| 1. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 2. |
- Bergström, Göran, 1964, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
-
Ingår i: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
-
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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| 3. |
- Eskner Skoger, Ulrika, 1968-
(författare)
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Mellan könsspecifika förväntningar och ett neutralt kunskapsideal : att förhålla sig till betydelser av kön som barnpsykolog i Sverige
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Detta avhandlingsarbete undersöker hur psykologer förhåller sig till de olika betydelser av kön som finns i de sammanhang de befinner sig i när de utövar sitt yrke. Genom att utforska de betydelser som barn- och ungdomspsykologer ger skillnader mellan flickor och pojkar har jag identifierat svårigheter och möjligheter när det gäller att inkludera sociala och kulturella aspekter i beskrivningar av barns och ungas psykologiska utveckling inom psykologiprofessionen i Sverige. Ett inkluderande av sociala och kulturella aspekter skulle bidra till en förståelse för hur barns psykologiska fungerande hänger ihop med de samhälleliga sammanhang de befinner sig i, och kunna användas för att ge barnen ett bättre stöd i behandlingsarbete. Metod Elva intervjuer med svenska barn- och ungdomspsykologer, samt tre svenska läroböcker i utvecklingspsykologi analyserades. Analyserna utgick från socialkonstruktionistiska och diskurspsykologiska perspektiv. Resultat Analyserna visade att psykologerna gav kön, genus och jämställdhet flera olika betydelser och att dessa olika betydelser ofta var motstridiga. Ett glapp identifieras mellan övergripande beskrivningar av barn och ungas utveckling där ambitionen att beskriva psykologisk utveckling som en interaktion mellan biologiska och kulturella faktorer tydligt kom till uttryck, och de mer konkreta beskrivningarna av psykologisk utveckling där ett biologiskt och/eller individinriktat synsätt gavs företräde. Detta glapp kom framförallt till uttryck i läroböckerna. I barn- och ungdomspsykologernas tal om sitt arbete blev ett annat glapp synligt. När de talade mer övergripande om vad ett professionellt förhållningssätt till kön innebar baserade sig talet på strävan efter neutralitet och en syn på kön som ovidkommande för psykologisk behandling. När talet handlade om det konkreta behandlingsarbetet konstruerades kön som skillnader. Barn- och ungdomspsykologerna tycktes sitta fast i ett dilemma mellan en könsneutral retorik och ett bemötande och en behandling som utgick från könsskillnader som ”naturliga”. Det snäva individfokus som kom till uttryck i psykologernas berättelser lyfts fram som en förklaring till att psykologerna inte själva tycktes uppmärksamma detta glapp under sitt berättande. En fråga där psykologerna ställde kritiska frågor kring jämställdhet och lika fördelning av resurser handlade om att så få flickor i yngre åldrar besöker barn- och ungdomspsykiatrin. Vid dessa tillfällen kom en vilja att omfatta flickors och pojkars olika livsvillkor som förklaring till könsskillnader till uttryck. Då det i deras tal inte fanns några kopplingar mellan den olika fördelningen av resurser och över- och underordning mellan kvinnor och män på en samhällsnivå, verkade psykologerna dock sakna tillgång till analytiska redskap att fullfölja tankarna om olika livsvillkor. Försöken att kontextualisera flickornas ”osynlighet” tycktes då landa i en anpassning efter könsstereotyper för ”deras eget bästa”. Jag identifierade några undantag från detta mönster. Några få psykologer uttryckte explicit ett jämställdhetsintresse och en önskan att arbeta på ett jämställt sätt i sitt behandlingsarbete. Analyserna av deras berättelser visar att professionella ideal när det gäller kunskapssyn hade stor betydelse för om, och hur, de kunde motarbeta ett könsstereotypt förhållningssätt i sitt arbete. En strategi att arbeta för jämställdhet utifrån ett neutralt kunskapsideal tycktes leda till ett fokus på ”likabehandling” och osynliggöra skillnader i värdering och handlingsutrymme mellan flickor och pojkar. En strategi att arbeta för jämställdhet som baserar sig i idealet ”rättvist resultat” tycktes öppna upp för möjligheter att upprätthålla uppmärksamheten på orättvisor och maktprocesser mellan könen. Slutsats Möjligheterna att inkludera kulturella och sociala betydelser av kön i psykologiskt behandlingsarbete med barn och unga verkar hänga nära samman med psykologers professionella ideal för vad som är legitim kunskap. I vilken utsträckning psykologerna hade tillgång till analytiska redskap att reflektera över kopplingar mellan problemen hos de flickor och pojkar de träffade och över- och underordning mellan kvinnor och män på en samhällsnivå var också viktigt. Sådana tankemässiga redskap, som utgår från feministiska teorier och genusvetenskap, saknades till stor del i de intervjuer och de läroböcker som granskades.
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| 4. |
- Hallberg, Gunilla
(författare)
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Effects of Endogenous and Exogenous Hormones on the Female Breast : With Special Reference to the Expression of Proteoglycans
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to study the effects of endogenous and exogenous hormones and mammographic breast density (BD) on cellular markers in non-cancerous female breast tissue. Women on the waiting list for breast reduction plastic surgery were recruited (n = 79), and randomized to 2 months of hormone therapy or no therapy before surgery. The women had a mammogram and a needle biopsy 2 months before surgery and tissue samples were obtained at the operation. In premenopausal women, estrogen receptor (ER)α levels were associated with age (p = 0.0002), were similar in the follicular and luteal phases of the menstrual cycle and were higher in parous than in nulliparous women (p = 0.009). Current smokers had lower PR levels than non-smokers (p = 0.019). Women on oral contraception had lower ERα (p = 0.048) and PR (p = 0.007) levels than women in the follicular phase. The ERα levels did not differ significantly between postmenopausal estrogen and estrogen-progestogen users, but PR levels were lower among estrogen-progestogen users (p = 0.03). We found lower expression of the genes for decorin and syndecans 1 and 4 in the luteal phase than in the follicular phase, among parous women. Protein levels of the androgen receptor, syndecan-4 and decorin was lower in premenopausal women who were using oral contraceptives (OC) than in those in the follicular phase (p = 0.002 - 0.02), whereas no significant differences between OC use and the luteal phase were found. In premenopausal women, BD was negatively associated with age and body mass index but was similar for the menstrual phases. Breast density was associated with genetic expression of the androgen receptor and remained significant after adjustment for age (rs = 0.56; p = 0.04). After adjustement for age, breast density was also marginally associated with expression of the caspase 3 gene (0.55; 0.053). However, protein levels of caspase 3 was negatively associated (-0.61; 0.03).
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| 5. |
- Hamreby, Kerstin, 1950-
(författare)
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Flickor och pojkar i den sociala barnavården : Föreställningar om kön och sociala problem under 1900-talet
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The topic of this study is girls and boys in the field of child welfare. The aim has been to trace and describe conceptions of gender, delinquency and social problems in child welfare from the end of the nineteenth century until the middle of the twentieth century. The sources of data in the study consist of legislative documents, journals and other historical literature representing the professional discourse. Two analytical approaches have been used. First, the sources were employed for descriptions of legislation and the legislative processes in child welfare. Second, the material was analyzed with a discursive approach to elucidate conceptions of gender and their importance in the legislative process and thus in the construction of social problems. Three main periods with different currants of ideas have been identified. In the first period moralism dominated. Thoughts about social problems were based in normative assumptions and scientific influences were rare. Child welfare legislation was deeply influenced by ideas of social control. Young people were to be controlled and disciplined especially through work: Girls through household work and care and boys through paid work. In the second period hygienism, ideas based in hygiene discourses, were the main trend. Genetically based arguments together with discussions about morality and poverty were used to explain social problems, and scientific methods were to be used to discipline and control young people. Proposals for measures take against social problems corresponded to two main lines, a hygienic-medical line and a social pedagogic line. The hygienic-medical line had a considerable influence on actions taken to prevent and deal with social problems. One example was the compulsory care and sterilization of certain young women to prevent them from reproducing. The social pedagogic line comprised parents’ education, the role of the family and sexual education. An increased use of psychological explanations for experiences and behaviour among individuals and groups was seen in the 1930’s; this marked the beginning of the third period, psychologism. During the period of psychologism, science, mainly represented by psychology and psychiatry, gradually achieved a greater impact in those processes where young people were categorized as social problems. If in the previous period external discipline was the means of control, in this period internalized self-discipline was to be the means of adjustment. The study showed that conceptions of girls and boys in child welfare were gendered throughout the first half of the twentieth century. This bias has had an impact on how girls and boys were treated in child welfare services. Discussions about social problems concerning girls were often about sexuality and sexual actions, and discussions concerning boys were about violence and criminality. Social problems among girls were seen above all as moral transgressions and social problems among boys as juridical transgressions. These differing conceptions are of great importance when considering how girls and boys were judged and treated according to the child welfare Acts in existence during the first part of the twentieth century.
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| 6. |
- Bergström, Göran, 1964, et al.
(författare)
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Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS.
- 2023
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 373, s. 46-54
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Tidskriftsartikel (refereegranskat)abstract
- Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomography angiography (CCTA) and expressed as segment involvement score (SIS).The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p<0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.
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| 7. |
- Björk, Stefan, 1972-
(författare)
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Män möter mödravård : om betydelsen av "vi" i mötet med mödrahälsovård, förlossningsvård och BB-vård
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I dagens Sverige är det en självklarhet att blivande pappor skall vara delaktiga och engagerade i graviditet, förlossning och omvårdnad av det nyfödda barnet. De flesta pappor är med vid besöken på barnmorskemottagningen inklusive ultraljudsundersökningen, deltar i föräldrautbildningen och är med vid barnets födelse. Ändå uttrycker många pappor missnöje med mödrahälsovården, förlossningsvården och BB-vården. När de tillfrågas om saken uppger de ofta att de känner sig utanför, osynliga och ovidkommande. Den här studien är ett försök att bättre förstå de upplevelserna.Studien grundar sig på intervjuer med tio svenska pappor. Pappornas berättelser om mötet med mödrahälsovården, förlossningsvården och BB-vården analyserades med en narrativ forskningsansats där särskilt fokus lades på hur de i berättelsen förekommande personerna framställdes eller positionerades.Avhandlingens resultat kan sammanfattas i tre punkter: (1) Mödrahälsovårdens fokus på de fysiska aspekterna av graviditet och förlossning innebär att den blivande/nyblivna pappan kan ha svårt att finna en meningsfull plats eller position i mötet med mödrahälsovård, förlossningsvård och BB-vård. (2) De intervjuade pappornas berättelser om dessa möten kan grovt sett indelas i "vi"-berättelser där pappan fann en obesvärad position och "jag"-berättelser där han inte gjorde det. Detta har jag tolkat som att papporna i dessa möten eftersträvade en "vi"-position där graviditet och förlossning kunde bli en för mamman och pappan gemensam angelägenhet. (3) Svårigheten att finna en obesvärad position i mötet med mödrahälsovård, förlossningsvård och BB-vård har i första hand att göra med att den blivande/nyblivna pappan inte är gravid, inte att han är man. Det är huruvida kroppen är gravid eller inte gravid som skapar gränsen, inte vilket kön kroppen har. Den sökta "vi"-positionen kan därför betecknas som könsirrelevant.En slutsats är att om mödrahälsovård, förlossningsvård och BB-vård vill göra den blivande mammans partner verkligt delaktig i graviditet, förlossning och spädbarnsomvårdnad är den relevanta frågan: hur kan man bidra till att den blivande/nyblivna mammans partner kan finna en position som bättre inkluderar honom/henne i detta möte? En möjlig sådan position är den i denna studie påvisade "vi"-position där graviditet, förlossning och spädbarnsomvårdnad är en för båda föräldrarna gemensam angelägenhet. Att ge plats för en "vi"-position innebär också att sträcka ut tidsperspektivet från graviditetens här-och-nu förbi den annalkande förlossningen till det som kommer därefter: föräldraskapet -- oavsett vem som har varit gravid.
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| 8. |
- Huang, Ying Ying, 1976-
(författare)
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Design and Evaluation of 3D Multimodal Virtual Environments for Visually Impaired People
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Spatial information presented visually is not easily accessible to visually impairedusers. Current technologies, such as screen readers, cannot intuitively conveyspatial layout or structure. This lack of overview is an obstacle for a visuallyimpaired user, both when using the computer individually and when collaboratingwith other users. With the development of haptic and audio technologies, it ispossible to let visually impaired users access to three-dimensional (3D) VirtualReality (VR) environments through the senses of touch and hearing.The work presented in this thesis comprises investigations of haptic and audiointeraction for visually impaired computer users in two stages.The first stage of my research focused on collaborations between sighted andblind-folded computer users in a shared virtual environment. One aspect Iconsidered is how different modalities affect one’s awareness of the other’sactions, as well as of one’s own actions, during the work process. The secondaspect I investigated is common ground, i.e. how visually impaired people obtaina common understanding of the elements of their workspace through differentmodalities. A third aspect I looked at was how different modalities affectperceived social presence, i.e. their ability to perceive the other person’sintentions and emotions. Finally, I attempted to understand how human behaviorand efficiency in task performance are affected when different modalities are usedin collaborative situations.The second stage of my research focused on how the visually impaired access3D multimodal virtual environment individually. I conducted two studies basedon two different haptic and audio prototypes concerning understanding the effectof haptic-audio modalities on navigation and interface design. One prototype thatI created was a haptic and audio game, a labyrinth. The other is a virtualsimulation environment based on the real world of Kulturhuset in Stockholm. Oneaspect I investigated in this individual interaction is how it is possible for users toaccess the spatial layout through a multimodal virtual environment. The secondaspect I investigated is usability; how the haptic and audio cues help visuallyimpaired people understand the spatial layout. The third aspect concernsnavigation and cognitive mapping in a multimodal virtual environment.This thesis contributes to the field of human-computer interaction for thevisually impaired with a set of studies of multimodal interactive systems, andbrings new perspectives to the enhancement of understanding real environmentsfor visually impaired users through a haptic and audio virtual computerenvironment.
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| 9. |
- Kriit, Hedi Katre, et al.
(författare)
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Using Distributed Lag Non-Linear Models to Estimate Exposure Lag-Response Associations between Long-Term Air Pollution Exposure and Incidence of Cardiovascular Disease
- 2022
-
Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:5
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Tidskriftsartikel (refereegranskat)abstract
- Long-term air pollution exposure increases the risk for cardiovascular disease, but little is known about the temporal relationships between exposure and health outcomes. This study aims to estimate the exposure-lag response between air pollution exposure and risk for ischemic heart disease (IHD) and stroke incidence by applying distributed lag non-linear models (DLNMs). Annual mean concentrations of particles with aerodynamic diameter less than 2.5 µm (PM2.5 ) and black carbon (BC) were estimated for participants in five Swedish cohorts using dispersion models. Simultaneous estimates of exposure lags 1–10 years using DLNMs were compared with separate year specific (single lag) estimates and estimates for lag 1–5-and 6–10-years using moving average exposure. The DLNM estimated no exposure lag-response between PM2.5 total, BC, and IHD. However, for PM2.5 from local sources, a 20% risk increase per 1 µg/m3 for 1-year lag was estimated. A risk increase for stroke was suggested in relation to lags 2–4-year PM2.5 and BC, and also lags 8–9-years BC. No associations were shown in single lag models. Increased risk estimates for stroke in relation to lag 1–5-and 6–10-years BC moving averages were observed. Estimates generally supported a greater contribution to increased risk from exposure windows closer in time to incident IHD and incident stroke. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
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| 10. |
- Landström, Eva, 1975-
(författare)
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To Choose or not to Choose Functional Foods, that is the Question : Swedish Consumers’ and Health-care Professionals’ Attitudes to and Use of Functional Foods
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to investigate attitudes to functional foods (here defined as foods with health claims) among Swedish consumers and health-care professionals. The aim is also to survey demographics and health interests associated with the consumption of functional foods among Swedish consumers. Finally, the aim is to investigate health-care professionals’ knowledge of and willingness to recommend functional foods to patients.Examples of functional foods used in the studies are probiotic fruit-drinks, probiotic milk-products, cholesterol-lowering spreads and fibre-rich bread with omega-3 fatty acids. Ten focus groups of consumers and three of health-care professionals were conducted. Two questionnaires were also used, one for consumers aged 17-75 years (n=2000) and one for health-care professionals (dieticians, n=100; registered nurses, n=200; physicians, n=200). Almost half of the consumers (48%) and exactly half (50%) of the health-care professionals responded.The consumers wondered whether the functional foods were normal foods or medicines. They considered functional foods unnecessary, unless you suffer from incurable diet-related problems. The consumers were worried that the foods could be used as a compensation for an unhealthy lifestyle. While the consumers in the focus groups were mainly sceptical towards functional foods, these foods are being consumed by those who perceive them as necessary, the health-conscious, the well-educated and people who have noticed effect of the foods.The registered nurses and physicians, in contrast to the dieticians, expressed doubts regarding the claimed effects of the functional foods. The dieticians rated higher knowledge and were more willing to recommend functional foods to patients than were the physicians and, to some extent, the registered nurses. The interviews with the health-care professionals revealed that the dieticians were more positive towards functional foods than the registered nurses and, primarily, the physicians. This was confirmed through the questionnaire. Those, who consumed functional foods, reported high knowledge, and perceived benefits of functional foods, were most likely to recommend these foods to patients.
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