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- Andersson, Anne, 1966-, et al.
(författare)
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Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010 : a nationwide survey
- 2019
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Ingår i: JOURNAL OF CLINICAL ONCOLOGY. - : American Society of Clinical Oncology. - 0732-183X. ; 37:15
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: In estrogen receptor (ER) positive early breast cancer (EBC) adjuvant endocrine therapy (AET) is crucial to reduce recurrence and mortality. Previous studies have shown that adherence to AET is lower than expected and could negatively affect outcome. Since the year of 2000, BC patients in Sweden are treated in accordance to national guidelines. Treatment is offered at a low cost for the patient. The aim of the study was to estimate the adherence to AET in Sweden by regions and age groups. Methods: Women with a first primary EBC diagnosis 2008-2010 were identified through the Swedish Cancer Registry (SCR). Individual tumour and treatment data were retrieved from the Swedish National Breast Cancer Registry (SNBCR). Patients with ER negative tumours, small tumours (≤ 10 mm) and metastatic disease was excluded from the study since there were no indication to AET. Likewise, were individuals with AET registered to be administered by a third part excluded. Dispensed treatment from pharmacies was obtained through the Swedish Prescription Registry and medication possession rate (MPR) was calculated as number of dispensed doses divided by treatment duration in days. Good adherence to treatment in a patient was set at MPR ≥ 80 %. Adherence was calculated for 3 and 5 years. Results: Twenty-one thousand sixteen (21 016) individuals with a first primary BC between 2008 and 2010 was identified through SCR of which 20 596 were registered in the SNBCR. A total of 10 176 met the inclusion criteria in the study. Adherence after 3 years was 88.0 % and after 5 years 82.5 %. Adherence differed between regions in Sweden and was positively associated with age at diagnosis between 41-74 years. Urban areas had a lower adherence than rural areas (80.7 % vs 83.6 %; p= <0.001). Conclusions: Adherence to AET in Sweden was good, although there were differences by age and urban and rural areas. Further studies are needed to identify factors affecting differences in adherence, with the purpose of initiate actions to increase adherence to AET in ER positive EBC patients.
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- Ek, Anna, et al.
(författare)
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Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents
- 2019
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Ingår i: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool.OBJECTIVE:This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting.METHODS:Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach.RESULTS:The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting-challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive.CONCLUSIONS:Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting.
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- Gyllén, Jenny, 1968, et al.
(författare)
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Important sources of information to support self-management for families of children with pediatric cataracts – based on PECARE Sweden/Sahlgrenska University Hospital
- 2015
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Ingår i: International Journal of Ophthalmic Practice. - : Mark Allen Group. - 2044-5504 .- 2052-2851. ; 6:1, s. 23-29
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT Purpose The aim of this study was to improve treatment concordance by investigating important sources of information on self-management for families of children with pediatric cataracts, from the perspective of parents and ophthalmologists. Methods This mixed-method study involved a deductive approach using a questionnaire administered to 69 families of children operated on and registered with the Swedish Pediatric Cataract Register (PECARE Sweden) in southern Sweden, as well as 30 pediatric ophthalmologists who monitored the patients upon their return to the local health care facility. An inductive approach was applied using analysis of open-ended questions about self-management. Both groups were asked about their perception of the value of strategies for providing information, and the timing of this. Results The response rate was 68% for families and 93% for ophthalmologists. Both groups agreed that ophthalmology visits were the most important source of information, followed by information in writing and online. Parents of children diagnosed before the age of 3 months were more likely to prefer written information. Content analysis revealed that a person-centred care is important. Conclusion Parents, particularly of the youngest children, requested more and directed information. By promoting self-management, a person-centred care may play a decisive role in treatment outcome.
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- Alger, Susanne, 1967-
(författare)
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Licence to drive : the importance of reliability for the validity of the Swedish driving licence test
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The Swedish driving licence test is a criterion-referenced test resulting in a pass or fail. It currently consists of two parts - a theory test with 65 multiple-choice items and a practical driving test where at least 25 minutes are spent driving in traffic. It is a high-stakes test in the sense that the results are used to determine whether the test-taker should be allowed to drive a car without supervision. As the only other requirements for obtaining a licence is a few hours of hazard education (and a short introduction if you intend to drive with a lay instructor) it is important that the test result, in terms of pass or fail, is reliable and valid. If this is not the case it could have detrimental effects on traffic safety. Examining all relevant aspects is beyond the scope of this licentiate thesis so I have focused on reliability.Methods Reliability for both the theoretical and practical test results was examined. As these are very different types of tests the types of reliability examined also differed. In order to examine inter-rater reliability of the driving test 83 examiners were accompanied by one of five selected supervising examiners for a day of tests. All in all 535 tests were conducted with two examiners assessing the same performance. At the end of the day the examiners compared notes and tried to determine the reason for any inconsistencies. Both examiners and students also filled in questionnaires with questions about background and preparation. As for studying decision consistency and decision accuracy of the theory test, three test versions (a total of around 12,000 tests) were examined with the help of methods devised by Subkoviak (Subkoviak, 1976, 1988) and Hanson & Brennan (Brennan, 2004; Hanson & Brennan, 1990).Results The results from two research studies concerning reliability were presented. Study I focused on inter-rater reliability in the driving test and in 93 per cent of cases the examiners made the same assessment. For the tests where their opinions differed there was no correlation to any of the background variables or other variables examined except for three, which had logical explanations and did not constitute a problem. Although there were cases where the differences were due to different stances on matters of interpretation the most common suggested cause was the placement in the car (back seat vs. front seat). Although the supervising examiners gave both praise and criticism as to how the test was carried out the study does not answer the question whether the tests were equal in terms of composition and difficulty.In Study II the focus was on decision consistency and decision accuracy in the theory test. Three versions of the theory tests were examined and, on the whole, found to be fairly similar in terms of item difficulty and score distribution, but the mean was so close to the cut-score (i.e. the score required to pass) that the pass rate differed somewhat between versions. Agreement coefficients were around .80 for all test versions (between .79 and .82 depending on method). Classification accuracy indicated an .87 probability of a correct classification.Conclusion It is important to examine the reliability and validity of the driving licence test since a misclassification can have serious consequences in terms of traffic safety. In the studies included here the rate of agreement between examiners is deemed as satisfactory. It would be preferable if the classification consistency and classification accuracy, as estimated by the methods used, were higher for the theory test, given its importance.While reliability in terms of agreement between raters/examiners or consistency and accuracy of classification are routinely examined in other contexts, such as large-scale educational testing, this is not often done for the driving licence tests. At the same time, the methods used here can be transferred to contexts where such properties are generally not examined. Collecting information about test-takers and examiners, like in Study I, can provide evidence concerning possible bias.Examining to what extent decisions are consistent is one important aspect of collecting evidence that shows that test results can be used to draw conclusions about driver competence. Still, regardless of outcome, validation is a process that never ends. There is always reason to examine various aspects and make further improvements. There are also many other relevant aspects to examine. A prerequisite for the validity of the score interpretation of a criterion-referenced test like this one is that the cut-score is appropriate and the content relevant. This should therefore be the subject of further research as the validation process continues.
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- Alghamdi, Azza
(författare)
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Approximation of pluricomplex Green functions : A probabilistic approach
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This PhD thesis focuses on probabilistic methods of approximation of pluricomplex Green functions and is based on four papers.The thesis begins with a general introduction to the use of pluricomplex Green functions in multidimensional complex analysis and a review of their main properties. This is followed by short description of the main results obtained in the enclosed papers.In Paper I, we study properties of the metric space of pluriregular sets, that is zero sets of continuous pluricomplex Green functions. The best understood non-trivial examples of such sets are composite Julia sets, obtained by iteration of finite families of polynomial mappings in several complex variables. We prove that the so-called chaos game is applicable in the case of such sets. We also visualize some composite Julia sets using escape time functions and Monte Carlo simulation.In Paper II, we extend results in Paper I to the case of infinite compact families of proper polynomials mappings. With composition as the semigroup operation, we generate families of infinite iterated function systems with compact attractors. We show that such attractors can be approximated probabilistically in a manner of the classic chaos game.In Paper III, we study numerical approximation and visualisation of pluricomplex Green functions based on the Monte-Carlo integration. Unlike alternative methods that rely on locating a sequence of carefully chosen finite sets of points satisfying some optimal conditions for approximation purposes, our approach is simpler and more direct by relying on generation of pseudorandom points. We examine numerically the errors of approximation for some simple geometric shapes for which the pluricomplex Green functions are known. If the pluricomplex Green functions are not known, the errors in Monte Carlo integration can be expressed with the aid of statistics in terms of confidence intervals.Finally, in Paper IV, we study how perturbations of an orthonomalization procedure influence the resulting approximate Bergman functions. To this end we consider the concept of near orthonormality of a finite set of vectors in an inner product space, understood as closeness of the Gram matrix of those vectors to the identity matrix. We provide estimates for the errors resulting from using nearly orthogonal bases instead of orthogonal ones. The motivation for this work comes from Paper III: when Gram matrices are calculated via Monte Carlo integration, the outcomes of standard orthogonalisation algorithms are nearly orthonormal bases.
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| 9. |
- Annerberg, Anna, 1972-
(författare)
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Gymnasielärares skrivpraktiker : skrivande som professionell handling i en digitaliserad skola
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to contribute to deeper knowledge about the writing practices of teachers in upper secondary school. Schools are under constant pressure to respond to the needs and expectations of an ever-changing society and political intentions. A major factor in this change which is taking place in schools is digitalization. Another factor is the adoption of new governing principles for schools involving management by goals and results, which brings increased demands for written documentation of teachers' work.In order to describe and problematize this development the thesis is based on a combination of Critical Discourse Analysis and New Literacy (Clark and Ivanič, 1997). The theoretical framework rests upon an understanding of writing as social action and the idea that texts both affect and are affected by the social environment. The empirical study focuses on twelve teachers and their writing practices, analyzed during week-long field visits over three years. The teachers' talk about their writing is used together with analyses of texts and images to investigate parts of teachers' writing which, according to the teachers, are considered complex and problematic.The findings indicate significant differences between the writing practices of the individual teachers, where each teacher has his or her own system of texts fulfilling different purposes. Despite these differences it is still possible to identify recurrent themes in the discursive conditions for teachers' writing: efficiency, reuse, authority, audit, relationships to addressees, and room to maneuver. The study illustrates possible dilemmas for teachers' writing at the intersection of teachers' professional responsibility and demands for accountability.
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- Birkeland, Kare I., et al.
(författare)
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Cardiovascular mortality and morbidity in patients with type 2 diabetes following initiation of sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs (CVD-REAL Nordic) : A Multinational Observational Analysis
- 2017
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Ingår i: The Lancet Diabetes and Endocrinology. - New York : Elsevier. - 2213-8587 .- 2213-8595. ; 5:9, s. 709-717
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Tidskriftsartikel (refereegranskat)abstract
- Background In patients with type 2 diabetes and a high cardiovascular risk profile, the sodium-glucose co-transporter-2 (SGLT2) inhibitors empagliflozin and canagliflozin have been shown to lower cardiovascular morbidity and mortality. Using real-world data from clinical practice, we aimed to compare cardiovascular mortality and morbidity in new users of SGLT2 inhibitors versus new users of other glucose-lowering drugs, in a population with a broad cardiovascular risk profile. Methods CVD-REAL Nordic was an observational analysis of individual patient-level data from the Prescribed Drug Registers, Cause of Death Registers, and National Patient Registers in Denmark, Norway, and Sweden. All patients who filled a prescription for glucose-lowering drugs between 2012 and 2015 were included and followed up until Dec 31, 2015. Patients were divided into new users of SGLT2 inhibitors and new users of other glucose-lowering drugs. Each SGLT2 inhibitor user was matched with three users of other glucose-lowering drugs by use of propensity scores. Hazard ratios (HRs) were estimated by country (Cox survival model) and weighted averages were calculated. Cardiovascular outcomes investigated were cardiovascular mortality, major adverse cardiovascular events (cardiovascular mortality, myocardial infarction, and ischaemic or haemorrhagic stroke), hospital events for heart failure (inpatient or outpatient visit with a primary diagnosis of heart failure), non-fatal myocardial infarction, non-fatal stroke, and atrial fibrillation. We also assessed incidence of severe hypoglycaemia. Findings Matched SGLT2 inhibitor (n=22 830) and other glucose-lowering drug (n=68 490) groups were well balanced at baseline, with a mean follow-up of 0.9 (SD 4.1) years (80 669 patient-years) and mean age of 61 (12.0) years; 40% (36 362 of 91 320) were women and prevalence of cardiovascular disease was 25% (22 686 of 91 320). 94% of the total SGLT2 inhibitor exposure time was for use of dapagliflozin, with 5% for empagliflozin, and 1% for canagliflozin. Compared with other glucose-lowering drugs, use of SGLT2 inhibitors was associated with decreased risk of cardiovascular mortality (HR 0.53 [95% CI 0.40-0.71]), major adverse cardiovascular events (0.78 [0.69-0.87]), and hospital events for heart failure (0.70 [0.61-0.81]; p<0.0001 for all). We did not identify significant differences between use of SGLT2 inhibitors and use of other glucose-lowering drugs for non-fatal myocardial infarction, non-fatal stroke, or atrial fibrillation. Compared with other glucose-lowering drugs, use of SGLT2 inhibitors was associated with a decreased risk of severe hypoglycaemia (HR 0.76 [0.65-0.90]; p=0.001). For cardiovascular mortality, the differences were similar for the 25% of individuals with cardiovascular disease at baseline and those without (HR 0.60 [0.42-0.85] vs 0.55 [0.34-0.90]), while for major adverse cardiovascular events the HR in the group with cardiovascular disease at baseline was 0.70 (0.59-0.83) versus 0.90 (0.76-1.07) in the group without. Interpretation In a population of patients with type 2 diabetes and a broad cardiovascular risk profile, SGLT2 inhibitor use was associated with reduced cardiovascular disease and cardiovascular mortality compared with use of other glucose-lowering drugs-a finding consistent with the results of clinical trials in patients at high cardiovascular risk.
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