| 1. |
- Axfors, Cathrine, et al.
(författare)
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Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden
- 2023
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Ingår i: Sexuality Research & Social Policy. - : Springer Nature. - 1868-9884 .- 1553-6610. ; 20:2, s. 479-490
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionGender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.MethodsCross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.ResultsThe proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.ConclusionsIn this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.Policy ImplicationsThe study fndings underline the need for individualized care and fexible gender afrming treatmentoptions. The role of somatic comorbidities should be further explored, and support should be ofered to transgender peoplein need. There is an unmet need for facial surgery among aM
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| 2. |
- Beckman, Ulrika, et al.
(författare)
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Årsrapport : Könsdysforiregistret 2021
- 2022
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Rapport (populärvet., debatt m.m.)abstract
- Könsdysforiregistret (KDR) är ett nationellt kvalitetsregister med syfte att följa upp och utveckla den könsbekräftande vården i Sverige. Könsbekräftande vård är vård och behandling vid könsdysfori: ett psykiskt lidande eller en försämrad förmåga att fungera i vardagen som orsakas av att det vid födelsen tillskrivna könet inte stämmer överens med könsidentiteten. Vård vid könsdysfori tillhör såväl specialistpsykiatrin som varierande somatiska vårdområden.Registret ämnar följa personer livslångt och är unikt i sitt slag i världen. Flera specialiteter är involverade under utredning och behandling. Dessa är psykiatri, endokrinologi, plastikkirurgi, gynekologi, reproduktionsmedicin, logopedi, foniatri och dermatologi. Den könsbekräftande vården i landet är för närvarande centrerad till Lund, Göteborg/Alingsås, Linköping, Stockholm, Uppsala och Umeå samt till några andra orter. Vården följer de nationella kunskapsstöd som Socialstyrelsen har tagit fram (Socialstyrelsen 2015/2021).Vården vid könsdysfori är multidisciplinär och multiprofessionell. Ett nationellt kvalitetsregister behöver därför spegla hela vårdområdet och KDR avser att samla data från samtliga delar. Det innebär att uppgifter registreras av vuxenpsykiatrin och barn- och ungdomspsykiatrin, barnendokrinologi och vuxenendokrinologi, logopedi och plastikkirurgi. Registret skiljer sig från övriga nationella kvalitetsregister som vanligen samlar in uppgifter från en specialitet eller möjligen två. Vi har också ambitionen att följa patienter som påbörjat kontakten med barn- och ungdomspsykiatri och barnendokrinologi i registret för att erhålla långtidsinformation om denna grupp. KDR är anslutet till Registercentrum Syd i Lund sedan 2015 och IT-plattformen är 3C.Data började registreras i KDR 2017 och hade år 2021 17 registrerande enheter (av 35 möjliga). Det är ett 100-tal enskilda användare som är verksamma inom psykiatri, endokrinologi, logopedi och plastikkirurgi. Totalt deltar 1994 patienter i registret, varav 266 nya registreringar gjordes under 2021. Täckningsgraden varierar påtagligt mellan olika enheter i landet. Under 2021 och var det i medeltal 21 procent av psykiatrins nybesök som registrerades och drygt 40 procent av logopedins. Den totala täckningsgraden av patienter i landet uppskattas till 32 procent för registret i sin helhet 2021. Merparten av deltagarna i registret är mellan 18 och 25 år. I åldern 0–17 år var två tredjedelar tillskrivet kvinnligt kön vid födelsen. I äldre åldersgrupper var fördelningen utifrån tillskrivet kön vid födelsen jämnare.Före könsbekräftande behandling krävs utredning vid någon av landets sex utredningsenheter för könsdysfori. Det är stor skillnad på varifrån remisserna för utredning av könsdysfori kommer. När 7 möjligheten till egenremiss tydligt uttrycks är det 40–50 procent som väljer att skriva en egenremiss. Av samtliga deltagare hade 79,7 procent efter utredningen fått diagnosen F64.0 (Transsexualism), 6,6 procent F64.9 (Könsidentitetsstörning, ospecificerad) och 8,5 procent F64.8 (Andra specificerade könsidentitetsstörningar).En central kvalitetsindikator är väntetider. Sammanfattningsvis har väntetiderna till nybesök ökat kraftigt inom psykiatrins utredningsenheter, från i medeltal 9 månader föregående år till 17 månader 2021. De totala antalet faktiskt genomförda nybesök vid landets två största utredningsenheter har samtidigt minskat, och en enhet pausade utredningsverksamheten helt. Det är sammantaget en mycket oroväckande utveckling i den del av vårdkedjan som tar emot flest remisser per år.Inom endokrinologin gjordes mycket få nyregistreringar under året, men underlaget tyder på att vårdgarantin om 90 dagar hålls vid två enheter, medan väntetiden är 10 månader vid en tredje enhet. Logopedin har i medeltal 5 månaders väntetid, vilket är en förbättring gentemot tidigare år. Plastikkirurgin har nyss börjat registrera vid en enhet, denna enhet hade i medel 3,5 månads väntetid till sina nybesök.Eftersom endast delar av landets enheter registrerar och täckningsgraden är låg ger inte den data som presenterats i rapporten någon fullständig bild av den könsbekräftande vården i Sverige och informationen behöver tolkas med försiktighet. Eftersom vården utvecklas och kunskapsläget förändras snabbt har KDR behövt revideras flera gånger sedan starten. Information om utredning och behandling av barn och ungdomar har tillkommit, vilket krävt revidering av formulären framför allt inom psykiatri och endokrinologi under år 2020 och 2021. Detta har försenat enheter att komma i gång med registrering av data.Vi ser nu att registreringsgraden ökar 2022 i och med att viktiga uppdateringar är gjorda och nya formulär kan tas i bruk. De nya formulären innebär både förenklingar i inmatning av data och förbättrad datakvalitet. För mer aktuell data om väntetider och registrering hänvisas till hemsidan och Delårsrapport 2022-09-15. Denna årsrapport ska läsas med Årsrapport 2018 som bakgrund vad gäller den könsbekräftande vårdens historia i Sverige samt en mera utförlig kunskapssammanställning inklusive referenser. Det har ännu inte skett någon forskning på data från Könsdysforiregistret, vilket gör att inga egna artiklar kan presenteras. Mer information finns på registrets hemsida, www.konsdysforiregistret.se
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| 3. |
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| 4. |
- Björeland, Ulrika, et al.
(författare)
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Hyaluronic acid spacer in prostate cancer radiotherapy : dosimetric effects, spacer stability and long-term toxicity and PRO in a phase II study
- 2023
-
Ingår i: Radiation Oncology. - : BioMed Central (BMC). - 1748-717X. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Perirectal spacers may be beneficial to reduce rectal side effects from radiotherapy (RT). Here, we present the impact of a hyaluronic acid (HA) perirectal spacer on rectal dose as well as spacer stability, long-term gastrointestinal (GI) and genitourinary (GU) toxicity and patient-reported outcome (PRO).METHODS: In this phase II study 81 patients with low- and intermediate-risk prostate cancer received transrectal injections with HA before external beam RT (78 Gy in 39 fractions). The HA spacer was evaluated with MRI four times; before (MR0) and after HA-injection (MR1), at the middle (MR2) and at the end (MR3) of RT. GI and GU toxicity was assessed by physician for up to five years according to the RTOG scale. PROs were collected using the Swedish National Prostate Cancer Registry and Prostate cancer symptom scale questionnaires.RESULTS: There was a significant reduction in rectal V70% (54.6 Gy) and V90% (70.2 Gy) between MR0 and MR1, as well as between MR0 to MR2 and MR3. From MR1 to MR2/MR3, HA thickness decreased with 28%/32% and CTV-rectum space with 19%/17% in the middle level. The cumulative late grade ≥ 2 GI toxicity at 5 years was 5% and the proportion of PRO moderate or severe overall bowel problems at 5 years follow-up was 12%. Cumulative late grade ≥ 2 GU toxicity at 5 years was 12% and moderate or severe overall urinary problems at 5 years were 10%.CONCLUSION: We show that the HA spacer reduced rectal dose and long-term toxicity.
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| 5. |
- Björeland, Ulrika, et al.
(författare)
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Impact of neoadjuvant androgen deprivation therapy on magnetic resonance imaging features in prostate cancer before radiotherapy
- 2021
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Ingår i: Physics and Imaging in Radiation Oncology. - : Elsevier. - 2405-6316. ; 17, s. 117-123
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: In locally advanced prostate cancer (PC), androgen deprivation therapy (ADT) in combination with whole prostate radiotherapy (RT) is the standard treatment. ADT affects the prostate as well as the tumour on multiparametric magnetic resonance imaging (MRI) with decreased PC conspicuity and impaired localisation of the prostate lesion. Image texture analysis has been suggested to be of aid in separating tumour from normal tissue. The aim of the study was to investigate the impact of ADT on baseline defined MRI features in prostate cancer with the goal to investigate if it might be of use in radiotherapy planning.Materials and methods: Fifty PC patients were included. Multiparametric MRI was performed before, and three months after ADT. At baseline, a tumour volume was delineated on apparent diffusion coefficient (ADC) maps with suspected tumour content and a reference volume in normal prostatic tissue. These volumes were transferred to MRIs after ADT and were analysed with first-order -and invariant Haralick -features.Results: At baseline, the median value and several of the invariant Haralick features of ADC, showed a significant difference between tumour and reference volumes. After ADT, only ADC median value could significantly differentiate the two volumes.Conclusions: Invariant Haralick -features could not distinguish between baseline MRI defined PC and normal tissue after ADT. First-order median value remained significantly different in tumour and reference volumes after ADT, but the difference was less pronounced than before ADT.
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| 6. |
- Björeland, Ulrika, et al.
(författare)
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Inter-fraction movements of the prostate and pelvic lymph nodes during IGRT
- 2018
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Ingår i: Journal of radiation oncology. - : Springer. - 1948-7894 .- 1948-7908. ; 7:4, s. 357-366
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Tidskriftsartikel (refereegranskat)abstract
- Objectivities: The aim of this study was to evaluate inter-fraction movements of lymph node regions that are commonly included in the pelvic clinical target volume (CTV) for high-risk prostate cancer patients. We also aimed to evaluate if the movements affect the planning target volumes. Methods: Ten prostate cancer patients were included. The patients underwent six MRI scans, from treatment planning to near end of treatment. The CTV movements were analyzed with deformable registration technique with the CTV divided into sections. The validity of the deformable registration was assessed by comparing the results for individual lymph nodes that were possible to identify in all scans. Results: Using repetitive MRI, measurements showed that areas inside the CTV (lymph nodes) in some extreme cases were as mobile as the prostate and not fixed to the bones. The lymph node volumes closest to the prostate did not tend to follow the prostate motion. The more cranial lymph node volumes moved less, but still independently, and they were not necessarily fixed to the pelvic bones. In 95% of the cases, the lymph node motion in the R-L direction was 2-4mm, in the A-P direction 2-7mm, and in the C-C direction 2-5mm depending on the CTV section. Conclusion: Lymph nodes and prostate were most mobile in the A-P direction, followed by the C-C and R-L directions. This movement should be taken into account when deciding the margins for the planning target volumes (PTV).
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| 7. |
- Björeland, Ulrika, 1974-
(författare)
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MRI in prostate cancer : implications for target volume
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prostate cancer (PCa) is the most common cancer among men, with 10 000 new cases per year in Sweden [1]. To diagnose PCa, magnetic resonance imaging (MRI) is used to identify and classify the disease. The patient’s treatment strategy depends on PCa classification and clinical data, which are weighted together into a risk group classification from 1–5. For patients with higher risk classes (>3), radiotherapy together with hormone therapy is a common treatment option [2].In radiotherapy (RT), individual treatment plans are created based on the patient’s anatomy. These plans are based on computed tomography (CT), often supplemented with MRI images. MRI and CT complement each other, as MRI has better soft tissue contrast and CT has better bone contrast. Based on the images, the volumes to be treated (target) and the volumes to be avoided (risk organs) are defined. Prostate RT is complex, and there are uncertainties regarding the patient's internal movements and how the patient is positioned before each treatment. To account for these uncertainties, the radiation field is expanded (extended margins to target) to ensure that the treatment volume receives its radiotherapy. RT is most often given in fractions. Fractionation, dose, and treatment volume depend on the patient’s risk category. The treatment area can be, for example, only prostate, prostate with extra radiation dose (boost) to an intraprostatic tumour, or prostate with lymph node (LN) irradiation. LN irradiation is most often given for preventive purposes for PCa with a risk classification >4, which means no cancer has been identified, but any microscopic spread to the LNs is being treated profylactically.In RT, target identification is essential both in the treatment planning images (CT/MRI) and at treatment. Studies have shown that PCa often re-occurs in or near the volume of the dominant (often largest) intraprostatic tumour [3, 4], and this volume is relevant for boosting. For patients treated with hormone therapy before radiotherapy, tumour identification is complicated. Hormones change the tumour characteristics, affecting the image contrast and making the tumour difficult to identify. To study this, we investigated whether texture analysis could identify the tumour volume after hormone therapy (paper II). However, even with texture analysis, the tumour was difficult to identify. A follow-up study examined whether the image information in MRI images taken before hormone therapy could indicate how the treatment fell out (paper IV). However, no correlation was seen between image features and the progression of PCa.Identifying the target and correctly positioning the patient for each treatment fraction is the most important procedure in radiotherapy. The prostate is a mobile organ; therefore, intraprostatic fiducial markers are inserted before treatment planning to reduce positioning uncertainties. Each radiotherapy session begins with an X-ray image where the markers are visible, and the radiation can be delivered based on the markers' position. The markers are also used as guidance for large target volumes, such as for prostate with LN irradiation. With better knowledge of the prostate and LN movements, the margins can potentially be reduced, followed by reduced radiation dose to healthy tissue and therefore reduced side effects for patients. Movements in the radiotherapy volume were the focus of paper I. Using MRI images, the movements of the prostate and LNs were measured during the course of radiotherapy, and we found that LN movement is independent of the movement of the prostate and that the movement varies in the target volume.In addition to the recurrence of PCa in the tumour area, there is an increased risk of recurrence in the prostate periphery close to the rectum. Since the rectum and prostate are in contact for some patients, RT must be adapted to make rectum side effects tolerable. One way to increase the distance between the prostate and the rectum is to inject a gel between the two organs. The distance makes it easier to achieve a better dose distribution to the PCa. This idea resulted in paper III, where patients were given a gel between the prostate and rectum. MRI was used to check the stability of the gel during the course of RT and was evaluated together with long-term follow-up of the patient’s well-being and acceptance of the gel. We found that the radiation dose to the rectum was lower with a spacer, although the spacer was not completely stable during treatment.
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| 8. |
- Eriksson, Erik, et al.
(författare)
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Att förebygga våldsbejakande extremism : En systematisk kartläggning av insatser
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna systematiska översikt är att bidra till kunskap om evidensbaserade insatser för att förebygga våldsbejakande extremism (VBE). Särskilt åsyftas insatser som ämnar att påverka intentionen att utföra VBE, snarare än påverka förmåga att utföra VBE. Med begreppet ”evidensbaserade” avses insatser där komparativ effektivitet har kunnat beläggas, d v s insatsers effekter i förhållande till kontroll eller i förhållande till alternativa insatser. Den systematiska översikten utgår från följande frågeställningar med ökande betydelse för att uppfylla syftet: 1. Vilka insatser som ämnar att påverka intentionen att utföra VBE finns beskrivna i litteraturen? 2. Vilka utfall finns rapporterade från dessa insatser? 3. Vilken kunskap ger rapporterade utfall om insatsers komparativa effektivitet, d v s insatsers effekter i förhållande till kontroll eller i förhållande till alternativa insatser? Metod: • Systematiska och manuella sökningar genomfördes utifrån PICO-struktur (population, intervention, kontroll och utfall) i åtta databaser och resulterade i 52 577 publikationer. • PICO-strukturen låg sedan till grund för relevanskriterier som användes för beslut om inklusion och exklusion genom gallring på titel och abstrakt. Gallringen resulterade i 370 publikationer. • I det sista steget granskades dessa 370 publikationer i fulltext gemensamt av två oberoende granskare. Motstridigheter i bedömning mellan granskare löstes med hjälp av en tredje bedömare. De slutligt inkluderade 111 publikationerna kunde användas för att besvara översiktens tre frågeställningar om insatser, utfall och insatsers komparativa effektivitet. Resultat: • De 111 publikationer som ansågs stämma på relevanskriterierna beskrev totalt 183 insatser. • 38 av 111 inkluderade publikationer innehöll utfall med någon sorts relevans för hypoteser om hur våldsbejakande extremism ska kunna förebyggas. Det betyder att endast 51 av totalt 183 kartlagda insatser beskrevs med någon typ av utfall. Endast 15 publikationer innehöll egen framtagen primärdata. • Den vanligaste namngivna insatsen som studerats i de inkluderade publikationerna är policyprogrammet Prevent i Storbritannien, följt av Channel, som är en specifik insats inom Prevent. • Vanliga kvalitativa utfall är respondenters upplevelser av förebyggande insatser. Kvantitativa effekter som undersökts är före-efter-mätningar av kunskapsnivå, antalet hindrade potentiella attacker eller antal personer som deltagit i exitprogram. • Intressanta resultat finns från lokala insatser för att minska paramilitärt våld och skapa försoning på Nordirland, exitprogram i Norge, Sverige och Tyskland samt utbildningsinsatser bland unga och praktiker. Dock saknas i materialet jämförande studier som kan säkerställa insatsernas komparativa effektivitet. • Jämförande studier av utbildningsinsatser pekar på ökad kunskap och förändrade attityder, dessvärre utan någon påvisbar koppling direkt till VBE. • Inga studier hittades med ett utfall som direkt berör VBE där en insats komparativa effektivitet framgår i förhållande till kontrollgrupp eller i förhållande till alternativa insatser. Detta ger fog för att påstå att översikten belagt att det i kartlagda studier inte finns någon evidensbaserad insats. • Proportionerna mellan det totala antalet publikationer där förebyggande av VBE tas upp (n=111) och antalet primärstudier (n=15) återspeglar en hög kritisk medvetenhet men låg kunskapsnivå om faktiska utfall inom förebyggande av VBE.
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| 9. |
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| 10. |
- Iliadis, Stavros I., 1983-, et al.
(författare)
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Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting
- 2020
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- The Transgender Congruence Scale (TCS) is a non-binary tool used in Sweden for gender dysphoria (GD) assessment; however, its Swedish version has not been validated. To investigate the psychometric properties of the TCS, its capacity to distinguish individuals with GD and its concurrent validity compared to other scales. Patients with GD (n=135) and controls (n=443) filled in a questionnaire containing sociodemographic questions, the TCS, the Utrecht Gender Dysphoria Scale (UGDS), and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). TCS had good discriminatory validity and internal consistency. Patients with GD, stratified by birth-assigned sex, had lower TCS scores compared to controls. Confirmatory factor analysis (CFA) supported the two-factor model of the TCS. Multiple-group CFA suggested measurement invariance between birth-assigned sexes and configural invariance between patients with GD and controls. Area under the ROC curve for birth-assigned males was 0.991 and for females 0.994. A TCS mean value of three provided sensitivity 94.3% and 95.1% as well as specificity 98.6% and 98% for aM and aF, respectively. The TCS was significantly correlated to UGDS and GIDYQ-AA. The TCS may be a valuable tool in the clinical assessment of individuals with GD.
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| 11. |
- Pistone, Isabella, 1987, et al.
(författare)
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A scoping review of interventions for preventing and countering violent extremism: Current status and implications for future research
- 2019
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Ingår i: Journal for deradicalization. - 2363-9849. ; :19, s. 1-84
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Forskningsöversikt (refereegranskat)abstract
- The growth of counter-terrorism efforts has been reported in a number of scholarly studies. These studies have also reported a shift in efforts to prevent future terrorism towards targeting potential future terrorists and preventing them from becoming radicalized, particularly in the Western world. The importance of evidence-based interventions is commonly stressed in the policy processes involved in installing interventions that have the aim of countering/preventing violent extremism (C/PVE). However, there is a lack of knowledge about the state of the evidence for interventions within this field. The objective of this scoping review was to map the evidence base for P/CVE interventions as reported in scholarly studies. We searched multiple databases using search terms related to violent extremism, terrorism and prevention to assess the research describing interventions for C/PVE. A total of 111 publications were included in the study. The interventions identified were most commonly implemented at the national level. Only 38 publications mentioned any kind of outcome and only two publications evaluated the comparative effectiveness of the interventions. The outcomes evaluated were knowledge and attitudes - outcomes without direct relevance for C/PVE. In conclusion, there is a lack of evidence-based interventions that focus on C/PVE. Future research should focus on evaluating the comparative effectiveness of outcomes that are relevant to C/PVE in order to fill this knowledge gap.
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| 12. |
- Pistone, Isabella, 1987, et al.
(författare)
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Suicidprevention genom utbildning och medvetandegöranden : En systematisk litteraturöversikt över förebyggande insatser utanför hälso- och sjukvården
- 2019
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med denna systematiska litteraturöversikt är att 1) kartlägga utbildning och medvetandegörande insatser, utanför hälso- och sjukvården, som förebygger suicid, och 2) bedöma effekterna av dessa insatser. De mest utvärderade insatserna är utbildningar för s.k. mediatorer, även benämnda gatekeepers som oftast riktar sig till vuxna, och utbildningar i skolan som riktar sig direkt till barn och unga. Utbildningsinsatserna bygger i stort på att öka deltagarnas kunskaper och färdigheter för att antingen kunna agera som mediatorer och hjälpa andra personer som mår dåligt, eller kunna hjälpa sig själva till att förbättra den psykiska hälsan och förebygga suicid. Kartläggningen visar att många studier har en robust studiedesign såsom kontrollerade studier med eller utan randomisering. Studierna spretar dock metodologiskt (t.ex. olika utfall och uppföljningstider), vilket gör det svårt att sammanväga de uppmätta effekterna. De viktigaste resultaten visar att: • Utbildningsinsatser som är riktade till barn och unga kan minska antalet självrapporterade suicidförsök och suicidtankar. Utbildningar som riktas direkt till elever är troligtvis effektivare än utbildningar som är riktade till lärare och annan skolpersonal som ska agera som hjälpare/gatekeepers (s.k. mediatorsutbildningar). • Effekten av utbildningsinsatser kan bero på flera faktorer, bl.a. på deltagarnas personliga egenskaper, t.ex. utbildningsnivå. Gene rellt sett krävs det mer forskning på området, framförallt större studier med längre uppföljningstider för att avgöra insatsernas effekt bland vuxna. Litteraturen identifierades via strukturerade sökningar i vetenskapliga databaser, via handsökningar och via en genomgång av referenslistor. Två omfattande sökningar i databaser genomfördes. Den första var inriktad på insatser som har ett uttalat syfte att förebygga suicid. Den andra var en breddad sökning som även omfattade insatser som ska förebygga psykisk ohälsa. Av de totalt 24 548 unika publikationer som identifierades var 173 relevanta för denna litteraturöversikt. De utfall som undersöktes var kunskaper om och attityder till suicid, färdigheter i att ingripa och förekomsten av suicidtankar och suicidförsök. Sammanlagt 41 av publikationerna kunde användas för att sammanväga effekterna genom metaanalys och narrativ analys. Baserat på litteraturen i denna översikt går det inte att uttala sig om utbildningsinsatsers effekt på antalet fullbordade suicid. Dels är det svårt att koppla förändringar i suicidtal till en isolerad preventionsinsats, dels skulle sådana effektstudier kräva mycket stora studiepopulationer och långa uppföljningstider för att ge statistiskt robusta resultat eftersom suicid är en relativt ovanlig händelse. Enskilda utbildningar och medvetandegörande insatser bör därför ses som en del av ett bredare suicidpreventivt arbete som omfattar insatser inom flera samhällssektorer.
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| 13. |
- Pistone, Isabella, 1987, et al.
(författare)
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The effects of educational interventions on suicide: A systematic review and meta-analysis
- 2019
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Ingår i: International Journal of Social Psychiatry. - : SAGE Publications. - 0020-7640 .- 1741-2854. ; 65:5, s. 399-412
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Forskningsöversikt (refereegranskat)abstract
- Background: Suicide is a major public health problem. Educational interventions for preventing suicidal behaviour are widely used, although little is known regarding the collective effectiveness of these interventions. Aim: We evaluated the existing evidence for the effectiveness of education interventions in the prevention of suicidal behaviour. Methods: In this systematic review and meta-analysis, we searched multiple databases using terms related to suicide prevention. The articles were reviewed by two independent reviewers, and the quality of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data from individual studies were combined in meta-analyses. Results: We identified 41 studies evaluating two different types of interventions: school-based education interventions and gatekeeper training. Education interventions showed significant gains in terms of knowledge and attitudes, though the effects seem to vary depending on subjects’ personal characteristics. School-based education interventions significantly reduced suicidal ideation and suicide attempts in youths. Gatekeeper training showed no significant effect on suicide attempts or gatekeeper skills, though the quality of evidence for the estimate, according to GRADE criteria, was rated as very low. Conclusion: The results of this study indicate that school-based education interventions are effective in preventing suicidal ideation and suicide attempts. In clinical practice, as well as in research, the development and implementation of educational interventions should focus on participants’ individual characteristics.
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| 14. |
- Rönningås, Ulrika, et al.
(författare)
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Signs and symptoms in relation to progression, experiences of an uncertain illness situation in men with metastatic castration-resistant prostate cancer : A qualitative study
- 2022
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Ingår i: European Journal of Cancer Care. - : Wiley-Blackwell. - 0961-5423 .- 1365-2354. ; 31:4
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Signs and symptoms are important in monitoring prostate cancer, but there is a lack of understanding about the men's interpretation of signs and symptoms in relation to disease progression in advanced phases of the disease. The aim was to illuminate the experience of signs and symptoms in relation to disease progression in men with metastatic castration-resistant prostate cancer (mCRPC).METHOD: Thirty longitudinal interviews were conducted with 11 men undergoing life-prolonging treatment for mCRPC. Conventional content analysis was used.RESULTS: The results illuminate an uncertainty that the men experience when interpreting signs and symptoms. The overarching theme was The experience of an uncertain illness situation within the framework of progression, with four subthemes: Symptoms triggering thoughts about disease progression; Making sense of signs, also in the absence of symptoms; Making sense of symptoms during treatment; Progression triggering thoughts about the remainder of life.CONCLUSION: In the uncertain illness situation, the men strive to make sense of signs and symptoms based on previous experiences and in relation to disease progression. Understanding the men's perspectives on signs and symptoms in this late phase may help health care professionals communicate about disease progression considering the balance between treatment outcome and quality of life.
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| 15. |
- Rönningås, Ulrika, et al.
(författare)
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Symptoms and quality of life among men starting treatment for metastatic castration-resistant prostate cancer : a prospective multicenter study
- 2024
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Ingår i: BMC Palliative Care. - : BioMed Central (BMC). - 1472-684X. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Men with metastatic castration-resistant prostate cancer (mCRPC) have an incurable disease. Along with prolonging life, symptom management is one of the main goals with treatment. This is also important from a palliative care perspective where the life prolonging outcomes should be balanced with quality of life (QoL) in this late phase. It is also essential in symptom management to view different dimensions of symptoms, for example how severe or distressing symptoms are, to support best QoL. Therefore, more knowledge is needed about the symptom experience when these treatments are initiated and thus the aim of this study was to describe different dimensions of symptoms in men with mCRPC starting their first-line of life-prolonging treatment, and to describe the association between symptom burden and QoL.METHODS: Baseline data from a prospective longitudinal study of 143 men with mCRPC starting their first-line life-prolonging treatment were used. Symptoms were measured using the Memorial Symptom Assessment Scale (MSAS) and global QoL was measured by the EORTC QLQ C-30. Data was analyzed using descriptive- and multivariable linear regression analyses.RESULTS: On average, the men had more than 10 symptoms (range 0-31 of 33). 50% or more reported sweats, lack of energy, pain, problems with sexual activity and sexual desire. The symptoms they reported as most severe, or most distressing were not always the ones that were reported as most frequent. There was an association between QoL and physical symptoms, and also between QoL, and analgesic use and prostate-specific antigen (PSA) values.CONCLUSION: Even if some men with mCRPC report many symptoms, the dimensions of severity and distress levels vary, and the most frequent symptoms was not always the most burdensome or distressing. There was an association between high physical symptom burden and QoL, suggesting that it is not the number of symptoms that affects QoL but rather the subjective perceived impact of the physical symptoms experienced. The knowledge of how men with mCRPC experience and perceive their symptoms may help health care professionals in symptom management aiming to improve QoL, which is a cornerstone in integrating early palliative care.
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| 16. |
- Sköld, Olle, FD, 1983-, et al.
(författare)
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Moving Forward with Digital Scientific Images : A Study of Infrastructure, Digitization Work, and Digital Research Practices
- 2019
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Ingår i: Proceedings of the Digital Humanities in the Nordic Countries 4th Conference (DHN 2019), Copenhagen, Denmark, March 5-8, 2019.. - Copenhagen. ; , s. 415-425
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Konferensbidrag (refereegranskat)abstract
- Scientific images are important and complex objects of study in the field of digital humanities for two principal reasons. Firstly, scientific images are key components in the making and communication of science in the present day and constitute central source materials in scholarly projects seeking to elucidate the historical practices of research and the development of scientific disciplines. Secondly, the archives, libraries, and museums (ALM) sector invest significant resources into the digitization and mediation of scientific images and it is a crucial success factor for both ALM institutions and future research initiatives that the premises and consequences of such efforts are thoroughly explored. This paper seeks to map which avenues of study and work that are crucial to pursue if available modes of curation, access, search, and analysis in digital collections of scientific images are to be meaningfully improved. The paper is based on a literature review and an overview of the current state of digitization work, digital collections, and digital infrastructures for storage and mediation at Uppsala University Libraries. Methodologically the paper makes use of action research and an adaptable, pragmatic, and ’exploratory’ approach to academic research. The study identifies five themes of study and work that, if competently pursued, promise to push the boundaries of what is known about scientific images forward in many areas of the digitization spectrum both in terms of best practices and theoretical understandings. The themes are: (1) method and infrastructure focus; (2) method focus; (3) digitization work focus; (4) epistemic and research-practice focus; (5) epistemic, methodological, and historiographical focus.
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| 17. |
- Özel, Faith, et al.
(författare)
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Exploring gender dysphoria and related outcomes in a prospective cohort study: protocol for the Swedish Gender Dysphoria Study (SKDS)
- 2023
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Ingår i: Bmj Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:4
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Tidskriftsartikel (refereegranskat)abstract
- Introduction There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin. Methods and analysis The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022. Ethics and dissemination The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.
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