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1.
  • Adolfsson, Jan, et al. (författare)
  • Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005 : Data from the national prostate cancer register in Sweden
  • 2007
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - Stockholm : Taylor & Francis. - 0036-5599 .- 1651-2065. ; 41:6, s. 456-477
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. Material and methods. Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. Results. In total, 72 028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of >100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score ≤6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged ≥75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. Conclusions. All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer
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2.
  • Adolfsson, Jan, et al. (författare)
  • Clinical characteristics and primary treatment of prostate cancer in Sweden between 1996 and 2005
  • 2007
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 41:6, s. 456-477
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The incidence of prostate cancer is rising rapidly in Sweden and there is a need to better understand the pattern of diagnosis, tumor characteristics and treatment. MATERIAL AND METHODS: Between 1996 and 2005, all new cases of adenocarcinoma of the prostate gland were intended to be registered in the National Prostate Cancer Register (NPCR). This register contains information on diagnosing unit, date of diagnosis, cause of diagnosis, tumor grade, tumor stage according to the TNM classification in force, serum prostate-specific antigen (PSA) levels at diagnosis and primary treatment given within the first 6 months after diagnosis. RESULTS: In total, 72,028 patients were registered, comprising >97% of all pertinent incident cases of prostate cancer in the Swedish Cancer Register (SCR). During the study period there was a considerable decrease in median age at the time of diagnosis, a stage migration towards smaller tumors, a decrease in median serum PSA values at diagnosis, a decrease in the age-standardized incidence rate of men diagnosed with distant metastases or with a PSA level of > 100 ng/ml at diagnosis and an increase in the proportion of tumors with Gleason score <6. Relatively large geographical differences in the median age at diagnosis and the age-standardized incidence of cases with category T1c tumors were observed. Treatment with curative intent increased dramatically and treatment patterns varied according to geographical region. In men with localized tumors and a PSA level of <20 ng/ml at diagnosis, expectant treatment was more commonly used in those aged > or =75 years than in those aged <75 years. Also, the pattern of endocrine treatment varied in different parts of Sweden. CONCLUSIONS: All changes in the register seen over time are consistent with increased diagnostic activity, especially PSA testing, resulting in an increased number of cases with early disease, predominantly tumors in category T1c. The patterns of diagnosis and treatment of prostate cancer vary considerably in different parts of Sweden. The NPCR continues to be an important source for research, epidemiological surveillance of the incidence, diagnosis and treatment of prostate cancer.
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3.
  • Bratt, Ola, 1963, et al. (författare)
  • Screening for prostate cancer: evidence, ongoing trials, policies and knowledge gaps
  • 2023
  • Ingår i: BMJ Oncology. ; 2:1, s. 1-9
  • Forskningsöversikt (refereegranskat)abstract
    • Long-term screening with serum prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to unacceptable overdiagnosis. Over the past decade, diagnostic methods have improved and the indolent nature of low-grade prostate cancer has been established. These advances now enable more selective detection of potentially lethal prostate cancer. This non-systematic review summarises relevant diagnostic advances, previous and ongoing screening trials, healthcare policies and important remaining knowledge gaps. Evidence synthesis and conclusions: The strong association between low serum PSA values and minimal long-term risk of prostate cancer death allows for adjusting screening intervals. Use of risk calculators, biomarkers and MRI to select men with a raised PSA value for biopsy and lesion-targeting rather than systematic prostate biopsies reduce the detection of low-grade cancer and thereby overdiagnosis. These improvements recently led the European Union to recommend its member states to evaluate the feasibility and effectiveness of organised screening programmes for prostate cancer. Nonetheless, important knowledge gaps remain such as the performance of modern diagnostic methods in long-term screening programmes and their impact on mortality. The knowledge gaps are currently being addressed in three large randomised screening trials. Population-based pilot programmes will contribute critical practical experience.
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4.
  • Godtman, Rebecka Arnsrud, 1981, et al. (författare)
  • Men's Acceptance of Screening for Prostate Cancer with Prostate-specific Antigen, Magnetic Resonance Imaging, and Prostate Biopsy
  • 2024
  • Ingår i: EUROPEAN UROLOGY ONCOLOGY. - 2588-9311. ; 7:3, s. 553-562
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A prerequisite before introducing a screening program is that the screening examinations are acceptable to participants. Objective: To evaluate the acceptance and bother of prostate cancer screening examinations. Design, setting, and participants: The randomized population -based G & Ouml;TEBORG-2 prostate cancer screening trial invited >37 000 men for prostate -specific antigen (PSA) testing followed by magnetic resonance imaging (MRI) in case of elevated PSA and prostate biopsy (targeted and/or systematic) if indicated. Outcome measurements and statistical analysis: Participants were asked to fill out a questionnaire and rate the level of bother associated with each examination (PSA, MRI, and prostate biopsy) on a categorical scale ranging from 1 to 5 (1 = "not at all bothersome" and 5 = "very bothersome"), and to rate their willingness to repeat the examinations, by marking an X on a continuous scale ranging from 0 to 10 (0 = "yes, without any hesitation" and 10 = "no, absolutely not''). Wilcoxon signed rank test was used. Results and limitations: Compliance with MRI was 96% (1790/1872), compliance with biopsy was 89% (810/907), and the response rate to the questionnaire was 75% (608/810). Men who underwent all examinations ( n = 577) responded that biopsy was more bothersome than PSA test ( p < 0.001) and MRI ( p < 0.001). High levels of bother (>= 4 out of 5) were reported by 2% (12/577) for PSA test, 8% (46/577) for MRI, and 43% (247/577) for biopsy. Men were more willing to repeat MRI than biopsy ( p < 0.001), but the difference was small (median 0.2 [interquartile range 0.1-0.6] vs 0.5 [0.1-2.0]). Conclusions: Biopsies are more bothersome than MRI, but a large majority of men accept to repeat both examinations if necessary. Omitting biopsy for MRI-negative men and shifting to targeted biopsies only will reduce bother for men participating in prostate cancer screening. Patient summary: We asked men how bothersome they found the prostate -specific antigen (PSA) test, magnetic resonance imaging (MRI), and prostate biopsies. Biopsies were more bothersome than PSA and MRI, but most men were willing to repeat all procedures if necessary. (c) 2023 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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5.
  • Hugosson, Jonas, 1955, et al. (författare)
  • Prostate Cancer Screening with PSA and MRI Followed by Targeted Biopsy Only.
  • 2022
  • Ingår i: The New England journal of medicine. - 1533-4406. ; 387:23, s. 2126-2137
  • Tidskriftsartikel (refereegranskat)abstract
    • Screening for prostate cancer is burdened by a high rate of overdiagnosis. The most appropriate algorithm for population-based screening is unknown.We invited 37,887 men who were 50 to 60 years of age to undergo regular prostate-specific antigen (PSA) screening. Participants with a PSA level of 3 ng per milliliter or higher underwent magnetic resonance imaging (MRI) of the prostate; one third of the participants were randomly assigned to a reference group that underwent systematic biopsy as well as targeted biopsy of suspicious lesions shown on MRI. The remaining participants were assigned to the experimental group and underwent MRI-targeted biopsy only. The primary outcome was clinically insignificant prostate cancer, defined as a Gleason score of 3+3. The secondary outcome was clinically significant prostate cancer, defined as a Gleason score of at least 3+4. Safety was also assessed.Of the men who were invited to undergo screening, 17,980 (47%) participated in the trial. A total of 66 of the 11,986 participants in the experimental group (0.6%) received a diagnosis of clinically insignificant prostate cancer, as compared with 72 of 5994 participants (1.2%) in the reference group, a difference of -0.7 percentage points (95% confidence interval [CI], -1.0 to -0.4; relative risk, 0.46; 95% CI, 0.33 to 0.64; P<0.001). The relative risk of clinically significant prostate cancer in the experimental group as compared with the reference group was 0.81 (95% CI, 0.60 to 1.1). Clinically significant cancer that was detected only by systematic biopsy was diagnosed in 10 participants in the reference group; all cases were of intermediate risk and involved mainly low-volume disease that was managed with active surveillance. Serious adverse events were rare (<0.1%) in the two groups.The avoidance of systematic biopsy in favor of MRI-directed targeted biopsy for screening and early detection in persons with elevated PSA levels reduced the risk of overdiagnosis by half at the cost of delaying detection of intermediate-risk tumors in a small proportion of patients. (Funded by Karin and Christer Johansson's Foundation and others; GÖTEBORG-2 ISRCTN Registry number, ISRCTN94604465.).
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6.
  • Josefsson, Andreas, 1979-, et al. (författare)
  • Performance of 4Kscore as a Reflex Test to Prostate-specific Antigen in the GÖTEBORG-2 Prostate Cancer Screening Trial
  • 2024
  • Ingår i: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560.
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and objective: We investigated whether adding 4Kscore as a reflex test to prostate-specific antigen (PSA) could improve the screening algorithm for prostate cancer (PC). Methods: In the GÖTEBORG-2 PC screening trial, 38 000men (50–60 yr) were invited to PSA testing and, if elevated, followed by magnetic resonance imaging (MRI). For 571 men with PSA ≥3.0 ng/ml and evaluable outcomes, 4Kscore was calculated. The performance using a prespecified 4Kscore cutoff of 7.5% was evaluated. Key findings and limitations: The area under the curve for 4Kscore to identify intermediate- and high-risk PC was 0.84 (95% confidence interval 0.79–0.89), and the positive predictive value, and negative predictive value were 15% (0.12–0.20) and 99% (97–100%), respectively. Of the 54 men diagnosed with intermediate- or high-grade PC, two had a 4Kscore cutoff below 7.5%, both with organ-confined intermediate-risk PC. Per 1000 men with elevated PSA, adding 4Kscore would have resulted in avoidance of MRI for 408 (41%) men, biopsies for 95 (28% reduction) men, and diagnosis of 23 low-grade cancers (23% reduction) while delaying the diagnosis of four men with intermediate-grade cancers (4%). Conclusions and clinical implications: Including 4Kscore as a reflex test for men with elevated PSA reduces the need for MRI and biopsy markedly, and results in less overdiagnosis of low-grade PC at the cost of delaying the diagnosis of intermediate-grade PC in a few men. These results add further evidence for including new blood-based biomarkers in addition to PSA to improve the harm and benefit ratio of PC screening and reduce the need for resource-demanding MRI and biopsies. Patient summary: In this study, 4Kscore, a blood-based biomarker, as a reflex test for men with elevated prostate-specific antigen (PSA), reduces the need for magnetic resonance imaging and biopsy. These results support the inclusion of new blood-based biomarkers in addition to PSA.
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7.
  • Kohestani, Kimia, et al. (författare)
  • Performance and inter-observer variability of prostate MRI (PI-RADS version 2) outside high-volume centres
  • 2019
  • Ingår i: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 53:5, s. 304-311
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Despite the growing trend to embrace pre-biopsy MRI in the diagnostic pathway for prostate cancer (PC), its performance and inter-observer variability outside high-volume centres remains unknown. This study aims to evaluate sensitivity of and variability between readers of prostate MRI outside specialized units with radical prostatectomy (RP) specimen as the reference standard.Materials and methods: Retrospective study comprising a consecutive cohort of all 97 men who underwent MRI and subsequent RP between January 2012 and December 2014 at a private hospital in Sweden. Three readers, blinded to clinical data, reviewed all images (including 11 extra prostate MRI to reduce bias). A tumour was considered detected if the overall PI-RADS v2 score was 3-5 and there was an approximate match (same or neighbouring sector) of tumour sector according to a 24 sector system used for both MRI and whole mount sections.Results: Detection rate for the index tumour ranged from 67 to 76%, if PI-RADS 3-5 lesions were considered positive and 54-66% if only PI-RADS score 4-5 tumours were included. Detection rate for aggressive tumours (GS >= 4 + 3) was higher; 83.1% for PI-RADS 3-5 and 79.2% for PI-RADS 4-5. The agreement between readers showed average values of 0.41 for PI-RADS score 3-5 and 0.51 for PI-RADS score 4-5.Conclusions: Prostate MRI evidenced a moderate detection rate for clinically significant PC with a rather large variability between readers. Clinics outside specialized units must have knowledge of their performance of prostate MRI before considering omitting biopsies in men with negative MRI.
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8.
  • Kohestani, Kimia, et al. (författare)
  • The Göteborg prostate cancer screening 2 trial: a prospective, randomised, population-based prostate cancer screening trial with prostate-specific antigen testing followed by magnetic resonance imaging of the prostate
  • 2021
  • Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 55:2, s. 116-124
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To describe the study design of the GoTEBORG prostate cancer screening (PC) 2 (Goteborg-2), a prospective, randomised, population-based trial of PC screening. This trial evaluates whether prostate-specific antigen (PSA) testing followed by 3 Tesla prostate magnetic resonance imaging (MRI) and targeted biopsy can reduce overdiagnosis, while maintaining the detection of clinically significant cancer, compared to PSA-screening and systematic biopsy. Materials and methods A random sample of men 50-60 years in the Goteborg area, Sweden, identified from the Total Population Register, were randomised to either a screening or control group (CG). Participants in the screening group (SG) were further randomised into one of three arms: (1) PSA-test; if PSA >= 3 ng/mL, then MRI and systematic biopsy, plus targeted biopsy to suspicious lesions as per Prostate Imaging - Reporting and Data System, version 2 (PI-RADSv2) 3-5; (2) PSA-test; if PSA >= 3 ng/mL, then MRI, and targeted biopsy only if PI-RADSv2 3-5; (3) identical to Arm 2, except lower PSA-cut-off >= 1.8 ng/mL. The primary outcome is the detection rate of clinically insignificant PC (defined as Gleason Score 3 + 3 [Grade Group 1]) comparing all men with PSA >= 3 ng/mL in Arm 1 vs. Arm 2 + 3. Results Randomisation and enrolment started in September 2015. Accrual has hitherto resulted in 38,770 men randomised to the SG. The participation rate is 50%. Invitation to the first screening round was completed in June 2020. Conclusions The Goteborg-2 trial will provide new knowledge about the performance of prostate MRI in a screening setting.
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9.
  • Maier, Stephan E, 1959, et al. (författare)
  • Prostate Cancer Diffusion-Weighted Magnetic Resonance Imaging: Does the Choice of Diffusion-Weighting Level Matter?
  • 2022
  • Ingår i: Journal of Magnetic Resonance Imaging. - : Wiley. - 1053-1807 .- 1522-2586. ; 55:3, s. 842-853
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Diffusion-weighted magnetic resonance imaging plays an important role in multiparametric assessment of prostate lesions. The derived apparent diffusion coefficient (ADC) could be a useful quantitative biomarker for malignant growth, but lacks acceptance because of low reproducibility. Purpose To investigate the impact of the choice of diffusion-weighting levels (b-values) on contrast-to-noise ratio and quantitative measures in prostate diffusion-weighted MRI. Study Type Retrospective and simulation based on published data. Subjects Patient cohort (21 men with Prostate Imaging-Reporting and Data System (PI-RADS) version 2 score >= 3) from a single-center study. Field Strength/Sequence 3 T/diffusion-weighted imaging with single-shot echo-planar imaging. Assessment Both clinical data and simulations based on previously acquired data were used to quantify the influence of b-value choice in normal peripheral zone (PZ) and PZ tumor lesions. For clinical data, ADC was determined for different combinations of b-values. Contrast-to-noise ratio and quantitative diffusion measures were simulated for a wide range of b-values. Statistical Tests Tissue ADC and the lesion-to-normal tissue ADC ratios of different b-value combinations were compared with paired two-tailed Student's t-tests. A P-value Findings about b-value dependence derived from clinical data and from simulations agreed with each other. Provided measurement was limited to two b-values, simulation-derived optimal b-value choices coincided with PI-RADSv2 recommendations. For two-point measurements, ADC decreased by 15% when the maximum b-value increased from 1000 to 1500 seconds/mm(2), but corresponding lesion-to-normal tissue ADC ratio showed no significant change (P = 0.86 for acquired data). Simulations with three or more measurement points produced ADCs that declined by only 8% over this range of maximum b-value. Corresponding ADC ratios declined between 2.6% (three points) and 3.8% (21 points). Simulations also revealed an ADC reduction of about 19% with the shorter echo and diffusion time evaluated. Data Conclusion The comprehensive assessment of b-value dependence permits better formulation of protocol and analysis recommendations for obtaining reproducible results in prostate cancer diffusion-weighted MRI. Level of Evidence 4 Technical Efficacy Stage 2
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10.
  • Möller, Fredrik, 1990, et al. (författare)
  • Prostate Cancers in the Prostate-specific Antigen Interval of 1.8-3 ng/ml: Results from the Göteborg-2 Prostate Cancer Screening Trial.
  • 2024
  • Ingår i: European Urology. - 0302-2838. ; 86:2, s. 95-100
  • Tidskriftsartikel (refereegranskat)abstract
    • Magnetic resonance imaging (MRI) and targeted biopsies reduce overdiagnosis of prostate cancer (PC). It is uncertain how this strategy performs for low prostate-specific antigen (PSA) levels.To investigate the Prostate Imaging Reporting and Data System (PI-RADS) distribution, frequency, and characteristics of screen-detected PC with PSA of 1.8-<3 ng/ml and 3-<10 ng/ml.In the population-based Göteborg-2 screening study, 17974 men choose to participate by having a PSA test (2015-2020). One-third of the participants (n=6006) were randomized to arm 3, men with a PSA value of ≥1.8 ng/ml were recommended for MRI. Men with positive MRI (PI-RADS 3-5) had four targeted biopsies from each MRI-visible lesion.Clinically significant PC was defined as Gleason score ≥3+4.A total of 6006 men were included. The median age was 55.9 yr (interquartile range [IQR] 52.6-59.6). Of them, 4929 (82%) had PSA of <1.8 ng/ml, 670 (11%) had PSA of 1.8-<3 ng/ml (low-PSA group, median PSA 2.1 ng/ml [IQR 1.9-2.5]), and 377 (6.3%) had PSA of 3-<10 ng/ml (high-PSA group, median PSA 3.9 ng/ml [IQR 3.3-5.0]). PI-RADS scores of 3, 4, and 5 were observed in 7.8%, 15%, and 1.0% of men in the low-PSA group, and in 6.9%, 17%, and 5.3% of men in the high-PSA group, respectively. PC was found in 64 men (41%, 95% confidence interval [CI] 0.33-0.49) with positive MRI findings in the low-PSA group, of whom 33 (21%) had Gleason 6 (insignificant PC) and 31 (20%) had Gleason ≥7 (significant PC). In the high-PSA group, PC was detected in 61 men (56%, 95% CI 0.46-0.66), of whom 26 (24%) had Gleason 6 (insignificant PC) and 35 (32%) had Gleason ≥7 (significant PC). Limitations include results from only a single screening round.A non-negligible number of men with PSA 1.8-3 ng/ml have clinically significant PC. Whether a delay in the diagnosis of these tumors until they reached PSA ≥3 ng/ml would impair their chance of cure remains to be evaluated.We studied screening using prostate-specific antigen (PSA) and magnetic resonance imaging in men with PSA 1.8-3 ng/ml. We found a non-negligible number of potentially harmful prostate cancers in these men.
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11.
  • Shrestha, Sarita, 1991-, et al. (författare)
  • The use of ICD codes to identify IBD subtypes and phenotypes of the Montreal classification in the Swedish National Patient Register
  • 2020
  • Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 55:4, s. 430-435
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Whether data on International Classification of Diseases (ICD)-codes from the Swedish National Patient Register (NPR) correctly correspond to subtypes of inflammatory bowel disease (IBD) and phenotypes of the Montreal classification scheme among patients with prevalent disease is unknown. Materials and methods: We obtained information on IBD subtypes and phenotypes from the medical records of 1403 patients with known IBD who underwent biological treatment at ten Swedish hospitals and retrieved information on their IBD-associated diagnostic codes from the NPR. We used previously described algorithms to define IBD subtypes and phenotypes. Finally, we compared these register-generated subtypes and phenotypes with the corresponding information from the medical records and calculated positive predictive values (PPV) with 95% confidence intervals. Results: Among patients with clinically confirmed disease and diagnostic listings of IBD in the NPR (N = 1401), the PPV was 97 (96-99)% for Crohn's disease, 98 (97-100)% for ulcerative colitis, and 8 (4-11)% for IBD-unclassified. The overall accuracy for age at diagnosis was 95% (when defined as A1, A2, or A3). Examining the validity of codes representing disease phenotype, the PPV was 36 (32-40)% for colonic Crohn's disease (L2), 61 (56-65)% for non-stricturing/non-penetrating Crohn's disease behaviour (B1) and 83 (78-87)% for perianal disease. Correspondingly, the PPV was 80 (71-89)% for proctitis (E1)/left-sided colitis (E2) in ulcerative colitis. Conclusions: Among people with known IBD, the NPR is a reliable source of data to classify most subtypes of prevalent IBD, even though misclassification commonly occurred in Crohn's disease location and behaviour and also among IBD-unclassified patients.
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12.
  • Sjöberg, Mats, 1965-, et al. (författare)
  • Infliximab or cyclosporine as rescue therapy in hospitalized patients with steroid-refractory ulcerative colitis : a retrospective observational study
  • 2012
  • Ingår i: Inflammatory Bowel Diseases. - : John Wiley & Sons. - 1078-0998 .- 1536-4844. ; 18:2, s. 212-218
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Cyclosporine (CsA) or infliximab (IFX) are used as rescue therapies in steroid-refractory, severe attacks of ulcerative colitis (UC). There are no data comparing the efficacy of these two alternatives. Methods: Outcome of rescue therapy was retrospectively studied in two cohorts of patients hospitalized due to steroid-refractory moderate to severe UC: 1) a Swedish-Danish cohort (n 49) treated with a single infusion of IFX; 2) an Austrian cohort (n 43) treated with intravenous CsA. After successful rescue therapy, maintenance immunomodulator treatment was given to 27/33 (82%) of IFX patients and to 31/40 (78%) of CsA patients. Endpoints were colectomy-free survival at 3 and 12 months. Kaplan-Meier and Cox regression models were used to evaluate the association between treatment groups and colectomy. Results: At 15 days, colectomy-free survival in the IFX cohort was 36/49 (73%) versus 41/43 (95%) in the CsA cohort (P = 0.005), at 3 months 33/49 (67%) versus 40/43 (93%) (P = 0.002), and at 12 months 28/49 (57%) versus 33/43 (77%) (P = 0.034). After adjusting for potential confounding factors, Cox regression analysis yielded adjusted hazard ratios for risk of colectomy in IFX-treated patients of 11.2 (95% confidence interval [CI] 2.4-53.1, P = 0.002) at 3 months and of 3.0 (95% CI 1.1-8.2, P = 0.030) at 12 months in comparison with CsA-treated patients. There were no opportunistic infections or mortality. Conclusions: Colectomy frequencies were significantly lower after rescue therapy with CsA than with a single infusion of IFX both at 3 and 12 months' follow-up. The superiority of CsA was seen principally during the first 15 days.
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13.
  • Varenhorst, Eberhard, 1937-, et al. (författare)
  • The National Prostate Cancer Register in Sweden 1998-2002 : trends in incidence, treatment and survival
  • 2005
  • Ingår i: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 39:2, s. 117-123
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To provide a descriptive review of the establishment of the National Prostate Cancer Register (NPCR) in Sweden, to present clinical characteristics at diagnosis and to calculate the relative survival of different risk groups after 5 years. MATERIAL AND METHODS: Since 1998, data on all newly diagnosed prostate cancers, including TNM classification, grade of malignancy, prostate-specific antigen (PSA) level and treatment, have been prospectively collected. For the 35,223 patients diagnosed between 1998 and 2002, relative survival in different risk groups has been calculated. RESULTS: Between 1998 and 2002, 96% of all prostate cancer cases diagnosed in Sweden were registered in the NPCR. The number of new cases increased from 6137 in 1998 to 7385 in 2002. The age-standardized rate rose in those aged < 70 years, while it was stable, or possibly declining from 1999, in the older age groups. The proportion of T1c tumours increased from 14% to 28% of all recorded cases. The age-adjusted incidence of advanced tumours (M1 or PSA > 100 ng/ml) decreased by 17%. The proportion of patients receiving curative treatment doubled. Patients with N1 or M1 disease or poorly differentiated tumours (G3 or Gleason score 8-10) had a markedly reduced relative 5-year survival rate. CONCLUSIONS: It is possible to establish a nationwide prostate cancer register including basic data for assessment of the disease in the whole of Sweden. The introduction of PSA screening has increased the detection of early prostate cancer in younger men and, to a lesser extent, decreased the incidence of advanced disease. The effect of these changes on mortality is obscure but the NPCR in Sweden will serve as an important tool in such evaluation.
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14.
  • Wallström, Jonas, et al. (författare)
  • Bi- or multiparametric MRI in a sequential screening program for prostate cancer with PSA followed by MRI? Results from the Goteborg prostate cancer screening 2 trial
  • 2021
  • Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 31, s. 8692-8702
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives The PIRADS Steering Committee has called for "higher quality data before making evidence-based recommendations on MRI without contrast enhancement as an initial diagnostic work up," however, recognizing biparametric (bp) MRI as a reasonable option in a low-risk setting such as screening. With bpMRI, more men can undergo MRI at a lower cost and they can be spared the invasiveness of intravenous access. The aim of this study was to assess cancer detection in bpMRI vs mpMRI in sequential screening for prostate cancer (PCa). Methods Within the ongoing Goteborg PCa screening 2 trial, we assessed cancer detection in 551 consecutive participants undergoing prostate MRI. In the same session, readers first assessed bpMRI and then mpMRI. Four targeted biopsies were performed for lesions scored PIRADS 3-5 with bpMRI and/or mpMRI. Results Cancer was detected in 84/551 cases (15.2%; 95% CI: 12.4-18.4) with mpMRI and in 83/551 cases (15.1%; 95% CI: 12.3-18.2%) with bpMRI. The relative risk (RR) for cancer detection with bpMRI compared to mpMRI was 0.99 (95% one-sided CI: > 94.8); bpMRI was non-inferior to mpMRI (10% non-inferiority margin). bpMRI resulted in fewer false positives, 45/128 (35.2%), compared to mpMRI, 52/136 (38.2%), RR = 0.92; 95% CI: 0.84-0.98. Of 8 lesions scored positive only with mpMRI, 7 were false positives. The PPV for MRI and targeted biopsy was 83/128 (64.8%) for bpMRI and 84/136 (61.8%) for mpMRI, RR = 1.05, 95% CI: 1.01-1.10. Conclusions In a PSA-screened population, bpMRI was non-inferior to mpMRI for cancer detection and resulted in fewer false positives.
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15.
  • Wallström, Jonas, et al. (författare)
  • Prostate Cancer Screening with Magnetic Resonance Imaging: Results from the Second Round of the Göteborg Prostate Cancer Screening 2 Trial.
  • 2022
  • Ingår i: European urology oncology. - : Elsevier BV. - 2588-9311. ; 5:1, s. 54-60
  • Tidskriftsartikel (refereegranskat)abstract
    • The Göteborg 2 prostate cancer (PC) screening (G2) trial evaluates screening with prostate-specific antigen (PSA) followed by magnetic resonance imaging (MRI) in case of elevated PSA levels.To assess the safety of using a 2-yr interval in men who were previously screened positive with PSA but had negative MRI or positive MRI with a negative biopsy.A total of 61 201 men aged 50-60 yr were randomized and 38 366 were invited for screening (years 2015-2020). Men with positive MRI (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3) were scheduled for targeted biopsies. Men with negative MRI or negative biopsies were reinvited after 2yr. Round 1 and 2 MRI scans (PI-RADS ≥3) of men not diagnosed with PC in round 1 were re-read and classified according to Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) by two radiologists. Interval PCs (detected outside the program before invitation to round 2) were identified by linking to the Regional PC Registry.Tabulation of overall detection of PC was done.Between October 2017 and June 2020, 474 men with round 1 elevated PSA and MRI underwent a second screening. Of those, 19% had nonelevated PSA in round 2 and were not examined further. Of the remaining 376 men, 89% had negative MRI. Targeted biopsies yielded 14 PCs: nine grade group (GG) 1 and five GG 2-3. In men with PI-RADS ≥3 and PC diagnosed in round 2, only two (GG 1) progressed according to the PRECISE criteria and the remainder were stable. Ten interval PCs were diagnosed: seven GG 1, one GG 2, and two GG 5. The two GG 5 PCs were PI-RADS 4 and 5 with negative round 1 biopsy.A 2-yr interval seems to be safe in men with negative MRI, while men with PI-RADS 4 and 5 lesions with negative biopsies should have a closer follow-up.In prostate cancer screening, a 2-yr follow-up seems to be safe if magnetic resonance imaging did not show highly suspicious findings.
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16.
  • Amid, C., et al. (författare)
  • Additive effects of the herbicide glyphosate and elevated temperature on the branched coral Acropora formosa in Nha Trang, Vietnam
  • 2018
  • Ingår i: Environmental Science and Pollution Research. - : Springer Science and Business Media LLC. - 0944-1344 .- 1614-7499. ; 25:14, s. 13360-13372
  • Tidskriftsartikel (refereegranskat)abstract
    • The combined effects of the herbicide glyphosate and elevated temperature were studied on the tropical staghorn coral Acropora formosa, in Nha Trang bay, Vietnam. The corals were collected from two different reefs, one close to a polluted fish farm and one in a marine-protected area (MPA). In the laboratory, branches of the corals were exposed to the herbicide glyphosate at ambient (28 degrees C) and at 3 degrees C elevated water temperatures (31 degrees C). Effects of herbicide and elevated temperature were studied on coral bleaching using photography and digital image analysis (new colorimetric method developed here based on grayscale), chlorophyll a analysis, and symbiotic dinoflagellate (Symbiodinium, referred to as zooxanthellae) counts. All corals from the MPA started to bleach in the laboratory before they were exposed to the treatments, indicating that they were very sensitive, as opposed to the corals collected from the more polluted site, which were more tolerant and showed no bleaching response to temperature increase or herbicide alone. However, the combined exposure to the stressors resulted in significant loss of color, proportional to loss in chlorophyll a and zooxanthellae. The difference in sensitivity of the corals collected from the polluted site versus the MPA site could be explained by different symbiont types: the resilient type C3u and the stress-sensitive types C21 and C23, respectively. The additive effect of elevated temperatures and herbicides adds further weight to the notion that the bleaching of coral reefs is accelerated in the presence of multiple stressors. These results suggest that the corals in Nha Trang bay have adapted to the ongoing pollution to become more tolerant to anthropogenic stressors, and that multiple stressors hamper this resilience. The loss of color and decrease of chlorophyll a suggest that bleaching is related to concentration of chloro-pigments. The colorimetric method could be further fine-tuned and used as a precise, non-intrusive tool for monitoring coral bleaching in situ.
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17.
  • Andersson, Jonas, 1975-, et al. (författare)
  • Estimation of patient skin dose in fluoroscopy : summary of a joint report by AAPM TG357 and EFOMP
  • 2021
  • Ingår i: Medical physics (Lancaster). - : John Wiley & Sons. - 0094-2405 .- 2473-4209. ; 48:7, s. e671-e696
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physicians use fixed C-arm fluoroscopy equipment with many interventional radiological and cardiological procedures. The associated effective dose to a patient is generally considered low risk, as the benefit-risk ratio is almost certainly highly favorable. However, X-ray-induced skin injuries may occur due to high absorbed patient skin doses from complex fluoroscopically guided interventions (FGI). Suitable action levels for patient-specific follow-up could improve the clinical practice. There is a need for a refined metric regarding follow-up of X-ray-induced patient injuries and the knowledge gap regarding skin dose-related patient information from fluoroscopy devices must be filled. The most useful metric to indicate a risk of erythema, epilation or greater skin injury that also includes actionable information is the peak skin dose, that is, the largest dose to a region of skin.Materials and Methods: The report is based on a comprehensive review of best practices and methods to estimate peak skin dose found in the scientific literature and situates the importance of the Digital Imaging and Communication in Medicine (DICOM) standard detailing pertinent information contained in the Radiation Dose Structured Report (RDSR) and DICOM image headers for FGI devices. Furthermore, the expertise of the task group members and consultants have been used to bridge and discuss different methods and associated available DICOM information for peak skin dose estimation.Results: The report contributes an extensive summary and discussion of the current state of the art in estimating peak skin dose with FGI procedures with regard to methodology and DICOM information. Improvements in skin dose estimation efforts with more refined DICOM information are suggested and discussed.Conclusions: The endeavor of skin dose estimation is greatly aided by the continuing efforts of the scientific medical physics community, the numerous technology enhancements, the dose-controlling features provided by the FGI device manufacturers, and the emergence and greater availability of the DICOM RDSR. Refined and new dosimetry systems continue to evolve and form the infrastructure for further improvements in accuracy. Dose-related content and information systems capable of handling big data are emerging for patient dose monitoring and quality assurance tools for large-scale multihospital enterprises.
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18.
  • Bengtsson, Daniel, et al. (författare)
  • Age and sex determination of mallards Anas platyrhynchos in autumn
  • 2016
  • Ingår i: Ornis Svecica. - 1102-6812 .- 2003-2633. ; 26, s. 61-81
  • Tidskriftsartikel (refereegranskat)abstract
    • The mallard is a well-known and important species in migration ecology, game management,and epidemiology. Males and females are generally easily told apart, whereas ageing isproblematic, due to individual timing of the moult cycle and lack of easily defined agecriteria. From examination and photographic documentation of mallards caught within a longtermringing program at Ottenby Bird Observatory (56°12′N, 16°24′E), we describe ninecharacters of plumage and bare parts to be used for ageing mallards in autumn. The reliabilityof these characters was tested by letting experienced bird ringers determine putative age ofbirds from photos. Age determination from any single character proved to be uncertain, as therate of correctly assigned mallard photos of each character was in the range of 51-85% formales and 48-89% for females. For both sexes, the lowest figure represented post-humeralsand the highest represented tertials. Rectrices, tertial coverts, and greater coverts also hadreasonably high scores (71-85%). With all characters at hand, 91% of the males and 95% ofthe females were correctly identified to age. As young mallards, with the progress of prebreedingmoult (completed from October onwards), acquire tail and tertials identical to adults,untypical individuals are better not assigned to an age category.
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19.
  • Bergman, Torbjörn, 1957-, et al. (författare)
  • Appendix : On definition and measurement
  • 2021
  • Ingår i: Coalition governance in Western Europe. - Oxford : Oxford University Press. - 9780198868484 ; , s. 727-748
  • Bokkapitel (refereegranskat)abstract
    • The appendix introduces our empirical study of the coalition life cycle.  The structure of each country chapter is based on six core tables, each one capturing a major stage in the coalition life cycle.  In the book chapters, the tables help structure the analysis and provide wealth of information and details of the coalition cycle. Nevertheless, the book chapters and this appendix only present a sample of the data and information that we have collected for this research project. For reasons of space, we have had to limit the presentation in the book chapters in terms of time-periods and variables. This appendix presents many more details that are important for readers who are not familiar with the definitions used in coalition research or interested in how particular variables where measured. In addition to the definitions and measurements presented in this appendix, all the data and all the variables are presented in an on-line data appendix at www.erdda.org.
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20.
  • Bi, Huijuan, et al. (författare)
  • A frame-shift mutation in COMTD1 is associated with impaired pheomelanin pigmentation in chicken
  • 2023
  • Ingår i: PLOS Genetics. - : Public Library of Science (PLoS). - 1553-7390 .- 1553-7404. ; 19:4
  • Tidskriftsartikel (refereegranskat)abstract
    • The biochemical pathway regulating the synthesis of yellow/red pheomelanin is less well characterized than the synthesis of black/brown eumelanin. Inhibitor of gold (IG phenotype) is a plumage colour variant in chicken that provides an opportunity to further explore this pathway since the recessive allele (IG) at this locus is associated with a defect in the production of pheomelanin. IG/IG homozygotes display a marked dilution of red pheomelanin pigmentation, whilst black pigmentation (eumelanin) is only slightly affected. Here we show that a 2-base pair insertion (frame-shift mutation) in the 5th exon of the Catechol-O-methyltransferase containing domain 1 gene (COMTD1), expected to cause a complete or partial loss-of-function of the COMTD1 enzyme, shows complete concordance with the IG phenotype within and across breeds. We show that the COMTD1 protein is localized to mitochondria in pigment cells. Knockout of Comtd1 in a mouse melanocytic cell line results in a reduction in pheomelanin metabolites and significant alterations in metabolites of glutamate/glutathione, riboflavin, and the tricarboxylic acid cycle. Furthermore, COMTD1 overexpression enhanced cellular proliferation following chemical-induced transfection, a potential inducer of oxidative stress. These observations suggest that COMTD1 plays a protective role for melanocytes against oxidative stress and that this supports their ability to produce pheomelanin.
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21.
  • Bjurshagen, Stefan, et al. (författare)
  • Fluorescence dynamics and rate equations analysis in Er3+,Yb3+ doped double tungstates
  • 2006
  • Ingår i: Applied Optics. - 1559-128X .- 2155-3165. ; 45:19, s. 4715-4725
  • Tidskriftsartikel (refereegranskat)abstract
    • The fluorescence dynamics in Er3+ and Yb3+ doped KGd(WO4)(2) and KY(WO4)(2) has been investigated. Lifetimes have been measured for the Yb(F-2(5/2)), Er(I-4(13/2)), and Er(S-4(3/2)) levels around 1, 1.5, and 0.55 mu m, respectively. The Yb(F-2(5/2)) lifetimes show a decreasing trend toward the limiting Er(I-4(11/2)) lifetime with increasing Er-to-Yb concentration ratio, whereas the Er(I-4(13/2)) lifetimes are mostly unaffected by the doping concentrations. A rate equation analysis has been performed to explain the observed behavior and gain is calculated for a continuous-wave laser at 1.53 mu m to find the optimum doping concentrations for high gain.
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22.
  • Björk, Jonas, et al. (författare)
  • Diagnostikstudier bör följa internationella riktlinjer : Planering och utvärdering kräver teoretiska och praktiska överväganden.
  • 2013
  • Ingår i: Läkartidningen. - 0023-7205. ; 110:11, s. 562-5
  • Tidskriftsartikel (refereegranskat)abstract
    • Planering, genomförande, rapportering och kritisk granskning av diagnostikstudier bör följa internationella riktlinjer, de sk STARD- och QUADAS-kriterierna, så att resultatens giltighet och generaliserbarhet går att bedöma. Basala kvalitetskriterier omfattar bla adekvat beskrivning av studiedesign, inklusions- och exklusionskriterier, patientkarakteristika, utförande av index- och referenstest inklusive eventuell blindning vid bedömning av testresultaten. Resultatet av indextestet för klassificering av individer som friska eller sjuka ska redovisas i en korstabell, tillsammans med sensitivitet, specificitet och prediktiva värden samt konfidensintervall som beskriver den statistiska osäkerheten. Jämförelser av diagnostisk tillförlitlighet mellan olika indextest ska underbyggas med adekvata statistiska metoder. Utöver diagnostisk tillförlitlighet är det viktigt att också utvärdera patientnyttan, dvs hur förändrad diagnostik påverkar morbiditet och mortalitet, samt hälsoekonomiska aspekter.
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23.
  • Björk, Maria, et al. (författare)
  • Validation of two brief instruments (the SURE and CollaboRATE) to measure shared decision-making in patients with restless legs syndrome
  • 2023
  • Ingår i: Journal of Sleep Research. - : John Wiley & Sons. - 0962-1105 .- 1365-2869.
  • Tidskriftsartikel (refereegranskat)abstract
    • Restless legs syndrome (RLS) is a common neurological disorder characterised by an urge to move arms and legs, usually associated with discomfort, pain, motor restlessness, and sleep disturbance. An individually adapted treatment is needed but difficult to optimise, which makes shared decision-making (SDM) important. However, brief validated instruments on how patients with RLS perceive their involvement in treatment decisions are lacking. Therefore, the aim was to validate two instruments, SURE (Sure of myself, Understand information, Risk-benefit ratio, Encouragement, i.e., to assess decisional conflict) and CollaboRATE (brief patient survey focused on SDM, i.e., to assess SDM), in patients with RLS. A cross-sectional design, including 788 participants with RLS (65% females, mean [SD] age 70.8 [11.4] years) from a national patient organisation for RLS, was used. A postal survey was sent out to collect data regarding weight, height, comorbidities, demographics, and RLS-related treatment data. The following instruments were included: the SURE, CollaboRATE, Restless Legs Syndrome-6 Scale, and eHealth Literacy Scale. Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the SURE and CollaboRATE. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age, gender, and medication groups were assessed. The SURE and CollaboRATE were both identified as unidimensional instruments with satisfactory internal consistency. No DIF across age and gender was identified, while significant DIF was observed for both the SURE and CollaboRATE regarding medication use categories. However, both the SURE and CollaboRATE are potential instruments to be used in research, but also as reflection tools by healthcare professionals, patients, and students to explore and assess SDM, and support its development in clinical care.
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24.
  • Boström, Jonas (författare)
  • Knowledge for Improving Healthcare Service Quality : Combining Three Perspectives
  • 2020
  • Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The Swedish public sector in general, and healthcare specifically, is struggling with large deficits: 19 of 21 regions have large negative results in 2019. The demands made by the citizens and their elected politicians that healthcare should offer effective, accessible, good and equal care are difficult to meet. However, when it comes to emergency care, Swedish healthcare scores high on international rankings. The difficulties and challenges today lie in ensuring good and equal care for the large groups of people with multiple illnesses, and patients who need long-term care from different healthcare providers. A complicated system has become even more complex.Organizational research has shown conflicts between different ways of working to improve and change the organization and the methods that support the daily work of providing healthcare services. Furthermore, quality research shows that there are knowledge gaps to be filled when it comes to understanding how complex problems should be handled and what kind of knowledge could contribute. This also applies to the tensions and conflicts that can arise when knowledge from patients, other professions and fields of knowledge must be integrated with the knowledge that the professions (physicians, nursing) possess. Several public organizations have in recent years also adopted methods, tools and approaches from the design field. Especially user involvement (human-centric), collaboration and visualization. Design research often highlights the methods which are favorable for handling complexity.The overall purpose of this thesis was therefore to gain a deeper understanding of how the quality development work in healthcare is expressed and how it is affected when different perspectives of knowledge are integrated - with a focus on improvement knowledge, professional knowledge and design thinking. Since the purpose of the licentiate thesis was to gain a deeper understanding of what happens when new knowledge to develop quality in healthcare emerges, the method is based on a qualitative approach. Three research questions were formulated and led to three studies. The first study, a literature review, showed that there is limited research in the area but that there are indications that user involvement in development work affects employees' attitudes and values. In study number two, a case study was set up using design methods and involving users. The results showed tensions between the improvement work and the daily clinical operations. This tension could primarily be attributed to the conflict between faster and slowerxviprocesses (doing and thinking), when moving between different practicing skills (design, improvement and professional). The last study aimed to understand more about the management's view of this, relatively new knowledge (design) in healthcare, in relation to the traditional way to work with improvement and change. The result stresses that there are potential conflicts between the different fields of knowledge. But the interviews were also interpreted as showing the synergy effects that can arise when different practitioners meet, and the results also show that different ways of thinking can challenge the traditional ways of handling improvement and change in the development of healthcare.The thesis result overall strengthens the research that shows that design can add another dimension to traditional improvement work in healthcare. However, there is also frustration about something which is perceived as more abstract and reflective and which can sometimes be slower than what the solutions-oriented professions, who work under great time pressure and with scarce resources, are used to. Furthermore, the thesis highlights the problem that also has been described in previous research and which signals the (in)ability to both share new knowledge and to absorb it.
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25.
  • Brännäs, Kurt, et al. (författare)
  • A new approach to modelling and forecasting monthly guest nights in hotels
  • 2002
  • Ingår i: International Journal of Forecasting. - : Elsevier. - 0169-2070 .- 1872-8200. ; 18:1, s. 19-30
  • Tidskriftsartikel (refereegranskat)abstract
    • Starting from a day-to-day model on hotel specific guest nights we obtain an integer-valued moving average model by cross-sectional and temporal aggregation. The two parameters of the aggregate model reflect mean check-in and the check-out probability. Letting the parameters be functions of dummy and economic variables we demonstrate the potential of the approach in terms of interesting interpretations. Empirical results are presented for a series of Norwegian guests in Swedish hotels. The results indicate strong seasonal patterns in both mean check-in and in the check-out probability. Models based on differenced series are preferred in terms of goodness-of-fit. In a forecast comparison the improvements due to economic variables are small. © 2002 International Institute of Forecasters. Published by Elsevier Science B.V.
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26.
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27.
  • Carlander (Goliath), Ida, 1968-, et al. (författare)
  • Being Me and Being Us in a Family Living Close to Death at Home
  • 2011
  • Ingår i: Qualitative Health Research. - : Sage Publications Inc. - 1049-7323 .- 1552-7557. ; 21:5, s. 683-695
  • Tidskriftsartikel (refereegranskat)abstract
    • We used interpretive description to describe how everyday life close to death was experienced and dealt with in families with one member who had a life-threatening illness. We performed 28 individual, couple, and group interviews with five families. We found two patterns, namely, “being me in a family living close to death” and “being us in a family living close to death.” “Being me” meant that every individual in the family had to deal with the impending death, regardless of whether or not he or she was the person with the life-threatening illness. This was linked to ways of promoting the individual’s self-image, or “me-ness.” This pattern was present at the same time as the pattern of “being us,” or in other words, being a family, and dealing with impending death and a new “we-ness” as a group. “Striving for the optimal way of living close to death” was the core theme.
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28.
  • Carlander (Goliath), Ida, et al. (författare)
  • Constructing family identity close to death
  • 2013
  • Ingår i: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 3:5, s. 379-388
  • Tidskriftsartikel (refereegranskat)abstract
    • Daily life close to death involves physical, psychological, and social strain, exposing patients and their family members to major transitions affecting relational patterns and identity. For the individual family member, this often means sharing life with a changing person in a changing relationship, disrupting both individual identity and family identity. Our aim was to deepen the understanding of individual experiences that are important in constructing family identity close to death at home. We performed a secondary analysis of qualitative data collected through 40 interviews with persons with life-threatening illness and the family members who shared everyday life with them. The analysis resulted in interpretive descriptions which provided three patterns important for creating family identity, which we here call “we-ness” close to death. The patterns were: being an existential person, being an extension of the other, and being together in existential loneliness. Together, these three patterns seemed to play a part in the construction of family identity; we-ness, close to death. One important finding was the tension between the search for togetherness in “we-ness” while dealing with an existential loneliness, which seemed to capture an essential aspect of being a family of which one member is dying.
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29.
  • Carlander (Goliath), Ida, 1968-, et al. (författare)
  • Four aspects of self-image close to death at home
  • 2011
  • Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : CoAction Publishing. - 1748-2623 .- 1748-2631. ; 6:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Living close to death means an inevitable confrontation with one’s own existential limitation. In this article, we argue that everyday life close to death embodies an identity work in progress. We used a narrative approach and a holistic-content reading to analyze 12 interviews conducted with three persons close to death. By illuminating the unique stories and identifying patterns among the participants’ narratives, we found four themes exemplifying important aspects of the identity work related to everyday life close to death. Two of the themes, named ‘‘Inside and outside of me’’ and ‘‘Searching for togetherness,’’ represented the core of the self-image and were framed by the other themes, ‘‘My place in space’’ and ‘‘My death and my time.’’ Our findings elucidate the way the individual stories moved between the past, the present, and the future. This study challenges the idea that everyday life close to impending death primarily means limitations. The findings show that the search for meaning, new knowledge, and community can form a part of a conscious and ongoing identity work close to death.
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30.
  • Carlander (Goliath), Ida, 1968- (författare)
  • Me-ness and we-ness in a modified everyday life close to death at home
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The overarching aim of this thesis was to describe how family members experienced everyday life with life-threatening illness close to death, with focus on self-image and identity. The thesis comprises four papers, each with a specific aim to illuminate various aspects of the phenomenon under study. The study population consisted of 29 participants; ten family caregivers and five families, including five patients with life threatening illness and their family members. Data were based on retrospective single interviews (paper I), prospective individual, couple and group interviews with the families over six to eighteen month (papers II-III). Interpretive description approach (papers I, II, IV), narrative method (paper III) and secondary analysis (paper IV) were used to analyze data. The findings show how living close to death influences everyday life at home, at several levels (papers I-IV). From the perspective of the dying person, narrations of daily situations was described by four themes related to identity and everyday life; inside and outside of me, searching for togetherness, my place in space and my death and my time. The changing body, pain, fatigue, decreased physical capacity and changed appearance, appeared to influence the dying person’s need for altered knowledge and community, and as a result the patterns of interaction within the families changed. The strive for knowledge and community took place at home, an arena for identity work and the conscious search for meaning, knowledge and community; it was limited by time and inevitable death (paper III). For the family member, life close to death can mean sharing life with a changing person in a changing relationship (paper II). It may mean that everyday life needs to be modified in order for it to work (papers I-IV). New patterns of dependence and an asymmetrical relationship affect all involved (papers III-IV). Daily life close to death is about finding the space to promote the individual self-image, me-ness, at the same time as finding new ways of being a family; we-ness (paper II). Regardless of being the ill person or not, the family members we interviewed had to face impending death, which challenged earlier ways of living together (papers I-IV). From the perspective of the relatives, the everyday life of caring for the dying family member was characterized by challenged ideals, stretched limits and interdependency (paper I). Situations that challenged the caregivers’ self-image were connected to intimacy, decreasing personal space and experiences such as “forbidden thoughts”. The findings suggest that the bodily changes were of importance for the self-image, and that the former approach to the own body was important in the process of experiencing the body. The person living close to death was in transition to something new; being dead in the near future. One way of handling the struggles of everyday life was to seek togetherness, strive to find other persons with similar experiences while sharing thoughts and feelings. Togetherness was sought within the family, in the health care system and on the internet; a sense of togetherness was also sought with those who had already died. The other family members were also in transition as the future meant living on without the ill family member and changing their status to for example being a widow or being motherless. Identity work close to death denotes creating an access ramp into something new; a transition into the unknown. From a clinical perspective, this study emphasizes the significance of creating a climate that allows caregivers to express thoughts and feelings.
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31.
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32.
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33.
  • Carlander, Ida, et al. (författare)
  • The Distrained Masculinity
  • 2016
  • Ingår i: EPAC 2015. - Newmarket : Hayward Medical Communications. - 9780954202231 ; , s. 206-
  • Konferensbidrag (refereegranskat)abstract
    • Dying is a gendered situated experience. Relatively few discussions about death and dying have looked beyond patient perspective in relation to culture and images of men and masculinity. Despite a growing body of literature on dying, criticalstudies about men and masculinitiesin relation to thisis needed. Aim: The aim wasto describe the perceived and self-reflected processes of dying in relation to gendered ideas of culture, family and identity. Methods: We used a narrative thematic approach to analyse 8 interviews conducted over 18 month with one man close to death. The analysisfocuses on the interplay of death and dying and examines how they can be related to the concept of hegemonic masculinity and the processes connecting such men with the position of being. Result: Three themes are presented here: The priorities – straightened, the body – revised, the fatherhood – comprised. Setting the prioritiesstraight when time was meted out entails revising norms connected to work and what it meansto be a“real”man. The navigation towards child-centered manhood representsinstant re-evaluation of work. The presence of body is a deeply rooted foundation in perceptions and ideas of masculinity. Hence, the body is often regarded as a machine, i.e. working and operating in socialsituations, and bodily decline is a dispossession of masculinity. Achieving the goal of a“positively involved fatherhood”indicatesthat the amount of involvement mattersin contemporary masculinity. Being presentseemsto involve a range of responsibilities,such as economy, practical and emotionalstrings even beyond death. Conclusion: The overarching“distrained masculinity”usesimages and ideals astoolsto reach last possible opportunitiesfor fulfillment rather than filling a function as a style and posing in gendered meanings, covering strategies of: concentration asin putting priorities wright, dispossession or loss due to bodily decline and, extension of responsibilities beyond death.
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34.
  • Dahlén, Micael, et al. (författare)
  • Changes in Physical Activity Are Associated with Corresponding Changes in Psychological Well-Being : A Pandemic Case Study
  • 2021
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601 .- 1661-7827. ; 20, s. 1-9
  • Tidskriftsartikel (refereegranskat)abstract
    • Societal crises and personal challenges are often followed by substantial changes in physicalactivity. Is there a link between such changes and psychological well-being? Seeking to answerthis question, we conducted a correlational study on a representative sample in Sweden during thefirst year of the COVID-19 pandemic (N = 1035). About 49% of the sample had decreased theirphysical activity compared to their self-reported activity level prior to the pandemic, whereas 32%had increased it. The results showed a positive and robust association between changes in dailyactivity level and corresponding changes in psychological well-being. Specifically, individuals whohad reduced their physical activity over the last year reported lower life satisfaction than before, andindividuals who had increased their physical activity reported higher life satisfaction than before.The amount of complete physical inactivity (sitting) showed a similar pattern as the exercise data,meaning that individuals who reported increasing inactivity per day also reported a greater declinein life satisfaction. Additional analyses showed that the association between daily activity level andlife satisfaction was somewhat stronger for men than for women, but there was no difference whencomparing individual versus organized activities. The current study was based on a cross-sectionaldesign, measuring self-reported change over time. Recent work from other research teams have usedlongitudinal data and experience-sampling in different settings, finding similar results. We concludethat there is good reason to recommend physical exercise as a coping strategy in difficult times.
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35.
  • Dahlén, Micael, et al. (författare)
  • The comeback effect : How happy are people who have recovered from a COVID-19 infection?
  • 2022
  • Ingår i: International Journal of Wellbeing. - : International Journal of Wellbeing. - 1179-8602. ; 12:2, s. 114-133
  • Tidskriftsartikel (refereegranskat)abstract
    • There is already a large body of research on the dramatic negative effects of COVID-19 on peoples’ mental and physical health. Millions of people have died, and the pandemic has negatively influenced the lives of billions of people. Luckily however, the vast majority of people infected with the virus, recovers. The happiness and wellbeing of these people have not been extensively studied. In the current paper, we ask the question: Are people who have recovered from a COVID-19 infection happier than those who have not been infected at all? Building on previous research on hedonic adaptation and counterfactual thinking, we hypothesize, and find, that those who have had an infection appear slightly happier than others.  The study relies on two surveys conducted in Sweden during the pandemic in 2020 (n=1029) and 2021 (n=1788).
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36.
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37.
  • Denker, B., et al. (författare)
  • Hot YAG:Yb3+:Er3+ crystal-a potential laser medium for high average power 1.5 μm lasers
  • 2006
  • Ingår i: Advanced solid-state photonics 2006. - : Optical Society of America. - 1557527989 - 9781557527981
  • Konferensbidrag (refereegranskat)abstract
    • The near-IR spectroscopic properties of YAG:Yb:Er crystals were investigated at high temperatures. It is shown that at 600°-800°C temperatures they become close to their corresponding properties in Er,Yb: phosphate laser glasses.
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38.
  • Denker, Boris, et al. (författare)
  • Luminescent and laser properties of Yb-Er:GdCa4O(BO3)3 : a new crystal for eye-safe 1.5-µm lasers
  • 2004
  • Ingår i: Applied physics. B, Lasers and optics (Print). - : Springer Science and Business Media LLC. - 0946-2171 .- 1432-0649. ; 79:5, s. 577-581
  • Tidskriftsartikel (refereegranskat)abstract
    • We present for the first time 1.5-μm laser emission in Yb-Er:GdCa 4O(BO3)3 (GdCOB). The crystals were grown by the Czochralski method from platinum crucibles. Spectroscopic and laser tests of the crystals are described. A continuous-wave output power of 80 mW was achieved in a monolithic microchip cavity under laser-diode pumping.
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39.
  • Denker, B., et al. (författare)
  • New crystalline material for 1.5 μm lasers : Yb,Er - Activated GdCa 4O(BO3)3
  • 2004
  • Ingår i: Advanced Solid-State Photonics. - Washington, D.C. : Optics Info Base, Optical Society of America. - 1557527717 ; , s. 430-434
  • Konferensbidrag (refereegranskat)abstract
    • A new crystalline medium for 1.5 μm Yb-Er lasers is proposed: GdCa 4O(BO3)3 (GdCOB). Its melting point allows crystal growth using platinum instead of iridium crucibles. Spectroscopic and laser tests of the new material are described. A maximum CW output power of 80 mW was achieved in a monolithic microchip cavity under laser diode pumping.
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40.
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41.
  • Denker, Boris, et al. (författare)
  • Yb3+,Er3+:YAG at high temperatures : energy transfer and spectroscopic properties
  • 2007
  • Ingår i: Optics Communications. - : Elsevier BV. - 0030-4018 .- 1873-0310. ; 271:1, s. 142-147
  • Tidskriftsartikel (refereegranskat)abstract
    • Energy transfer and spectroscopic properties at high temperatures have been investigated in Er,Yb:YAG crystals. It is shown that at elevated temperatures around 600-800 degrees C these characteristics become similar to those in the efficient 1.5 mu m laser medium - Er,Yb-doped phosphate glasses. (c) 2006 Elsevier B.V. All rights reserved.
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42.
  • Dillner, Joakim, et al. (författare)
  • Antibodies to SARS-CoV-2 and risk of past or future sick leave
  • 2021
  • Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The extent that antibodies to SARS-CoV-2 may protect against future virus-associated disease is unknown. We invited all employees (n=15,300) at work at the Karolinska University Hospital, Stockholm, Sweden to participate in a study examining SARS-Cov-2 antibodies in relation to registered sick leave. For consenting 12,928 healthy hospital employees antibodies to SARS-CoV-2 could be determined and compared to participant sick leave records. Subjects with viral serum antibodies were not at excess risk for future sick leave (adjusted odds ratio (OR) controlling for age and sex: 0.85 [95% confidence interval (CI) (0.85 (0.43-1.68)]. By contrast, subjects with antibodies had an excess risk for sick leave in the weeks prior to testing [adjusted OR in multivariate analysis: 3.34 (2.98-3.74)]. Thus, presence of viral antibodies marks past disease and protection against excess risk of future disease. Knowledge of whether exposed subjects have had disease in the past or are at risk for future disease is essential for planning of control measures.Trial registration: First registered on 02/06/20, ClinicalTrials.gov NCT04411576.
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43.
  • Elmhagen, Bodil, et al. (författare)
  • A boreal invasion in response to climate change? : Range shifts and community effects in the borderland between forest and tundra
  • 2015
  • Ingår i: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 44:1, s. 39-50
  • Tidskriftsartikel (refereegranskat)abstract
    • It has been hypothesized that climate warming will allow southern species to advance north and invade northern ecosystems. We review the changes in the Swedish mammal and bird community in boreal forest and alpine tundra since the nineteenth century, as well as suggested drivers of change. Observed changes include (1) range expansion and increased abundance in southern birds, ungulates, and carnivores; (2) range contraction and decline in northern birds and carnivores; and (3) abundance decline or periodically disrupted dynamics in cyclic populations of small and medium-sized mammals and birds. The first warm spell, 1930-1960, stands out as a period of substantial faunal change. However, in addition to climate warming, suggested drivers of change include land use and other anthropogenic factors. We hypothesize all these drivers interacted, primarily favoring southern generalists. Future research should aim to distinguish between effects of climate and land-use change in boreal and tundra ecosystems.
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44.
  • Elmhagen, Bodil, 1973-, et al. (författare)
  • Changes in vole and lemming fluctuations in northern Sweden 1960-2008 revealed by fox dynamics
  • 2011
  • Ingår i: Annales Zoologici Fennici. - : Finnish Zoological and Botanical Publishing Board. - 0003-455X .- 1797-2450. ; 48:3, s. 167-179
  • Tidskriftsartikel (refereegranskat)abstract
    • Cyclic dynamics with extensive spatial synchrony has long been regarded as characteristic of key herbivores at high latitudes. This contrasts to recent reports of fading cycles in arvicoline rodents in boreal and alpine Fennoscandia. We investigate the spatio-temporal dynamics of boreal red fox and alpine arctic fox in Sweden as a proxy for the dynamics of their main prey, voles and Norwegian lemming, respectively. We analyse data from five decades, 1960-2008, with wavelets and autocorrelation approaches. Cyclic dynamics were identified with at least one method in all populations (arctic fox n = 3, red fox n = 6). The dynamics were synchronous between populations, or coupled with a 1-yr lag, in 8 of 13 pairwise comparisons. Importantly though, the dynamics were heterogeneous in space and time. All analytical approaches identified fading cycles in the three arctic fox populations and two northern red fox populations. At least one method identified similar patterns in three southern red fox populations. Red fox dynamics were cyclic in the 1970s primarily, while arctic fox dynamics was cyclic until the late 1980s or early 1990s. When cyclic, 4-yr cycles dominated in arctic fox and northern red fox, whilst 3-4-yr cycles was found in southern red foxes. Significant cyclic regimes reappeared in the 1990s or 2000s in two red fox populations and one arctic fox population. Cycles and regionally coupled dynamics appeared associated in northern arctic and red foxes. This study supports accumulating evidence which suggests that cyclic and synchronous patterns in the dynamics of lemmings and voles are nonstationary in space and time. Furthermore, the similar patterns of change in both fox species indicate that persistence of cycles is governed by similar mechanisms in lemmings and voles.
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45.
  • Elvén, Maria, 1973-, et al. (författare)
  • Changes in Physical Activity and Sedentary Behavior before and during the COVID-19 Pandemic : A Swedish Population Study
  • 2022
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Governments have enforced measures to limit the spread of COVID-19 with varying degrees of success, which could affect people’s physical activity (PA) and sedentary behavior. This study aimed to examine changes in PA levels, types of PA, and sedentary behavior in the Swedish population before and during the COVID-19 pandemic. Associations between changed PA levels and demographical and behavioral determinants were also investigated. In December 2020, 1035 individuals (18–79 years old) completed a survey about their PA and sedentary behavior before and during the pandemic. Factors influencing their PA were also explored. Fifty-one percent of the sample reported reduced total PA, 18% had no change, and 31% increased their PA. Overall, organized PA decreased the most and sedentary behavior increased. The youngest and oldest age groups reported the greatest reduction in PA, while middle-aged groups reported the most increased PA. Men reported a larger increase in sedentary behavior than women. Mental and physical capability was associated with change in PA. In conclusion, this study indicates that, during the COVID-19 pandemic, the majority of the Swedish population have decreased PA levels with a concurrent increase in sedentary behavior, which may have negative health consequences. Interventions are recommended to address both PA and sedentary behavior, specifically to strengthen people’s ability to perform PA and focusing on the youngest and oldest age groups. 
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46.
  • Elvén, Maria, 1973-, et al. (författare)
  • The impact of the COVID-19 pandemic on Swedes’ physical activity and sedentary behaviour
  • 2022
  • Konferensbidrag (refereegranskat)abstract
    • Background: Despite the proven health benefits of physical activity (PA), more than a quarter of the world’s adult population is insufficiently physically active, which increases the risk of diseases and premature death. During the COVID-19 pandemic governments have implemented enforced measures to limit the spread of the virus, which could affect people’s PA.  Aim: This study aimed to examine changes in PA levels, types of PA, and sedentary behavior in the Swedish population before and during the COVID-19 pandemic. Associations between demographical and behavioral determinants, and changes in PA were also investigated. Method: In December 2020, 1.035 individuals (18-79 y) completed a survey about PA and sedentary behavior, at present and before the pandemic. Factors influencing their PA were also explored.  Results: Fifty-one percent of the sample reduced total PA, 18% had no change and 31% increased PA. Overall, organized PA, for example at fitness centers and sport training, decreased the most, and sedentary behavior increased. The youngest and the oldest age groups reported the greatest reduction of PA, while the middle age groups reported the most increased PA. Mental and physical capability was associated with PA change. Conclusion: During the pandemic, most of the Swedish population have decreased PA levels with a concurrent increase in sedentary behavior. This may have both a short-and long-term negative health impact on individuals’ and populations’ health.  Implications for caring in a changing world: As physical inactivity already is a global public health problem during non-pandemic circumstances this study’s findings call for further actions during and after the pandemic to support people in maintaining or increasing daily PA and decreasing sedentary behavior. Interventions in health care are recommended to strengthen peoples’ ability to perform PA, focus on the youngest and oldest age groups, and be applied on an individual basis as well as in organizational contexts.
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47.
  • Eriksson, Henrik, et al. (författare)
  • Experiences of long-term home care as an informal caregiver to a spouse : Gendered meanings in everyday life for female carers
  • 2013
  • Ingår i: International Journal of Older People Nursing. - Oxford : Wiley. - 1748-3735 .- 1748-3743. ; 8:2, s. 159-165
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. One of the most common circumstances in which a woman gradually steps into a long-term caregiver role at home involves caring for a spouse suffering from dementia. Little attention has been paid to examining the experiences and motivations of such caregivers from a feminist perspective. Methods. Twelve women, all of whom were informal caregivers to a partner suffering from dementia, were interviewed on the following themes: the home, their partner's disease, everyday life, their relationship and autonomy. The results of these interviews were analysed in relation to gender identity and social power structures using a feminist perspective. Results. The findings of this study show that the informants frequently reflected on their caregiving activities in terms of both general and heteronormative expectations. The results suggest that the process of heteropolarisation in these cases can be an understood as a consequence of both the spouse's illness and the resulting caring duties. Also, the results suggest that the act of caring leads to introspections concerning perceived 'shortcomings' as a caregiver. Finally, the results indicate that it is important to recognise when the need for support in day-to-day caring is downplayed. Conclusions. Women view their caregiving role and responsibilities as paramount; their other duties, including caring for themselves, are deemed less important. We stress that the intense commitment and responsibilities that women experience in their day-to-day caring must be acknowledged and that it is important for healthcare professionals to find mechanisms for providing choices for female caregivers without neglecting their moral concerns. Implications for practice. Female carers face difficulties in always living up to gendered standards and this need to be considered when evaluating policies and practices for family carers.
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48.
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49.
  • Flinck, Marianne, et al. (författare)
  • Cardiac output measured by electrical velocimetry in the CT suite correlates with coronary artery enhancement: a feasibility study.
  • 2010
  • Ingår i: Acta radiologica. - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 51:8, s. 895-902
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Cardiac output (CO) is inversely related to vascular contrast medium (CM) enhancement during computed tomography (CT). Impedance cardiography with a new technique, electrical velocimetry (EV), may create opportunities to measure CO pre-examination for adaptation of CM injection parameters. Purpose: To relate COEV measured by radiology staff to aortic attenuation as a measure of coronary artery attenuation during CT coronary angiography (CTCA), and to formulate a tentative statistical model to adapt CM injection parameters to CO. Material and Methods: COEV was measured immediately before 100 kVp CTCA (64-multirow detector) in 27 patients with presumed coronary artery disease. For CTCA, 260 mg I/kg (maximum dosage weight: 80/90 kg for women/men) was injected intravenously during 12 s. Simple linear regression analysis was performed to explore the correlation between aortic attenuation (Hounsfield units, HU) and body weight, the influence of COEV on aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s), and to establish a tentative formula on how to adapt CM injection parameters to COEV and desired aortic attenuation. Results: The correlation between aortic attenuation and body weight was weak and non-significant (r=−0.14 after outlier exclusion). A significant negative correlation (r=−0.63) was found between aortic attenuation adjusted to injected CM dose rate (HU per mg I/kg/s) and COEV. The resulting formula, CM dose rate=COEV×(aortic attenuation−240)/55, made it possible to calculate CM volumes and injection rates at various COs and, for example, the present mean aortic attenuation (438 HU), injection time (12 s), CM concentration (320 mg I/ml), and a certain body weight. Conclusion: EV makes it possible to measure CO in the CT suite before vascular examinations. Hence, CM doses may be decreased in low CO states to reduce the risk of CM-induced nephropathy without jeopardizing diagnostic quality and may be increased in high CO states to avoid poor enhancement.
  •  
50.
  • Fragemann, Anna, et al. (författare)
  • Frequency converters from visible to mid-infrared with periodically poled RbTiOPO4
  • 2003
  • Ingår i: Applied Physics Letters. - : AIP Publishing. - 0003-6951 .- 1077-3118. ; 83:15, s. 3090-3092
  • Tidskriftsartikel (refereegranskat)abstract
    • Electric-field poling has been used to fabricate quasi-phase-matched frequency converters in RbTiOPO4. A more accurate Sellmeier equation has been obtained for wavelengths between 0.43 and 3.4 mum. The dispersion of the thermo-optic coefficient for n(z) refractive index has been derived in the near- to mid-infrared spectral region. The nonlinear performance of periodically poled RbTiOPO4 obtained in the infrared optical parametric devices is comparable to that of periodically poled KTiOPO4.
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