| 1. |
- Law, Lucy, 1987-
(författare)
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Subclinical cardiovascular disease and health related quality of life in patients with radiographic axial spondyloarthritis
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Radiographic axial spondyloarthritis (r-axSpA) is a chronic inflammatory rheumatic disease predominantly affecting the axial skeleton. The global prevalence of r-axSpA is between 0.1-1.4%. The disease is associated with extra-musculoskeletal manifestations (EMMs) such as anterior uveitis (AU), as well as increased risk of cardiovascular disease (CVD)-related comorbidities such as atherosclerosis that significantly contribute to mortality and the burden of disease in patients with r-axSpA. The increased CVD risk is not fully explained by traditional CVD risk factors, and little is known about the difference in CVD risk profiles between the sexes. Moreover, the association of disease related variables and subclinical signs of CVD by ultrasound remain to be comprehensively investigated in a well-characterized and sex stratified patient cohort. Additionally, studies investigating factors related to health-related quality of life (HRQoL) in patients with r-axSpA acknowledge that r-axSpA patients have a lower HRQoL than the general population. However, constancy in study methods and comparison to general population controls, especially stratified by sex, are limited. Objectives: The global aim of this thesis was to explore novel methods relating to the evaluation, detection, and monitoring of factors contributing to the burden of CVD in patients with r-axSpA, and to increase knowledge about HRQoL. More specifically, to study the impact of r-axSpA on HRQoL (Paper 1) and identify novel ultrasound markers of subclinical CVD (Papers 2-4) in patients with r-axSpA, overall, stratified by sex, and compared to controls. Materials and methods: Paper 1: The Short Form-36 (SF-36) questionnaire was used to assess HRQoL in patients with r-axSpA from Western Sweden (n=210, females 42.4%). Each patient was compared to 5 age- and sex-matched persons from the SF-36 Swedish normative population database (n=1055). Papers 2-4: Ultrasound was used to (i) assess bilateral common carotid arterial (CCA) stiffness by calculation of b-stiffness index and circumferential 2D strain (Paper 2); (ii) measure mean bilateral carotid intima media thickness (cIMT) and investigate its relationship with biomarkers of inflammation (Paper 3); and (iii) assess the mean thickness of the epicardial adipose tissue (EAT) deposit and its associations with traditional CVD related risk factors (Paper 4). Papers 2-4 used a well characterized patient group from Northern Sweden (‘Backbone cohort’, n=155, female 31.0%). The control group for paper 2 included 46 age- and sex- matched persons from the local population, with no traditional CVD risk factors. The control group for papers 3 and 4, was derived from the Umeå region Swedish CArdioPulmonary bioImaging Study (SCAPIS) recall study (n= 400, females 51.0%). All results were presented stratified by sex. Uni- and multi-variate regression analysis methods were used to evaluate associations with disease and demographic variables. All studies were of cross-sectional design.Results: Paper 1: Patients exhibited significantly lower HRQoL compared to controls (P<0.001). Upon stratification by sex, both sexes scored significantly lower physical compared to the mental HRQoL scores. Multivariable logistic regression analysis found that patients with a longer disease duration, worse physical function (assessed by the Bath Ankylosing Spondylitis Functional Index (BASFI), high disease activity (measured by the Ankylosing Spondylitis Disease Activity Score (ASDAS)), or who lived alone had significantly lower physical HRQoL. Lower mental HRQoL was associated with fatigue, high ASDAS and living alone. Some differences in sex were also found. Paper 2: Patients had higher mean bilateral CCA b-stiffness index, and lower 2D CCA circumferential strain, compared to controls. Multivariate linear regression analysis found that several disease related parameters, in addition to age, were related to 2D circumferential strain (R2 0.33), whereas only age was related to b-stiffness index (R2 0.19). Paper 3: Linear regression analysis, with various adjustment models, showed that patients had increased cIMT compared to controls. White blood cell (WBC)- and monocyte- count were the only inflammatory biomarkers associated with cIMT. This association was only seen in male patients and remained after adjustments. Paper 4: Mean EAT was thicker in r-axSpA patients overall and stratified by sex compared to controls. No difference in mean EAT was found between the sexes. There were borderline significant associations between EAT thickness and cholesterol levels in male patients.Conclusion: Patients with r-axSpA have decreased HRQoL and increased subclinical indicators of CVD compared to controls. By modifying factors, such as ASDAS-CRP and fatigue, HRQoL may be improved in patients with r-axSpA. Additionally, ultrasound methods are non-invasive, and easily obtainable, offering additional insights into the factors that influence the risk of CVD in r-axSpA patients. Although further studies are required to validate novel ultrasound methods, these techniques represent a powerful approach to non-invasively to detect, monitor, and help manage CVD related comorbidities.
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| 2. |
- Lindqvist, Karin, 1987-
(författare)
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Making Connections : Outcomes and the Role of the Therapeutic Relationship in Internet-Delivered Psychodynamic Treatment for Adolescent Depression
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Major depressive disorder (MDD) is ranked one of the most burdensome disorders for adolescents worldwide. There is an urgent need for accessible interventions, as many adolescents suffering from MDD do not receive treatment. Internet-delivered interventions remove barriers to seeking and receiving treatment, and internet-delivered cognitive behavioural therapy (ICBT) has been found to be effective for adolescent MDD. However, not all are helped by ICBT and treatment alternatives are needed. Internet-delivered psychodynamic therapy (IPDT) has previously been tested with promising effects in adults, but no studies have assessed its efficacy for adolescents. Furthermore, little is known about mechanisms of change in internet interventions targeting adolescent MDD and how adolescents experience the therapeutic relationship in IPDT. This thesis aims to evaluate efficacy as well as processes and experiences of IPDT, from different perspectives.Study I investigated effects of IPDT for adolescents aged 15–18 (n = 76) suffering from MDD, compared to control condition. IPDT was found to be significantly more effective than a supportive control condition on reducing depression (d = 0.82). Furthermore, moderate to large significant effects in favour of IPDT were found for comorbid anxiety, emotion regulation and self-compassion.Study II explored participants’ (n = 18) experiences of the psychotherapeutic relationship in IPDT. Semi-structured interviews were analysed using thematic analysis. Four themes were created: “a meaningful and significant relationship with someone who cared”, “a helping relationship with someone who guided and motivated me through therapy”; “a relationship made safer and more open by the fact that we didn’t have to meet”; and “a nonsignificant relationship with someone I didn’t really know and who didn’t know me”.Study III examined the relationship between therapeutic alliance, emotion regulation and outcome week-by-week in IPDT and ICBT for adolescent depression (n = 272). Results showed that therapeutic alliance, as rated by both therapist and participant, predicted outcome in depressive symptoms week-by-week in both treatments. Furthermore, this relationship was mediated by emotion regulation, again in both treatments.In conclusion, results from this thesis indicate that IPDT may be a viable treatment option for adolescent depression. Furthermore, it is possible to form a close and safe relationship between therapist and participant, experienced as important for the psychotherapeutic process by many participants. Lastly, therapeutic alliance plays an important role in both IPDT and ICBT for adolescent depression, partly through its effect on emotion regulation.
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| 3. |
- Jederud, Sandra
(författare)
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New manifestations of the practice-theory dilemma – consequences of ‘the practice turn’ in teacher education
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis comprises four studies that concern the specific part of practicum within teacher education, its relation to the university-based components and how new organizational ideas entail different consequences for student teachers’ opportunities for learning the profession. The overall purpose is to analyze policies related to learning in practice and shed light on what implications are involved when reorganizing Swedish teacher education within the ‘practice turn’. More explicitly, the purpose is to illuminate two manifestations of a more practice-based teacher education – paired practicum within specific practice schools and work-integrated teacher education, where student-teachers are employed as teachers while attending courses at university. Two concepts of knowledge are used as the main theoretical framework; spectator knowledge and participant knowledge, and the concept of boundary crossing and enfolded learning mechanisms. The data are extracted from policy documents regarding the two latest teacher education reforms in 2001 and 2009, as well as from interviews with different parties pertaining within the above two manifestations of the practice turn. Study I concerns whether there are signs of a practice turn in national policy regarding teacher education and how this is addressed in local policy. The study focuses on what is expressed regarding the opportunities student teachers are provided with in order to learn the profession of teaching. Study II explores how pre-school student teachers perceive their opportunities for learning within paired practicum at specific practice schools. Study III also addresses paired practicum within specific practice schools, but data is collected from mentors within upper secondary school regarding their perception of this way of organizing practice. Finally, Study IV concerns a work-integrated teacher education programme and how teacher educators perceive students´ opportunities for learning when they move between the contexts of work and university. The results mainly show that there is an ambivalence concerning what should be given the most value regarding student teachers´ opportunities for learning. Findings also show that the manifestations of ‘the practice turn’ imply a shifting of positions for student-teachers as well as mentors and university teachers. The four studies also identify that the organizational structures of practice have implications for what opportunities for learning students are provided with. Thus, structural changes regarding practice within teacher education enfold that adequate curriculum changes are needed. Furthermore, changes at an organizational level at university, at the connected specific practice schools, and in the workplaces where work-integrated student-teachers are employed are needed.
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| 4. |
- Åström Malm, Ida
(författare)
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Clinical aspects of arterial wall stiffness with a focus on abdominal aortic aneurysm
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Cardiovascular diseases are the most common type of age-related diseases and can affect health in several ways. As a result of increased life expectancy around the world, the prevalence of cardiovascular diseases is expected to increase. Early detection of cardiovascular morbidity is important to reduce mortality and also to improve cardiovascular health. Arterial stiffness is a well-known independent predictor of cardiovascular morbidity and mortality. The central arterial walls become stiffer with age, which has an important impact on cardiac work. The development of arterial stiffness is not an immutable and inexorable process. Instead, it should be seen as a potential target of interventions that aim to slow the vascular ageing process. Arterial stiffness in individuals affected by abdominal aortic aneurysm (AAA) is an understudied area. AAA is a disease that predominantly affects elderly males. The disease is usually asymptomatic, but a rupture of the aneurysm is life threatening. Even without rupture, individuals with an AAA have an increased risk of other major cardiovascular events, but the underlying mechanisms of this increased risk are unclear.Aim: The overall aim of the research in this thesis was to investigate clinical aspects of arterial stiffness with a focus on AAA.Methods: All studies in this thesis used a quantitative and a cross-sectional design. Paper I compared elderly hypertensive females with elderly hypertensive males and examined the effects of FBN1 genotypes within each sex. The study cohort in Paper I underwent physiological cardiovascular examinations with a focus on pulse wave analysis and blood pressure. In addition, blood samples were taken after overnight fasting. The study cohorts in Papers II–IV were males with AAA and age-matched controls without AAA. The participants underwent physiological cardiovascular examinations, and blood samples were taken after overnight fasting. In Paper II, the speed and shape of the pulse wave and blood pressure were studied non-invasively to evaluate the properties of the arterial system. In Paper III, the heart was studied using two-dimensional ultrasound with a focus on evaluation of the function of the left ventricle. In Paper IV, analyses of IL-10 levels were added to the previously performed studies.Results: A sex-related difference was found in the augmentation index (females: 36%; males 33%; p<0.001) and systolic blood pressure (females: 169 mmHg; males: 162 mmHg; p<0.05) of the elderly hypertensive participants in Paper I. In addition, females, but not males, displayed differences in augmentation index and systolic blood pressure among different FBN1 genotypes; females with the FBN1 2/3 genotype had higher augmentation index (p<0.05) and systolic blood pressure (p<0.05) than those with the FBN1 2/2 and 2/4 genotypes. In Paper II, differences in central pulse wave velocity (12.3 m/s versus 10.9 m/s; p<0.001) and peripheral pulse wave velocity (9.4 m/s versus 9.1 m/s; p<0.05) were seen between patients with AAA and controls. In Paper III, patients with AAA had lower left ventricular ejection fraction (55±8% versus 57±7%) and global longitudinal strain (19±3% versus 20±3%) than controls (both p<0.05). Moreover, the patients with AAA had lower mitral annular plane systolic excursion and higher E/e' compared with the controls (both p<0.05). In Paper IV, patients with AAA had higher levels of Interleukin-10 (21.5±14.0 ng/ml versus 16.6±9.3 ng/ml) compared with controls (p<0.01), and within the AAA cohort, patients with diabetes had higher levels of Interleukin-10 than those without diabetes (26.4±17.3 versus 20.4±13.0; p<0.05).Conclusion: The results from this thesis highlight the possibility to use pulse wave velocity and augmentation index for risk stratification in patients already affected by cardiovascular diseases. The results contribute new knowledge about arterial stiffness and left ventricle function in males with AAA. Moreover, they contribute knowledge to support new and individualised treatments for arterial stiffness in males with AAA in the future.
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| 5. |
- Bergström, Göran, 1964, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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Ingår i: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 6. |
- Casely-Hayford, Jeffrey, et al.
(författare)
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Enculturating a Protective Professional Community - Processes of Teacher Retention in a Swedish Hard-to-Staff School
- 2024
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Ingår i: Education Sciences. - : MDPI. - 2227-7102. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- This study presented a positive deviant case: a Swedish hard-to-staff school which has had a low rate of teacher turnover over time. In line with the purpose of studying positive deviance in organisations, our exploratory inquiry was geared towards understanding how and why 'at-risk' teachers, i.e., teachers who teach in subjects which are known to have high levels of staffing difficulties in Sweden, stayed at this particular school. Using a modified grounded theory approach, our results suggested that teachers remained at the school due to being embedded in a protective professional community that was enculturated by different expressions of collegiality. Finally, these findings are discussed in relation to the theoretical concepts of teachers' job embeddedness and social capital.
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| 7. |
- Casely-Hayford, Jeffrey, et al.
(författare)
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What makes teachers stay? : A cross-sectional exploration of the individual and contextual factors associated with teacher retention in Sweden.
- 2022
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Ingår i: Teaching and Teacher Education. - : Elsevier. - 0742-051X .- 1879-2480. ; 113
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Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study aimed to identify individual and contextual factors associated with Swedish teachers' intention to remain in the profession. A sample of 5903 elementary-year teachers completed a questionnaire between 2004 and 2011 assessing their health and perception of individual and contextual factors at work. The findings showed that teachers' intention to remain in the profession is mainly explained by individual factors, predominantly by teachers' perceived health state, work motivation and collegial support. The main implication is the importance of teachers' perceived health state for their intention to remain, underscoring the importance of a health promoting work environment in schools. (c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 8. |
- Lindqvist, Anna-Karin, 1952-, et al.
(författare)
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Arkeologiska undersökningar av den förromerska boplatsen i Gene, Raä 59:1 i Själevads socken, Ångermanland
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Excavation report of an important site close to the farm from the Roman Iron Age and Migration Period site at Gene, in northern Ångermanland. The reported site shows new aspects of the transition from the traditional mobile and semi-mobile hunter-gatherer society to the new way of life style with three-aisled longe house and stalled animials. The closeness in time and space illuminate in a new way the how this transition took place. On this world-wide issue it is suggested that regional causes may be seeked.
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| 9. |
- Lindqvist, Karin, et al.
(författare)
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Therapeutic alliance is calming and curing - The interplay between alliance and emotion regulation as predictors of outcome in Internet-based treatments for adolescent depression
- 2023
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Ingår i: Journal of Consulting and Clinical Psychology. - : American Psychological Association (APA). - 0022-006X .- 1939-2117. ; 91:7, s. 426-437
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Therapeutic alliance is one of the most stable predictors of outcome in psychotherapy, regardless of theoretical orientation. The alliance–outcome relationship in internet-based treatments has been investigated with mixed results. There is preliminary evidence that emotion regulation can work as a mediator for the alliance–outcome relationship. The present study aimed to investigate whether alliance predicted outcome session by session in two internet-based treatments for adolescent depression, and whether this relationship was mediated by emotion regulation.Method: Two hundred and seventy-two participants aged 15–19 years and diagnosed with depression were randomized to 10 weeks of internet-based psychodynamic or cognitive behavioral treatment. Both therapists and patients rated the alliance weekly. Patients also rated depressive symptoms and emotion regulation weekly. Analyses were made using cross-lagged panel modeling.Results: Alliance, as rated by both therapist and patient, predicted depression scores the following week. Emotion regulation rated by the patient also predicted depression scores the following week. Furthermore, alliance scores predicted emotion regulation scores the following week, which in turn predicted depression scores the week after, supporting the hypothesis that alliance influences outcome partly through emotion regulation. There were no group differences in any of these relationships.Conclusion: Alliance seems to play an important role in internet-based treatments, partly through emotion regulation. Clinicians working with text-based treatments should pay attention to the working alliance.
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| 10. |
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