| 1. |
- Alftberg, Åsa, et al.
(författare)
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Conversations about Death and Dying with Older People : An Ethnographic Study in Nursing Homes
- 2018
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Ingår i: Healthcare. - : MDPI. - 2227-9032. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Nursing homes are often places where older persons “come to die.” Despite this, death and dying are seldom articulated or talked about. The aim of this study was to explore assistant nurses’ experiences of conversations about death and dying with nursing home residents. This study is part of an implementation project through a knowledge-based educational intervention based on palliative care principles. An ethnographic study design was applied in seven nursing homes, where eight assistant nurses were interviewed and followed in their daily assignments through participant observations. The assistant nurses stated that they had the knowledge and tools to conduct such conversations, even though they lacked the time and felt that emotional strain could be a hinder for conversations about death and dying. The assistant nurses used the strategies of distracting, comforting, and disregarding either when they perceived that residents’ reflections on death and dying were part of their illness and disease or when there was a lack of alignment between the residents’ contemplations and the concept of dying well. They indicated that ambivalence and ambiguity toward conversations about death and dying should be taken into consideration in future implementations of knowledge-based palliative care that take place in nursing homes after this project is finalized.
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| 2. |
- Bjarnegård, Niclas, et al.
(författare)
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Age affects proximal brachial artery stiffness : differential behaviour within the length of the brachial artery?
- 2003
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Ingår i: Ultrasound in Medicine and Biology. - 0301-5629. ; 29:8, s. 1115-1121
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Tidskriftsartikel (refereegranskat)abstract
- With increasing age, the diameter of central elastic arteries increases, whereas their distensibility decreases. The purpose of this study was to investigate the mechanical properties of the proximal brachial artery in relation to age and gender. Distensibility coefficient (DC), stiffness and compliance coefficient (CC) were calculated in 136 healthy males and females (range 9-82 y) using echo-tracking sonography. CC decreased with age in both genders, but CC was higher in males. Stiffness increased and DC decreased with age in an exponential manner, without any differences between genders. In conclusion, as in central elastic arteries, the distensibility of the proximal brachial artery decreases with age, in contrast to earlier reports on the muscular distal brachial artery. This may imply that the transition between elastic and muscular artery behavior is within the length of the brachial artery. In future studies using the brachial artery, the examination site needs to be defined.
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| 3. |
- De Basso, Rachel, et al.
(författare)
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Increased cardiovascular risk without generalized arterial dilating diathesis in persons who do not have abdominal aortic aneurysm but who are first-degree relatives of abdominal aortic aneurysm patients
- 2015
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Ingår i: Clinical and Experimental Pharmacology and Physiology. - : Wiley. - 1440-1681 .- 0305-1870. ; 42:6, s. 576-581
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Tidskriftsartikel (refereegranskat)abstract
- There is a strong genetic predisposition towards abdominal aortic aneurysm (AAA), but it is unknown whether persons without AAA but with first-degree relatives who are AAA patients have a generalized dilating diathesis, defect arterial wall mechanics, or increased cardiovascular risk. The aim of the study was to investigate arterial diameters and wall mechanics at multiple arterial sites in these subjects and compare them with controls without a family history of AAA. This study included 118 first-degree relatives of patients with AAA and 66 controls (age: 40-80years). The abdominal aorta, common carotid artery, common femoral artery, and popliteal artery were investigated by echo-tracking ultrasound. The relatives had no arterial dilatation, but they did tend to have smaller diameters than controls. Relatives had a higher heart rate, diastolic blood pressure, and mean arterial pressure than controls. The distensibility coefficient and the compliance coefficient were decreased in all arteries in male relatives, adjusted for age and smoking; these coefficients were normalized after adjustment for mean arterial pressure and heart rate. Female relatives had a lower compliance coefficient in the abdominal aorta, adjusted for age and smoking. After adjustment for mean arterial pressure and heart rate, the difference disappeared. No general arterial dilatation in relatives without AAA was found, supporting the hypothesis that the dilating diathesis is linked to the aneurysmal manifestation in the abdominal aorta. Although the threat of aneurysmal dilatation and rupture seems to be lacking in these subjects, heart rate, blood pressure, and arterial wall stiffness were all increased, which may indicate a higher risk of developing cardiovascular morbidity and mortality.
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| 4. |
- De Basso, Rachel, et al.
(författare)
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Low wall stress in popliteal artery – other mechanisms responsible for the predilection of aneurysmal dilatation?
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The popliteal artery (PA) is, after aorta, the most common site for aneurysm formation. Why the PA is more susceptible than other peripheral muscular arteries is unknown. We hypothesised that the wall composition, which in turn affects wall properties, as well as the circumferential wall stress imposed on the arterial wall, might differ compared to other muscular arteries. The aim was to study the circumferential wall stress of the PA in healthy subjects with the adjacent muscular common femoral artery (CFA) as a comparison.Material and Methods: Ninety-four healthy subjects were included in this study (45 males, range 10-78 years and 49 females, range 10-83 years). The lumen diameter (LD) and intima-media thickness (IMT) in the PA and CFA were investigated with a Philips P700 ultrasound device. Together with blood pressure the circumferential wall stress was defined according to the law of Laplace adjusted for IMT.Results: The diameter increased with age in both PA and CFA (P<.001), with males having larger diameter than females (P<.001). IMT increased with age in both PA and CFA (P<.001), with higher IMT values in males only in PA (P<0.001). The calculated wall stress was unchanged with age in both arteries, but lower in PA than in CFA in both male and female subjects (P<0.001).Conclusion: This study shows that the popliteal and common femoral artery wall stress is maintained during ageing, probably due to compensatory remodeling response with an increase in arterial wall thickness. However, the stress imposed on the popliteal artery wall is quite low, indicating that other mechanisms than wall stress contribute to the process of pathological arterial dilatation in the popliteal artery.
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| 5. |
- De Basso, Rachel, et al.
(författare)
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Low wall stress in the popliteal artery: Other mechanisms responsible for the predilection of aneurysmal dilatation?
- 2014
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Ingår i: Vascular Medicine. - : SAGE Publications (UK and US). - 1477-0377 .- 1358-863X. ; 19:2, s. 131-136
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Tidskriftsartikel (refereegranskat)abstract
- The popliteal artery (PA) is, after aorta, the most common site for aneurysm formation. Why the PA is more susceptible than other peripheral muscular arteries is unknown. We hypothesized that the wall composition, which in turn affects wall properties, as well as the circumferential wall stress (WS) imposed on the arterial wall, might differ compared to other muscular arteries. The aim was to study the WS of the PA in healthy subjects with the adjacent, muscular, common femoral artery (CFA) as a comparison. Ninety-four healthy subjects were included in this study (45 males, aged 10-78 years and 49 females, aged 10-83 years). The diameter and intima-media thickness (IMT) in the PA and CFA were investigated with ultrasound. Together with blood pressure the WS was defined according to the law of Laplace adjusted for IMT. The diameter increased with age in both PA and CFA (p<0.001), with males having a larger diameter than females (p<0.001). IMT increased with age in both PA and CFA (p<0.001), with higher IMT values in males only in PA (p<0.001). The calculated WS was unchanged with age in both arteries, but lower in PA than in CFA in both sexes (p<0.001). In conclusion, this study shows that the PA and CFA WS is maintained during aging, probably due to a compensatory remodelling response with an increase in arterial wall thickness. However, the stress imposed on the PA wall is quite low, indicating that mechanisms other than WS contribute to the process of pathological arterial dilatation in the PA.
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| 6. |
- Debasso, Rachel, 1978-, et al.
(författare)
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The popliteal artery, an unusual muscular artery with wall properties similar to the aorta : Implications for susceptibility to aneurysm formation?
- 2004
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Ingår i: Journal of Vascular Surgery. - : Elsevier BV. - 0741-5214 .- 1097-6809. ; 39:4, s. 836-842
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The popliteal artery is, after the aorta, the most common site for aneurysm formation. Why the popliteal artery is more susceptible than other peripheral muscular arteries is unknown. An important factor may be differences in arterial wall composition as compared with other peripheral muscular arteries, which in turn affect wall properties. These are however unknown. We studied the mechanical wall properties of the popliteal artery in healthy subjects. Material and Methods: An ultrasound echo-tracking system was used to measure pulsatile changes in popliteal diameter in 108 healthy subjects (56 female, 52 male, age range, 9-82 years). In combination with blood pressure, stiffness (β), strain, cross-sectional artery wall compliance coefficient (CC), and distensibility coefficient (DC) were calculated. Intima-media thickness (IMT) was registered with a Philips P700 ultrasound scanner. Results: The popliteal diameter increased with age, and was larger in male subjects than in female subjects (P < .001). Fractional diameter change (strain) decreased with age (P < .001), and strain values were lower in male subjects than in female subjects (P < .01). Accordingly, stiffness increased with age (P < .001), with higher stiffness values in male subjects (P < .01). DC decreased with age (P < .001), with lower DC values in male subjects (P < .01). CC decreased with age, with no difference between genders (P < .001). IMT increased with age (P < .001), with higher IMT values in male subjects (P < .001). The increase in IMT did not affect distensibility. Conclusion: The wall properties of the popliteal artery are affected by age and gender, not only with an increase in diameter, but also with an age-related decrease in distensibility, with male subjects having lower distensibility than in female subjects. This seems not to be the behavior of a true muscular artery, but of a central elastic artery, such as the aorta, and might have implications for susceptibility to arterial dilatation, as well as the association of aneurysm formation between the aorta and the popliteal artery.
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| 7. |
- Goldsteins, Gundars, et al.
(författare)
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Characterisation of two highly amyloidogenic mutants of transthyretin
- 1997
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Ingår i: Biochemistry. - : American Chemical Society (ACS). - 0006-2960 .- 1520-4995. ; 36:18, s. 5346-5352
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Tidskriftsartikel (refereegranskat)abstract
- The plasma protein transthyretin (TTR) has the potential to form amyloid under certain conditions. More than 50 different point mutations have been associated with amyloid formation that occurs only in adults. It is not known what structural changes are introduced into the structure of this otherwise stable molecule that results in its aggregation into insoluble amyloid fibrils. On the basis of calculations of the frequency of known mutations over the polypeptide, we have constructed two mutants in the D-strand of the polypeptide. These molecules, containing either a deletion or a substitution at amino acid positions 53−55, were unstable and spontaneously formed aggregates upon storage in TBS (pH 7.6). The precipitates were shown to be amyloid by staining with thioflavin T and Congo Red. Their ultrastructure was very similar to that of amyloid fibrils deposited in the vitreous body of patients with familial amyloidotic polyneuropathy type 1 with an amino acid replacement in position 30 (TTRmet30). Like amyloid isolated from the vitreous body of the eye, the amyloid precipitates generated from the TTR mutants exposed a trypsin cleavage site between amino acid residues 48 and 49, while plasma TTRmet30 isolated from amyloidosis patients as well as wild-type TTR only showed minor trypsin sensitivity. Our data indicate that the mutants we have constructed are similar to amyloid precursors or may share structural properties with intermediates on a pathway leading to amyloid deposits of plasma TTR.
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| 8. |
- Görman, Frida, et al.
(författare)
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Klimatpåverkan från en byggnads hela livscykel: Bakgrundsrapport till anvisningar för LCA-beräkningar
- 2024
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Senast år 2045 ska Sverige enligt det nationella klimatmålet inte ha några nettoutsläpp av växthusgaser till atmosfären. För att nå detta mål måste alla sektorer bidra. Bygg- och anläggningssektorn står för ungefär en femtedel av Sveriges totala klimatpåverkan och har tagit fram en färdplan för fossilfri konkurrenskraft för att bidra till detta mål. En del av åtgärderna i färdplanen är att minska klimatpåverkan från byggnader under hela dess livscykel, det vill säga utöver byggskedet ska även användningsskedet och slutskedet ingå. Genomförandet av en klimatberäkning av en byggnads hela livscykel är däremot inte helt enkelt och kräver flera aktiva metodval och antaganden.Krav på beräkning av en byggnads hela livscykel förekommer även både i EU:s taxonomi och det uppdaterade Energy Performance of Buildings Directive (EPBD). Trots dessa krav saknas nationella riktlinjer för hur sådana beräkningar bör utföras. Detta projekt har syftat till att ta fram gemensamma anvisningar för beräkning av byggnaders hela livscykel.Gemensamma beräkningsanvisningar för bygg- och fastighetsbranschen förväntas underlätta jämförelser mellan olika beräkningar samtidigt som de bidra till konkurrensneutralitet mellan aktörer. Gemensamma beräkningsanvisningar är också en förutsättning för att kunna förhålla sig till mål och gränsvärden samt rikta klimatförbättrande åtgärder. Enskilda aktörer i Sverige, så som byggentreprenörer och fastighetsägare, ska då kunna analysera sina åtgärder mot så väl nationella som EU:s krav.I detta projekt har särskilt fokus lagts på framtagande av beräkningsanvisningar för användningsskedet och slutskedet av byggnaders livscykel. Detta beror på att beräkningsmetodik och anvisningar för byggskedet redan har utvecklats nationellt genom lagen om klimatdeklaration för byggnader, som trädde i kraft den 1 januari 2022.De framtagna beräkningsanvisningarna är avsedda att vara gemensamma, verktygsneutrala och förenkla beräkningen av klimatpåverkan från en byggnads hela livscykel. Målet är att de ska vara i linje med LCA-kraven för nya byggnader enligt EU:s taxonomi, EPBD och standarden för klimatberäkningar av byggnader, EN 15978. Det är viktigt att notera att anvisningarna kan behöva uppdateras när mer information blir tillgänglig, exempelvis genom den delegerade akten till EPBD som ska komma i december 2025.Framtagna beräkningsanvisningarna har arbetats fram tillsammans med branschen genom en workshopserie, en kompletterande workshop med påföljande remissrunda för preliminära beräkningsanvisningar. Efter den inledande workshopsserien testades olika metodval, LCA-data och scenarioantaganden i fallstudier. Resultaten från dessa fallstudier låg sedan till grund för den kompletterande workshopen. Därefter sammanfattades resultaten i preliminära beräkningsanvisningar som skickades ut på remiss till projekt- och referensgrupper.Utöver projektgrupp och referensgrupp har ytterligare aktörer bjudits in till ett informationsmöte där dessa aktörer hade möjlighet att ge synpunkter och kommentarer utifrån deras roll. På detta möte deltog cirka 40 olika organisationer. På så sätt har det som tagits fram förankrats hos sektorns olika aktörer.Utfallet från workshops, fallstudier och hearing har resulterat i en rad slutsatser och rekommendationer som presenteras i denna rapport. Ett antal frågor har också identifierats som behöver arbetas vidare med i framtida projekt. Gemensamt med denna rapport har beräkningsanvisningar tagits fram som beskriver vilka regler som beräkningarna av en byggnads livscykel ska följa.De viktigaste slutsatserna från genomförandet av projektet och vid framtagande av beräkningsanvisningar kan sammanfattas med följande punkter:• Användning av beräkning enligt framtagna beräkningsanvisningar som ensamt beslutsunderlag kan vara problematisk.• Klimatförbättringsscenario baserat på beslutade åtgärder ska användas för delar av livscykeln, för att avspegla en mer realistisk minskad klimatpåverkan över tid.• Ursprungsgarantier (gröna avtal) och liknande ska inte användas eftersom det inte speglar den faktiska påverkan från använd energi.• Svensk elmix ska användas, nordisk elmix rekommenderas som tillägg.• Lokala värden för fjärrvärme rekommenderas men svenskt medelvärde kan användas.• EPD:er med marknadsbaserad energimix bör undvikas om möjligt.• Egna scenarion och antaganden ska inte användas då de är svåra att verifiera och jämförbarhet mellan beräkningarna minskar.• Nuvarande standard belyser inte potentiell nytta med flexibla och demonterbara byggnader, varför särskilda indikatorer för detta bör tas fram.• Scenariobaserade data (modul A4 till D) från EPD:er för byggmaterial ska inte användas.
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| 9. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field. image
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| 10. |
- Persson, Åsa, 1966-
(författare)
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De politiska partiernas rättspolitik
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Political parties act in law and politics and have opinions that can be aligned along a law-politics dimension. The purpose of this thesis is to problematize and analyze the conceptualization of law and politics as distinctly separate phenomena by studying the law and politics dimension in Swedish party politics. Specifically, it is a study of political parties´views and arguments as regards core elements of the relationship between the individual and the state. The research problematizes knowledge about law and politics in the borderland between legal scholarship and political science. To identify political parties´views and arguments as regards law and politics the study contains their views and arguments as regards state use of concealed and coercive measures, legal aid and legislation for the protection of and support to victims of crime. In order to capture possible shifts in party positions the study covers the twentieth century. These cases are of central importance of the field and are closely connected to the principles of protection and accessibility of the law as expressions of the principle of rule of law. From the 1970s the material revealed increasing concern for legal principles or values such as privacy, equality before the law, accessibility of the law, and the right of the individual to be secure from crime. These arguments was most forcefully made by the Liberal and the Left parties. The Social Democratic Party, has had a noticeably unprincipled attitude as regards law and politics and seems to be navigating without any compass other than the finances of the state. As regards the Conservative Party, the analysis leads to almost the same conclusion. The most consistent parties on the law-politics dimension are the Liberal Party and even more the Left Party. The relationship between law and politics cannot be described in terms of separation or boundaries. On the contrary, there is an essential interaction and mutual relationship. The political parties have in recent years drawn up programmes in the field of law and politics. In spite of that, it is hardly an overstatement to assert that legal issues as matters of principle do not occur frequently in preparatory documents preceding legislation. Yet the motives laid out in such documents have a significant influence on how legislation is interpreted.
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