| 1. |
- Dahl, Anna, 1975-
(författare)
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Body mass index, cognitive ability, and dementia : prospective associations and methodological issues in late life
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.
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| 2. |
- Löfgren, Hans O., 1961-
(författare)
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Preventive psychosocial parental and school programmes in a general population
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Numerous preventive programmes have emerged, and need to be investigated to determine their effects on the normal population. Earlier studies have shown a decrease in depressive symptoms, positive effects on children’s disruptive behaviour problems, and an improvement in parental competence. About a fifth of the parents in previous studies had problem-oriented (targeted) reasons for enrolment, whereas the rest of the parents had general (universal) reasons. The results of those studies suggest that the programmes are cost effective in terms of Quality-Adjusted Life Years.Aim Four sub-studies were performed, and their aims were to investigate the effect of parental training programmes (PTPs) in a naturalistic setting on parents’ mental health in the general population, to investigate how PTPs affect parents’ sense of parental competence, to investigate how PTPs affect parental stress and analyse the parents open questions about the PTPs, and to investigate the feasibility and to measure the effect on depression, anxiety, and social problems of two preventive school programmes for pupils in grade 7.Method In a longitudinal quantitative study in a real-world setting, 279 parents from the general population in northern Sweden participated in five PTPs. A comparison group of 702 parents without intervention was included. Simultaneously, a community sample of 59 pupils in grade 7 participated in two preventive school programmes. Both studies were conducted from 2010 to 2013. Parents were assigned to professionally supported interventions that included 5-10 two-hour sessions. Respondents filled in a web-based questionnaire with the General Health Questionnaire (GHQ), the Parents Sense of Competence (PSOC) for parents who had children aged 0-17 years, and the Swedish Parenthood Stress Questionnaire (SPSQ) for parents who had children aged 0-10 years. The intervention groups’ results were compared to comparison group of 702 parents from northern Sweden that had not participated in any parental training programme. In the school study, one of the preventive programmes was an ongoing programme called “Life-Skills”, and the other was an implemented Canadian programme called “Choosing Healthy Actions and Thoughts” (CHAT). The pupils completed a test battery including the Sense of Coherence (SOC), the Children’s Depression Inventory (CDI), and the Youth Self-Report (YSR) instruments. Follow up of the parental programme study was done six months after the post-intervention measure, and follow up of the school study was at one year.Results The improvements in GHQ were statistically significant for the mean of the 279 parents in the intervention group compared to the mean of a comparison group of the 702 parents who did not receive any intervention. This suggests that evidence-based PTPs enhance parental well-being even for parents without problems. The intervention group showed a statistically significant improvement in parental competence compared to the comparison group over time. The intervention itself had a significant effect on parental satisfaction, but the efficacy effect was not sustained when taking into account potential confounders. In the SPSQ, the intervention group was smaller due to the fact that the instrument was not validated for children over the age of 10 and one of the parental training groups was only for parents of teenagers. A reduction of stress in the sub-scale of health problems was detected, but no other subscale showed the intervention to have a significant effect when controlling for confounding variables. In the school study, both programmes had good feasibility according to the stake- holders and had several positive mental health outcomes over time. Compared to Life-Skills, CHAT had more significant positive effects on reducing anxious/depressive symptoms and girls experienced significant positive effects on reduced anxious/depressive behaviour, while boys reduced their aggressive behaviours.Conclusions Earlier studies indicate that PTPs enhance perceived parental competence among referred parents. The present study shows that PTPs applied in the general population might also enhance perceived parental benefits such as improved health and satisfaction, suggesting that PTPs can be an important preventive strategy to enhance parenthood. The results suggest that parents who feel a need to increase their parenting competence might participate in PTPs based on lower scores than the comparison control group both before and after the intervention. The school-based programme shows that schools may be a suitable arena for preventive programmes because there was a significant short-term improvement in depression symptoms. Further studies need to explore how parents’ participation in PTPs affects children’s mental health in the general population in quantitative longitudinal studies in real-word settings. There is also a need for bigger studies and RCTs on school preventions and on how children’s health develops naturally in the population.
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| 3. |
- Hedin, Charlotte Rose Hawkey, et al.
(författare)
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Effects of Tumor Necrosis Factor Antagonists in Patients With Primary Sclerosing Cholangitis
- 2020
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Ingår i: Clinical Gastroenterology and Hepatology. - : Elsevier BV. - 1542-3565 .- 1542-7714. ; 18:10, s. 2-2304
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Few patients with primary sclerosing cholangitis (PSC) and inflammatory bowel diseases (IBDs) are exposed to tumor necrosis factor (TNF) antagonists because of the often mild symptoms of IBD. We assessed the effects of anti-TNF agents on liver function in patients with PSC and IBD, and their efficacy in treatment of IBD. Methods: We performed a retrospective analysis of 141 patients with PSC and IBD receiving treatment with anti-TNF agents (infliximab or adalimumab) at 20 sites (mostly tertiary-care centers) in Europe and North America. We collected data on the serum level of alkaline phosphatase (ALP). IBD response was defined as either endoscopic response or, if no endoscopic data were available, clinical response, as determined by the treating clinician or measurements of fecal calprotectin. Remission was defined more stringently as endoscopic mucosal healing. We used linear regression analysis to identify factors associated significantly with level of ALP during anti-TNF therapy. Results: Anti-TNF treatment produced a response of IBD in 48% of patients and remission of IBD in 23%. There was no difference in PSC symptom frequency before or after drug exposure. The most common reasons for anti-TNF discontinuation were primary nonresponse of IBD (17%) and side effects (18%). At 3 months, infliximab-treated patients had a median reduction in serum level of ALP of 4% (interquartile range, reduction of 25% to increase of 19%) compared with a median 15% reduction in ALP in adalimumab-treated patients (interquartile range, reduction of 29% to reduction of 4%; P =.035). Factors associated with lower ALP were normal ALP at baseline (P <.01), treatment with adalimumab (P =.090), and treatment in Europe (P =.083). Conclusions: In a retrospective analysis of 141 patients with PSC and IBD, anti-TNF agents were moderately effective and were not associated with exacerbation of PSC symptoms or specific side effects. Prospective studies are needed to investigate the association between use of adalimumab and reduced serum levels of ALP further.
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| 4. |
- Keller, Christina, 1961-
(författare)
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Virtual Learning Environments in Higher Education : A Study of User Acceptance
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the thesis was to create knowledge about factors influencing acceptance of virtual learning environments among academic staff and students in blended learning environments. The aim was operationalised by four research questions. To answer the research questions, several studies were performed applying the methods of survey study, conceptual-analytical research, a qualitative meta-analysis combined with a single case study and a comparative, explanatory case study. The empirical studies were performed at five universities in Sweden, Norway and Lithuania. In the thesis, a technology acceptance perspective extended with the perspectives of organisational learning and diffusion of innovations was used. The findings indicated that the contextual factor of culture was powerful in influencing acceptance of virtual learning environments, positively as well as negatively. High degrees of performance expectancy, results demonstrability and social influence affected acceptance of virtual learning environments positively. The degree of social influence was hypothesised to be mediated by the contextual factor of culture. The organisational culture of universities, expressed as shared values of what is good quality teaching and learning, were found to partly oppose values inherent in the virtual learning environments. The factor of students’ learning styles did not have any impact on acceptance of virtual learning environments. The original version of the technology acceptance model was found to be insufficient in explaining differences in acceptance of virtual learning environments. In the conclusions of the thesis, a descriptive and explanatory model of virtual learning environments acceptance among academic staff and students in blended learning environments is presented applying the combined perspectives of organisational learning, technology acceptance and diffusion of innovations. Implications for practice are put forward, emphasizing culture as an important factor to consider in the implementation of virtual learning environments.
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| 5. |
- Nilsson, Ulrika
(författare)
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Kampen om Kvinnan : Professionalisering och konstruktioner av kön i svensk gynekologi 1860-1925
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis investigates how gynaecology was established as a medical speciality in Sweden in the 1860s and onwards. Gender, power, professionalisation and the production of scientific knowledge are central themes. While previous research has shown that gynaecology as a discipline depends upon notions of Woman as radically different from Man, I show how this was manifested within Swedish gynaecology, an initially all male environment. Of special interest is institutionalisation, early career-paths and the development of therapy methods and theory. I argue that gynaecology reproduced and contributed to notions of sex-difference and a gender complementary way of thinking.While gynaecology was formed as a surgically interventionist speciality with strong manly connotations, an education reform aiming at opening higher education to women was simultaneously discussed and eventually carried out during the 1860s and 70s. The advocates of this reform portrayed women as especially fit for becoming teachers and physicians, particularly treating women and children. Thus, two opposing gendered professional ideals operated. By focusing an elite group of early women physicians, I outline how the gynaecological construction of womanliness related to women physicians and how women physicians engaged with this notion: what strategies they used to enter a profession as manly as gynaecology had become; and how women gynaecologists engaged with their men colleagues’ therapeutic methods and views on patients and women.
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| 6. |
- Norman, Sven, 1984-
(författare)
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Lake bathymetry as driver of salmonid population size structure and biomass
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Most fish species undergo ontogenetic niche shifts from feeding on pelagic zooplankton, to larger benthic invertebrates and in some cases also to fish. These ontogenetic niche shifts have strong impact on the interactions within and between species, with effects on individual growth, population abundance and food web dynamics. The productivity of northern lakes is mainly controlled by light-limited primary production in benthic habitats, highlighting the importance of lake bathymetry for the abundance of benthic algae feeding macroinvertebrates, which is an important resource for fish. Theory predicts that variation in fish size structure and biomass can arise due to size-dependent differences in competitive abilities between juvenile and adults in each of their niches and by variation in niche- and habitat-specific resource production i.e. pelagic zooplankton and benthic macroinvertebrates.In this thesis, using gradient studies in mountain lakes, I studied how habitat-specific production and lake bathymetry variation affect growth, size structure and biomass in Arctic char and brown trout populations. Results showed that lake bathymetry determine the benthic contribution to whole lake primary production and the degree of ontogenetic niche shift from zooplankton to macroinvertebrates. In correspondence with theory, production of Arctic char and brown trout were related to stage- and habitat-specific gross primary production (GPP) as an increased benthic contribution to whole lake GPP in general increased individual size, population production and biomasses. Lake bathymetry also influenced the niche shift to piscivory in brown trout as reliance on piscivory were higher in relatively deep lakes more dominated by Arctic char. Finally, in a model approach, responses to different size selective harvest regulations showed that the size structure of Arctic char were more sensitive to fishing in shallow than in deep lakes. Size regulations protecting both smaller and the largest adults were shown to best preserve size structure, especially in shallower lakes. Collectively, these results contribute to the understanding of how variation in productivity and availability of stage- and habitat-specific resources and the presence of ontogenetic niche shifts affect the growth, size structure and biomass of fish. Specifically, the results highlighted the importance of shallow benthic habitats for individual size and biomass of salmonids in mountain lakes and suggests that management strategies based on relationships between lake bathymetry and population size structure and biomass could be a simple approach for sustainable management of lake salmonid population.
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