In this paper, these points of departure will be explored based on the expectations and experiences of the first twelve admitted doctoral students and their supervisors.
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| 6. |
- Ivarsson, Sten-A., et al.
(författare)
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Glutamate decarboxylase antibodies in non-diabetic pregnancy precedes insulin-dependent diabetes in the mother but not necessarily in the offspring
- 1997
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Ingår i: Autoimmunity. - 0891-6934. ; 26:4, s. 261-269
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Tidskriftsartikel (refereegranskat)abstract
- We studied the risk for diabetes of glutamate decarboxylase (GAD65Ab) and islet cell (ICA) autoantibodies in non-diabetic pregnant mothers and their children. Pregnancy and cord blood sera were collected in 1970-87 from about 35,000 mothers who delivered a child in the city of Malmo, Sweden. A total of 42 mothers were identified in 1988 who, 1-18 years after their pregnancies, had developed either insulin-dependent (n = 22) or non-insulin dependent (n = 20) diabetes mellitus. First, in 123 pregnant mothers selected as controls, 0.8% had GAD65Ab and 0.8% ICA. Second, among the mothers with non-insulin dependent diabetes, 7/20 (35%) had GAD65Ab eight months to 13 years, 10 months before clinical diagnosis. Third, in mothers who later developed insulin-dependent diabetes, 12/22 (55%) had GAD65Ab and 10/22 (45%) had ICA in pregnancies preceding the clinical diagnosis by 13 months to 9 years, 4 months. In 1996, none of the children born to the 42 mothers have developed diabetes. GAD65Ab and ICA in non-diabetic pregnancies may predict insulin-dependent diabetes in the mother but not necessarily in the offspring.
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| 7. |
- Ng, Nawi, 1974, et al.
(författare)
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Sustainable Behavior Change for Health Supported by Person-Tailored, Adaptive, Risk-Aware Digital Coaching in a Social Context: Study Protocol for the STAR-C Research Programme
- 2021
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Ingår i: Frontiers in Public Health. - : Frontiers Media SA. - 2296-2565. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Vasterbotten Intervention Programme (VIP) in the Region Vasterbotten Sweden is one of the very few cardiovascular disease (CVD) prevention programmes globally that is integrated into routine primary health care. The VIP has been shown as a cost-effective intervention to significantly reduce CVD mortality. However, little is known about the effectiveness of a digital solution to tailor risk communication strategies for supporting behavioral change. STAR-C aims to develop and evaluate a technical platform for personalized digital coaching that will support behavioral change aimed at preventing CVD. Methods: STAR-C employs a mixed-methods design in seven multidisciplinary projects, which runs in two phases during 2019-2024: (i) a formative intervention design and development phase, and (ii) an intervention implementation and evaluation phase. In the 1st phase, STAR-C will model the trajectories of health behaviors and their impact on CVDs (Project 1), evaluate the role of the social environment and social networks on behavioral change (Project 2) and assess whether and how social media facilitates the spread of health information beyond targeted individuals and stimulates public engagement in health promotion (Project 3). The findings will be utilized in carrying out the iterative, user-centered design, and development of a person-tailored digital coaching platform (Project 4). In the 2nd phase, STAR-C will evaluate the implementation of the coaching programme and its effectiveness for promoting behavioral change and the spreading of health information across social networks and via social media (Project 5). The cost-effectiveness (Project 6) and ethical issues (Project 7) related to the coaching programme intervention will be evaluated. Discussion: The STAR-C research programme will address the knowledge and practice research gaps in the use of information technologies in health promotion and non-communicable disease (NCD) prevention programmes in order to narrow the health inequality gaps. Ethics: STAR-C has received approval from the Swedish Ethical Review Authority (Dnr. 2019-02924;2020-02985). Dissemination: The collaboration between Umea University and Region Vasterbotten will ensure the feasibility of STAR-C in the service delivery context. Results will be communicated with decision-makers at different levels of society, stakeholders from other regions and healthcare professional organizations, and through NGOs, local and social media platforms.
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| 10. |
- Andersson, Roger, et al.
(författare)
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Analysis of the relationship between UV-absorbance of solute contents during a dialysis session
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In this paper, the influence from patient anamnesis and haemodialysis session specifications onto the relationship between obtained ultra violet (UV) absorbance and urea concentration in the spent dialysate were discussed. A characterisation of the relationship was done by an intercept value and a slope. Recently, a new a dialysate monitoring device, using UV- absorbance, been developed by our group which has found a relationship between the UV- absorbance and waste products in the dialysate but this relationship vary between patients. In the present investigation, 13 patients performing totally 84 sessions were characterised using 31 possible affecting parameters. Using a multi-regression analysis 11 parameters were found significant as affecting parameters. In a novel mathematical model approach the obtained UV- absorbance and incorporating possible affecting parameters we could predict urea concentration from the UV-absorption in the spent dialysate in the total material of patients and dialysis sessions. For all the 84 sessions R2 between 0.938 and 0.996 were obtained. A performed analysis of variance rejects the assumption of equal conditions for the relationship between diabetics and non-diabetics patients in the material (F=5.2 for intercept and F=14.4 for slope). The urea concentration could be estimated with an accuracy of 11% (one standard deviation) which is normally clinically sufficient. The non-invasive UV -absorption method therefore seems to have great potential for monitoring and control haemodialysis sessions.
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