| 1. |
- Christiansen, Iben Maj, 1964-, et al.
(författare)
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The crosscurrents of Swedish mathematics teacher education
- 2021
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Ingår i: International perspectives on mathematics teacher education. - Waxhaw, NC, USA : Information Age Publishing. - 9781648026317 - 9781648026294 - 9781648026300 ; , s. 9-48
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Bokkapitel (refereegranskat)abstract
- As with any programs in teacher education, Swedish mathematics teacher education is influenced by changing political winds, developments in Information and Communication Technology (ICT), culture, history, PISA results, research-based program designs, and a fair amount of passion. Content and outcomes are nationally determined and include the requirement of a strong research foundation, but this is often not how practcing techers work, which exerts its own pull on teacher education. The specific implementations of programs take different forms at the universities that offer mathematics teacher education. In order to provide a comprehensive yet meaningful ntroduction to both the current system and current practices, we describe the overall organization of Swedish mathematics teacher education, and then offer short cases of implemented programs. To ensure inclusivity, the various parts are written by mathematics educators from the respective institutions. In this way, both variation across mathematicas teacher education for diffrent grade levels and variation across different institutions working with the same national directives can be distinguished. Issues such as the academization of teacher education are problematized, as are other forces that constitute the crosscurrents in Swedish mathematics teacher education.
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| 2. |
- Christiansen, Iben, et al.
(författare)
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Crosscurrents of Swedish Mathematics Teacher Education
- 2021
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Ingår i: International Perspectives on Mathematics Teacher Education. - Charlotte, North Carolina : Information Age Publishin (IAP).
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Mathematics teacher education includes the mathematics content teachers need to understand, the ways that pedagogical approaches are developed, the messages about the nature of mathematics teaching and learning, and the interface between tertiary preparation and school contexts. Scholars from Sweden, France, Malawi, Singapore, New Zealand, Brazil, the USA, and Canada provide insights for the mathematics education community’s understanding of how teacher educators in different countries structure, develop, and implement their respective mathematics teacher education programs. Several themes emerged across the chapters, including: varied approaches to developing culturally responsive pedagogies and/or Indigenous perspectives to ensure equity for all students; issues and challenges in fostering partnerships and collaborations among various stakeholders, with partnerships involving connections with mathematics classroom teachers, school districts, and/or mathematicians or mathematics departments; strategies for developing mathematics knowledge for teaching, providing insights into messages about what it means to learn mathematics in terms of content and pedagogy; and preparing teachers who have flexibility and resourcefulness. This book will be of interest to those responsible for higher education, including teacher educators, researchers in mathematics teacher education, instructors of graduate courses preparing future teacher educators, as well as policy makers.
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| 3. |
- Morfeldt, Johannes, 1983-, et al.
(författare)
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Economic and operational factors in energy and climate indicators for the steel industry
- 2015
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Ingår i: Energy Efficiency. - : Springer Science and Business Media LLC. - 1570-646X .- 1570-6478. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- European steel producers need to increase energy efficiency and reduce CO2 emissions to meet requirements set by European policies. Robust indicators are needed to follow up these efforts. This bottom-up analysis of traditional energy and climate indicators is based on plant level data from three Swedish steel producers with different product portfolios and production processes. It concludes that indicators based on both physical and economic production are interlinked with aspects both within and outside the company gates. Results estimated with Partial Least Squares Regression (PLSR) confirm that steel production has complex relationships with markets, societal context and operational character of the industry. The study concludes that: (i) physical indicators (based on crude steel production) may be useful at the process level, but not at the industry-wide level, (ii) the value added is not a reliable alternative since it cannot be properly estimated for companies belonging to larger international groups, and (iii) structural shifts may influence the results significantly, and veil improvements made at the process level. Finally, harmonized system boundary definitions are vital for making indicators comparable between companies. The use of traditional indicators, as defined today, may lead to uninformed decisions at the company as well as policy levels.
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| 4. |
- Morfeldt, Johannes, 1983-, et al.
(författare)
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Improving energy and climate indicators for the steel industry : the case of Sweden
- 2015
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Ingår i: Journal of Cleaner Production. - : Elsevier. - 0959-6526 .- 1879-1786. ; 107, s. 581-592
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Tidskriftsartikel (refereegranskat)abstract
- Energy and climate indicators are required for monitoring and controlling the effectiveness of regional as well as national initiatives towards increasing energy efficiency and reducing carbon dioxide (CO2) emissions. Indicators are also needed for monitoring measures implemented within companies. Recent studies show that traditional energy efficiency indicators do not capture product differentiation or value creation in the steel industry, while observed trends capture structural shifts instead. In this study, methods combining physical and techno-economic perspectives on energy and CO2 efficiency are proposed for alleviating these problems. The methods were evaluated using data from three Swedish steel producers. The results compensate for structural shifts when focused on physical production. When focused on economic production, the methods represent the value creation of the companies more strongly than traditional indicators. The proposed methods may be useful complements to traditional indicators for monitoring energy and CO2 efficiency. However, the trends show strong links with the economic climate, which may reduce companies’ possibilities of using the indicators for monitoring their own performance. The study confirms the high complexity in monitoring energy and CO2 efficiency within steel companies focused on high-value market segments. Further research is required in exploring issues related to data confidentiality, product portfolios and processes represented in the method, influence of external factors, and aggregating indicators at sectoral level.
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| 5. |
- Morfeldt, Johannes, 1983-, et al.
(författare)
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Robusta energi- och klimatindikatorer för stålindustrin
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Traditionellt använda indikatorer för att utvärdera energieffektivisering och växthusgasutsläppsminskning är energi per ton av ett produktslag, energi per förädlingsvärde, energi per produktionsvärde, växthusgasutsläpp per ton av ett produktslag, växthusgasutsläpp per förädlingsvärde samt växthusgasutsläpp per produktionsvärde. Inom järn- och stålsektorn används framför allt den fysiska indikatorn energi per producerat ton råstål. Detta forskningsprojekt har haft som mål att utvärdera och vidareutveckla energiindikatormetodologin. Sandvik Materials Technology (SMT), Höganäs Sweden AB och SSAB EMEA deltagit med detaljerade, specifika, företagsdata och insikter i produktion och marknad. Företagen representerar olika sätt att framställa stål i Sverige och kan därför anses i ett vidare perspektiv representera svensk stålindustri. Ett stort steg har tagits genom att skapa en bättre förståelse för hur företags strukturer och verksamheter påverkas av olika externa faktorer och på vilket sätt det speglas i de traditionella energieffektivitetsindikatorerna. Traditionella indikatorer är idag inte robusta nog att användas för att följa upp, eller styra, annat än separata processer inom företagen. De bör därför inte utgöra underlag för lagstiftning eller tillståndsprövning. De mer vidareutvecklade indikatorerna, som tagits fram i denna studie, är inte heller tillräckligt robusta för att användas för styrning, men kommer till rätta med några av de effekter som påverkar de traditionella. Effektivitetsindex baserade på den fysiska produktionsindikatorn minskar påverkan av strukturförändringar. Den ekonomiska produktionsindikatorn fångar tydligt produktvärde, men är starkt kopplad till det ekonomiska klimatet. Antalet parametrar som påverkar energieffektiviseringen är stort och endast ett fåtal har fortfarande beaktats. Energieffektivisering som har gjorts inom ramen för PFE syns i resultaten. Det är viktigt att utvecklingsarbetet kring indikatorer fortsätter då energi- och CO2-effektivitet är en central fråga både för stålindustrin och för samhället.
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| 6. |
- Åsenlöf, Pernilla, et al.
(författare)
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Step-Up : An Innovative Stepped-Care Protocol for Tailored Behavioral Medicine Treatment in the Management of Musculoskeletal Pain in Primary Care
- 2013
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 72:Suppl. 3, s. A120-A120
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multimodal rehabilitation and tailored behavioral medicine treatments should be provided to patients suffering from persistent and activity limiting pain according to current state-of-science. There is also evidence that a minimal intervention including 'stay-active advice' can produce effects comparable to effects of comprehensive treatment packages. Nevertheless, there is a gap of knowledge regarding which individuals who benefit the most from which modalities of pain treatment, at what time point, and with the highest cost-effectiveness. Accordingly, we have set up an innovative stepped-care protocol for the management of musculoskeletal pain in primary care, which is evaluated in a randomized controlled trial.Objectives: The aim is to compare effects and cost-effectiveness of a stepped care model including advice and tailored behavioral medicine pain treatment (experimental condition) with a stepped care model including advice and physical exercises (comparison condition) for patients with low back and neck pain and/or widespread pain including fibromyalgia in primary care. A further aim is to characterize patients who benefit/do not benefit from the respective steps i.e. treatments varying in dose and content.Methods: A stratified randomized stepped care design is applied. Stratification is based on primary care center and psychological risk profile. A consecutive selection is performed at primary care centers in southern, central and northern Sweden. After having received a minimal intervention (step 1) comprising 'stay-active advice', participants scoring high on the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) according to preset criteria are randomly allocated to an eight-week treatment in step 2. The experimental condition includes supervised physical exercises integrated with either (a) graded activity, or (b) hierarchical graded exposure depending on psychological risk profile. The comparison condition includes supervised physical exercises irrespective of risk profile. Primary outcome is pain-related disability complemented with a comprehensive set of secondary outcomes adhering to the IMMPACT recommendations.Results: The stepped-care design will be presented including illustrations of conclusions possible to draw with this kind of innovative design.Conclusions: There is a call for stepped-care interventions within pain intervention research, particularly in the primary care setting. However, published studies are still lacking. This study will contribute to an important progression of behavioral medicine pain treatments by the way treatments are tailored in accordance with psychological risk profile. This will be discussed to stimulate research activities and collaboration within this area of research and clinical implementation.
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| 7. |
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| 8. |
- Ahlin, Jane, et al.
(författare)
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Strategies to develop and strengthen human factors and ergonomics knowledge among stakeholders in Sweden
- 2015
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Ingår i: Proceedings 19th Triennial Congress of the IEA, Melbourne 9-14 August 2015. - Melbourne : International Ergonomics Association.
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Konferensbidrag (refereegranskat)abstract
- Knowledge and application of human factors and ergonomics (HFE) has significant potential as auseful tool and solution provider in the development, design and implementation of safe, efficient and sustainable artefacts and systems. Yet, it seems that this HFE knowledge is not utilised to its full potential. In a world of competing financial and commercial priorities, HFE specialists have apparently not succeeded in selling the systems approach as a tool towards improved overall systems performance and human well-being.The present paper describes the strategic and practical workperformed by the Swedish Ergonomics and Human Factors Society (EHSS) to strengthen the quality of human factors and ergonomics knowledge and practice among various stakeholders in Sweden. EHSS view human factors and ergonomics as a systems and design oriented discipline that extends across all aspects of human activity. Beyond the traditional domains of specialization within the discipline, the physical, cognitive and organisational ergonomics, EHSS has identified three focus areas; visual ergonomics, voice ergonomics and ergonomics design for all.Practitioner Summary: This paper presents the strategic and practical work performed by the Swedish Ergonomics and Human Factors Society (EHSS) in order to strengthen the quality of human factors and ergonomics knowledge and practice in Sweden. EHSS has identified three focus areas for its strategic work: visual ergonomics, voice ergonomics and ergonomics design for all.
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| 9. |
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| 10. |
- Akselsson, Anna, et al.
(författare)
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Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study
- 2019
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 20, s. 32-37
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.
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| 11. |
- Akselsson, Anna, et al.
(författare)
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Increased labor induction and women presenting with decreased or altered fetal movements : A population-based survey
- 2019
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:5
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Women's awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction.MATERIAL AND METHODS: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week's gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks' gestation in 2014 in Stockholm comprises the reference group.RESULTS: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3-1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4-1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more.CONCLUSIONS: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.
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| 12. |
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Akselsson, Anna, et al.
(författare)
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Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women
- 2020
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Ingår i: Bjog-an International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 127:7, s. 829-837
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Tidskriftsartikel (refereegranskat)abstract
- Objective To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes. Design Cluster-randomised controlled trial. Setting Sixty-seven maternity clinics in Stockholm, Sweden. Population Women with singleton pregnancy with birth from 32 weeks' gestation. Methods Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register. Main outcome measures Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery. Results No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41(+6) (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99). Conclusions Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age. Tweetable abstract Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.
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| 17. |
- Akselsson, Anna, et al.
(författare)
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Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area - a population-based study
- 2020
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Ingår i: Global health action. - : Informa UK Limited. - 1654-9880 .- 1654-9880 .- 1654-9716. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup. Objective We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia. Methods In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register. Results An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25-3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88-2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29-2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08-0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group. Conclusions A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.
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| 18. |
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| 19. |
- Akselsson, Anna, et al.
(författare)
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Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy
- 2017
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.
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| 20. |
- Andersson, Anna, et al.
(författare)
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Waterworks-specific composition of drinking water disinfection by-products
- 2019
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Ingår i: Environmental Science. - Cambridge : Royal Society of Chemistry. - 2053-1400 .- 2053-1419. ; :5, s. 861-872
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Tidskriftsartikel (refereegranskat)abstract
- Reactions between chemical disinfectants and natural organic matter (NOM) upon drinking water treatment result in formation of potentially harmful disinfection by-products (DBPs). The diversity of DBPs formed is high and a large portion remains unknown. Previous studies have shown that non-volatile DBPs are important, as much of the total toxicity from DBPs has been related to this fraction. To further understand the composition and variation of DBPs associated with this fraction, non-target analysis with ultrahigh resolution Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) was employed to detect DBPs at four Swedish waterworks using different types of raw water and treatments. Samples were collected five times covering a full year. A common group of DBPs formed at all four waterworks was detected, suggesting a similar pool of DBP precursors in all raw waters that might be related to phenolic moieties. However, the largest proportion (64–92%) of the assigned chlorinated and brominated molecular formulae were unique, i.e. were solely found in one of the four waterworks. In contrast, the compositional variations of NOM in the raw waters and samples collected prior to chemical disinfection were rather limited.This indicated that waterworks-specific DBPs presumably originated from matrix effects at the point of disinfection, primarily explained by differences in bromide levels, disinfectants (chlorine versus chloramine) and different relative abundances of isomers among the NOM compositions studied. The large variation of observed DBPs in the toxicologically relevant non-volatile fraction indicates that non-targeted monitoring strategies might be valuable to ensure relevant DBP monitoring in the future.
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| 21. |
- Bachrach-Lindström, Margareta, et al.
(författare)
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Patients on the waiting list for total hip replacement : a 1-year follow-up study
- 2008
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 22:4, s. 536-542
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Tidskriftsartikel (refereegranskat)abstract
- Patients on the waiting list for total hip replacement: a 1-year follow-up study Untreated osteoarthritis (OA) in the hip causes pain and reduced physical and social functioning. The aim of this study was to evaluate the effect of waiting time on health-related quality of life (HRQOL), functional condition and dependence on help at the time of surgery and during follow-up 1 year after surgery. A further aim was to elucidate possible differences between men and women. Two hundred and twenty-nine consecutively included patients with OA in the hip were interviewed when assigned to the waiting list, again 1 week prior to surgery with unilateral total hip replacement (THR), and 1 year after surgery. Health-related quality of life and function were measured using the Nottingham Health Profile, EuroQoL and the Western Ontario and McMaster Universities Osteoarthritis Index. The result showed that the average waiting time was 239 days, that 15% of the patients were operated on within 3 months, and that 21% had to wait more than 6 months. At the time of surgery, HRQOL had deteriorated significantly (p < 0.05) and the number of patients receiving support from relatives had increased from 31% to 58% during the wait. At the 1-year follow-up, both HRQOL and functional condition had improved significantly despite the wait, and the need for support from relatives had decreased to 11% (p < 0.001). In conclusion, long waiting time for THR is detrimental to patients HRQOL causing reduced functional condition, pain and increased need for support from relatives, which limit the independence in daily life.
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| 22. |
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| 23. |
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| 24. |
- Blomqvist, S, et al.
(författare)
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Indirect effects of lemming cycles on sandpiper dynamics: 50 years of counts from southern Sweden
- 2002
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Ingår i: Oecologia. - : Springer Science and Business Media LLC. - 1432-1939 .- 0029-8549. ; 133:2, s. 146-158
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Forskningsöversikt (refereegranskat)abstract
- The bird-lemming hypothesis postulates that breeding success of tundra-nesting geese and waders in Siberia follows the cyclic pattern of lemming populations, as a result of predators switching from lemmings to birds when the lemming, population crashes. We present 50 years of data on constant-effort catches of red knot Calidris canutus and curlew sandpiper C. ferruginea at an autumn migratory stopover site (Ottenby) at the Baltic Sea, supplemented with literature data on winter censuses of dark-bellied brent goose Branta b. bernicla and white-fronted goose Anser albifrons in northwestern Europe, and waders in Germany and Southern Africa. Number and proportion of juveniles in these bird populations (both our own and literature data) were compared with an index of predation pressure (calculated from the abundance of lemmings on the Taimyr peninsula), and climate indices for the North Eurasia and the North Atlantic regions. The index of predation pressure correlated significantly with the number of juveniles of red knot and curlew sandpiper, but not with number of adults. Also, this index correlated with the reproductive performance of geese and waders reported in the literature. Fourier analysis revealed a significant deviation from random noise with the maximum spectral density at the period length of 3 years for number of juvenile red knots and curlew sandpipers captured at Ottenby, abundance of lemmings, reproduction in arctic fox Alopex lagopus, and reproductive performance in geese on the Siberian tundra. Also, the date of passage at Ottenby for adult red knot and curlew sandpiper showed a spectral density peak at a period length of 3 years, the latter species also showing a peak at a period length of 5-6 years. Passage dates for adult red knot and curlew sandpiper were earlier in years of high predation pressure compared with years of low predation pressure. The fluctuations in reproductive success of the studied Siberian goose and wader species appear to be primarily influenced by biotic factors in the breeding area, rather than by abiotic factors, such as climate oscillations. Annual variations in migratory arctic bird populations may have far reaching effects in habitats along their migration routes and in their wintering areas. We suggest a link between lemming cyclicity in the Northern Hemisphere and predation pressure on Southern Hemisphere benthos, in which the signal is carried between continents by long distance migrating waders.
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| 25. |
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| 26. |
- Bondesson, Susanne, et al.
(författare)
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Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris.
- 2008
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Ingår i: Coronary Artery Disease. - 0954-6928. ; 19:8, s. 627-634
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: As more patients survive coronary events, the prevalence of patients with refractory angina pectoris is increasing. The aim was to evaluate the effects of enhanced external counterpulsation (EECP) and spinal cord stimulation (SCS) and compare with optimal medically treated patients with refractory angina. METHODS: 153 patients with refractory angina were treated with either EECP, SCS, or were retained on their pharmacological treatment (control). Glyceryl trinitrate usage and Canadian Cardiovascular Society classification were registered at baseline, 6 and 12 months after therapy. RESULTS: Both EECP and SCS reduced the angina as compared with controls (P<0.001). Patients treated with EECP showed a more effective reduction as compared with SCS patients (P<0.05). Both treatments resulted in significantly decreased glyceryl trinitrate usage at 6 and 12 months follow-up (P<0.001). The nitrate consumed was unaltered in the controls. DISCUSSION: The results from this study show that both EECP and SCS therapy reduce angina in patients with refractory angina pectoris; the response to EECP was slightly more effective than that to SCS. Thus, EECP can be used as an alternative treatment for patients not responding to electrical stimulation. The beneficial effects in the treated groups were maintained during the 12 months follow-up period.
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| 27. |
- Bondesson, Susanne, et al.
(författare)
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Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation
- 2010
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 19:5, s. 287-294
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure. Methods. 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate were measured pre- and post-treatment and at 12 months follow-up. Results. EECP treatment altered the blood pressure in patients with refractory angina pectoris. A decrease in the blood pressure was more common in the EECP group compared with the reference group. In the reference group, an increase in the blood pressure was more common. A correlation between a decrease in blood pressure after EECP treatment and a higher baseline MAP, SBP and DBP was seen. No such correlation was seen in the reference group. The blood pressure response did not persist at 12 months follow-up. Conclusion. EECP treatment affects the blood pressure in patients with refractory angina pectoris. The decreased blood pressure may be a result of an improved exercise capacity, an improved endothelial function and vasoreactivity in general.
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| 28. |
- Bondesson, Susanne, et al.
(författare)
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Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation
- 2011
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Ingår i: Journal of geriatric cardiology : JGC. - 1671-5411. ; 8:4, s. 215-223
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Tidskriftsartikel (refereegranskat)abstract
- To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation (EECP) in patients with chronic refractory angina. Methods Twenty patients diagnosed with refractory angina were divided into EECP (n = 10) or no EECP (n = 10) groups. The data were compared to matched healthy subjects (n = 20). The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry. The vascular responsiveness to iontophoretic administration of acetylcholine (ACh), sodium nitroprusside (SNP) and local skin warming were studied. Measurements of Canadian Cardiovascular Society (CCS)-class, blood pressure and plasma samples were registered. Results EECP patients showed reduced CCS-class compared to no EECP (P < 0.05). Both EECP and no EECP (P < 0.05) groups had decreased systolic blood pressure (SBP) as compared to SBP at baseline (P < 0.05). There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up. Responses to heating, the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects (P < 0.05). EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class. Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh, SNP and heat compared to healthy subjects. Although EECP reduced the CCS-class, this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.
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| 29. |
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| 30. |
- Brolin, Sara, et al.
(författare)
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Exploring the educational needs of patients with systemic vasculitis using the educational needs assessment tool
- 2022
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Ingår i: Rheumatology. - : Oxford University Press. - 2514-1775. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Knowledge and health literacy enable patients to monitor symptoms and disease impact. Educational needs have previously been explored in rheumatology, but scarcely for patients with ANCA-associated vasculitis (AAV). The aim of the study was to assess the educational needs among patients with AAV using the educational needs assessment tool (ENAT).Methods: This was a cross-sectional observational study including adults with AAV. Educational needs were captured by ENAT. Total ENAT (0-117 points, with higher numbers indicating higher educational need) and the seven domains (managing pain, movement, feelings, disease process, treatment, self-management and support systems) were explored regarding sex, age, education, diagnosis, disease duration and disease activity. To compare domains, a percentage response (0-100%) was calculated.Results: One hundred and seventy-eight individuals (50% men; 34% with disease duration ≤2 years) were included. The total ENAT mean was 66.5 (s.d. 26.6; 57%), with domains as follows: disease process, 78%; self-management, 69%; treatments, 64%; feelings, 56%; managing pain, 48%; support systems, 47%; and movement, 41%. Higher educational needs were found among women in the domains movement, feelings and disease process and in total ENAT (all P < 0.04) compared with men. Higher educational needs were also seen in patients with disease duration ≤2 years regarding disease process, self-management and support systems and in total ENAT compared with patients with longer disease duration (all P < 0.03).Conclusion: This study revealed great educational needs among AAV patients. Some groups expressed higher needs (women and those with shorter disease duration). Increased education for patients with AAV might lead to improved self-care and treatment adherence.
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| 31. |
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| 32. |
- Conaway, H Herschel, et al.
(författare)
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Retinoids inhibit differentiation of hematopoietic osteoclast progenitors.
- 2009
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Ingår i: The FASEB journal. - Bethesda, Md. : Wiley. - 1530-6860 .- 0892-6638. ; 23:10, s. 3526-38
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Tidskriftsartikel (refereegranskat)abstract
- Whether vitamin A promotes skeletal fragility, has no effect on fracture rate, or protects against bone loss is unclear. In the present study, effects of retinoids on osteoclast differentiation in cultured mouse bone marrow cells (BMCs), bone marrow macrophages (BMMs), spleen cells, and RAW264.7 cells were evaluated by analyzing osteoclast formation and expression of genes important in signal transduction and osteoclast function. All-trans-retinoic acid (ATRA) did not stimulate osteoclastogenesis in BMCs, but inhibited hormone and RANKL-induced gene expression and formation of osteoclasts. In BMMs, spleen cells, and RAW264.7 cells, osteoclast differentiation and formation stimulated by M-CSF/RANKL were inhibited (IC(50) = 0.3 nM) by ATRA. The effect was exerted at an early step of RANKL-induced differentiation. ATRA also abolished increases of the transcription factors c-Fos and NFAT2 stimulated by RANKL and suppressed down-regulation of the antiosteoclastogenic transcription factor MafB. By comparing effects of several compounds structurally related to ATRA, as well as by using receptor antagonists, evaluation pointed to inhibition being mediated by RARalpha, with no involvement of PPARbeta/delta. The results suggest that activation of RARalpha by retinoids in myeloid hematopoietic precursor cells decreases osteoclast formation by altering expression of the transcription factors c-Fos, NFAT2, and MafB.
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| 33. |
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| 34. |
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| 35. |
- Elfström Pettersson, Katarina, 1959-
(författare)
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Production and Products of Preschool Documentation : Entanglements of children, things, and templates
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objective of the present study is to produce knowledge about how children, things, documents, computers, teachers, templates and other entities take part in and produce documentation in preschool systematic quality development work. The thesis asks questions about how and what is produced as quality in preschool documentation. Through a posthumanist agential realist approach, the study engages empirically in video recordings of preschool documentation practices from one Swedish preschool, and in documentation from four other Swedish preschools.The results, presented in four articles, show that documentation practice is complex and entangled with a variety of entities, human and non-human, and spaces and time. The study shows how children’s participation in production of documentation does not depend on which documentation method is used. In the study, objects such as computers, images and coloured labels, together with teachers’ attitudes and agendas, have an impact on the way that children are involved in producing documentation. The results also show that the products of documentation, intra-acting with a local template, with past and present preschool traditions and policies, produce rather than represent certain elements of quality such as teachers’ actions, children’s interests and thematic work. The thesis produces knowledge about how the focus of preschool documentation shifts away from individual children and towards teachers’ activities, and creates possibilities for what preschool practices and quality may become.
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| 36. |
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| 37. |
- Emilson, Christina, et al.
(författare)
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Concurrent validity and stability of subgroup assignment based on three levels of pain condition severity in patients with musculoskeletal pain
-
Tidskriftsartikel (refereegranskat)abstract
- Pain screening instruments have been used to identify risk factors for poor prognosis and are recommended for the stratification of treatment for musculoskeletal pain. The aim of this study was to investigate the concurrent validity of subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire compared with reference instruments: The Pain Disability Index, the Tampa Scale for Kinesiophobia, and the Pain Catastrophizing Scale. A secondary aim was to investigate the stability of the subgroup assignment over a defined period of time. Participants (n=40) aged 18-65 years were recruited from five primary health care centers in Sweden. Data were collected using self-reported questionnaires. The subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire were predefined to low, moderate or high pain condition severity. The reference instrument data were dichotomized into low or high level based on previously used cut-off scores. Concurrent validity was analyzed with Fisher´s exact test. Stability was calculated using quadraticweighted kappa analysis. The results indicated acceptable psychometric properties of the subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire regarding concurrent validity, and the stability over two to three weeks. To further increase validity, it is suggested that subgroup assignment is complemented with other measures assessing e.g. pain catastrophizing. In conclusion, assignment to subgroups with low, moderate and high pain condition severities based on the Örebro Musculoskeletal Pain Screening Questionnaire, could be used as a valid base for stratified treatment for patients with musculoskeletal pain.
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| 38. |
- Erdling, Andre, et al.
(författare)
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Enhanced external counter pulsation in treatment of refractory angina pectoris: two year outcome and baseline factors associated with treatment failure
- 2008
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261. ; 8:39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Enhanced external counter pulsation (EECP) is a non-invasive treatment option for patients with refractory angina pectoris ineligible to further traditional treatment. The aim of this study was to evaluate the effect of EECP on patients at a Scandinavian medical centre and to investigate if outcome can be predicted by analysing baseline factors. Methods: 86 consecutive patients (70 male, 16 female) were treated with EECP and followed for two years post treatment. Canadian cardiovascular society (CCS) class was analysed, and medication and adverse clinical events were researched prior to EECP, at the end of the treatment, and at six, 12 and 24 months thereafter. Patients responding to therapy by improving at least one CCS class were compared with those who failed to respond. Any differences in background factors were recorded and analysed. Results: 79% of the patients responded to therapy by improving at least one CCS class. In general, the CCS class improved by one class after EECP treatment (3.05 before versus 2.14 after treatment). A total of 61.5% of the initial responders showed sustained improvement at the 12 month follow-up while 29% presented sustained improvement after 24 months. Treatment was most effective among patients suffering from CCS class III-IV angina pectoris, while patients suffering from CCS class II angina pectoris improved transiently but failed to show sustained improvement after the 12 month follow- up. Diabetes mellitus and calcium channel antagonists were more common among the non-responders (p < 0.05). Conclusion: This study confirms the safety and efficiency of EECP as a treatment option for patients suffering from refractory angina pectoris. The therapy is most beneficial in patients suffering from severe angina (CCS III-IV) while sustained response to therapy could not be verified among patients suffering from CCS class II angina pectoris.
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| 39. |
- Georgsson, Susanne, et al.
(författare)
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To be taken seriously and receive rapid and adequate care : womens' requests when they consult health care for reduced fetal movements.
- 2016
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Ingår i: Midwifery. - Edinburgh : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 40, s. 102-108
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: decreased fetal movement is a reason for women to seek health care in late pregnancy.OBJECTIVE: to examine what pregnant women who present with decreased fetal movements want to communicate to health care professionals and to other women in the same situation.DESIGN: a qualitative descriptive study.SETTING AND PARTICIPANTS: questionnaires were distributed in all seven labour wards in Stockholm from 1 January to 31 December 2014 to women who consulted care due to decreased fetal movements. In total, 3555 questionnaires were completed of which 1 000 were included in this study. The women's responses to the open ended question: "Is there something you want to communicate to health care professionals who take care of women with decreased fetal movement or to women who experience decreased fetal movements?", were analysed with manifest content analysis.FINDING: three categories were revealed about requests to health care professionals: Pay attention to the woman and take her seriously, Rapid and adequate care and Improved information on fetal movements. Regarding what the women want to communicate to other pregnant women, four categories were revealed: Contact health care for check-up, Pay attention to fetal movement, Recommended source of information and Practical advice.CONCLUSION: pregnant women who consult health care due to decreased fetal movements want to be taken seriously and receive rapid and adequate care with the health of the infant as the primary priority. The women requested uniform information about decreased fetal movements. They wished to convey to others in the same situation the importance of consulting care once too often rather than one time too few.
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| 40. |
- Gradén, Mattias, 1974-
(författare)
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Vindkraft i Dalarna : Från acceptans och lokalisering till planering och eftertanke
- 2011
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines prerequisites for wind power diffusion in a county in Sweden that quite recently was concidered to be of interest for electricty production from renewable energy sources. Three different municipalities: Falun, Mora and Orsa in the county of Dalarna are highlighted. Their view on permitting processes of wind power installations are investigated. Other actors, such as exploiters and local citizens are also being analysed. This study shows that the local acceptance was very high when the first wind power parks were built, much thanks to local politicians and local citizens. For the politicians the wind power symbolised a key to a better green society, for the local citizens the wind power meant some economical advantages. The first wind power parks were localised to areas because of good wind conditions and social factors, especially from local communities. However, results from this study shows that the acceptance for wind power the last few years, in generel, has decreased. The local authorities have also been conscious of some negative consequenses from already built wind power parks. As a response they started to add planning tools to the permitting process.
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| 41. |
- Granath, Annika, 1979-, et al.
(författare)
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How is the patient perspective captured in ANCA-associated vasculitis research? An integrative review
- 2023
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Ingår i: Rheumatology. - : Oxford University Press. - 2514-1775. ; 7:3
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: The aim was to describe how the patient perspective is captured in clinical research on ANCA-associated vasculitis (AAV).METHODS: This integrative review included 2149 publications found in four different databases and manual searches. After screening, 156 articles remained. All articles were sorted and categorized, and 77 original articles were analysed further.RESULTS: The patient perspective was captured with patient-reported outcome measures (PROMs), single-item questionnaires, project-specific questionnaires and interviews. The most common aspects measured were health-related quality of life, anxiety and depression, and fatigue, and the least common were lifestyle habits, relationships and self-management.CONCLUSION: The patient perspective was captured predominantly with generic PROMs and occasionally with a qualitative approach. AVV is a lifelong disease, and the results from this review show that not all aspects of importance to patients are covered with the PROMs used in research. Future studies should include the areas that are the most important for patients.
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| 42. |
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| 43. |
- Granbom, Marianne, et al.
(författare)
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A public health perspective to environmental barriers and accessibility problems for senior citizens living in ordinary housing
- 2016
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Housing environments that hinder performance of daily activities and impede participation in social life have negative health consequences particularly for the older segment of the population. From a public health perspective accessible housing that supports active and healthy ageing is therefore crucial. The objective of the present study was to make an inventory of environmental barriers and investigate accessibility problems in the ordinary housing stock in Sweden as related to the functional capacity of senior citizens. Particular attention was paid to differences between housing types and building periods and to identify environmental barriers generating the most accessibility problems for sub-groups of senior citizens.METHODS: Data on environmental barriers in dwellings from three databases on housing and health in old age was analysed (N = 1021). Four functional profiles representing large groups of senior citizens were used in analyses of the magnitude and severity of potential accessibility problems. Differences in terms of type of housing and building period were examined.RESULTS: High proportions of one-family houses as well as multi-dwellings had substantial numbers of environmental barriers, with significantly lower numbers in later building periods. Accessibility problems occurred already for senior citizens with few functional limitations, but more profound for those dependent on mobility devices. The most problematic housing sections were entrances in one-family houses and kitchens of multi-dwellings.CONCLUSIONS: Despite a high housing standard in the Swedish ordinary housing stock the results show substantial accessibility problems for senior citizens with functional limitations. To make housing accessible large-scale and systematic efforts are required.
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| 44. |
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| 45. |
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| 46. |
- Gustafsson, Johanna, et al.
(författare)
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Predictors of the first cardiovascular event in patients with systemic lupus erythematosus : a prospective cohort study
- 2009
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 11:6, s. R186-
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION :Cardiovascular disease (CVD) is a major cause of premature mortality among Systemic lupus erythematosus (SLE) patients. Many studies have measured and evaluated risk factors for premature subclinical atherosclerosis, but few studies are prospective and few have evaluated risk factors for hard endpoints, i.e. clinically important cardiovascular events (CVE). We investigated the impact of traditional and lupus associated risk factors for the first ever CVE in a longitudinal cohort of SLE patients.METHODS : A total of 182 SLE patients (mean age 43.9 years) selected to be free of CVE were included. Cardiovascular and autoimmune biomarkers were measured on samples collected after overnight fasting at baseline. Clinical information was collected at baseline and at follow up. End point was the first ever CVE (ischemic heart, cerebrovascular or peripheral vascular disease or death due to CVD). Impact of baseline characteristics/biomarkers on the risk of having a first CVE was evaluated with Cox regression.RESULTS :Follow up was 99.5% after a mean time of 8.3 years. Twenty-four patients (13%) had a first CVE. In age-adjusted Cox regression, any positive antiphospholipid antibody (aPL), elevated markers of endothelial activation (von Willebrand factor (vWf), soluble vascular cellular adhesion molecule-1 (sVCAM-1)) and fibrinogen predicted CVEs. Of SLE manifestations, arthritis, pleuritis and previous venous occlusion were positively associated with future CVEs while thrombocytopenia was negatively associated. Among traditional risk factors only age and smoking were significant predictors. In a multivariable Cox regression model age, any positive aPL, vWf and absence of thrombocytopenia were all predictors of the first CVE.CONCLUSIONS : In addition to age, positive aPL, biomarkers indicating increased endothelial cell activity/damage, and absence of thrombocytopenia were independent predictors of CVEs in this prospective study. Our results indicate that activation of the endothelium and the coagulation system are important features in SLE related CVD. Furthermore, we observed that the risk of CVEs seems to differ between subgroups of SLE patients.
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| 47. |
- Gustafsson, Johanna T, et al.
(författare)
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Cigarette smoking, antiphospholipid antibodies and vascular events in Systemic Lupus Erythematosus
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 74:8, s. 1537-1543
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Smoking can induce autoantibodies in persons who are genetically predisposed to rheumatoid arthritis. We investigated the association between smoking and antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE), a question not previously addressed. Further, we explored the relationship between smoking, aPL and vascular events (arterial and venous, VE).METHODS: In this cross-sectional study, clinical evaluation and questionnaire data were collected from 367 prevalent SLE patients. At the same time, we measured aPL (anticardiolipin (aCL), anti-β2 glycoprotein-1 (aβ2GP1) antibodies IgG/IgM/IgA, and lupus anticoagulant (LA)), and a large set of other SLE-associated autoantibodies for comparison. Association analyses using logistic regression models with smoking, (ever, former and current with never as reference) and antibody status as outcome variable were performed. As a secondary outcome, we investigated the associations between aPL, smoking and VE.RESULTS: In multivariable-adjusted models ever, and in particular former, cigarette smoking was associated with the most pathogenic aPL; LA, aCL IgG and aβ2GP1 IgG. Other SLE-associated autoantibodies were not associated with smoking. The combination of smoking and aPL was strongly associated with VE. We noted a positive interaction between smoking-LA and smoking-'triple aPL' positivity for previous VE.CONCLUSIONS: We investigated a large set of commonly occurring autoantibodies in SLE, but only aPL were positively associated with a history of smoking. This association was especially apparent in former smokers. Among ever regular smokers who were aPL positive, we observed a strikingly high frequency of former VE. The underlying mechanisms and temporality between smoking, aPL and VE need further investigations.
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| 48. |
- Gustafsson, Johanna T, et al.
(författare)
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Excess atherosclerosis in systemic lupus erythematosus A matter of renal involvement : Case control study of 281 SLE patients and 281 individually matched population controls
- 2017
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Systemic lupus erythematosus (SLE), is a heterogeneous disease which predominantly affects young females (90%). SLE is associated with a shorter life expectancy than in the general population. Standardized mortality ratios (SMR) of 2.4 have been reported, which is comparable to diabetes. In modern societies cardiovascular disease (CVD) is the major cause of premature mortality. Accelerated atherosclerosis is generally assumed to be the underlying cause for SLE related CVD. However, previous studies diverge regarding whether atherosclerosis is more common in SLE than in controls. With this in mind and based on own clinical experience we hypothesized that accelerated atherosclerosis is not a general feature of SLE, but prevails in SLE subgroups.METHODS: 281 SLE patients and 281 individually age and sex matched population controls, were investigated clinically. Fasting blood samples and risk factor data were collected. All participants were subject to B-mode ultrasonography of the carotid arteries. Carotid plaque occurrence and mean intima media thickness (mIMT) were recorded. Two SLE subgroups previously described to be at high CVD risk; 1) patients with nephritis and 2) patients with anti-phospholipid antibodies (aPL), and one subgroup reported to be at comparatively lower CVD risk; patients positive for Sjögren´s syndrome antigens A/B (SSA/SSB) antibodies were analyzed separately in comparison with their respective matched controls.RESULTS: Median age was 49 (IQR 36-59) years, 93% were females. Manifest CVD; ischemic heart, cerebro- and peripheral vascular disease, prevailed in patients (12% vs. 1%, p<0.0001). Overall plaque prevalence did not differ (20% vs. 16%), but patients had slightly higher mIMT than controls (0.56 vs. 0.53 mm, p<0.0033). After age adjustment plaques, but not mIMT, remained associated with previous CVD events. Therefore we focused further analyses on plaques, a more robust measure of atherosclerosis. Patients with nephritis (40%), but neither aPL (25%) nor SSA/SSB (40%) positive patients, had more plaques than their respective controls (23% vs. 11%, p = 0.008). Notably, patients with nephritis were younger than other SLE patients (45 vs.49 years, p = 0.02). To overcome the confounding effect of age we performed an age-matched nested case-control analysis, which demonstrated that patients with nephritis had twice as often plaques (23%) as both non-nephritis patients (11%, p = 0.038) and controls (12%, p = 0.035).CONCLUSIONS: In SLE excess carotid plaques are essentially confined to the SLE subgroup with nephritis. This subgroup had plaques twice as often as age-matched non-nephritis SLE patients and population controls. Non-nephritis SLE patients, including the aPL positive subgroup, which has a high CVD risk, had similar prevalence of plaques as controls. To prevent later CVD events, this novel observation calls for risk factor screening and initiation of anti-atherosclerotic treatment selectively in SLE nephritis patients. Preferably at nephritis onset, which is often at a young age. In a general perspective this study demonstrates the importance to perform careful clinical subgroup analyses when investigating heterogeneous, hitherto not clearly defined, conditions like SLE.
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| 49. |
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| 50. |
- Hansson, Anders, 1953-, et al.
(författare)
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Opening Pandora's box: The experiences of having an asymptomatic aortic aneurysm under surveillance
- 2012
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Ingår i: Health Risk & Society. - : Informa UK Limited. - 1369-8575 .- 1469-8331. ; 14:4, s. 341-359
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Tidskriftsartikel (refereegranskat)abstract
- Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Vastra Gotaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not.
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