| 1. |
- Barros, Guilherme, 1992-
(författare)
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Estimation of hazard ratios from observational data with applications related to stroke
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objective of this thesis is to examine some challenges that may emerge when conducting time-to-event studies based on observational data. Time-to-event (also called survival) is a setting that involves analyzing how different factors may influence the length of time until an individual experiences the event of interest. This type of analysis is commonly applied in fields such as medical research and epidemiology. In this thesis, which focuses on stroke, we are interested in the time to a recurrent stroke or the death of a patient who survived a first stroke.Hazard ratios are one of the main parameters estimated in time-to-event studies. Hazard ratios involve comparing the risk of experiencing the event between two groups, usually a treated group and an untreated group. They can also involve other factors, such as different age groups. Hazard ratios can be estimated from the data by using the Cox regression model.Observational data, in contrast to experimental data, involves data collected without any intervention or random assignment of treatment to the individuals. Confounders, that is, variables that distort or obscure the true relationship between treatment and outcome, are always present and need to be controlled for in observational studies.National registers are an important source of observational data. A national registry is a centralized database or system that collects, stores, and maintains information about a specific population or group of individuals within a country. Sweden is known for its detailed and complete national registers. In this thesis, data from the Swedish Stroke Register (Riksstroke) is used to study factors related to stroke.In time-to-event studies involving observational data, several challenges may arise for the researcher during data analysis. Some individuals may not experience the event during the observation period and thus the information about their time until the event is incomplete. These individuals are considered as censored. Some individuals may experience another event rather than the one of interest, a competing risk. Additionally, models must be properly constructed, with researchers selecting variables and determining the suitable functional form.Four papers are included in the thesis. Paper I demonstrates how to handle competing risks in survival analysis. The study involves comparing individuals with and without standard modifiable risk factors and their risks of a recurrent stroke or death using data from the Swedish Stroke Register.The estimation of marginal hazard ratios is a common theme in the other three papers. All involve simulation studies in order to extend methods and explore best practices when estimating marginal hazard ratios.Paper II explores non-parametric methods that can be used as alternatives to more traditional parametric methods when balancing datasets in order to estimate a marginal hazard ratio. A case study was also conducted using data from the Swedish Stroke Register involving the prescription of anticoagulants at hospital discharge after a stroke.Paper III is about how censoring affects marginal hazard ratio estimation, even with perfect balancing of the dataset. We study this issue, taking into consideration varying effect sizes and censoring rates. A procedure to attenuate the problem is also studied.Paper IV concerns covariate selection in the case of high-dimensional data. High-dimensional data involves cases in which the number of covariates in the study is comparable to the number of individuals, and therefore covariate selection methods are needed. In the paper, we explore some of these methods and suggest a best-performing procedure. As Paper II, Paper IV involves a case study of anticoagulant prescription using data from the Swedish Stroke Register.
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| 2. |
- Beer, Torfinn, 1992-
(författare)
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An epidemiological perspective on heart and lung weight in cardiac and intoxication deaths
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The main purpose of a medico-legal autopsy is to determine the cause and manner of death. A forensic pathologist makes assessments of this using several sources of information, one of which is the discrepancy between measured organ weight and reference values. Of particular interest is the heart weight in heart disease and the weight of the lungs in fatal intoxications. In this thesis, a linear model of lung weight was created, but the model could at best explain only 13% of the variation in combined lung weight (Paper I). Unsurprisingly, this meant that the model was a poor definition of “normal” lung weight and could not be used to identify intoxication cases (Paper II). A ratio of lung weight to heart weight (LWHW ratio) also failed to differentiate intoxication cases from controls. The poor performance of these methods could plausibly have been due to fatal intoxications with only some substances being associated with increased lung weight, but an analysis showed that many common intoxicants were associated with heavier lungs than hanging deaths (Paper III). To establish heart weight references more applicable in a medico-legal autopsy population, a model of heart weight accounting for undiagnosed cardiac hypertrophy was created (Paper IV). The model showed that for a decedent of average the evidence that a was hypertrophic reached, substantial support at around 470 g.In conclusion, a definition of “heavy lungs” remains elusive. However, it seems to be a finding compatible with fatal intoxications with many substances and the low predictive value found may be due to study design. The heart weight model presented allows pathologists to assess the evidence of cardiac hypertrophy more easily than previously published models.
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| 3. |
- Darehed, David, 1986-
(författare)
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The impact of organizational and temporal factors on acute stroke care in Sweden
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Acute stroke carries a high risk of morbidity and death, but early treatment can improve outcomes. Intravenous stroke thrombolysis (IVT) is one such treatment, it is however time-sensitive and show better outcomes the sooner it is given. Most studies on time to IVT so far have looked at fixed time-intervals, and studies of short delays in clinical practice are relatively scarce. Another well-established treatment is managing acute stroke patients in stroke units (SU). Admission rates to a SU as first destination of hospital care have improved over time in Sweden. In the past decade however, the rates have leveled out at around 75-80% without further improvement. A hypothesis is that in-hospital overcrowding contributes. Previous studies have shown that outcomes after stroke differ between hospital types, and also vary depending on time of admission, with higher mortality seen for off-hours, weekend and winter admissions. The reasons behind temporal variations are not fully understood, but it has been proposed that environmental, patient-related and organizational factors contribute. The overall aim of this thesis was to study the effect of organizational factors on quality of care and outcomes after stroke, primarily focusing on the role of in-hospital overcrowding, in-hospital time to IVT and time of admission, while also studying differences between hospitals.Methods: All papers in this thesis were based on data from the Swedish stroke register (Riksstroke), a national quality register that holds data on patient related factors, acute care and outcomes. Paper I included 13,955 patient admissions from 14 hospitals in Region Norrbotten and Region Skåne from 2011-2014, enriched with data on in-hospital bed occupancy. Papers II-IV included all 72 Swedish hospitals caring for patients with acute stroke. Paper II included data from 2011-2015 (N=113,862), paper III from 2011-2016 (N=132,744) and paper IV from 2010-2017 (N=14,132). Analyses included descriptive statistics, unadjusted analyses and multivariable adjusted analyses.Results: We found that each percent increase in in-hospital bed occupancy above 85% decreased admission rates to a SU as first destination of hospital care by 1.5% (odds ratio (OR) 0.985, 95% confidence interval (CI) 0.978-0.992), with significant differences between hospitals. Admission rates were also lower off-hours, compared to on-hours (OR 0.73, 95% CI 0.70-0.75). Over time, admission rates to a SU as first destination of hospital care decreased in university hospitals, while they increased in specialized non-university hospitals and community hospitals. Each minute delay in door-to-needle time (DNT) decreased the odds of 90-day survival by 0.6% (OR 0.994, 95% CI 0.992-0.996), increased the odds of ICH within 36 hours by 0.3% (OR 1.003, 95% CI 1.000-1.006), and led to significantly higher odds of a worsening in functional outcomes at 3 months by 0.3-0.4%. DNT within 30 minutes was most likely daytime, and varied between hospital types. 90-day survival was lowest for patients admitted in January (81.5%), and highest for those admitted in May (84.1%) (OR 1.28, 95% CI 1.17-1.40).Conclusion: We found that in-hospital overcrowding decrease admission rates to a SU as first destination of hospital care, and that even short delays in DNT decreases survival, increases ICH complications and leads to a worsening in functional outcomes in routine clinical practice. We also found that quality of care varied depending on time of admission and between hospitals, indicating unequal care. Organizational differences should be accessible through quality improvement efforts aiming to implement robust local guidelines for in-hospital stroke treatment.
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| 4. |
- Björk, Marie, 1963-
(författare)
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Att främja elevers teoretiska utforskande av bassystemet : En undervisningsutvecklande studie i matematik på mellanstadiet
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Den här licentiatuppsatsen handlar om hur en undervisning kan främja elevers förståelse av tiobassystemet genom att de bjuds in till en undervisning där de kan delta i ett kollektivt utforskande av bassystemet, som en övergripande nivå av tiobassystemet. Syftet är att exemplifiera och diskutera hur en undervisning, som främjar elevernas möjligheter att utveckla ett tänkande om tiobassystemet på en generell eller övergripande nivå, kan utformas. Vidare är syftet att studera vad i en undervisning, designad enligt principerna för lärandeverksamhet, som kan förstås som förebyggande i specialpedagogisk mening.Studien bygger på resultatet av två artiklar med följande frågeställningar: 1) Vilka aspekter i uppgifternas utformning och genomförande främjar elevers möjligheter att pröva relationen mellan olika bastal och övergång till successivt större respektive mindre talenheter? 2) Vad i elevernas resonemang och arbete med speciellt designade uppgifter kan ses som tecken på teoretiskt tänkande om bassystemet?Learning study har använts som forskningsramverk och genererat data för uppsatsens två artiklar. Learning studyn genomfördes i årskurs 4, tillsammans med tre matematiklärare. Design och analys är inspirerad av El’konins och Davydovs matematiska program och några principer från lärandeverksamhet. Analysen i de bägge artiklarna är genomförd med stöd av teoretiska principer för lärandeverksamhet. Datamaterialet består av videoinspelningar från tre lektioner (totalt cirka 420 minuter), transkriptioner och datasammanställningar av uppgifter, transkriptioner och anteckningar från utvärderingarna i det iterativa arbetet med lektionerna.Resultatet består av tre aspekter som behöver synliggöras genom uppgifternas utformning och genomförande för att eleverna ska kunna arbeta teoretiskt med bassystemets struktur: (1) Bastalet, (2) Tal som mätetal, och (3) Talenheternas representationer. Eleverna behöver urskilja aspekterna för att kunna identifiera att det fattas en lämplig talenhet och för att kunna pröva och reflektera över relationen mellan bastalet och övergången till successivt större respektive mindre talenheter i olika baser. Resultatet består också av ett antal exempel på tecken på teoretiskt tänkande inom tre identifierade kategorier: 1) basens funktion för det värde som siffrorna anger i talet, 2) positionsväxling, och (3 entalet som ett av en kvantitet. I analysen har Davydovs definition av teoretiskt tänkande, som något som kan komma till uttryck i form av teoretisk reflektion, analys och planering samt reproduktion av grundläggande principer för ett specifikt ämnesinnehåll, använts.Resultatet ger ett bidrag till den matematikdidaktiska forskningen och till den specialpedagogiska forskningen med inriktning mot matematik genom beskrivningar av de tre aspekterna och av tecken på teoretiskt tänkande. Vidare kan beskrivningarna av uppgifternas utformning och genomförande användas i undervisning och i fortsatta studier.I diskussionen behandlas hur en undervisning kan utformas som främjar elevernas möjligheter att utveckla ett teoretiskt tänkande om bassystemet. Diskussionen behandlar också vad i en undervisning designad enligt principerna för lärandeverksamhet som kan förstås som förebyggande i specialpedagogisk mening genom att skapa möjligheter för elever att redan tidigt i grundskolan kollektivt utforska och förstå hela positionssystemet som en struktur. Slutligen diskuteras implikationer för specialundervisning och studiens bidrag.
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| 5. |
- Byhamre, Marja Lisa, 1981-
(författare)
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Snus use and mortality : associations, potential mechanisms, and socioeconomic aspects
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Snus is a smokeless tobacco product made of a moist powder of ground tobacco. It is used mainly in the Nordic countries, although increasingly popular internationally. The Swedish snus tradition dates back to the seventeenth century, and it is now used daily by about 23% of the male and 6% of the female population. Snus contains high levels of nicotine as well as carcinogenic substances and microorganisms that could potentially cause adverse health effects. The physiological effects of snus use include acutely raised blood pressure and heart rate, and increased cardiac oxygen demand, while the psychological response results in alertness and anxiety reduction. The high nicotine content causes rapid onset of addiction. Previous research on snus use and health is largely inconclusive, but indicates increased risks of all-cause, cardiovascular and cancer mortality. This thesis aimed to further investigate the health effects of snus use, with a focus on mortality, potential underlying mechanisms, and the impact of socioeconomic factors. Four original papers form the base of this thesis. The first study was performed on a pooled dataset of eight Swedish cohorts (The Swedish Collaboration on Health Effects of Snus use), including over 169 000 men. We found an increased risk of all-cause (HR 1.28, 95% CI 1.20; 1.35), cardiovascular, and other cause mortality, and indications of raised cancer mortality. The second study was set within an interventional program in northern Sweden (Västerbotten Intervention Programme) and included 46 000 men and women. It showed increased mortality overall (estimates similar to first study), from cardiovascular diseases, and external causes (e.g., accidents and suicide) that remained after controlling for socioeconomic status. We found these associations in groups of varying socioeconomic background (e.g., both basic education and high-income groups), suggesting that increased mortality risks among snus users are not restricted to certain socioeconomic groups. Studies three and four investigated potential underlying mechanisms that might contribute to increased mortality among snus users, including established cardiometabolic risk factors in study three (the metabolic syndrome and its components: obesity, hypertension, type 2-diabetes and abnormal blood lipids) and more novel risk factors in study four (low-grade inflammation, low vitamin D-concentrations, and altered iii testosterone levels). The analytical samples were drawn from a long- term follow-up study of around 900 16-year-olds in a municipality in northern Sweden (Northern Sweden Cohort, study three) and more than 6 000 participants in another population-based cohort (the Northern Sweden MONICA study, study four). We found no associations between snus use and established cardiometabolic risk factors, but there was evidence of lower concentrations of inflammatory and vitamin D-status biomarkers in both men and women, and higher testosterone concentrations in men who were currently using snus. We conclude that snus use is associated with increased all-cause and cardiovascular mortality, and to death by other causes, that may be restricted to external causes. Cancer mortality may also be increased among snus users. The associations cannot be fully explained by differences in socioeconomic status among snus users and non-users. Established cardiometabolic risk factors do not seem to be the main mechanisms behind these associations. Lower inflammatory biomarker levels among snus users may serve as a protective factor, while lower vitamin D-concentrations and increased testosterone levels may be part of an underlying mechanism linking snus use to increased mortality. Future research should focus on the health consequences of snus use among women, on other possible links between snus use and death, and on mortality in different cancers among users of snus. The health consequences of dual use of snus and cigarettes should also be assessed.
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| 6. |
- Eriksson, Maria A., 1965-, et al.
(författare)
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Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men
- 2020
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor & Francis. - 0036-5513 .- 1502-7686. ; 80:4, s. 303-308
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Tidskriftsartikel (refereegranskat)abstract
- Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACE(i)) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACE(i) enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA-PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA-PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACE(i). In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.
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| 7. |
- Eriksson, Mimmi, 1986-
(författare)
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Super liquid-repellent surfaces - interactions and gas capillaries
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Super liquid-repellent surfaces have attracted a lot of interest in recent years. In addition to the large scientific interest there are many potential technological applications ranging from self-cleaning materials to microfluidic devices. In this thesis, interactions between liquid-repellent surfaces in liquids were studied, with the aim to investigate the detailed mechanisms of super liquid-repellence, such as superhydrophobicity and superamphiphobicity. An atomic force microscope (AFM) was used to measure the interaction forces between super liquid-repellent surfaces and a microsphere in different liquids. Additionally, a setup combining AFM with laser scanning confocal microscopy (LSCM) was used, which enabled simultaneous imaging in order to capture the microscopic events between the sphere and the surface during a force measurement. The confocal images successfully visualized how the strongly attractive forces measured between liquid-repellent surfaces are due to the formation of a gaseous capillary bridge between the two surfaces. Similar long-ranged forces with capillary formation and growth were observed both in water and in lower surface tension liquids. Additionally, the confocal images enabled determination of the capillary shape and volume, and the data showed an increase of the capillary volume during the major part of the process of separating the surfaces. A gaseous layer underneath the liquid at super liquid-repellent surfaces was also visualized with LSCM, and it was concluded that this gaseous layer is responsible for the formation and growth of large gas capillaries. It was found that an increased amount of available gas in the gaseous layer influenced the interactions and allowed the capillary to grow larger during separation. Further, theoretical calculations based on the size and shape of the capillary suggested that a small under pressure in the capillary drives the gas to flow from the gaseous surface layer into the capillary, facilitating growth during separation.
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| 8. |
- Johansson, Cecilia, 1988-
(författare)
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Risk markers and incidence of atrial fibrillation in northern Sweden
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Atrial fibrillation (AF) is the most common clinically significant arrythmia with a prevalence of approximately 3% in the general population. Less is known about the incidence of AF. In order to reduce the incidence of AF, it is of essence to identify modifiable risk factors for the disease.Aims: The aims of this thesis were (1) to estimate the incidence of AF and to assess the prevalence of provoking factors and risk factors for stroke and systemic embolism at the time of AF diagnosis, (2) to study the association between alcohol consumption and risk of AF, (3) to study the association between weight, height, weight change, and risk of AF, and (4) to study the association between normal or high normal blood pressure (BP), compared to optimal BP, and risk of AF.Methods: To determine the incidence of AF and the prevalence of provoking factors and risk factors for stroke and systemic embolism at AF diagnosis, an observational study was performed between January 1, 2011, and December 31, 2012, in the municipalities of Skellefteå and Norsjö, Västerbotten, Sweden. Diagnosis registries were searched for cases of incident AF. All AF diagnoses were verified by electrocardiogram. Data regarding provoking factors, type of AF and presence of risk factors for stroke and systemic embolism (as assessed by the CHA2DS2-VASc score) was obtained from medical records. Incidence was calculated by dividing the number of incident AF cases by the time at risk for the population.The association between alcohol consumption, weight, height, weight change, normal BP, high normal BP, and risk of AF was investigated in a population-based cohort study of participants of the Västerbotten Intervention Programme (VIP). Residents of Västerbotten County aged 30, 40, 50 and 60 years who had participated in the VIP health examinations between January 1, 1988, and September 5, 2014, were included. Individuals who had been diagnosed with AF before participating in the VIP were excluded. Study participants were followed until a diagnosis of AF, death, migration from the study area, or the end of the study on September 5, 2014. Incident AF cases were identified using the Swedish National Patient Registry. The health examinations included measurements of height and weight, systolic BP, diastolic BP, fasting glucose, oral glucose tolerance, and cholesterol. Participants also answered a questionnaire addressing any history of diabetes and myocardial infarction, alcohol use, education level, smoking habits, medications, and physical activity. Optimal BP was defined as BP < 120/80 mm Hg. Normal BP was defined as BP 120–129/80–84 mm Hg. High normal BP was defined as BP 130–139/85–89 mm Hg. Hypertension was defined as BP ≥ 140/90 mm Hg. Cox proportional hazards regression analysis was used to assess the associations between alcohol consumption, weight, height, weight change, normal BP, high normal BP, and risk of AF. These were performed with crude, age-adjusted, and multivariable models adjusted for other cardiovascular risk factors (age, sex, body mass index, hypertension, cholesterol, previous myocardial infarction, diabetes, problem drinking, smoking, education level, and leisure-time physical activity).Results: The incidence of AF was 4.0 cases of AF per 1000 person-years. In approximately one fifth of participants, a provoking factor was present at the first episode of AF. The CHA2DS2-VASc score was 2 or higher in 81% of participants. Permanent AF was the most common type of AF and was seen in about one third of the participants.When studying the association between alcohol consumption and risk of AF, 109,230 health examination participants were included in the study cohort and were followed for 1,484,547 person-years. During the study period, 5230 participants developed incident AF. Men with alcohol consumption in the highest quartile (≥ 4.83 standard drinks weekly) had a hazard ratio (HR) of 1.21 (95% confidence interval [CI] 1.09-1.34) for AF in a multivariable model when compared to men with an alcohol consumption in the lowest quartile (< 0.90 standard drinks weekly). In men, problem drinking was also associated with an increased risk of AF (HR 1.24, 95% CI 1.10–1.39 in a multivariable model). Among women, no significant association between alcohol consumption, problem drinking, and risk of AF was identified.In a fully adjusted model, height, weight, body mass index, and body surface area were positively associated with risk of incident AF. Among participants who underwent two health examinations 10 years apart, 1142 persons developed AF. The mean weight change from baseline was a weight gain of 4.8%. There was no significant association between either weight gain or weight loss and risk of AF.In the study of the association between normal BP, high normal BP, and risk of AF, 109,697 persons with a total of 162,982 health examinations were included. Incident AF was diagnosed in 5260 participants. There was an increased risk of incident AF in persons with normal BP (HR 1.11, 95% CI 1.01–1.27) and in persons with high normal BP (HR 1.23, 95% CI 1.10–1.38) compared to optimal BP in a multivariable model. Systolic BP and diastolic BP were associated with risk of incident AF, with HRs of 1.11 (95% CI 1.10–1.13) and 1.13 (95% CI 1.09–1.16) per 10 mmHg, respectively, in multivariable models. A restricted cubic spline analysis indicated a gradually increasing risk of AF with increasing systolic BP and diastolic BP.Conclusions: AF has an incidence of 4.0 per 1000 person-years. Alcohol consumption and problem drinking were associated with higher risk of AF in men, but not in women. Weight, height, body mass index, and body surface area were associated with increased risk of incident AF. Normal BP and high normal BP, when compared to optimal BP, were associated with increased risk of incident AF.
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| 9. |
- Nord, Andreas, professor, 1976-, et al.
(författare)
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Språkhandledares gränsarbete : Dilemman i språkhandledning inom högre utbildning
- 2023
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Ingår i: Ämnesdidaktiska perspektiv på språk och litteratur. - Uppsala : Institutionen för nordiska språk, Uppsala universitet. - 1651-9132. - 9789198695045 - 9789198695052 ; , s. 159-182
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Konferensbidrag (refereegranskat)abstract
- De flesta svenska lärosäten har i dag språkverkstäder med uppdraget att stötta studenterna i utvecklingen av akademiska språkliga praktiker. Trots att uppdraget har en stark koppling till universitetens kärnverksamheter utbildning och forskning organiseras verksamheterna i allmänhet i marginalen, inom ramen för service- eller stödfunktioner. I denna studie utforskas hur verksamma språkhandledare från språkverkstäder vid fyra lärosäten i kollegiala gruppsamtal talar om egna exempel från verksamheten, särskilt sådana som innebär professionella dilemman. Syftet är att synliggöra det ”gränsarbete” på olika nivåer som behöver utföras för att hantera yrkesutövandet genom att förhålla sitt eget handlande till andra intressenters handlande och förväntningar och verksamhetens underliggande villkor.Analysen visar att gränsarbete är centralt för språkhandledarnas professionella praktik, genom att många av de dilemman som deltagarna redogör för berör ansvarsrelationer och frågor om vad språkhandledaren ska göra – och inte göra – i relation till studenter, universitetslärare och i viss mån även i relation till organisatoriska förutsättningar. En vanlig gränsproblematik är t.ex. att behöva hantera att studenter kan utgå från en avvikande uppfattning om var gränserna går för vad språkhandledarna kan och ska bidra med än den språkhandledarna har. Till problematiken hör att möta förväntningar om att, som det uttrycks i materialet, ”rätta” eller ”fixa” texter.Resultaten relateras till tidigare forskning som diskuterat hur en s.k. autonom syn på litteracitet genomsyrar akademin och skapar en förståelse av litteracitet som individuell färdighet och språk som något som enkelt kan ”fixas”. Utifrån detta diskuteras hur språkverkstädernas marginaliserade position riskerar att bidra till att reproducera en sådan syn.
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| 10. |
- Ollila, Hanna M, et al.
(författare)
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How do clinicians use post-COVID syndrome diagnosis? Analysis of clinical features in a Swedish COVID-19 cohort with 18 months’ follow-up : a national observational cohort and matched cohort study
- 2024
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Ingår i: BMJ Public Health. - : BMJ Publishing Group Ltd. - 2753-4294. ; 2:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: SARS-CoV-2 infection causes acute COVID-19 and may result in post-COVID syndrome (PCS). We aimed to investigate how clinicians diagnose PCS and identify associated clinical and demographic characteristics.Methods: We analysed multiregistry data of all SARS-CoV-2 test-positive individuals in Sweden (n=1 057 174) between 1 February 2020 and 25 May 2021. We described clinical characteristics that prompt PCS diagnosis in outpatient and inpatient settings. In total, there were 6389 individuals with a hospital inpatient or outpatient diagnosis for PCS. To understand symptomatology, we examined individuals diagnosed with PCS at least 3 months after COVID-19 onset (n=6389) and assessed factors associated with PCS diagnosis.Results: Mechanical ventilation correlated with PCS (OR 114.7, 95% CI 105.1 to 125.3) compared with no outpatient/inpatient contact during initial COVID-19. Dyspnoea (13.4%), malaise/fatigue (8%) and abnormal pulmonary diagnostic imaging findings (4.3%) were the most common features linked to PCS. We compared clinical features of PCS with matched controls (COVID-19 negative, n=23 795) and COVID-19 severity-matched patients (COVID-19 positive, n=25 556). Hypertension associated with PCS cohort (26.61%) than in COVID-19-negative (OR 17.16, 95% CI 15.23 to 19.3) and COVID-19-positive (OR 9.25, 95% CI 8.41 to 10.16) controls, although most individuals received this diagnosis before COVID-19. Dyspnoea was the second most common feature in the PCS cohort (17.2%), and new to the majority compared with COVID-19-negative (OR 54.16, 95% CI 42.86 to 68.45) and COVID-19-positive (OR 18.7, 95% CI 16.21 to 21.57) controls.Conclusions: Our findings highlight factors Swedish physicians associate with PCS.
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