| 1. |
- Clapham, Eric, et al.
(författare)
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The association between exposure to clozapine, olanzapine, and quetiapine and the outcomes perimyocarditis and heart failure : A population-based cohort study
- 2023
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 326
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Tidskriftsartikel (refereegranskat)abstract
- The risk of cardiac adverse events following clozapine use is debated and is unknown for the chemically related and widely used antipsychotics olanzapine and quetiapine. National Swedish registers were used to identify all patients 16-75 years old with antipsychotic dispensations between 2005 and 2018. The short-term outcome was a diagnosis of perimyocarditis (pericarditis and/or myocarditis) within two months of first dispensation, and the long-term outcome was heart failure (including cardiomyopathy) within three years. Cox regressions with time varying exposure were used to estimate hazard rates (HR) and their 95% confidence intervals (CI). A total of 201,045 individuals were included in the cohort. The risk of developing perimyocarditis during clozapine treatment tripled compared to no antipsychotic treatment (HR 3.4, CI 1.6-7.3), although the absolute rate remained comparably low. The long-term risk of heart failure during clozapine treatment was also elevated (HR 1.3, CI 1.1-1.7). Treatment with either or both olanzapine or quetiapine was not associated with an increased relative risk of perimyocarditis, or heart failure compared to no antipsychotic treatment. Clozapine use is therefore associated with a substantially elevated short-term risk of perimyocarditis and an increased risk of heart failure within three years.
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| 2. |
- Ekstrand, Charlotta, et al.
(författare)
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Cancer risk in patients with primary immune thrombocytopenia - A Swedish nationwide register study
- 2020
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Ingår i: Cancer Epidemiology. - : ELSEVIER SCI LTD. - 1877-7821 .- 1877-783X. ; 69
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Tidskriftsartikel (refereegranskat)abstract
- Background: Immune thrombocytopenia (ITP) is an autoimmune disease treated with immunosuppressive agents, thrombopoietin receptor agonists, immunomodulation drugs and/or splenectomy. Patients with ITP have been found to have increased risk ofhematological malignancies. Studies investigating stomach/liver cancer are contradictory and the risk of developing other solid tumors is largely unknown. We aimed at estimating risk of overall and organ-specific cancers in patients with primary ITP.Methods: The study population was Swedish patients with at least one ITP diagnosis recorded in the National Patient Register and a 1:10 matched comparison cohort from the population. The study period covers 1997-2016. The Cancer Register and the Cause of Death Register provided data on malignancies and deaths, respectively. Primary ITP was identified using an established algorithm. We used time-split Cox models to estimate hazard ratios (HRs) with 95 % confidence intervals (CIs), adjusted for age, sex, index-year, county, income, education, Charlson score and number of inand outpatient contacts.Results: In total 66,134 individuals were included in the study. Patients with ITP had higher risk of gastrointestinal, skin (all morphologies), lymphoid and hematological cancers. Adjusted HR (95 % CI) for cancer was 1.37 (1.27-1.48), with highest risk during the first year, but with increased risk remaining for up to 20 years for men. For women, the overall risk was increased during the first year, HR (95 % CI) 2.00 (1.55-2.60). A significantly increased liver cancer risk was seen up to 9 years after diagnosis.Conclusion: Patients with primary ITP have higher risk of cancer than the population. The observed increased risk does not seem to be solely due to surveillance bias, but might be associated with ITP or its treatments. Treating hematologists need to have high index of suspicion for cancer.
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| 3. |
- Elenis, Evangelia, 1983-, et al.
(författare)
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Estrogen-modulating treatment among mid-life women and COVID-19 morbidity and mortality : a multiregister nationwide matched cohort study in Sweden
- 2024
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Ingår i: BMC Medicine. - : BioMed Central (BMC). - 1741-7015. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIt has been repeatedly shown that men infected by SARS-CoV-2 face a twofold higher likelihood of dying, being hospitalized or admitted to the intensive care unit compared to women, despite taking into account relevant confounders. It has been hypothesized that these discrepancies are related to sex steroid hormone differences with estrogens being negatively correlated with disease severity. The objective of this study was therefore to evaluate COVID-19-related mortality and morbidity among peri- and postmenopausal women in relation to estrogen-containing menopause hormonal treatments (MHT).MethodsThis is a national register-based matched cohort study performed in Sweden between January 1 to December 31, 2020. Study participants comprised women over the age of 53 years residing in Sweden. Exposure was defined as prescriptions of local estrogens, systemic estrogens with and without progestogens, progestogens alone, or tibolone. MHT users were then compared with a matched cohort of non-users. The primary outcome consisted of COVID-19 mortality, whereas the secondary outcomes included inpatient hospitalizations/outpatient visits and confirmed SARS-CoV-2 infection. Multivariable adjusted Cox regression-derived hazard ratios (HRs) were calculated.ResultsUse of systemic estrogens alone is associated with increased COVID-19 mortality among older women (aHR 4.73, 1.22 to 18.32), but the association is no longer significant when discontinuation of estrogen use is accounted for. An increased risk for COVID-19 infection is further observed for women using combined systemic estrogens and progestogens (aHR 1.06, 1.00 to 1.13) or tibolone (aHR 1.21, 1.01 to 1.45). Use of local estrogens is associated with an increased risk for COVID-19-related death (aHR 2.02,1.45 to 2.81) as well as for all secondary outcomes.ConclusionsSystemic or local use of estrogens does not decrease COVID-19 morbidity and mortality to premenopausal background levels. Excess risk for COVID-19 morbidity and mortality was noted among older women and those discontinuing systemic estrogens. Higher risk for death was also noted among women using local estrogens, for which non-causal mechanisms such as confounding by comorbidity or frailty seem to be the most plausible underlying explanations.
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| 4. |
- Langerth, Ann, et al.
(författare)
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ERCP‑related perforations : a population‑based study of incidence,mortality, and risk factors
- 2020
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Ingår i: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 34, s. 1939-1947
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Tidskriftsartikel (refereegranskat)abstract
- Background: Perforations related to endoscopic retrograde cholangiopancreatography (ERCP) are rare but feared adverse events with highly reported morbidity and mortality rates. The aim was to evaluate the incidence and outcome of ERCP-related perforations and to identify risk factors for death due to perforations in a population-based study.Methods: Between May 2005 and December 2013, a total of 52,140 ERCPs were registered in GallRiks, a Swedish nationwide, population-based registry. A total of 376 (0.72%) were registered as perforations or extravasation of contrast during ERCP or as perforation in the 30-day follow-up. The patients with perforation were divided into fatal and non-fatal groups and analyzed for mortality risk factors. The case volume of centers and endoscopists were divided into the upper quartile (Q4) and the lower three quartile (Q1-3) groups. Furthermore, fatal group patients' records were reviewed.Results: Death within 90 days after ERCP-related perforations or at the index hospitalization occurred in 20% (75 out of 376) for all perforations and 0.1% (75 out of 52,140) for all ERCPs. The independent risk factors for death after perforation were malignancy (OR 11.2, 95% CI 5.8-21.6), age over 80 years (OR 3.8, 95% CI 2.0-7.4), and sphincterotomy in the pancreatic duct (OR 2.8, 95% CI 1.1-7.5). In Q4 centers, the mortality was similar with or without pancreatic duct sphincterotomy (14% vs. 13%, p = 1.0), but in Q1-3 centers mortality was higher (45% vs. 21%, p = 0.024).Conclusions: ERCP-related perforations are severe adverse events with low incidence (0.7%) and high mortality rate up to 20%. Malignancy, age over 80 years, and sphincterotomy in the pancreatic duct increase the risk to die after a perforation. The risk of a fatal outcome in perforations after pancreatic duct sphincterotomy was reduced when occurred at a Q4-center. In the case of a complicated perforation a transfer to a Q4-center may be considered.
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| 5. |
- Linder, Elkanah, et al.
(författare)
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Knowledge support for environmental information on pharmaceuticals : experiences among Swedish Drug and Therapeutics Committees
- 2023
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTwo publicly available Swedish knowledge support systems, “Pharmaceuticals and Environment” on Janusinfo.se and Fass.se, provide environmental information on pharmaceuticals. Janusinfo is provided by the public healthcare system in Stockholm and Fass is provided by the pharmaceutical industry. The objectives of this study were to investigate the experiences among Swedish Drug and Therapeutics Committees (DTCs) with using the databases, retrieve development proposals for these, and investigate the DTCs’ challenges with working with pharmaceuticals in the environment.MethodsA cross-sectional survey with 21 questions, both closed and open-ended, was distributed electronically in March 2022 to Sweden’s 21 DTCs. Descriptive statistics and inductive categorization were used for the analysis.ResultsA total of 132 respondents from 18 regions filled out the survey. The average regional response rate was 42%. The DTCs used the knowledge supports to consider environmental aspects of pharmaceuticals in their formularies and in education. Respondents were more familiar with Janusinfo compared to Fass but appreciated the availability of both. The DTCs especially valued the concrete proposals for certain active pharmaceutical ingredients on Janusinfo. Respondents requested that all medicinal products have environmental information on Fass. Challenges included lack of data, lack of transparency from the pharmaceutical industry and difficulties considering the environmental aspect of pharmaceuticals in their healthcare practice. Respondents wanted more knowledge, clear messages, and legislation to support their work to reduce the negative environmental impact of pharmaceuticals.ConclusionsThis study demonstrates that knowledge supports for environmental information on pharmaceuticals are valuable for the DTCs in Sweden, but the respondents experienced challenges in their work in this field. The study can provide insights to those in other countries interested in considering environmental aspects in their formulary decision-making.
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| 6. |
- Linder, Johanna, et al.
(författare)
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”Kojan” – den pedagogiska potentialen i den vilda naturen
- 2024
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Konferensbidrag (populärvet., debatt m.m.)abstract
- Om föredraget: Barn får mindre utrymme i den offentliga miljön. Ofta skapas den utifrån de vuxnas perspektiv. Var kan barn få upptäcka, leka, skapa och lära? I projektet ”Kojan” samarbetade Österhängens konsthall, konstnärer samt barn i åldrarna 4–12 år kring nya lösningar och svar på hur platser för barn kan utformas och användas och därmed också nya metoder för hur dessa kan skapas.Natursnokarnas, Naturskyddsföreningens barn- och familjeverksamhet, motto är att varenda unge ska känna sig hemma i naturen. Att få lära känna och förstå mer om naturen gör också att vi vill vara med och hjälpa, skydda och bevara den. Inom verksamheten är barnen och deras vuxna varandras medupptäckare.Vad händer när vi ger utrymme för barns egna önskningar, fantasi och skapande?Välkomna till ett föredrag om Naturskyddsföreningens verksamhet Natursnokarna, Österängens konsthall och det praktiknära forskningsprojektet "Kojan".
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| 7. |
- Lundh Snis, Ulrika, 1970-, et al.
(författare)
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Enhancing Quality through Work Integrated Learning and Collaboration Partnership
- 2022
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Ingår i: International Conference on Work Integrated Learning. - Trollhättan : University West. - 9789189325302 ; , s. 90-91
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- For Sweden to be able to compete in the global economy, our students with a degree from higher education must be ready for a career in working life. Today's work life is facing a major ongoing transformation, characterized by increased complexity, higher specialization, and digitalization. This demands competencies beyond traditional theoretical knowledge, such as preparing for uncertainty and unknown outcomes (Barnett, 2000; Vallo Hult & Byström, 2021). Therefore, it is essential to engage students in learning to learn, i.e., lifelong learning so that the tools and methods for learning in higher education can also be developed through future work (Billett, 2014; Islind, Norström, Vallo Hult, & Ramadani Olsson, 2021). For University West, this means that our education programs must be developed in collaboration with industry partners from the surrounding society to provide arelevant and attractive education, which corresponds to the labour market's long-term competence needs. We want our students to develop abilities and skills that enable them to be part of and drive sustainable societal development in practice.Work Integrated Learning (WIL) is University West's overarching profile, based on the concept of advanced knowledge – characterized by complex problem solving – and the mutual acknowledgment of advanced knowledge within the academy and among its partners. What characterizes WIL at University West is that we have developed and refined a combination of different approaches over a long period, including research -based WIL, through fundamental learning concepts such as socio- cultural, critical and action-oriented learning theories. These influences have shaped WIL at University West into a dynamic and academic area of knowledge and subject. In order to achieve a strategic and qualitative development of work-integrated learning, the University West Board decided to WIL-certify all educational programs with a clear sustainability perspective. The quality processis called the WIL certification process. It has now been developed at the university fortwo years.Experience andrefinements are ready to mature into an overall quality framework worth conceptualizing and disseminating to more universities that systematically want to develop WIL as an explicit quality dimension in higher educa tion. The project is still ongoing but have generated some preliminary findings and outcomes from the initial phase. Data collection activities include workshops and focus groups with selected participants from the target groups at the university (managers/prefects and teachers) as well as at the collaborative partner organization (managers and supervisors/mentors). The focus of the workshops was placed on capturing the participants understanding and perspectives on WIL as a concept, and to map the conditions for and experiences of conducting WIL in teaching and learning at work. We aim for identifying good (or less good) examples of WIL, what they are, how they are understood and why they are (or are not) important.The purpose of this paper is to describe the lessons learned so far and present a conceptual quality framework for WIL in higher education with a clear connection to sustainable development. The quality framework may function as a mediating “support object” between higher education institutions, industry partners, and actors in the surrounding society to promote WIL concepts and experiences in collaboration strategies.
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| 8. |
- Lundh Snis, Ulrika, 1970-, et al.
(författare)
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Enhancing Work-Integrated Learning (Wil) through Strategic Stakeholder Collaboration
- 2023
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Ingår i: ICERI 2023 Proceedings. - : The International Academy of Technology, Education and Development. - 9788409559428 ; , s. 1298-1302
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- For graduates to be able to compete in the global world, study programmes must include knowledge, competences and skills that ensures that students with a higher education degree are ready for both a complex working life and continuous competence development. This demands competencies beyond traditional theoretical knowledge, such as preparing for uncertainty and unknown outcomes. Therefore, it is essential to engage students in learning to learn, i.e., lifelong learning so that the tools and methods for learning in higher education can also be developed through future work.At University West (UW) in Sweden, this means that programmes are developed in collaboration with societal partners to provide a relevant and attractive educational offer. The University West uses the concept of work-integrated learning (WIL) to embrace a sustained/systematic collaboration with strategic partners outside academia. We consider that knowledge is created in the encounter between academia and our strategic partners, through the integration of knowledge, skills and competences acquired both within academia and work life.To achieve a strategic and qualitative development of work-integrated learning (WIL), the Board of University West in 2018 decided to WIL-certify all educational programs including a sustainability perspective and enhance this process by engaging in strategic partnerships with stakeholders from civic society to international companies. The process is a development of existing and future programmes and their pedagogical approach. The WIL certification process has developed into a renewal of the pedagogical approach through a development process based on a lively exchange of experiences from study programme representatives from political science to nursing; and discussions with our strategic partners that benefits both students, staff as well as the strategic partners through competence development and lifelong learning.The purpose of this paper is to describe the lessons learned so far and present a conceptual quality framework for WIL in higher education with a clear connection to sustainable development. Based on the experiences from the development of the institutional WIL project and a Swedish Innovation agency (VINNOVA) research project we aim for a better understanding and insights into how theoretical and practical knowledge can enhance learning both within academia and within strategic partners. Data collection activities include workshops and focus groups with selected participants from the target groups at the university (managers/prefects and teachers) as well as at the collaborative partner organization (managers and supervisors/mentors). Initial findings suggest that the meeting between academia, working life and the surrounding society can ensure that insights, solutions and mutual development are created to meet the challenges society faces. The paper will discuss the methodology of creating work-integrated learning environments that include well-functioning communication and a community of practice (Wenger, 1998) connecting learners, teachers, and other staff with local, regional and national stakeholders.
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| 9. |
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| 10. |
- Pendrill, Ann-marie, et al.
(författare)
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Round and round in circles-shifting relevance structures as students discuss acceleration and forces during circular motion in a vertical plane
- 2023
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Ingår i: European journal of physics. - : Institute of Physics (IOP). - 0143-0807 .- 1361-6404. ; 44:5
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Tidskriftsartikel (refereegranskat)abstract
- Working out the relations between the forces involved in circular motion in a vertical plane can be challenging for first-year students, as illustrated in this analysis of a 30 min group discussion of a textbook problem where a remote-control model car moves with constant speed inside a cylinder. The analysis includes timelines of semiotic resources used, as well as of topics brought up by individual students. Questions from the students include: what is that force you drew on the paper? Does it act on the car or on the wall? What keeps the car from falling down? The normal force and the 'centripetal force' both point to the center-does it mean they are the same? Is it only a gravitational force at the top? Does the normal force at the bottom just cancel gravity or does it need to be larger? What is 'normal' about the normal force? Arriving at the correct numerical result is insufficient evidence for student understanding of forces in circular motion! Can students with fragmentary understanding bring their pieces together to solve the puzzle? From the timelines, we can identify a few critical moments where the discussion changes focus. This happens when one of the students in the group introduces a new dimension of variation, e.g. a reminder about the force of gravity, a free-body diagram drawn, as well as diagrams drawn in other parts of the circle than the top or bottom, where the centripetal and normal forces are no longer in the same direction. Embodied experiences are invoked, but only at a very late stage in the discussion. For teachers, an awareness of the different ways students use terms and think about the forces can be a guide to offering a larger variation in the interventions, as well as in problems assigned.
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