| 1. |
- Chen, Deliang, 1961, et al.
(författare)
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Summary of a workshop on extreme weather events in a warming world organized by the Royal Swedish Academy of Sciences
- 2020
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Ingår i: Tellus Series B-Chemical and Physical Meteorology. - : Stockholm University Press. - 1600-0889 .- 0280-6509. ; 72:1
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Tidskriftsartikel (refereegranskat)abstract
- Climate change is not only about changes in means of climatic variables such as temperature, precipitation and wind, but also their extreme values which are of critical importance to human society and ecosystems. To inspire the Swedish climate research community and to promote assessments of international research on past and future changes in extreme weather events against the global climate change background, the Earth Science Class of the Royal Swedish Academy of Sciences organized a workshop entitled 'Extreme weather events in a warming world' in 2019. This article summarizes and synthesizes the key points from the presentations and discussions of the workshop on changes in floods, droughts, heat waves, as well as on tropical cyclones and extratropical storms. In addition to reviewing past achievements in these research fields and identifying research gaps with a focus on Sweden, future challenges and opportunities for the Swedish climate research community are highlighted.
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| 2. |
- Karimi, Masoud, et al.
(författare)
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A retrospective study of extracolonic, non-endometrial cancer in Swedish Lynch syndrome families 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis 11 Medical and Health Sciences 1117 Public Health and Health Services
- 2018
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Ingår i: Hereditary Cancer in Clinical Practice. - : Springer Science and Business Media LLC. - 1731-2302 .- 1897-4287. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lynch Syndrome is an autosomal dominant cancer syndrome caused by pathogenic germ-line variants in one of the DNA-mismatch-repair (MMR) genes MLH1, MSH2, MSH6 or PMS2. Carriers are predisposed to colorectal and endometrial cancer, but also other cancer types. The purpose of this retrospective study was to characterize the tumour spectrum of the Swedish Lynch syndrome families. Methods: Data were obtained from genetically verified 235 Lynch families from five of the six health care regions in Sweden. The material was stratified for gender, primary cancer, age and mutated gene and the relative proportions of specific cancer types were compared to those in the general population. Results: A total of 1053 family members had 1493 cancer diagnoses of which 1011 were colorectal or endometrial cancer. Individuals with pathogenic variants in MLH1 and MSH2 comprised 78% of the cohort. Among the 482 non-colorectal/non-endometrial cancer diagnoses, MSH2 carriers demonstrated a significantly increased proportion of urinary tract, gastric, small bowel, ovarian and non-melanoma skin cancer compared to the normal population. MLH1 carriers had an elevated proportion of gastrointestinal cancers (gastric, small bowel, pancreas), while MSH6 carriers had more ovarian cancer than expected. Gastric cancer was predominantly noted in older generations. Conclusion: Lynch syndrome confers an increased risk for multiple cancers other than colorectal and endometrial cancer. The proportions of other cancers vary between different MMR genes, with highest frequency in MSH2-carriers. Gender and age also affect the tumour spectrum, demonstrating the importance of additional environmental and constitutional parameters in determining the predisposition for different cancer types.
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| 3. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten
- 2022
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Ingår i: Aftonbladet. - 1103-9000.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
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| 4. |
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| 5. |
- Avallin, Therese, et al.
(författare)
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Person-centred pain management for the patient with acute abdominal pain : An ethnography informed by the Fundamentals of Care framework
- 2018
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74:11, s. 2596-2609
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
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| 6. |
- Björck, Erik
(författare)
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Genetic studies of follicular and mantle cell lymphoma
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-Hodgkin lymphoma is a malignancy derived from lymphoid tissues. In Sweden, non-Hodgkin lymphoma constituted 3% of all cancers recorded in 2003. Follicular and mantle cell lymphoma are the two types of non-Hodgkin lymphomas studied in this thesis. The treatment modalities of these lymphomas vary, and the reasons why some patients have a good response to therapy while other fail to respond are largely unknown. To address this problem we compared the gene expression of follicular lymphomas that had good response to therapy with follicular lymphomas that did not respond. The investigated treatment was combination chemotherapy with CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone). With high-density oligonucleotide arrays we could show that 14 genes involved in the G2/M transition of the cell cycle were up-regulated in the responders compared with the non-responders. Six out of these 14 genes were correlated with survival in a cohort of 57 patients with follicular lymphoma. Furthermore, one of these genes was also investigated with immunohistochemistry and there was a good correlation between mRNA expression and protein expression of this gene (Paper I). The gene expression measured with high-density oligonucleotide arrays was correlated with survival in two independent cohorts of follicular lymphoma. A total of 21 genes were associated with a prolonged survival in both cohorts. This association was independent of the international prognostic index. Genes of particular interest in this study were ERCC1, PTAFR, C4A, RPL23A, BCLAF and ABCC5 (Paper II). The gene expression in mantle cell lymphoma was also studied with high-density oligonucleotide arrays. Differences in genetic profiles were shown between tumors with a high and a low proliferation rate and also between primary and relapsed tumors (Paper III). In mantle cell lymphoma the prevalence of mutated V H-genes was investigated. In a cohort of 110, 17% of the tumors had somatic mutations. This implies that a subgroup of mantle cell lymphomas has a post germinal center origin. It was further demonstrated that there was a preferential V H3-21 usage in 19% of the tumors, and that patients with tumor usage of this V H-gene had a longer survival compared with the rest of the patients (Paper IV) .
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| 7. |
- Björck, Inger, et al.
(författare)
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Cereal grains for nutrition and health benefits: Overview of results from in vitro, animal and human studies in the HEALTHGRAIN project
- 2012
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Ingår i: Trends in Food Science & Technology. - : Elsevier BV. - 1879-3053 .- 0924-2244. ; 25:2, s. 87-100
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological studies have linked whole grain intake to the prevention of the metabolic syndrome, obesity and associated chronic diseases such as CVD and T2D. The Nutrition module within the HEALTHGRAIN project, included 10 partners and undertook in vitro, animal and humanin vivo studies with the overall aims of elucidating the components and mechanisms underlying the health benefits of cereal grains. This review summarises the major outcomes of these studies, including yet unpublished findings.
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| 8. |
- Bolander Laksov, Klara, 1973-, et al.
(författare)
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Developing clinical education based on medical education research - findings from a faculty development program
- 2018
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Ingår i: Amee 2018: Educating the Future Healthcare Professional and the Roles of the Teacher. ; , s. 52-52
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Konferensbidrag (refereegranskat)abstract
- BackgroundStudents in health and medical education spend a great deal of their education in clinical learning environments. There is today a growing knowledge of how learning in the clinical education environment can be facilitated, as well as about existing barriers to the implementation of these skills. By studying how clinical teachers engaged in educational development work, we wanted to better understand the conditions and systems required for successful implementation. This project aimed at examining the conditions for the successful use of medical-educational research results to stimulate learning in clinical education. Summary of workBased on knowledge generated from educational research, a faculty development program was designed to enable five teams of clinical teachers from three university hospitals to participate in a faculty development program aiming to develop, implement and evaluate an educational 'tool' together. The five teams that participated in the program were interviewed in focus groups at the start and end of the program. Observational and document data were collected throughout the process.Summary of resultsAll teams managed to develop a tool aimed at students or clinical teachers, implement and evaluate it. The faculty development program and its structure as a year-long scaffolding of driving and legitimising change processes in the clinical environment was acknowledged as facilitating the implementation of the educational tools. One year after the end of the program, four of the five teams had presented their work at medical education conferences, three teams are currently working to publish their work.Discussion & ConclusionThe design of the program around building capacity for change together with workshops focusing different aspects of Mayer and Stensaker's Change process prescriptors was identified as a successful framework for successful implementation and use of medical education research in the clinical education environment.Take-home messageThe invitation of teams to faculty development program, together with a design building on scaffolding educational change and leadership enabled participants to translate medical education research into their clinical teaching practice.
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| 9. |
- Bolander Laksov, Klara, 1973-, et al.
(författare)
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Från engagerad individ till fungerande systemperspektiv på pedagogisk utveckling i klinisk utbildningsmiljö
- 2018
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Konferensbidrag (refereegranskat)abstract
- Detta 10-åriga forskningsprojekt har titeln ’Från engagerad individ till fungerande systemperspektiv’. Projektet, som påbörjades 2010 tar sin utgångspunkt i problemet med att det trots att det återkommande tas goda initiativ till att förändra och utveckla den pedagogiska miljön, i detta fall inom den kliniska utbildningen, tycks vara svårt att etablera pedagogisk utveckling som är hållbar över tid. Syftet med projektet är att undersöka både hur studenter interagerar med utbildningsmiljön för att lära, och vilka förutsättningar som finns för lärares möjligheter att bedriva pedagogisk utveckling i sådan miljö, samt pröva en modell för pedagogisk utveckling och undersöka vad resultatet av detta blev. Vi har i projektet sökt oss till systemteori (Senge, Engeström, Billet) som ett sätt att bättre fö rstå den komplexa miljö som den kliniska utbildningsmiljön ugör. Olika teoretiska perspektiv har guidat olika stadier i projektet. Den övergripande forskningsfrågan bottnar i Peter Senges arbete och idén om den lärande organisationen (2006). Genom att förstå den kliniska utbildningsmiljön som en lärande organisation, som ett intrikat system där olika delar interagerar och skapar förutsättningar för lärande, hoppades vi kunna belysa skillnader mellan olika kliniska utbildningsmiljöer i en jämförande fallstudie. I utforskandet av studenters lärande i den kliniska utbildningsmiljön har Stephen Billets (2001; 2004; 2008) arbete, med lärande som ett resultat av relationen mellan praktikens/ arbetsplatsens erbjudande i fråga om deltagande och individens engagemang, utgjort en viktig utgångspunkt i studierna för att bättre förstå sjuksköterske- och läkarstudenters interaktion och lärande med den kliniska utbildningsmiljön. Vad gäller förutsättningarna för kliniska lärare att arbeta med pedagogiskt förändringsarbete i den kliniska miljön vände vi oss till Yrjö Engeströms arbete (1999; 2010; 2011). Engeströms syn på mänsklig aktivitet som sammanhängande i ett aktivitetssystem som påverkar varandra fungerar som utgångspunkt för en serie studier där vi undersöker lärares drivkrafter till att ägna sig åt pedagogiskt förändringsarbete och förutsättningarna för att bedriva utvecklingsprocesser samt dess resultat. De metodologiska utgångspunkterna för projektet har bottnat i ett sociokonstruktivistiskt perspektiv, och utgår från ett flertal olika sätt att samla data för att fokusera på olika aspekter i den kliniska utbildningsmiljön och de ledare, lärare och studenter som verkar i den. Det är dock huvudsakligen intervjuer, både individuella intervjuer (27) och fokusgruppintervjuer (6), men också ett stort antal observationer (200h), som utgjort underlag för våra studier. Resultaten av projektet som helhet visar på flera centrala aspekter för möjligheterna till lärande i den kliniska utbildningsmiljön. Studiernas visar att engagemanget och utgångspunkterna hos de individer, både studenter, kliniker som lärare, och ledare, som deltar i miljön är mycket centralt (Elmberger et al., inskickad). I våra studier identifierade vi systemför den kliniska utbildningsmiljön som har sin utgångspunkt i väldigt olika organisationsrationaliteter (Laksov et al, 2015). Dessa olikheter kunde ibland upplevas av studenter som motsägelsefulla (Liljedahl et al, 2015). Den kliniska utbildningsmiljön är komplex, men genom att lärare och pedagogiska ledare tar ett perspektiv på studenter som deltagare snarare än konsumenter, finns möjlighet att underlätta för studenters insocialisering i både sin profession, och i vad det innebär att vara student i den kliniska miljö n (Liljedahl et al 2016; 2017). Som deltagare lär sig studenterna att förhålla sig till de normer, värderingar och praktiker som förekommer i de olika miljöerna. Genom deltagandet i den kliniska miljön får de också möjlighet att lära sig vikten av att balansera mellan att anpassa sig, och att vara flexibel, och därmed utveckla sin professionella identitet (Liljedahl et al 2016; 2017). Förhållanden som framstår som särskilt utmanande i den kliniska utbildningsmiljön är de spä nningar som olika aktivitetssystem skapar i relation till utbildningsverksamheten och man kan ifrågasätta om och på vilket sätt olika aktörer som är involverade i högre utbildning tar ett sådant helhetsperspektiv, och om detta är möjligt? Seminariet läggs upp som en introduktion (15min) följt av en diskussion med utgångspunkt i följande frågor: Vilka styrkor och svagheter finns i ett systemperspektiv på pedagogisk utveckling? Med bas i vår och andras forskning, vad innebär hållbarhet i utvecklingen av pedagogisk verksamhet? Hur ser möjliga modeller ut för att implementera högskolepedagogisk forskning i olika utbildningsmiljöer? Vilken bäring har våra resultat i andra utbildningsmiljöer?
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| 10. |
- Bolander Laksov, Klara, et al.
(författare)
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Shifting to team-based faculty development: a programme designed to facilitate change in medical education
- 2022
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Ingår i: Higher Education Research and Development. - : Informa UK Limited. - 0729-4360 .- 1469-8366. ; 41:2, s. 269-283
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Tidskriftsartikel (refereegranskat)abstract
- The value of traditional faculty development programmes has been questioned regarding its effectiveness in transforming clinical education. Rather than training faculty separately from their colleagues, the faculty development programme described in this paper presented an opportunity for teams of faculty to improve clinical education by developing tools grounded in medical education research. The five participating teams were interviewed in focus groups at the end of the programme and followed up with emails and phone calls three years after the end of the programme. The interview data were analysed according to conventional content analysis. Immediately after completion of the programme, all teams had managed to implement their tools, and three years later, four were still in use. The study demonstrates that critical success factors for faculty development to transform change in practice included a design focused on a stepwise, longitudinal programme; coaching of teams; management and peer engagement, and programme days that created space for reflection, development, and discussion.
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| 11. |
- Conley, Daniel, et al.
(författare)
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Hypoxia-Related Processes in the Baltic Sea
- 2009
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 43:10, s. 3412-3420
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Tidskriftsartikel (refereegranskat)abstract
- Hypoxia, a growing worldwide problem, has been intermittently present in the modern Baltic Sea since its formation ca. 8000 cal. yr BP. However, both the spatial extent and intensity of hypoxia have increased with anthropogenic eutrophication due to nutrient inputs. Physical processes, which control stratification and the renewal of oxygen in bottom waters, are important constraints on the formation and maintenance of hypoxia. Climate controlled inflows of saline water from the North Sea through the Danish Straits is a critical controlling factor governing the spatial extent and duration of hypoxia. Hypoxia regulates the biogeochemical cycles of both phosphorus (P) and nitrogen (N) in the water column and sediments. Significant amounts of P are currently released from sediments, an order of magnitude larger than anthropogenic inputs. The Baltic Sea is unique for coastal marine ecosystems experiencing N losses in hypoxic waters below the halocline. Although benthic communities in the Baltic Sea are naturally constrained by salinity gradients, hypoxia has resulted in habitat loss over vast areas and the elimination of benthic fauna, and has severely disrupted benthic food webs. Nutrient load reductions are needed to reduce the extent, severity, and effects of hypoxia.
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| 12. |
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| 13. |
- Elmberger, Agnes, et al.
(författare)
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Collaborative knotworking – transforming clinical teaching practice through faculty development
- 2020
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 20
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Tidskriftsartikel (refereegranskat)abstract
- Background: Faculty development is important for advancing teaching practice in health professions education. However, little is known regarding how faculty development outcomes are achieved and how change in practice may happen through these activities. In this study, we explored how clinical educators integrated educational innovations, developed within a faculty development programme, into their clinical workplaces. Thus, the study seeks to widen the understanding of how change following faculty development unfolds in clinical systems. Methods: The study was inspired by case study design and used a longitudinal faculty development programme as a case offering an opportunity to study how participants in faculty development work with change in practice. The study applied activity theory and its concept of activity systems in a thematic analysis of focus group interviews with 14 programme attendees. Participants represented two teaching hospitals, five clinical departments and five different health professions. Results: We present the activity systems involved in the integration process and the contradiction that arose between them as the innovations were introduced in the workplace. The findings depict how the faculty development participants and the clinicians teaching in the workplace interacted to overcome this contradiction through iterative processes of negotiating a mandate for change, reconceptualising the innovation in response to workplace reactions, and reconciliation as temporary equilibria between the systems. Conclusion: The study depicts the complexities of how educational change is brought about in the workplace after faculty development. Based on our findings and the activity theoretical concept of knotworking, we suggest that these complex processes may be understood as collaborative knotworking between faculty development participants and workplace staff through which both the output from faculty development and the workplace practices are transformed. Increasing our awareness of these intricate processes is important for enhancing our ability to make faculty development reach its full potential in bringing educational change in practice.
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| 14. |
- Elmberger, Agnes, et al.
(författare)
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Contradictions in clinical teachers' engagement in educational development : an activity theory analysis
- 2019
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Ingår i: Advances in Health Sciences Education. - : Springer Science and Business Media LLC. - 1382-4996 .- 1573-1677. ; 24:1, s. 125-140
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Tidskriftsartikel (refereegranskat)abstract
- Many medical universities offer educational development activities to support clinical teachers in their teaching role. Research has focused on the scope and effectiveness of such activities and on why individual teachers attend. However, systemic perspectives that go beyond a focus on individual participants are scarce in the existing literature. Employing activity theory, we explored how clinical teachers' engagement in educational development was affected by the systems they act within. Three focus groups were held with clinical teachers from different professions. A thematic analysis was used to map the contradictions between the systems that the participants were part of and the manifestations of these contradictions in the system of education. In our model, clinical teachers were part of three activity systems directed by the objects of patient care, research and education respectively. Contradictions arose between these systems as their objects were not aligned. This manifested through the enacted values of the academic hospital, difficulties establishing educational discussions in the clinical workplace, the transient nature of educational employments, and impediments to developing a teacher identity. These findings offer insights into the complexities of engaging in educational development as clinical teachers' priorities interact with the practices and values of the academic hospital, suggesting that attention needs to shift from individual teachers to developing the systems in which they work.
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| 15. |
- Elmberger, Agnes, et al.
(författare)
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Faculty development participants' experiences of working with change in clinical settings
- 2023
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 57:7, s. 679-688
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Many universities offer faculty development to support teachers in developing and improving clinical education in the health professions. Although research shows outcomes on individual levels after faculty development, little is known about its contribution to change within the organisation. To advance current faculty development and ensure that it can support wider educational change in healthcare organisations, a better understanding of educational change practices in these settings is needed. This study therefore explores the experiences of working with educational change in clinical workplaces from the perspective of clinical educators that have undergone faculty development training. The study adopts perspectives on change as influenced by context to include the impact from clinical workplaces on individuals' change work.Methods: A collective case study design with a multi-institutional approach was applied and individual interviews with 14 clinical educators from two universities, one in Sweden and one in South Africa, were conducted. Data were analysed separately before a cross-case analysis was performed, synthesising the findings from both sites.Findings: Participants shared experiences of having limited opportunities to work with educational change beyond their own individual teaching practices within their clinical workplaces. Also, participants appeared to refrain from leading change and rather pursued change on their own or relied on indirect approaches to change. They described several workplace aspects influencing their work, including the organisation and management of teaching, the resources and incentives for teaching and the attitudes and beliefs about teaching within the clinical community.Conclusions: The study shows that clinical educators are part of communities and contexts that shape their approaches to educational change and influence which changes are feasible and which ones are not. It thus adds to the understanding of change as contextual and dynamic and contributes with implications for how to advance faculty development to better support change in practice.
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| 16. |
- Elmberger, Agnes, et al.
(författare)
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From faculty development program to educational change in the clinical workplace : exploring the transfer of educational innovations through activity theory
- 2018
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Ingår i: Amee 2018: Educating the Future Healthcare Professional and the Roles of the Teacher. ; , s. 51-51
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Konferensbidrag (refereegranskat)abstract
- BackgroundFaculty development programs (FD) are aiming to advance the teaching practice in health professions education (HPE) by equipping teachers with knowledge and skills as professional educators. Research on faculty development has focused on scope and effectiveness of FD, however, little is regarding how knowledge learned in FD is transformed into the workplace and how change may happen as a result of FD. Drawing on activity theory and its notion of individual action as closely connected to context, we sought to explore the transfer of educational innovations into the clinical workplace . Summary of workFive interprofessional teams of clinical teachers attended a one-year FDP where they created and transferred educational innovations to their workplaces. The participants were interviewed in 3 focus groups at the end of the program, and analyzed thematically. The findings were discussed in relation to activity theory.Summary of resultsTransfer of the educational innovation was characterized by three interacting and iterative processes: the educational innovation itself 1) the innovation process, including time and support during development as well as the development of the aim of the innovation; 2) the clinical workplace process, including interactions with the workplace, acquiring mandate to change, communication and negotiation; 3) team process, including team development, collective action and adopting new roles.Discussion and ConclusionsUnderstanding change and pedagogical knowledge transfer is central in developing and sustaining educational scholarship and high quality teaching in HPE. This study suggest that transfer of educational innovations created in a FDP comprise multiple interacting processes taking place in two activity systems, the workplace and the team. Contradictions arise between these systems as they have partly differing objects.Take-home MessagesAs transfer between faculty development and teaching practices seem to be a case of interlinked processes in multiple social systems, faculty development should support participants in navigating this transfer and consider the workplace as an active part in the process.
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| 17. |
- Ergatoudes, Constantinos, et al.
(författare)
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Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome
- 2016
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Ingår i: BMC cardiovascular disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI. METHODS: Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment. RESULTS: The mean age of the study cohort (n = 200) at the index AMI was 63.0 +/- 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL < 1.8 mmol/L was achieved in 18.5% of the cohort, regular exercise in 45.5% and systolic blood pressure <140 mmHg in 57.0%. Anti-platelet therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%. CONCLUSIONS: Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.
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| 18. |
- Forsberg, Anna, et al.
(författare)
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Colonoscopy findings in high-risk individuals compared to an average-risk control population
- 2015
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 50:7, s. 866-874
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: There is clear evidence of reduced morbidity and mortality from regular colonoscopy programs in patients with Lynch syndrome (LS). Today, also individuals with empirically increased risks of colorectal cancer (CRC) are offered colonoscopic surveillance. The aim was to compare the findings at the first screening colonoscopy in LS carriers, and individuals with an increased risk of bowel cancer due to family history of CRC with a control population. Methods: Altogether 1397 individuals with an increased risk for CRC were divided in four risk groups: one with LS carriers and three groups with individuals with different family history of CRC. The findings were compared between the different risk groups and a control group consisting of 745 individuals from a control population who took part in a population-based colonoscopy study. Results: In LS, 30% of the individuals had adenomas and 10% advanced adenomas. The corresponding figures in the other risk groups were 14-24% and 4-7%, compared with 10% and 3% in the control group. The relative risk of having adenomas and advanced adenomas was, compared to controls, significantly higher for all risk groups except the group with the lowest risk. Age was a strong predictor for adenomas and advanced adenomas in both risk individuals and controls. Conclusions: Individuals with a family history of CRC have a high prevalence and cumulative risk of adenomas and advanced adenomas, and screening is motivated also in this risk group.
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| 19. |
- Forsberg, Anna M., et al.
(författare)
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Prevalence of colonic neoplasia and advanced lesions in the normal population : a prospective population-based colonoscopy study
- 2012
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:2, s. 184-90
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Tidskriftsartikel (refereegranskat)abstract
- Objective. There are few prospective studies of the prevalence of colonic neoplasia in the normal population. In order to properly evaluate screening-protocols for colorectal cancer in risk groups (e.g., older subjects or those with a family history), it is essential to know the prevalence of adenomas and cancer in the normal population. Methods. A prospective population-based colonoscopy study on 745 individuals born in Sweden aged 19-70 years was conducted (mean age 51.1 years). All polyps seen were retrieved and examined. Results. Out of the 745 individuals 27% had polyps, regardless of kind. Adenomas were found in 10% of the individuals and finding of adenomas was positively correlated to higher age. Men had adenomas in 15% and women in 6% of the cases. Women had a right-sided dominance of adenomas. Hyperplastic polyps were seen in 21% of the individuals. The presence of hyperplastic polyps was significantly positively correlated to the presence of adenomas. Advanced adenomas were seen in 2.8% of the study participants, but no cancers were detected. Conclusion. One in 10 healthy subjects had an adenoma but advanced adenomas were uncommon. Men and women have a different adenoma prevalence and localization. The results provide baseline European data for evaluating colonoscopy screening-protocols for colorectal cancer risk groups, and the findings may have implications for colon cancer screening in the normal, otherwise-healthy population.
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| 20. |
- Gredmark-Russ, Sara, et al.
(författare)
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Active cytomegalovirus infection in aortic smooth muscle cells from patients with abdominal aortic aneurysm
- 2009
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Ingår i: Journal of Molecular Medicine. - : Springer Science and Business Media LLC. - 0946-2716 .- 1432-1440. ; 87:4, s. 347-356
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Tidskriftsartikel (refereegranskat)abstract
- Cytomegalovirus (CMV) is associated with atherosclerosis and transplant vascular sclerosis. The aim of this study was to explore the hypothesis that active CMV infection in the vessel wall could be associated with abdominal aortic aneurysm (AAA). We examined the prevalence of CMV in AAA specimens from 22 patients undergoing surgery and, in five cases, characterized the function of smooth muscle cells (SMCs) from the aneurysm in vitro. Twenty-one (95%) of the 22 AAA specimens were CMV positive by a polymerase chain reaction assay, in situ hybridization, or a highly sensitive immunohistochemical staining technique. No positive cells were found in aortas from three CMV-seronegative organ donor cadavers. CMV immediate-early and late antigens were expressed in SMCs in the lesions and were associated with 5-lipoxygenase (5-LO) expression. CMV-positive intimal SMCs migrated 6.6 +/- 1.5 times more efficiently than CMV-negative medial SMCs (p < 0.05). In vitro CMV infection of medial SMCs resulted in a 3.2 +/- 1.2 times increase in migration (p < 0.05). The intimal migration was significantly inhibited by antibodies against basic fibroblast growth factor (bFGF; p < 0.05) in a dose-dependent fashion. Antibodies against platelet-derived growth factor (PDGF)-AB, insulin-like growth factor 1, vascular endothelial growth factor (VEGF), RANTES, monocyte chemoattractant protein 1 (MCP-1), macrophage inflammatory protein (MIP)-1alpha, or interleukin-1beta did not significantly affect intimal SMC migration. However, intimal and medial SMCs secreted similar amounts of bFGF, MCP-1, MIP-1alpha, RANTES, PDGF-AB, PDGF-BB, epidermal growth factor, and VEGF. CMV infection in vitro of intimal and medial cells did not result in significant changes of bFGF or MCP-1 secretion. Since CMV infection can affect several functional parameters in SMCs, including several key factors in infected SMCs, our findings provide support for the hypothesis that CMV contributes to the pathogenesis of abdominal aortic aneurysm.
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| 21. |
- Hammar, Björn, et al.
(författare)
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Dystrophia Helsinglandica : a new type of hereditary corneal recurrent erosions with late subepithelial fibrosis
- 2009
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Ingår i: Acta ophthalmologica. - : Wiley. - 1755-3768 .- 1755-375X. ; 87:6, s. 659-667
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To describe the phenotype of an autosomal-dominant corneal dystrophy with an early onset of recurrent corneal erosions and development of subepithelial fibrosis in the cornea, and also to exclude genetic linkage to known corneal dystrophies with autosomal-dominant inheritance and clinical resemblance. Methods: We describe the medical history and clinical findings in individuals from a seven-generation family with recurrent corneal erosions. A total of 43 individuals were evaluated by ophthalmological examination. Genomic DNA was prepared from peripheral blood and polymorphic microsatellite markers were analysed to study haplotypes surrounding genes causing corneal dystrophies with similar phenotypes. Results: Erosive symptoms usually lasted for between 1 and 10 days. By the age of 7 almost all of the affected individuals suffered from recurrent corneal erosions. The attacks generally declined in frequency and intensity from the late 20s, but all examined individuals had developed subepithelial fibrosis by the age of 37. The fibrosis generally started in the mid periphery and was followed in some family members by central fibrosis and the development of gelatinous superficial elevations. Only a marginal reduction of visual acuity was seen in a few individuals. The affected individuals did not share haplotypes for genetic microsatellite markers surrounding genes that are known to cause autosomal-dominant corneal dystrophies. Conclusion: We describe a new type of autosomal-dominant corneal disorder with recurrent corneal erosions and subepithelial fibrosis not significantly affecting visual acuity.
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| 22. |
- Hammar, Björn, 1963-
(författare)
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Two New Corneal Diseases Characterized by Recurrent Erosions
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Recurrent corneal erosions are a common complication of superficial corneal wounds. They most commonly arise following a trauma, in association with various corneal dystrophies, or are idiopathic.The main aim of this thesis was to investigate two hereditary corneal diseases with recurrent erosions in order to find out if they had been described before, and more specifically to describe the clinical picture and the morphological changes, differentiate them from other known autosomal dominant corneal dystrophies with a clinical resemblance, and to exclude genetic linkage to known corneal dystrophies with autosomal-dominant inheritance and a clinical resemblance.The thesis is based on two families of subjects belonging to different phenotypes. The subjects from Småland (Dystrophia Smolandiensis) belonged to a six-generation family, which included 171 individuals of whom 44 were affected individuals, and the family from Hälsingland (Dystrophia Helsinglandica) included sevengenerations of 342 individuals, of whom 84 were affected. The individuals in both families were investigated by collection of medical history through medical records and questionnaires assessing different aspects of the diseases, pedigree analysis, and from clinical examination. Haplotype analysis was used to exclude genetic linkage of both diseases to known autosomal-dominant corneal dystrophies with a clinical resemblance. The morphological changes in Dystrophia Smolandiensis were investigated by examining affected individuals with in-vivo confocal microscopy and/or slit-lamp biomicroscopy, and examining corneal tissue samples using histopathology and immunohistochemistry. In Dystrophia Helsinglandica, the morphological changes were described using in-vivo confocal microscopy and/or slit-lamp biomicroscopy, but also using videokeratography and corneal sensitivity measurement.The main results were the findings of two new corneal disorders with autosomal dominant inheritance, characterized by recurrent corneal erosions.In Dystrophia Smolandiensis the symptoms often started within the first year of life. The number of recurrences per year was highest from the onset and for about 30-40 years, and the duration of recurrence could stretch up to 21 days. The frequency of recurrences was variable in the disease from continuous symptoms to once a year and tended to decrease later in life. The risk of having recurrences did not disappear completely with age. Typical precipitating factors of recurrence were draught and a common cold. About two thirds of the affected individuals responded well to oral vitamin B treatment, but no other therapy has so far been successful. In Dystrophia Smolandiensis development of corneal opacifications or secondary scarring of varying type and degree was seen in about half of the subjects. Opacifications were first noted at the age of about 7 years, but usually first seen at the age of 20-40 years. Corneal grafting was performed in nine individuals, and recurrences were seen in all grafts. The corneal buttons showed epithelial hyperplasia, partial or total loss of Bowman’s layer, and subepithelial fibrosis in the light microscope. The deeper stroma, Descement’s membrane, and endothelium were normal. Confocal microscopy confirmed loss of Bowman’s layer and revealed that the corneal nerves either were normal in their sub-basal plexa or showed signs of regeneration. None of the morphological findings were specific. We believe that the opacifications are reactive corneal changes to repeated erosive events.The onset in Dystrophia Helsinglandica was usually at the age of 4-7 years and late-developing subepithelial fibrosis not significantly affecting visual acuity was seen in all affected individuals over the age of 37 years. The number of recurrences per year was highest from the onset and for about 20-30 years, and the duration of recurrence was usually up to about a week. The frequency of recurrences tended to decrease in the disease with increasing age, but did not cease completely. The precipitating factor of recurrence was typically a minor trauma. No therapy has so far been successful in the family. The corneal changes of affected individuals were classified into different stages from a nearly normal cornea to progressive fairly discrete subepithelial fibrosis of the central cornea. Discrete localized Subepithelial fibrosis in the periphery or mid-periphery (stage I) was the sole finding in 12% of the individuals. A more widespread subepithelial fibrosis, mainly in the mid-periphery, was found in 31% of the individuals (stage II). In stage III, the subepithelial fibrosis engaged the central cornea but did not affect the vision to a significant degree. In late phases of stage III small jellylike corneal irregularities could be seen. We believe that the opacifications are reactive changes to repeated erosive events.In conclusion this thesis describes two new corneal disorders – Dystrophia Smolandiensis and Dystrophia Helsinglandica.
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| 23. |
- Kapferer-Seebacher, Ines, et al.
(författare)
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Periodontal Ehlers-Danlos Syndrome Is Caused by Mutations in C1R and C1S, which Encode Subcomponents C1r and C1s of Complement
- 2016
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Ingår i: American Journal of Human Genetics. - : Cell Press. - 0002-9297 .- 1537-6605. ; 99:5, s. 1005-1014
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Tidskriftsartikel (refereegranskat)abstract
- Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder characterized by early-onset periodontitis leading to premature loss of teeth, joint hypermobility, and mild skin findings. A locus was mapped to an approximately 5.8 Mb region at 12p13.1 but no candidate gene was identified. In an international consortium we recruited 19 independent families comprising 107 individuals with pEDS to identify the locus, characterize the clinical details in those with defined genetic causes, and try to understand the physiological basis of the condition. In 17 of these families, we identified heterozygous missense or in-frame insertion/deletion mutations in C1R (15 families) or C1S (2 families), contiguous genes in the mapped locus that encode subunits C1r and C1s of the first component of the classical complement pathway. These two proteins form a heterotetramer that then combines with six C1q subunits. Pathogenic variants involve the subunit interfaces or inter-domain hinges of C1r and C1s and are associated with intracellular retention and mild endoplasmic reticulum enlargement. Clinical features of affected individuals in these families include rapidly progressing periodontitis with onset in the teens or childhood, a previously unrecognized lack of attached gingiva, pretibial hyperpigmentation, skin and vascular fragility, easy bruising, and variable musculoskeletal symptoms. Our findings open a connection between the inflammatory classical complement pathway and connective tissue homeostasis.
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| 24. |
- Liljedahl, Matilda, et al.
(författare)
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How workplace learning is put into practice: contrasting the medical and nursing contexts from the perspective of teaching and learning regimes.
- 2023
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Ingår i: Advances in health sciences education : theory and practice. - : Springer Science and Business Media LLC. - 1382-4996 .- 1573-1677.
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Tidskriftsartikel (refereegranskat)abstract
- Health professions education places significant emphasis on learning in the clinical environment. While experiences of workplace learning have been extensively investigated, practices of workplace learning explored through field work have been less utilized. The theoretical framework of teaching and learning regimes acknowledges aspects of power and conflict in its consideration of what guides teachers and learners in their practice of workplace learning. This study aimed to explore practices of workplace learning in the two adjacent healthcare professions; medicine and nursing. We adopted an ethnographic qualitative design. Field observations and follow-up interviews were performed in three clinical departments and the data set comprised 12 full days of observations and 16 formal follow-up interviews. Thematic analysis was performed deductively according to the theoretical framework. Four teaching and learning regimes were found in the data. In the medical context, workplace learning was either practiced as reproduction of current practice or through stimulation of professional development. In the nursing context, workplace learning was either based on development of partnership between student and supervisor or on conditional membership in a professional community. The medical and nursing contexts demonstrated varying underpinnings and assumptions relating to teaching and learning. The respective practices of workplace learning in the medical and nursing context appear to hold substantial differences which might have implications for how we understand practices of workplace learning. We further conclude that the theoretical framework of teaching and learning regimes in this study proved useful in exploring workplace learning.
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| 25. |
- Liljedahl, Matilda, et al.
(författare)
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Navigating without a map: how medical students interact with clinical learning environments
- 2019
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Ingår i: Studies in Higher Education. - : Informa UK Limited. - 0307-5079 .- 1470-174X. ; 44:2, s. 275-286
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Tidskriftsartikel (refereegranskat)abstract
- © 2017 Society for Research into Higher Education Through an exploration of the interdependence between workplace affordances and individual engagement, this study addressed how medical students interact with clinical learning environments (CLEs). Building on the workplace participatory practices approach outlined by Billett, CLEs can be viewed as constructed through a negotiation of meaning between the workplace and the student. Inspired by ethnography, an observational study using field observations and follow-up interviews was performed. Workplace affordances included being given a marginal status in the healthcare team which students adapted to through striving to fit into the workplace. Further, there were many potential activities available to students; however, students seemed selective in terms of what activities they elected to engage in. As such, interacting with CLEs entailed students navigating complexity without the immediate access to any explicit ‘map’ of workplace learning. This study indicates that workplaces increasingly need to invite and include students in the practice of workplaces.
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| 26. |
- Liljedahl, Matilda, et al.
(författare)
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To belong or not to belong : nursing students' interactions with clinical learning environments - an observational study
- 2016
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: Belongingness has been argued to be a prerequisite for students' learning in the clinical setting but making students feel like they belong to the workplace is a challenge. From a sociocultural perspective, workplace participatory practices is a framework that views clinical learning environments to be created in interaction between students and the workplace and hence, are dependent on them both. The aim of this study was to explore the interdependence between affordances and engagement in clinical learning environments. The research question was: How are nursing students influenced in their interactions with clinical learning environments? Methods: An observational study with field observations and follow-up interviews was performed. The study setting comprised three academic teaching hospitals. Field observations included shadowing undergraduate nursing students during entire shifts. Fifty-five hours of field observations and ten follow-up interviews with students, supervisors and clinical managers formed the study data. A thematic approach to the analysis was taken and performed iteratively with the data collection. Results: The results revealed that students strived to fill out the role they were offered in an aspirational way but that they became overwhelmed when given the responsibility of care. When students' basic values did not align with those enacted by the workplace, they were not willing to compromise their own values. Workplaces succeeded in inviting students into the community of nurses and the practice of care. Students demonstrated hesitance regarding their desire to belong to the workplace community. Conclusion: The results imply that the challenge for clinical education is not to increase the experience of belongingness but to maintain students' critical and reflective approach to health care practice. Additionally, results suggest students to be included as an important stakeholder in creating clinical learning environments rather than being viewed as consumer of clinical education.
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| 27. |
- Lorant, Tomas, 1975-, et al.
(författare)
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Safety, immunogenicity, pharmacokinetics, and efficacy of degradation of anti-HLA antibodies by IdeS (imlifidase) in chronic kidney disease patients
- 2018
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Ingår i: American Journal of Transplantation. - : Elsevier BV. - 1600-6135 .- 1600-6143. ; 18:11, s. 2752-2762
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Tidskriftsartikel (refereegranskat)abstract
- Safety, immunogenicity, pharmacokinetics, and efficacy of the IgG-degrading enzyme of Streptococcus pyogenes (IdeS [imlifidase]) were assessed in a single-center, open-label ascending-dose study in highly sensitized patients with chronic kidney disease. Eight patients with cytotoxic PRAs (median cytotoxic PRAs of 64%) at enrollment received 1 or 2 intravenous infusions of IdeS on consecutive days (0.12 mg/kg body weight ×2 [n = 3]; 0.25 mg/kg ×1 [n = 3], or 0.25 mg/kg ×2 [n = 2]). IgG degradation was observed in all subjects after IdeS treatment, with <1% plasma IgG remaining within 48 hours and remaining low up to 7 days. Mean fluorescence intensity values of HLA class I and II reactivity were substantially reduced in all patients, and C1q binding to anti-HLA was abolished. IdeS also cleaved the IgG-type B cell receptor on CD19+ memory B cells. Anti-IdeS antibodies developed 1 week after treatment, peaking at 2 weeks. A few hours after the second IdeS infusion, 1 patient received a deceased donor kidney offer. At enrollment, the patient had a positive serum crossmatch (HLA-B7), detected by complement-dependent cytotoxicity, flow cytometry, and multiplex bead assays. After IdeS infusion (0.12 mg/kg ×2) and when the HLA-incompatible donor (HLA-B7+) kidney was offered, the HLA antibody profile was negative. The kidney was transplanted successfully.
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| 28. |
- Naudin, Clément, et al.
(författare)
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Active but inoperable thrombin is accumulated in a plasma protein layer surrounding Streptococcus pyogenes.
- 2015
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Ingår i: Thrombosis and Haemostasis. - 0340-6245. ; 114:4, s. 717-726
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Tidskriftsartikel (refereegranskat)abstract
- Activation of thrombin is a critical determinant in many physiological and pathological processes including haemostasis and inflammation. Under physiological conditions many of these functions are involved in wound healing or eradication of an invading pathogen. However, when activated systemically, thrombin can contribute to severe and life-threatening conditions by causing complications such as multiple multi-organ failure and disseminated intravascular coagulation. In the present study we investigated how the activity of thrombin is modulated when it is bound to the surface of Streptococcus pyogenes. Our data show that S. pyogenes bacteria become covered with a proteinaceous layer when incubated with human plasma, and that thrombin is a constituent of this layer. Though the coagulation factor is found attached to the bacteria with a functional active site, thrombin has lost its capacity to interact with its natural substrates and inhibitors. Thus, the interaction of bacteria with human plasma renders thrombin completely inoperable at the streptococcal surface. This could represent a host defense mechanism to avoid systemic activation of coagulation which could be otherwise induced when bacteria enter the circulation and cause systemic infection.
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| 29. |
- Nogué, Sandra, et al.
(författare)
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The human dimension of biodiversity changes on islands
- 2021
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Ingår i: Science. - : American Association for the Advancement of Science (AAAS). - 0036-8075 .- 1095-9203. ; 372:6541, s. 488-491
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Tidskriftsartikel (refereegranskat)abstract
- Islands are among the last regions on Earth settled and transformed by human activities, and they provide replicated model systems for analysis of how people affect ecological functions. By analyzing 27 representative fossil pollen sequences encompassing the past 5000 years from islands globally, we quantified the rates of vegetation compositional change before and after human arrival. After human arrival, rates of turnover accelerate by a median factor of 11, with faster rates on islands colonized in the past 1500 years than for those colonized earlier. This global anthropogenic acceleration in turnover suggests that islands are on trajectories of continuing change. Strategies for biodiversity conservation and ecosystem restoration must acknowledge the long duration of human impacts and the degree to which ecological changes today differ from prehuman dynamics.
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| 30. |
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| 31. |
- Sjögren, Vilhelm, et al.
(författare)
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Feasibility of switching from alteplase to tenecteplase for stroke thrombolysis : a retrospective cohort analysis
- 2023
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Ingår i: IBRO Neuroscience Reports. - : Elsevier. - 2667-2421. ; 14, s. 353-357
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: Tenecteplase (TNK-tPA) has several benefits over alteplase (tPA) in treatment of acute ischaemic stroke. Randomised controlled trials have shown promising results. In June 2017, the Stroke Unit at Sundsvall County Hospital switched from tPA to TNK-tPA in standard clinical practice. This study examines the effects of that shift.Methods: All thrombolysis treatments performed during the first twenty-four months with TNK-tPA (168) were compared to the last twenty-four months with tPA (191). Data were collected from patient records. Follow-up time was 30 days. Co-primary outcomes were death and symptomatic intracranial haemorrhage (SICH). Secondary outcomes were types of intracerebral bleeding and cause of death. Tertiary outcome was door-to-needle time (DNT).Results: Treatment groups were of comparable age (75.7 ± 0.2 years). tPA-treated patients had an NIHSS (National Institutes of Health Stroke Scale) score of 9.2 versus 7.5 for TNK-tPA. Patients older than 80 had more severe strokes (median NIHSS 9 versus 5). SICH occurred in 6 (3.6 %) patients in the TNK-tPA group and in 2 (1.0 %) treated with tPA, odds ratio (OR) 3.41 (0.70–16.7). Numbers for death were 21 (12.5 %) and 31 (15.2 %), OR 0.77 (0.46–1.29), meaning no statistically significant differences in primary outcomes. There were no significant differences in secondary outcomes. Predominant cause of death was cerebral infarction. DNT with tenecteplase was shorter: mean 44 versus 26, and median 35 versus 19 min.Conclusions: Switching from alteplase to tenecteplase was associated with shorter time to treatment. To draw certain conclusions regarding safety or efficacy would require a larger material.
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| 32. |
- Sturesson Stabel, Linda, et al.
(författare)
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Navigating Affordances for Learning in Clinical Workplaces : A Qualitative Study of General Practitioners’ Continued Professional Development
- 2022
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Ingår i: Vocations and Learning. - : Springer Science and Business Media LLC. - 1874-785X .- 1874-7868. ; 15:3, s. 427-448
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Tidskriftsartikel (refereegranskat)abstract
- Medical specialists’ lifelong learning is essential for improving patients’ health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett’s theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.
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| 33. |
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| 34. |
- Walentowitz, Anna, et al.
(författare)
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Long-term trajectories of non-native vegetation on islands globally
- 2023
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Ingår i: Ecology Letters. - : Wiley. - 1461-023X .- 1461-0248. ; 26:5, s. 729-741
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Tidskriftsartikel (refereegranskat)abstract
- Human-mediated changes in island vegetation are, among others, largely caused by the introduction and establishment of non-native species. However, data on past changes in non-native plant species abundance that predate historical documentation and censuses are scarce. Islands are among the few places where we can track human arrival in natural systems allowing us to reveal changes in vegetation dynamics with the arrival of non-native species. We matched fossil pollen data with botanical status information (native, non-native), and quantified the timing, trajectories and magnitude of non-native plant vegetational change on 29 islands over the past 5000 years. We recorded a proportional increase in pollen of non-native plant taxa within the last 1000 years. Individual island trajectories are context-dependent and linked to island settlement histories. Our data show that non-native plant introductions have a longer and more dynamic history than is generally recognized, with critical implications for biodiversity baselines and invasion biology.
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| 35. |
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| 36. |
- Wanhainen, Anders, et al.
(författare)
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Misleading study in The Lancet on the outcome of the Swedish AAA screening program : Stor enighet om att screening för bukaortaaneurysm räddar liv.
- 2018
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Ingår i: Läkartidningen. - 1652-7518. ; 115
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
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| 37. |
- Wanhainen, Anders, et al.
(författare)
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[Misleading study in The Lancet on the outcome of the Swedish AAA screening program].
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115
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Tidskriftsartikel (refereegranskat)abstract
- In a recent publication in The Lancet Johansson and colleagues claim no effect on aneurysm mortality among men participating in the Swedish AAA screening program, and question its justification. The study is, however, limited by a corrupt study design and incorrect data, making the publication misleading. On the contrary, several RCTs and contemporary nationwide data with sufficient follow-up clearly show that AAA screening saves lives and is highly cost-effective. The program has so far identified about 6000 men with an AAA, of whom 1500 have been operated on to prevent rupture. Thus, more than 750 men have experienced a longer life (by a mean of 8 years) as a result of the program. Continuous evaluation of the program is important but requires a scientifically sound methodology.
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| 38. |
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| 39. |
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