| 1. |
- Hälleberg-Nyman, Maria, 1968-
(författare)
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Urinary catheter policies for short-term bladder drainage in hip surgery patients
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients.In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation.In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.
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| 2. |
- Folkersen, Lasse, et al.
(författare)
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Genomic and drug target evaluation of 90 cardiovascular proteins in 30,931 individuals.
- 2020
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Ingår i: Nature metabolism. - : Springer Science and Business Media LLC. - 2522-5812. ; 2:10, s. 1135-1148
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Tidskriftsartikel (refereegranskat)abstract
- Circulating proteins are vital in human health and disease and are frequently used as biomarkers for clinical decision-making or as targets for pharmacological intervention. Here, we map and replicate protein quantitative trait loci (pQTL) for 90 cardiovascular proteins in over 30,000 individuals, resulting in 451 pQTLs for 85 proteins. For each protein, we further perform pathway mapping to obtain trans-pQTL gene and regulatory designations. We substantiate these regulatory findings with orthogonal evidence for trans-pQTLs using mouse knockdown experiments (ABCA1 and TRIB1) and clinical trial results (chemokine receptors CCR2 and CCR5), with consistent regulation. Finally, we evaluate known drug targets, and suggest new target candidates or repositioning opportunities using Mendelian randomization. This identifies 11 proteins with causal evidence of involvement in human disease that have not previously been targeted, including EGF, IL-16, PAPPA, SPON1, F3, ADM, CASP-8, CHI3L1, CXCL16, GDF15 and MMP-12. Taken together, these findings demonstrate the utility of large-scale mapping of the genetics of the proteome and provide a resource for future precision studies of circulating proteins in human health.
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| 3. |
- Tellgren, Britt, 1951-
(författare)
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Från samhällsmoder till forskarbehörig lärare : kontinuitet och förändring i en lokal förskollärarutbildning
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- From Mother of Society to a Teacher Qualified for Post-graduate Studies – Continuity and Change in a Local Pre-school Education. The aim of this thesis is to throw light upon the basic values and representations of knowledge within a local female teacher education tradition and identify what kind of expectations are held of a pre-school teacher over time. The main question concerns central values and notions in a local pre-school teacher education regarding what is expected of a recognised pre-school teacher between the beginning of the 20th century and the first decade of the 21st century. A key interest is how these underlying values and notions are maintained and how they are transformed over time. Another interest is how these values and notions are maintained and transformed when they meet other teacher education traditions and when they are confronted with traditional academic values. The preschool teacher education is deeply rooted in a female tradition and the study presented here also focuses on the role that gender plays in the formation, changes and continuity of the central values in pre-school teacher education. The empirical sources include in-depth-interviews with 22 lecturers and supervisors from a local pre-school education in addition to document studies of selected materials from the archives of the Department of Education at Örebro University and at the Örebro University Library. The historical context and the dimension of time have been analysed using James Wertsch’s (2002) conception of voices of collective remembering in addition to the concepts of knowledge cultures (Englund & Linné 2005, Nerland 2008) and communities of practice (Lave and Wenger 2003). The results presented in this dissertation indicate that major shifts have occurred in the collective memory of the local pre-school teacher education during the 20th century and the first years of the 21st century. I have distinguished seven historical periodic themes in the analysis. These are: Mother of society – formation of a new female activity system (ca 1902–1942), All-round kindergarten leader (ca 1942–1963), Personality development and child observation (ca 1963–1972), Developmental psychology and dialogue pedagogy (ca 1972–1977), Education in a university setting and a citizen of society (ca 1977–1983), Reflective child pedagogue (ca 1982 1993) and Teacher of younger children – qualified for a research tradition (ca 2001– 2007).
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| 4. |
- Thulin, Susanne, 1953-
(författare)
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Lärares tal och barns nyfikenhet : kommunikation om naturvetenskapliga innehåll i förskolan
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to generate new knowledge about how children and teachers communicate scientific contents in preschool. The general research question is formulated as: How do the object of learning and the act of learning appear in communication about scientific contents in preschool? This thesis is a collection of three (previously published) empirical studies and takes shape in the encounter between a projected knowledge acquisition task for preschool and the educational tradition of preschool.The research approach is based primarily on phenomenography focussing on developmental pedagogy. The results are discussed in relation to situated learning and the assumptions about the task of preschool characterising the social practice that is brought to light. The thesis is based on the assumption that teachers are bearers of taken-for-granted ideas about what the ‘good preschool’ is, and that these ideas affect the way they interpret new tasks.The empirical basis consists of video observations from two preschools working with different thematic projects: Life in the tree stump and How soil is formed. The analysis is delimited to the verbal communication occurring between children and teachers about the scientific content. The children are aged between three and six years. All observations have been transcribed to text and analysed according to the following research questions: Study I: (i) What is communicated as the object of learning in the theme work about natural scientific phenomena in the preschool studied? (ii) What acts of learning appear in the communication of the object of learning? Study II is a re-analysis of the linguistic usage in the empirical data from Study I. Research questions of Study II are: is there any systematic pattern in the use of anthropomorphic speech regarding (i) who uses this language, (ii) when it is used and (iii) what it is used for? Study III is delimited to children’s perspective, and the research questions are: (i) What do children ask about during theme work with a natural scientific process in preschool? (ii) Can any tendency towards change be discerned with regard to what kind of questions children ask in the course of the theme work?The results have thrown light on what natural science is in these preschools, a questioning teacher, an education ideal as an interpretative framework and children’s meeting with the object of learning. The results are discussed in relation to a feasible didactic perspective based on the educational ideal of preschool and in relation to a critical didactic perspective concerning teachers’ will, courage and competence to make the content visible. Finally, with the implementation of the raised knowledge task for preschool in mind, prominence is given to the need of critical reflection over the role of language as maintaining a discourse and the concepts established.
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| 5. |
- Anderbro, Therese
(författare)
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Behavior change intervention and fear of hypoglycemia in type 1 diabetes
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Individuals with type 1 diabetes require lifelong insulin supply as well as behavioral adjustments for good treatment result. Only a minority reach the goal for glycemic control set in order to reduce the risk of severe long-term complications. Interventions based on cognitive behavior therapy (CBT) have been proposed to improve diabetes-management, but evidence for its efficacy in adults with poorly controlled type 1 diabetes is sparse. One common barrier to optimal diabetes-management is fear of hypoglycemia (FOH), especially in those who have experienced severe hypoglycemic episodes. Thus there is a need for a valid and reliable instrument to assess individuals who are affected by FOH. It is also vital to identify factors associated with FOH in order to find targets for interventions to reduce fear.Aim: The overall aims of this thesis were to evaluate a CBT intervention for poorly controlled individuals with type 1 diabetes and to explore fear of hypoglycemia in an effort to gain deeper knowledge of possible targets for interventions to reduce FOH.Methods: All four studies applied quantitative designs. Study I was a randomized controlled trial in which a cognitive behavioral intervention was evaluated on poorly controlled adult persons with type 1 diabetes. Study II was a psychometric evaluation of a Swedish version of the Hypoglycemia Fear Survey (HFS) in a survey study in adult persons with type 1 diabetes. Studies III and IV were cross-sectional survey studies employed on adults with type 1 diabetes exploring disease-specific, demographic, (studies III and IV) emotional and psychosocial factors (study IV) related to FOH.Results and conclusions: Study I: The intervention group receiving CBT showed significant improvements in HbA1c, diabetes related distress, well-being, FOH, perceived stress, anxiety and depression as well as frequency in self monitoring of blood glucose. Study II: A three- factor solution was found for the Swedish version of the HFS with the dimensions Worry, Behavior and Aloneness. Cronbach’s alpha for the total scale was 0.85 and varied between 0.63 – 0.89 in the subscales. Convergent validity was also supported with moderate correlation between Swe-HFS and Swe-PAID-20. The Swe-HFS seems to be a reliable and valid instrument to measure FOH in adults with type 1 diabetes. Study III: Seven hundred and sixty- four persons (55%) responded to the questionnaire. The HFS-Worry subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, hypoglycemic symptoms during hyperglycemia and hypoglycemic unawareness. The HFS-Aloneness subscale was significantly associated with frequency of severe hypoglycemia, number of symptoms during mild hypoglycemia, gender, frequency of mild hypoglycemia, HbA1c, hypoglycaemic unawareness and visits to the emergency room because of severe hypoglycemia. FOH proved to be more prevalent in females. Frequency of severe hypoglycemia was identified as the most important factor associated with FOH. Study IV: A total of 469 (61%) persons responded to the questionnaire. The HFS was significantly associated with The Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale and Social Phobia Scale. Together with the disease-specific factors the regression model explained 39% of the variance. Support for a positive association between FOH and anxiety was present and previously identified gender differences were confirmed. Differences between the subgroups on factors associated with FOH were found that may have implications in developing interventions
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| 6. |
- Furukawa, Toshi A., et al.
(författare)
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Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual data
- 2021
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Ingår i: Lancet psychiatry. - London, United Kingdom : Elsevier. - 2215-0374 .- 2215-0366. ; 8:6, s. 500-511
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Forskningsöversikt (refereegranskat)abstract
- Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42.0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1.83 [95% credible interval (CrI) -2.90 to -0.80]) and that relaxation might be harmful (1.20 [95% CrI 0.17 to 2.27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0.32 [95% CrI 0.13 to 0.93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. 511
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| 7. |
- Johansson, Anna, 1965-
(författare)
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Sleep-Wake-Activity and Health-Related Quality of Life in Patients with Coronary Artery Disease and evaluation of an individualized non-pharmacological programme to promote self-care in sleep
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sleep is a basic need, important to physical and psychological recovery. Insomnia implies sleep-related complaints, such as difficulty falling asleep, difficulty staying asleep, early awakening, or non-restorative sleep (NRS) in an individual who has adequate circumstances and opportunity to sleep. Insomnia is also related to impairment of daytime functions. The prevalence of reported sleep disturbances varies between 15% and 60% in patients with coronary artery disease (CAD) up to five years after intervention. Disturbed sleep may have a negative impact on self-care capacity and behaviours. Little attention has been given to evaluation of sleep promotion through individualized non-pharmacological interventions among CAD patients.The overall aim of this thesis was to describe the impact of sleep quality and disrupted sleep on health-related quality of life (HRQoL) in patients with stable CAD, in comparison to a population-based group. The objective was also to evaluate an individualized non-pharmacological programme to promote self-care in sleep.Four studies were conducted during seven years, starting in 2001. Patients from six hospitals in the south of Sweden were invited to participate. In addition, an age and gender matched population-based group was randomly selected during the same period as the patients and was used for comparison with the CAD patients in two of the studies. Data was collected through interviews, self-reported questionnaires, a study specific sleep diary and actigraphy registrations. A pretest-posttest control design was used to evaluate whether an individualized non-pharmacological intervention programme could promote self-care in sleep-activity in CAD patients.The results showed a high prevalence of insomniac CAD patients out of whom a large proportion were non-rested insomniacs. This showed that NRS is one of the core symptoms of insomnia. On the other hand there were weak or non-significant gender differences with increasing insomnia severity. Severe insomniac CAD patients displayed a two or threefold higher presleep arousal or anxiety score and were more limited in taking physical exercise than the general population. Generally low sleep efficiency (SE%) was revealed in the studies, particularly among severe non-rested insomniac CAD patients.Among CAD patients, the individualized non-pharmacological programme to promote self-care in sleep-activity indicated improvements in sleep and HRQoL.This thesis elucidates the importance of focusing on the individual’s perception of their sleep-activity and health in their local context and supporting self-care management. Furthermore, it is of importance that nurses set individual goals together with the patient in order to increase self-efficacy to promote HRQoL.
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| 8. |
- Karyotaki, Eirini, et al.
(författare)
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Internet-Based Cognitive Behavioral Therapy for Depression : A Systematic Review and Individual Patient Data Network Meta-analysis
- 2021
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Ingår i: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 78:4, s. 361-371
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Forskningsöversikt (refereegranskat)abstract
- IMPORTANCE: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them.OBJECTIVE: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information.DATA SOURCES: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019.STUDY SELECTION: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization.DATA EXTRACTION AND SYNTHESIS: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression.MAIN OUTCOMES AND MEASURES: Patient Health Questionnaire-9 (PHQ-9) scores.RESULTS: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9.CONCLUSIONS AND RELEVANCE: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
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| 9. |
- Rohlin, Malin
(författare)
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Att styra i namn av barns fritid : En nutidshistoria om konstruktionen av dagens fritidshem i samordning med skolan
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Governing in the name of children’s leisure time: A contemporary history of the construction of today’s school-age childcare (fritidshem) in coordination with the schools.The purpose of this study is to provide a perspective on the recent restructuring of the cooperation between schools and school-age childcare in Sweden. To achieve that goal the study also focuses on varying conceptions of school-age childcare through different time periods. The subject matter of the study is the reasoning embodied in various concepts of how school-age childcare and schools should cooperate, as well as their methods of coordination. The changing conceptions of school-age childcare over a period of time raise questions about its pedagogic identity. The actual focus of the study is on the ways of reasoning that guide school-age childcare now and have guided it in the past, and how this reasoning governs and exercises power in the name of children’s leisure time.The empirical basis of the study consists of various texts, most of which are official reports and propositions, professional texts, and earlier investigations on the coordination between school-age childcare the schools.At the end of the 1990s school-age childcare was transferred from the arena of social policy to that of educational policy. The change was emphasized in the discussion about a holistic view, which then produced the team as the logical tangible form for cooperation.The theoretical basis for the study is Michel Foucault’s and his followers’ analyses of the modern welfare state’s reasoning about governing. Foucault calls his perspective governmentality. This concept emphasizes the thinking and ideas in the name of which governing takes place. The object of governing is influenced, in other words, by the thinking that is the basis of the actual steering.The governing of school-age childcare is approached from three angles. These are costs/economy and the connections between compulsory school and voluntary afternoon activities. The third angle is about the relation between children’s social development and knowledge. The assumption is made that these angles provide a certain mode of thinking about today’s school-age childcare. Today’s governmentalities, which I call the pedagogical thought, emerged during the late 1970s. This mentality in turn appeared against the background of other historical figures of thought, e.g. the work mentality of the early 1900s as well as the recreation mentality of the 1930 and 1940s. The metaphors of the “child exempted from school attendance” and what I call the “village-child” show a strained relationship between what is stated in texts and the reasoning in pedagogical practice. In the 1970s the texts introduced a holistic view in childcare.The governmentalities that organize the school-age childcare of the 1990s are characterized by the discussion of holistic views and the team, and contain different aspects than the discussions of the early 1900s, the 1940s and -50s, and the1970s and -80s. The strategies and techniques developed aim at neutralizing the dichotomy of social development/knowledge. Assumptions about the child’s growth are not just a matter of an ambition to govern the whole child/pupil. Comprehensive control affects cognitive, emotional, and ethical values. Today’s reasoning also has an impact on the temporal aspects of the child’s existence – a life-long learning.Keywords: governmentality, leisure time, school-age childcare, school, social development, knowledge, developmental psychology, cooperation, holistic view, team
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| 10. |
- Skeppner, Elisabet [Elisabeth], 1962-
(författare)
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Penile carcinoma : from first symptom to sexual function and life satisfaction following organ-sparing laser treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe how patients with penile carcinoma experienced their symptoms, treatment seeking and the impact of the diagnosis and treatment on sexual function, sexual activity and life satisfaction. The thesis contains two studies of patients treated with organ-sparing laser therapy, a retrospective study (Papers II and III) of 46 patients treated between 1986-2000 and a prospective study (Papers I and IV) of 50 patients between 2005 and 2009 and additional 34 partners. In both studies face-to-face interviews were used with a structured questionnaire; and self-assessment instruments IIEF-5, LiSat-11, and HADS. An ad hoc comparator population of men aged 34–74 years from a nationally representative investigation of sexual life and life satisfaction in Swedes was chosen for some of the questions concerning sexuality and life satisfaction. We found a delay of more than 6 months in 37% of the patients in the retrospective study and 65% of the patients in the prospective study. The single most important reason for patients’ delay was embarrassment. Nine patients had a doctors’ delay of more than 3 months from first special visit until diagnosis. Eight of these patients consulted dermatologists and were subjected to repeated biopsies, leaving premalignant results (I, II). All patients younger than 75 years (34/46) in the retrospective study reported that they were sexual active before treatment, 80% of these had resumed their activity by the time of the interview. Furthermore, except for satisfaction with somatic health, similar—or even higher—proportions of patients than comparators were satisfied with life as a whole and with other domains of life including satisfaction with sexual life (III). We found that 21/29 couples were sexually active with intercourse before treatment and 17 couples resumed their activity. Two items differed markedly from the comparators; considerably fewer patients were satisfied with their somatic health, and satisfaction with sexual life (at 12 months follow-up). Couples with an active partner-related sexuality at 12 months follow-up, reported coherence in high satisfaction with life as a whole (IV).In conclusion, patients with penile carcinoma delay for a long time after identifying symptoms before seeking contact with the health care system. This delay is mainly caused by embarrassment in describing the symptom to health care personnel and deficient knowledge about the disease. Organ- sparing technique offers good, satisfying cosmetic results and the possibility of maintaining sexual activity and function to a great extent.
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| 11. |
- Windahl, Torgny, 1948-
(författare)
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Clinical aspect of laser treatment of lichen sclerosus and squamous cell carcinoma of the penis
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of these studies was to investigate the efficacy, complications and the long term results after laser treatment of lichen sclerosus et atrophicus and of squamous cell carcinoma of the penis.Patients and Methods: Paper I: In a prospective study from 1985-1991, 62 men with histologically verified lichen sclerosus et atrophicus were given carbon dioxide (CO2) laser treatment following the failure of local corticosteroid treatment. The study was subsequently updated at a median follow-up time of 14 years.Paper II-IV: Sixty-seven men aged 26 to 87 (mean 60 years) with newly diagnosed penile carcinoma were included in a prospective study. The patients were treated by a new combined laser method (CO2 and Nd:YAG) between 1986 and 2000. The median follow-up time was 42 months (range 12-186 months). All patients could be assessed for local recurrence, progression and survival at the end of 2001. Forty-six patients agreed to participate in face-to-face interviews addressing sexual activity, sexual function/dysfunction, satisfaction and cosmetic results.Results: Paper I: The laser treatment was successful in 47 patients (76%) with no local symptoms at a mean follow-up of 30 months. Fifty-three of the 62 men were alive when the update was carried out in February 2004, and we were able to get in contact with 50 of them. Forty of these patients (80%) had no local symptoms or visible lesion. We found concomitant squamous cell carcinoma of the penis in two patients and two further patients had died from anal cancer.Paper II-IV: Local recurrences appeared in 13 patients (19%) at a median follow up of 42 months, and 10 of these patients were successfully retreated with laser treatment. Two patients died from penile carcinoma. The disease-specific 5-years survival rate was 95%. Concomitant lichen sclerosus was found in 11 patients. All patients younger than 75 years reported that they were sexually active before the treatment, and 80% of them had resumed their sexual activity after the treatment. Ten patients (22%) reported decreased erectile function after the treatment, while 33 patients (72%) reported unaltered erectile function. The cosmetic result was regarded as satisfying or very satisfying in 78% of the patients.Conclusion: Carbon dioxide laser treatment is an efficient treatment for lichen sclerosus et atrophicus with excellent long-term results, and the side effects are few. One disadvantages of the treatment is a slow postoperative healing process. Combined CO2 and Nd:YAG laser treatment is effective for treatment of the primary tumour in patients with localized penile carcinoma. It can be safely carried out with good local tumour control and highly satisfactory results with respect to cosmetic aspects and sexual function.
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| 12. |
- Andersson, Gunnel, 1958-
(författare)
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Urinary incontinence : prevalence, treatment seeking behaviour, experiences, and perceptions among persons with and without urinary leakage
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to describe urinary incontinence (UI) from a population perspective and to describe experiences and perceptions of UI from an individual perspective. This includes assessing the prevalence of urinary incontinence as well as describing treatment seeking and experiences of living with UI. A secondary aim was to describe the perception of UI among cultures other than the Swedish mainstream, exemplified in this case by Syrian women living in Sweden. Both quantitative and qualitative methods were used, including questionnaires and interviews. Studies I and II were quantitative studies based on a population-based study. Together with a postal survey on general health and living conditions “Life & Health”, a questionnaire on urinary incontinence was sent out to 15 360 randomly-selected residents aged 18-79 in Orebro County, Sweden. In Study I, UI was found to affect 19%. The majority of the respondents experienced minor problems, and only 18% of those reporting UI wanted treatment. However, there was also a group who reported severe problems, but despite this 42% of them did not want treatment. Study II investigated why people with UI refrain from seeking care and treatment. It was found that the desire for treatment was regulated by the frequency of UI, being restricted from participating in various activities, the degree of inconvenience, and the type of UI. Studies III and IV were both qualitative interview studies, describing older women’s experiences of living with UI (Study III) and Syrian women’s perceptions of UI (Study IV). There were similarities between the results of these two studies; the women described UI as a normal and expected problem, and they knew that the district nurse could prescribe incontinence protections and that treatments existed. In both studies, the women expressed difficulties in making contact with the health care service, while the women who did not speak Swedish (Study IV) also had difficulties due to different communication problems. In conclusion, it is important that health care resources are optimized to identify and meet the needs of those who experience major problems with UI, and that there is awareness of the communication difficulties that can be present in meeting with people who speak other languages. However it is also important not to medicalize those who experience minor problems and who have the desire to manage on their own.
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| 13. |
- Andrén, Ove, 1963-
(författare)
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Natural history and prognostic factors in localized prostate cancer
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The natural history of localized prostate cancer is not fully understood. In most patients the tumor will never progress to a lethal disease, while a subset of patients will ultimately die of the disease. Efficient tools to separate indolent from lethal disease is currently lacking which means that many patients will be offered treatment without any benefit, but still be at risk of experiencing treatment related side effects. The aims of these studies were to get more insight into the natural history of untreated localized prostate cancer, to assess the prognostic value of established clinical parameters such as Gleason score, nuclear grade and tumor volume and, moreover, some new prognostic markers Ki-67, AMACR and MUC-1. We also aimed to study time trends in the detection of incidental tumors in Sweden. Patients with localized disease (n=223) and no initial treatment were followed for 21 years. Most patients had a favorable outcome. However, a subset of patients developed lethal disease even beyond 15 years of follow-up and these patients define the group that may benefit most from treatment with curative intent. Patients with poorly differentiated tumors experienced a 9 time higher risk of dying in prostate cancer. The studies on prognostic markers are based on a cohort of patients (n=253) with incidental prostate cancer detected by transurethral resection for presumed benign hyperplasia. All patients were left without initial treatment. Gleason grade, nuclear grade and tumor volume turned all out to be independent prognostic factors. MUC-1, AMACR and Ki-67 also carried prognostic information. However, after adjustment for Gleason grade, nuclear grade and tumor volume only MUC-1 and AMACR remained as statistically significant prognostic factors. When tested for sensitivity and specificity they all failed and, consequently, they seem to be of less value in daily practice for cancelling an individual patient regarding the choice of treatment. Time trends in incidental prostate tumors in Sweden were analyzed in a cohort of patients with prostate tumors detected by transurethral resection (TUR-P). Through linkage of the national registration number (NRN) with several registers, e.g. the Swedish Cancer Registry, the National Inpatient registry and the Cause of Death Registry we identified, during the period 1970 through 2003, in total 23288 patients with incidental prostate cancer, who constituted the study group. As comparison group we choose all patients diagnosed with prostate cancer between 1970-2003 excluding those with incidental cancer, in total 112204 patients. Our result confirms earlier findings that there has been a dramatic change over time in incidence of incidental prostate cancers in Sweden, which parallels the introduction of prostate specific antigen. We also found that the cumulative incidence of prostate cancer death is high in the incidental group, opposing earlier findings that incidental tumours are a non-lethal disease.
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| 14. |
- Berntson, Erik, 1975-
(författare)
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Employability perceptions : Nature, determinants, and implications for health and well-being
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis is to increase our understanding of perceived employability. Employability perceptions refer to individuals’ beliefs about their possibilities of finding new, equal, or better employment. How people perceive their possibilities of getting employment is important in a labour market characterised by flexibility and uncertainty, and the present thesis sets out to investigate the nature, determinants, and implications of employability perceptions, using two population-based samples. In Study I, the aim was to study if employability and self-efficacy are two distinct but related constructs and, along with this, to investigate the nature of their association. The results from this study indicated that employability was distinct from self-efficacy and, furthermore, that employability predicted subsequent self-efficacy. In Study II, the aim was to identify predictors of perceived employability. The combination of situational and individual factors was identified as important for employability perceptions. National economic prosperity, living/working in metropolitan areas, poor physical and good psychological work environments, formal education, and competency development were found to be positively associated with perceived employability. The aim of Study III was to investigate if employability could predict subsequent health and well-being. The results from this study implied that individuals who reported higher levels of employability also reported better global health and mental well-being, but not physical complaints, one year later, after controlling for work environment variables and previous health status. In conclusion, the present thesis has implications for theory as well as practice when it concludes that employability is not primarily a self-evaluation, that it is dependent on individual as well as situational factors, and that it has implications for health and well-being.
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| 15. |
- Evangelou, Evangelos, et al.
(författare)
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Genetic analysis of over 1 million people identifies 535 new loci associated with blood pressure traits.
- 2018
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Ingår i: Nature Genetics. - : Springer Science and Business Media LLC. - 1061-4036 .- 1546-1718. ; 50:10, s. 1412-1425
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Tidskriftsartikel (refereegranskat)abstract
- High blood pressure is a highly heritable and modifiable risk factor for cardiovascular disease. We report the largest genetic association study of blood pressure traits (systolic, diastolic and pulse pressure) to date in over 1 million people of European ancestry. We identify 535 novel blood pressure loci that not only offer new biological insights into blood pressure regulation but also highlight shared genetic architecture between blood pressure and lifestyle exposures. Our findings identify new biological pathways for blood pressure regulation with potential for improved cardiovascular disease prevention in the future.
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| 16. |
- Franzén, Karin, 1958-
(författare)
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Interventions for urinary incontinence in women : survey and effects on population and patient level
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Urinary Incontinence is a common health problem that can cause both severe medical and social problems, resulting in negative impact on different aspects of Quality of Life. In 2000, the Swedish Council on Health Technology Assessment (SBU) published a systematic review, “Treatment of Urinary Incontinence” where multiple knowledge gaps in the field of UI, all of considerable clinical importance, were pointed out.Several of these knowledge gaps have been the starting points for the projects in this thesis. The overall aim has been to study the impact of different interventions for urinary incontinence in women on the population level but also on the patient group level, for assessessing the significance of UI on general living conditions and to validate instruments to measure quality of life to be used as part of the evaluation of treatment effectiveness.Paper I: A population-based study where UI amongst women was found to be commonly associated with different psychosocial problems and an expressed feeling of vulnerability.Paper II: A population-based study where informative material on UI to the general public in order to increase knowledge and encourage self management was found promising for meeting increasing demands and optimizing healthcare resources.Paper III: A randomized controlled trial where both electrical stimulation and drug therapy reduced the number of micturitions and improved QoL in women with urge or urge incontinence, but electrical stimulation was not found to be superior to drug therapy.Paper IV: A prospective cohort study where the international questionnaires UDI-6 and IIQ-7 after translation and validation, showed good responsiveness and were easy to administer and to fill out. The UDI-6 scale did not accomplish the same solid result in the psychometrical analysis as the IIQ-7 scale but both scales showed good responsiveness and can thereby be recommended for clinical use.
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| 17. |
- Ivarsson, Pia-Maria, 1957-
(författare)
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Barns gemenskap i förskolan
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This study is about children’s communities. It is also about children’s everyday interaction in a pre-school setting and how they utilise interactional and institutional resources to construct peer communities and to group themselves within them. The peer communities discussed in this study are embedded in an institutional context, namely the pre-school setting.To capture this phenomenon an ethnographic approach was used. Included in the benefits of choosing this approach are the opportunities to study everyday practices and children’s activities in a pre-school setting. Participant observations, child interviews and video recordings were used when the data were subsequently constructed and analysed.One feature underlying the pre-school setting as a social context is the organisation of time and space. Time and space structure children’s activities and their material and immaterial resources and social relations. This is shown in an example related to a little boy’s (Mattias) story of everyday practices in pre-school. Another illustrative example of how time and space form the structure for routines and social relations is when the children play a game called ‘the ting-a-ling train’. Still another example of an interesting finding was discovered when the children swung together in the pre-school playground.The preschool conditions allow children to construct their own strategies to gain access to the interactive space, where their negotiations and the organisation of time and space are of vital importance. Another important finding is that activity and talk about activity are functions that are inter-related and that children use as interactional resources.When the children become members of a pre-school group they are at the same time constructed as pre-schoolers. They are ‘doing-being’ pre-schoolers and at a same time constructing the everyday practice called pre-school. Interaction and social context are entwined, which means that a study of children’s peer communities in a pre-school setting offers valuable knowledge about the world of children and about the pre-school as a social context.
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| 18. |
- Johansson, Kristina, 1971-
(författare)
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Broad Entrance - Vague Exit : The trajectory of Political Science students through higher education into working life
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to describe Political Science students’ experiences of studies and work life. Students’ reflections on their study situation as well as their envisaged and later experienced work life have been analysed through cross-sectional as well as longitudinal data. Central research questions are how students at the beginning and the end of their studies perceive their study program, how the communication patterns between teacher and students are negotiated, and what discourses of knowledge and competence operate in the program and in work life as well as how students of Political Science experience the transition from higher education to working life at two European universities, and how Political science students and students in two professional programmes experience the transition from higher education to work life. The empiri-cal studies are presented in four articles. Ethnography, phenomenography and discourse analysis have been applied. The results show that students embark on the program with dreams of being in the halls of power in Brussels or becoming famous by appearing in the media. They are, however, also driven by a Bildung incentive. Towards the end of their studies, more down-to-earth visions of the future as investigators have replaced their previous dreams. Another result is the ongoing negotiations about their role and the purpose of e.g. seminars, which convey double messages about what to say and when to contribute. They also report a rational and generic relationship between their studies and the work tasks, indicating that they have acquired a set of general skills that are helpful for them in their work. When moving from studies into work life, they report having a feeling of being squeezed between the politicians and the general public. Surprisingly, few of them regard themselves as having power in the decision-making arena.
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| 19. |
- Morberg, Åsa, 1945-
(författare)
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Ämnet som nästan blev : En studie av metodiken i lärarutbildningen 1842- 1988
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The development of "teaching practice" (Sw: "metodik") in teacher training (compulsory school level, that is, primary and secondary junior high school or grades 1 to 9) from 1842 to 1988 is described. Based on a number of evaluations of teacher training the following questions are posed: Has an earlier central role for teaching practice in teacher training changed? Has teaching practice become marginalised in teaching training? The empirical sources for this thesis are white papers and curricula for teacher. The approach adopted is based on frame factor theory.Teaching pratice has deep historical roots and tracing them can provide an interesting perspetive on the role of teaching practice today. The work reported here is the first detailed analysis of the place of teaching practice in the training of teachers for the Swedish compulsory school system. The development of teaching practice is traced step by step through each of the state reforms of teacher training for compulsory schools.Teaching practice is here defined as those techniques necessary for a successful meeting between teacher and pupil. The results show that in the development from 1842 to 1988, responsibility for the learning process shifted from, firstly, being the sole responsibility of the teacher to later becoming the sole responsibility of the pupil. In 1842 teaching practice was based on what is known as the Bell and Lancaster method. By 1862 each school topic hade devised its own formal structured methodology. At the beginning of the 20th century a more modern teaching practice, influenced by the "activity school" movement, was introduced. This was an important step toward teaching practice becoming a specialized discipline of its own. The 1968 school reform created a more scientifical model of teaching practice. Teaching practice for seconday school teacher education (junior high school) is also discussed in the context of a probationary year for these teachers (so called "Grades 4-9 Teachers"). Another focus of the thesis is the clash of traditons between Teacher Training Colleges and Universities as manifested in the most recent teacher training programmes for comprehensive compulsory school teachers (so called, Grades 1-7 Teachers). These tensions have come about since the incorporation of Teacher Training Colleges into the University and Constituent College system. The research reported attempts to explain how and why teaching practice in 1968 became a formal, but not in academic terms, a discipline of its own. Three dominant codes have been identified: the parallel code 1842-1886, the conflicting code 1914-1958, and the integrating code 1968-1988. The delineation of the State's code of university subject areas is also discussed, particularly in the light of the special problem of the varying status of the subject area known as "teaching practice". A presentation of the various categories of teacher trainers that have been involved in lecturing on teaching practice is also presented. It is concluded that variations in teaching practice have been used as a governemental tool in directing the development of teacher training and ultimatley in the development of the schooling system itself.
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