| 11. |
- Lilliecreutz, Caroline, et al.
(author)
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Student-led clinic cervical cancer screening-medical students views on progression of learning, quality of Pap smears and women s experiences of the visit - a mixed methods study
- 2023
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In: BMC Medical Education. - : BMC. - 1472-6920. ; 23:1
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Journal article (peer-reviewed)abstract
- BackgroundStudent-led clinics (SLC) have been described, but not in gynecology. Gynecology is a subject typically covered in the last terms of medical training, however it includes few opportunities for students to tackle all phases of a consultation and a shortage of opportunities to perform gynecological examinations. Therefore, we started a student-led clinic for cervical cancer screening (SLC-CCS) in Linkoping, Sweden and aimed to evaluate students views on the progression of learning, the quality of the Papanicolaou (Pap) smear, and women s experiences of the visit, using mixed methodology.MethodsThe implementation of the SLC-CCS is described in detail. Students (n = 61) taking part in the SLC-CCS between January and May 2021 were invited to participate in a follow-up discussion (n = 24) focused around four themes: attitudes and expectations prior to participation, experiences of the patient encounter, organization of the placement, and reflections on and suggestions for further development of the placements. The group meetings were conducted in Swedish, recorded, transcribed verbatim and subjected to a qualitative, descriptive thematic analysis. Thematic analysis is considered an appropriate method of analysis for seeking to understand experiences, thoughts, or behaviors across a data set. The proportion of Pap smears lacking cells from the squamous epithelium during the study period was compared with data from the same clinic before the SLC-CCS started. A validated questionnaire on womens experience of the Pap smear visit was provided. Answers were compared between women who had the Pap smear taken by a student or a healthcare provider.ResultsThree different themes were generated: growing confidence in the clinical situation, embodied awareness of variation in anatomy, doubting accuracy of ones own performance. The percentage of Pap smears lacking cells from the squamous epithelium were equal (2%) during the study period compared to the period before the SLC-CCS started (p = 0.28). No difference was found in the satisfaction index between the women examined by a student, those examined by a healthcare provider, or women who did not know who the examiner was (p = 0.112).ConclusionsThe students expressed a growing confidence in the clinical situation and there was high satisfaction from the women. The quality of the Pap smears taken by the students was equal to the quality of those taken by the health care staff. All these findings indicate that high patient safety was maintained during this activity support the recommendation to include SLC-CCS as part of the medical training.
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| 12. |
- Ntalla, Ioanna, et al.
(author)
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Multi-ancestry GWAS of the electrocardiographic PR interval identifies 202 loci underlying cardiac conduction
- 2020
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In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 11:1
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Journal article (peer-reviewed)abstract
- The electrocardiographic PR interval reflects atrioventricular conduction, and is associated with conduction abnormalities, pacemaker implantation, atrial fibrillation (AF), and cardiovascular mortality. Here we report a multi-ancestry (N=293,051) genome-wide association meta-analysis for the PR interval, discovering 202 loci of which 141 have not previously been reported. Variants at identified loci increase the percentage of heritability explained, from 33.5% to 62.6%. We observe enrichment for cardiac muscle developmental/contractile and cytoskeletal genes, highlighting key regulation processes for atrioventricular conduction. Additionally, 8 loci not previously reported harbor genes underlying inherited arrhythmic syndromes and/or cardiomyopathies suggesting a role for these genes in cardiovascular pathology in the general population. We show that polygenic predisposition to PR interval duration is an endophenotype for cardiovascular disease, including distal conduction disease, AF, and atrioventricular pre-excitation. These findings advance our understanding of the polygenic basis of cardiac conduction, and the genetic relationship between PR interval duration and cardiovascular disease. On the electrocardiogram, the PR interval reflects conduction from the atria to ventricles and also serves as risk indicator of cardiovascular morbidity and mortality. Here, the authors perform genome-wide meta-analyses for PR interval in multiple ancestries and identify 141 previously unreported genetic loci.
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| 13. |
- Schulte-Herbrüggen, Helfrid, et al.
(author)
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Beteendeförändring och vattenbesparing : Erfarenheter från kommunikationsinsatser
- 2021
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Reports (pop. science, debate, etc.)abstract
- Att sätta värde på vatten blir allt viktigare. Rapporten sammanställer kommunikationsinsatser och lärdomar om vattenbesparing i hushåll från elva VA-huvudmän i Sverige. Den ger också förslag på fortsatt arbete för att åstadkomma en hållbar vattenanvändning.Att värdesätta vattnet är inte aktuellt bara i Sverige utan var också temat för FN:s rapport om den globala vattenanvändningen, Valuing Water (World Water Development Report, 2021). Framför allt efter sommaren 2018 är bevattningsförbud vanliga i Sveriges kommuner, och det pågår ett arbete för att kommunicera vattnets värde och minska vattenanvändningen. Vissa kommuner har som mål att sänka den genomsnittliga användningen från 140 till 100 liter per person och dag.För att tillgängliggöra goda exempel kring vattenbesparing och beteendeförändring genomfördes ett projekt där VA-huvudmän och kommunikatörer ingick. Målet var att underlätta erfarenhetsutbyte mellan olika kommuner, att ta fram konkreta exempel med kostnads-nyttouppskattningar, och att ta fram förslag på hur man kan fortsätta utveckla strategier för minskad vattenanvändning med VA-huvudmän som målgrupp.Rapporten innehåller en sammanställning av de vattenbesparingskampanjer och andra erfarenheter som projektet tagit del av under perioden december 2020 till juni 2021. Den innehåller exempel från elva VA-huvudmän: Tingsryds kommun, Uppsala Vatten och Avfall AB, Värmdö kommun, Sydvatten AB, Enköpings kommun, Region Gotland, Laholmsbuktens VA, Vatten och avloppskompetens i Norr AB (Vakin), Borgholm Energi, Mörbylånga kommun och Kalmar Vatten AB. Bidrag från högskolestudenter som arbetat med frågan presenteras också kort. Rapporten hämtar också lärdomar från andra områden, främst arbetet med matsvinn och energibesparing.Projektet visade att mycket av det kommunikationsarbete som genomfördes av VA-huvudmän och kommunens kommunikatörer ingick i ordinarie uppdrag och arbetstid. Vid specifika kampanjinsatser gick det åt betydande arbetstid. Kostnader för kampanjmaterial och annonsering varierade i projektkommunerna från 10 000 till 500 000 kronor. Vattenbesparingen var mellan 7 och 20 procent vid intensivt kampanjarbete i samband med krislägen. Region Gotland uppskattade att 5 till 7 procent av deras vattenbesparing var en följd av beteendeförändring.Kapacitetsbrist och hög säsongsvariation var vanliga anledningar till att man behövde arbeta med vattenbesparing. Det styrkte vikten av kommunikation, medvetenhet kring vattenresursen och beteendeförändringar. Lärdomar från projektet är att det är viktigt att ha mål för vattenbesparingsarbetet och att även kommunens eget arbete med vattenbesparing är betydelsefullt. Kommunikation kring vattenbesparing kan vara en utmaning, men positiva budskap når fler. Det är också viktigt att mäta och följa upp vattenanvändningen. Projektet ger förslag på en kommunikationstrappa kring vattenbesparing. Trappan börjar med höjning av medvetenheten kring vatten som en begränsad resurs och slutar med tydliga mål och systemförändring, bland annat återcirkulering av vatten.För att ändra människors beteende behövs det både kunskap (kommunikation) och tekniska åtgärder. Rapporten föreslår fortsatt forskning när det gäller grundläggande attityder till vattenanvändning hos olika målgrupper, möjligheter att mäta effekter av olika kampanjstrategier genom digitala mätare, samt utveckling av digitala visualiseringsverktyg.
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| 16. |
- van de Vegte, Yordi, et al.
(author)
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Genetic insights into resting heart rate and its role in cardiovascular disease
- 2023
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In: Nature Communications. - : Springer Nature. - 2041-1723. ; 14:1
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Journal article (peer-reviewed)abstract
- The genetics and clinical consequences of resting heart rate (RHR) remain incompletely understood. Here, the authors discover new genetic variants associated with RHR and find that higher genetically predicted RHR decreases risk of atrial fibrillation and ischemic stroke. Resting heart rate is associated with cardiovascular diseases and mortality in observational and Mendelian randomization studies. The aims of this study are to extend the number of resting heart rate associated genetic variants and to obtain further insights in resting heart rate biology and its clinical consequences. A genome-wide meta-analysis of 100 studies in up to 835,465 individuals reveals 493 independent genetic variants in 352 loci, including 68 genetic variants outside previously identified resting heart rate associated loci. We prioritize 670 genes and in silico annotations point to their enrichment in cardiomyocytes and provide insights in their ECG signature. Two-sample Mendelian randomization analyses indicate that higher genetically predicted resting heart rate increases risk of dilated cardiomyopathy, but decreases risk of developing atrial fibrillation, ischemic stroke, and cardio-embolic stroke. We do not find evidence for a linear or non-linear genetic association between resting heart rate and all-cause mortality in contrast to our previous Mendelian randomization study. Systematic alteration of key differences between the current and previous Mendelian randomization study indicates that the most likely cause of the discrepancy between these studies arises from false positive findings in previous one-sample MR analyses caused by weak-instrument bias at lower P-value thresholds. The results extend our understanding of resting heart rate biology and give additional insights in its role in cardiovascular disease development.
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| 17. |
- Värendh, Maria, et al.
(author)
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Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study
- 2021
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In: Sleep and Breathing. - : Springer Berlin/Heidelberg. - 1520-9512 .- 1522-1709. ; 25:4, s. 1851-1857
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Journal article (peer-reviewed)abstract
- Purpose: Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms.Methods: In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112).Results: Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47).Conclusion: Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.
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