| 1. |
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| 2. |
- Arver, Brita, et al.
(author)
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Bilateral Prophylactic Mastectomy in Swedish Women at High Risk of Breast Cancer: A National Survey.
- 2011
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In: Annals of surgery. - : Lippincott Williams and Wilkins; 1999. - 1528-1140 .- 0003-4932. ; 253:6, s. 1147-1154
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Journal article (peer-reviewed)abstract
- BACKGROUND/OBJECTIVE:: This study attempted a national inventory of all bilateral prophylactic mastectomies performed in Sweden between 1995 and 2005 in high-risk women without a previous breast malignancy. The primary aim was to investigate the breast cancer incidence after surgery. Secondary aims were to describe the preoperative risk assessment, operation techniques, complications, histopathological findings, and regional differences. METHODS:: Geneticists, oncologists and surgeons performing prophylactic breast surgery were asked to identify all women eligible for inclusion in their region. The medical records were reviewed in each region and the data were analyzed centrally. The BOADICEA risk assessment model was used to calculate the number of expected/prevented breast cancers during the follow-up period. RESULTS:: A total of 223 women operated on in 8 hospitals were identified. During a mean follow-up of 6.6 years, no primary breast cancer was observed compared with 12 expected cases. However, 1 woman succumbed 9 years post mastectomy to widespread adenocarcinoma of uncertain origin. Median age at operation was 40 years. A total of 58% were BRCA1/2 mutation carriers. All but 3 women underwent breast reconstruction, 208 with implants and 12 with autologous tissue. Four small, unifocal, invasive cancers and 4 ductal carcinoma in situ were found in the mastectomy specimens. The incidence of nonbreast related complications was low (3%). Implant loss due to infection/necrosis occurred in 21 women (10%) but a majority received a new implant later. In total, 64% of the women underwent at least 1unanticipated secondary operation. CONCLUSIONS:: Bilateral prophylactic mastectomy is safe and efficacious in reducing future breast cancer in asymptomatic women at high risk. Unanticipated reoperations are common. Given the small number of patients centralization seems justified.
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| 3. |
- Bergkvist, Karin
(author)
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Life situation in patients and their family members after allogeneic hematopoietic stem cell transplantation : aspects of health and support in different care settings
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Allogeneic hematopoietic stem cell transplantation (HSCT) is mainly an intensive treatment option for hematology malignancies. During the past decades, improved care and treatment have been systematically developed. One example is the possibility for patients to choose to be at home rather than in the hospital during the early neutropenic phase after HSCT. Recent studies have shown positive medical advantages with home care. The overall aim of this thesis was to describe patients and family members’ life situation after HSCT, as well their experiences from two different care setting: the patient’s home or the hospital. Data from patient-reported experiences were used in studies I and II and patient reported- outcomes in study III. In study IV data from family members experiences were used. Data from 173 (study I n=41; study II n= 15; study III n= 117) patients and 14 family members (study IV) were included in the thesis.In study I patients in both the hospital care group and the home care group expressed high satisfaction with the care and support during the acute post- transplantation phase.In study II four categories were identified from the interviews with patients To be in a safe place, To have a supportive network, My way of taking control, and My uncertain way back to normal.In study III, a cross-sectional survey was conducted and the majority of patients in both hospital care (77%) and home care (78%) rated their general health as ‘good’. A median of 14 symptoms were reported by patients in both hospital (0- 36) and home care (1-29). There were no significant differences regarding general health, symptom occurrence or self-efficacy between patients in hospital and those in home care.In study IV interviews with family members generated a main category, Being me and being us in an uncertain time was identified and five generic categories To receive the information I need, To meet a caring organization, To be in different care settings, To be a family member, and To have a caring relationship.In summary, numerous factors (the care routines, information, the competence and support from the health care team) related to the care were shown to influence the feeling of being safe regardless of care setting. Both patients and family members express the uncertainty associated with the HSCT. Different strategies (to have faith, being positive, hope and live in the present) were used to balancing the uncertainty. The majority of patients in both hospital care and home care rated their general health as ‘good’. A high symptom occurrence was reported in both groups in median five years post HSCT.
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| 4. |
- Sorgenfrei, Simon, Docent, et al.
(author)
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Mångreligiositet och sekularitet i svenskt polisväsende, vård, skola och offentlig förvaltning : en forskningsöversikt
- 2021
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Reports (other academic/artistic)abstract
- Under de senaste decennierna har Sverige genomgått stora demografiska och politiska förändringar. Tillsammans har dessa inneburit att Sverige idag samtidigt är ett av Europas mest sekulariserade och mest mångreligiösa länder. Den snabba demografiska förändring Sverige har genomgått har ställt många inför nya, stora och i vissa fall skyndsamma kunskapsbehov samtidigt är forskningen om situationen delvis eftersatt. I denna rapport identifieras hur den nya situationen relaterar till det lagstadgade uppdrag som svenskt polisväsende, vård, skola och offentlig förvaltning har. Den forskning som gjorts inom dessa områden sammanfattas och de viktigaste forskningsbehoven identifieras.
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| 5. |
- Appelgren, M., et al.
(author)
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Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial
- 2022
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In: Breast. - : Elsevier BV. - 0960-9776 .- 1532-3080. ; 63, s. 16-23
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Journal article (peer-reviewed)abstract
- Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1-2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQC30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.
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| 6. |
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| 7. |
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| 8. |
- Bergkvist, Karin, et al.
(author)
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Family members' life situation and experiences of different caring organisations during allogeneic haematopoietic stem cells transplantation: : A qualitative study
- 2018
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In: European Journal of Cancer Care. - : Wiley-Blackwell. - 0961-5423 .- 1365-2354. ; 27:1
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Journal article (peer-reviewed)abstract
- The aim of this study was to describe family members' life situation and experiences of care in two different care settings, the patient's home or in hospital during the acute post-transplantation phase after allogeneic haematopoietic stem cell transplantation (HSCT). Data were collected through semi-structured interviews with 14 family members (seven women and seven men). An inductive qualitative content analysis was used to analyse the data. The majority of the family members' (n = 10) had experiences from home care. The findings show the family members' voice of the uncertainty in different ways, related with the unknown prognosis of the HSCT, presented as Being me being us in an uncertain time. The data are classified into; To meet a caring organisation, To be in different care settings, To be a family member and To have a caring relationship. Positive experiences such as freedom and security from home care were identified. The competence and support from the healthcare professionals was profound. Different strategies such as adjusting, having hope and live in the present used to balance to live in an uncertain time. The healthcare professionals need to identify psychosocial problems, and integrate the psychosocial support for the family to alleviate or decrease anxiety during HSCT, regardless of the care setting.
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| 9. |
- Bergkvist, Karin, et al.
(author)
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General health, symptom occurrence, and self-efficacy in adult survivors after allogeneic hematopoietic stem cell transplantation : a cross-sectional comparison between hospital care and home care
- 2015
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 23:5, s. 1273-83
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Journal article (peer-reviewed)abstract
- PURPOSE: Earlier studies have shown that home care during the neutropenic phase after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is medically safe, with positive outcomes. However, there have been few results on long-term outcomes after home care. The aims of this study were to compare general health, symptom occurrence, and self-efficacy in adult survivors who received either home care or hospital care during the early neutropenic phase after allo-HSCT and to investigate whether demographic or medical variables were associated with general health or symptom occurrence in this patient population.METHODS: In a cross-sectional survey, 117 patients (hospital care: n = 78; home care: n = 39) rated their general health (SF-36), symptom occurrence (SFID-SCT, HADS), and self-efficacy (GSE) at a median of 5 (1-11) years post-HSCT.RESULTS: No differences were found regarding general health, symptom occurrence, or self-efficacy between groups. The majority of patients in both hospital care (77 %) and home care (78 %) rated their general health as "good" with a median of 14 (0-36) current symptoms. Symptoms of fatigue and sexual problems were among the most common. Poor general health was associated with acute graft-versus-host disease (GVHD), low self-efficacy, and cord blood stem cells. A high symptom occurrence was associated with female gender, acute GVHD, and low self-efficacy.CONCLUSIONS: No long-term differences in general health and symptom occurrence were observed between home care and hospital care. Thus, home care is an alternative treatment method for patients who for various reasons prefer this treatment option. We therefore encourage other centers to offer home care to patients.
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| 10. |
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| 11. |
- Bergkvist, Karin, et al.
(author)
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Hospital care or home care after allogeneic hematopoietic stem cell transplantation : patients' experiences of care and support
- 2013
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In: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 48, s. S468-S468
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Journal article (peer-reviewed)abstract
- PURPOSE:Treatment at home during the pancytopenic phase after allogeneic hematopoietic stem cell transplantation (HSCT) has been an option for patients at our center since 1998. Earlier studies have shown that home care is safe and has medical advantages. In this study, we present patients' experiences of care and support while being treated in hospital or at home during the acute post-transplantation phase.METHOD:Patients (n = 41, 22 in hospital care and 19 in home care) answered the SAUC questionnaire at discharge (when home, or from hospital). Both statistical analysis and deductive content analysis were used.RESULTS:The patients were highly satisfied with the care and support during the acute post-transplantation phase. Patients in home care were found to be more satisfied with care in general than patients in hospital care. The importance of safety, empathy, and encouragement from healthcare staff were expressed regardless of where care was given. Patients also felt that receipt of continuous, updated information during treatment was important and they had a strong belief in HSCT but were uncertain of the future regarding recovery.CONCLUSIONS:The main findings of this study were that in comparison to hospital care, home care does not appear to have a significant negative effect on patients' experiences of care and support during the acute post-transplantation phase. In addition patients in home care felt safe, seen as a person and encouragement seem to empower the patients at home. Thus, this study may encourage other transplantation centers to provide home care if the patients want it.
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| 12. |
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| 13. |
- Bergkvist, Karin, et al.
(author)
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Patients' experiences of different care settings and a new life situation after allogeneic haematopoietic stem cell transplantation
- 2018
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In: European Journal of Cancer Care. - : Hindawi Limited. - 0961-5423 .- 1365-2354. ; 27:1
-
Journal article (peer-reviewed)abstract
- Over the past 20 years, considerable healthcare resources have shifted from an inpatient to an outpatient setting. To be in an outpatient setting or at home after allogeneic haematopoietic stem cell transplantation (allo-HSCT) has been shown to be medically safe and beneficial to the patient. In this study we describe patients' experiences of different care settings (hospital or home) and a new life situation during the acute post-transplant phase after HSCT. Semi-structured interviews were conducted with 15 patients (six women and nine men) 29-120 days after HSCT. An inductive qualitative content analysis was performed to analyse the data. The analysis resulted in four categories: To be in a safe place, To have a supportive network, My way of taking control, and My uncertain return to normality. The findings showed that patients undergoing HSCT felt medically safe regardless of the care setting. The importance of a supportive network (i.e. the healthcare team, family and friends) was evident for all patients. Both emotional and problem-focused strategies were used to cope with an uncertain future. Being at home had some positive advantages, including freedom, having the potential for more physical activity, and being with family members. The study highlights some key areas thought to provide more personalised care after HSCT.
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| 14. |
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| 15. |
- Bergkvist, Karin, et al.
(author)
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Support in the context of allogeneic hematopoietic stem cell transplantation : The perspectives of family caregivers
- 2020
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In: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 46
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND AIM: Family caregivers are often involved in helping recipients during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although the distress that often arises along the trajectory is evident to family caregivers, research on their perceptions of providing and receiving support is limited. The aim of this study was to explore family caregivers' experiences of providing and receiving support during allo-HSCT.METHOD: Data were collected through semi-structured interviews with fourteen family caregivers 16 weeks after the recipient's allo-HSCT. Inductive qualitative content analysis was used to analyse the data.RESULTS: The analysis revealed four generic categories that focus on prerequisites for family caregivers' ability to provide support: Individual characteristics influence the ability to be supportive, Social context influences the ability to be supportive, Medical information provides knowledge and a sense of participation and Interaction with the healthcare organization provides a sense of participation. These prerequisites are linked in the fifth generic category: Family caregivers' support is multifaceted and dependent on the recipient's health.CONCLUSIONS: Family caregivers' risk of experiencing a stronger sense of uncertainty and lack of participation is higher in the absence of the above-mentioned prerequisites. Professional support is thus required, which implies that the healthcare organization is responsible for identifying the needs of each family caregiver and delivering individualized support.
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| 16. |
- Bergkvist, Karin, et al.
(author)
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Symptom experiences during chemotherapy treatment-With focus on nausea and vomiting
- 2006
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In: European Journal of Oncology Nursing. - : Elsevier BV. - 1462-3889 .- 1532-2122. ; 10:1, s. 21-29
-
Journal article (peer-reviewed)abstract
- Nausea and vomiting are common and well-studied symptoms in cancer care. Most previous studies have focused on the frequency and management of these symptoms. The aim of the study was to acquire a deeper understanding of cancer patients' symptom experiences with a focus on nausea and vomiting during chemotherapy treatment, and the consequences these have on their daily lives. Nine women with different types of cancer and chemotherapy treatments were admitted for chemotherapy treatment and participated in the study. Semi-structured interviews were conducted and analysed using content analysis inspired by Kvale's methods of clarifying and developing new meaning. Five main categories were identified as ''before cancer diagnosis'', ''being ill-consequences on daily life'', ''going through chemotherapy treatment'', ''coping with treatment'' and ''after treatment-looking forward to a normal life''. The present findings suggest that the individual experiences of nausea and vomiting during chemotherapy treatment may have a profound effect on how treatment is perceived and may influence future decisions concerning further treatment. (C) 2005 Elsevier Ltd. All rights reserved.
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| 17. |
- Bergkvist, Linda, Assistant professor, 1979-, et al.
(author)
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Redesigning Professional Development on Digital Transformation Using Andragogy as a Theoretical Lens
- 2023
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In: Proceedings of the 22nd European Conference on e-Learning - ECEL 2023. - : Academic Conferences and Publishing International Limited. - 9781914587900 - 9781914587917 ; , s. 25-32, s. 25-32
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Conference paper (peer-reviewed)abstract
- Regarding the ongoing digitalisation in the knowledge society, professional development seems more crucial than ever. The need for upskilling and reskilling is described as continuous lifelong learning, which must be combined and synchronised with the life of full-time working learners. Content, pedagogical models and instructional design in university courses are often created for students in Bachelor's and Master's programs instead of tailored for adults working full-time. This study describes and discusses andragogy as a potential knowledge base for redesigning professional development courses on digital transformation. Evaluations from two instances of a course for professionals on digital transformation showed that the course participants overall are satisfied with the course. However, only a few course participants take the exam to get credits. Therefore, the research question that guided this study was, "What redesign options for increased pass rates and learner satisfaction in professional development for adult learners can be identified using andragogy as a theoretical lens?" The course is on distance and contains four modules with synchronous and asynchronous learning activities, resulting in five European Credit Transfer System (ECTS). The empirical material consisted of course participants' check-in presentation before the course started, mid-term evaluation, final evaluations, and a learning diary containing 58 entries. The data was deductively analysed using the theory of andragogy as an analytical lens. The findings imply that instructors should put effort into how different parts of the course are connected, supporting learners' need to know. Further, to enhance the course participants' prior experience as a resource for learning by adding learning activities, they exchange experiences and examples with each other, adding to their learning process and networking. The pedagogic parts of understanding the theoretical course material could be split into pieces through exercises where the participants apply conceptual models and concepts to real-situation problems. The learning diary could help the participants align the new knowledge with their prior knowledge with a focus on professional roles and work situations. The identified redesign options create opportunities to increase pedagogical parts like readiness, orientation, and motivation to learn according to the current higher education system.
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| 18. |
- Brodén, Karin, 1963-, et al.
(author)
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Redesigning Technology-Enhanced Professional Development to Facilitate Lifelong Learning
- 2023
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In: ICERI2023 Proceedings. - Sevilla : IATED. - 9788409559428 ; , s. 604-611
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Conference paper (peer-reviewed)abstract
- Professional development is more crucial than ever, especially in supporting ongoing digitalisation in the knowledge society. The need for upskilling and reskilling is described as continuous lifelong learning, which must be combined and synchronised with the lives of full-time working learners. Content, pedagogical models and instructional design in university courses are often centred on students in their early twenties with little to no work experience instead of tailored for experienced professionals working full-time. One such course is the foundation for this study: a course on digitalisation and digital transformation targeting professionals with at least two years of work experience in digital transformation. Therefore, the research question that guided this study was: "How can a distance course for professionals be redesigned to facilitate lifelong learning?" The redesign aims to increase satisfaction with the course and the number of participants taking their exams. The course contains four modules with synchronous and asynchronous learning activities, resulting in 5 ECTS credits (the European Credit Transfer System). The analysed empirical material consists of course participants' check-in presentation before the course started, mid-term evaluation, final evaluation, and a learning diary containing 58 entries. The empirical material was inductively and iteratively analysed following the main steps of thematic analysis. Two of the researchers conducted the first steps of the analysis individually. The following steps were a joint coding procedure to reach a consensus. This part of the analysis included several discussions with the other researchers. The inductive analysis identified 70 initial codes that reflected issues related to course design, learning activities, course information, and instructions. The initial codes were clustered into seventeen more abstract themes based on similarities. The themes related to strengths and weaknesses/challenges with the course. The strengths were analysed as, among others, discussions with course participants in other domains, recordings introducing scientific articles, focused and direct instructions on the learning management system (LMS), and the course is held online at the same weekly time. Perceived challenges were, for example, reading scientific articles and understanding and transferring the content to their work situation, lack of correspondence among the modules, not all modules being published simultaneously on the LMS, and the general problem of mixing work and studies. Despite that, the material showed satisfied course participants, where only a few ended the course by taking the exam to get their credits, which is one of academia’s ways to quantify learning. Based on the data analysis, course and learning activities will be redesigned and developed to be tested and evaluated in a forthcoming course instance in autumn 2023.
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| 19. |
- Eriksson, Linda, et al.
(author)
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Important factors associated with sick leave after allogeneic haematopoietic stem cell transplantation : A 1-year prospective study
- 2021
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In: Journal of cancer survivorship. - : Springer Science and Business Media LLC. - 1932-2259 .- 1932-2267. ; 15:6, s. 933-941
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Journal article (peer-reviewed)abstract
- PURPOSE: This study examines sick leave (SL) and factors associated with full-time SL 1 year after allogeneic haematopoietic stem cell transplantation (allo-HSCT) in patients of working age from 2009 to 2016 (n = 122).METHODS: Questionnaire data were collected on admission to the allo-HSCT unit, at 7 months and 1 year after allo-HSCT. Associations between factors and SL were analysed using logistic regression analyses.RESULTS: One year after allo-HSCT, 76% of participants were on SL, with 36% on full-time SL. In univariable analyses, chronic graft-versus-host-disease (cGvHD) (OR 3.07; 95% CI 1.34-7.07; p = 0.01), having symptoms of depression at 7 months (OR 4.81; 95% CI 1.69-13.69; p = 0.00) and low levels of vocational satisfaction at 7 months after treatment (OR 3.27; 95% CI 1.27-8.41; p = 0.01) were associated with full-time SL 1 year after allo-HSCT. cGvHD (OR 3.43; 95% CI 1.35-8.73; p = 0.01) and having symptoms of depression at 7 months after allo-HSCT (OR 3.37; 95% CI 1.2-11.58; p = 0.02) remained significant in multivariable analysis.CONCLUSION: The majority of allo-HSCT survivors were on SL 1 year after treatment, and cGvHD, low vocational satisfaction and depressive symptoms were associated with full-time SL 1 year after allo-HSCT.IMPLICATIONS FOR CANCER SURVIVORS: Healthcare professionals need to be observant of and manage the consequences of cGvHD and patients' symptoms of depression in order to support them appropriately in their return-to-work process.
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| 20. |
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| 21. |
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| 22. |
- Eriksson, Linda Victoria, et al.
(author)
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Symptom burden and recovery in the first year after allogeneic hematopoietic stem cell transplantation
- 2023
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In: Cancer Nursing. - 0162-220X .- 1538-9804. ; 46:1, s. 77-85
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patients are affected by various symptoms after allogeneic hematopoietic stem cell transplantation (allo-HSCT) that can affect recovery. Research has mainly focused on symptom occurrence; thus, little is known about patients' overall symptom burden.OBJECTIVE: The aim of this study was to examine patient-reported symptom burden in the first year after allo-HSCT and whether a high symptom burden 4 months after allo-HSCT predicts recovery, that is, general health and sick leave, 1 year after transplantation.METHODS: Allo-HSCT patients aged 18 to 65 years were included (n = 189). Questionnaire data were collected on admission to the allo-HSCT unit, as well as 4 and 7 months and 1 year after allo-HSCT. Logistic regression evaluated relationships between demographic characteristics, chronic graft-versus-host disease, physical activity, and a high symptom burden.RESULTS: Tiredness, susceptibility to infection, disinterest in sex, and physical weakness remained the most frequent symptoms, while distressing symptoms varied during the first year after allo-HSCT.Poor general health 1 year after allo-HSCT was associated with older age, low physical activity, and a high symptom burden 4 months after allo-HSCT. Full-time sick leave 1 year after allo-HSCT was associated with chronic graft-versus-host disease, low physical activity, and a high symptom burden 4 months after transplantation.CONCLUSIONS: Experiencing a high symptom burden 4 months after allo-HSCT can affect recovery 1 year after transplantation. Furthermore, low physical activity 4 months after allo-HSCT can predict both general health and sick leave 1 year after transplantation.IMPLICATIONS FOR PRACTICE: Repeated symptom assessment, including experienced distress, is central for reducing overall symptom burden and supporting recovery after allo-HSCT.
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| 23. |
- Forsberg, Samuel
(author)
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Power Grid Resilience to High Impact Low Probability Events
- 2023
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Licentiate thesis (other academic/artistic)abstract
- The electrification of societies and the decarbonisation of electricity production are changing energy systems worldwide. A fast transition towards the replacement of fossil fuels by intermittent renewable energy sources is expected in the next decades to combat climate change. A significant share of the produced electricity is likely to be generated from offshore wind farms, due to the abundant wind resources in the offshore regions and the lack of available onshore sites. However, increased electricity dependence in combination with expanded offshore wind power generation introduce new vulnerabilities to the society. Specifically, the effects of high impact low probability (HILP) events are considered as potential threats to the power system, not least because of the increasing number of extreme weather events. Therefore, research on power grid vulnerability and power system resilience to HILP events are of significant interest.This thesis presents results of studies investigating power grid vulnerability from a topological perspective, and resilience to storm conditions of power systems with varying dependencies on offshore wind. To achieve this, methods based on complex network theory and AC power flow analysis have been developed, tested, and evaluated. Further, geospatial wind data from historical extreme storm events have been used to generate realistic power production profiles from hypothetical offshore wind farms.The results strengthen that complex network concepts can be used successfully in the context of power grid vulnerability analysis. Further, the results show that the resilience of power systems with large dependencies on offshore wind differ vastly depending on the grid properties and control strategies, which are further discussed in this thesis.
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| 24. |
- Forsberg, Samuel, et al.
(author)
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Power grid vulnerability analysis using complex network theory : A topological study of the Nordic transmission grid
- 2023
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In: Physica A. - : Elsevier. - 0378-4371 .- 1873-2119. ; 626
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Journal article (peer-reviewed)abstract
- To reduce the vulnerability of power grids to high impact low probability (HILP) events, analysis methods can be applied to quantify the criticality of the nodes in the grid. The method implemented in this article is one originating from complex network theory. It is used to quantify the structural vulnerability of an open-source transmission grid model representing the Nordic transmission grid. The analytical measures used are clustering coefficient and betweenness, closeness, degree, and combined centrality, which are weighted with respect to the estimated values of the transmission lines’ series reactance. The results, which are presented in the form of geographic and network representations, show substantial differences in terms of criticality between the nodes. The most critical ones are highlighted in geographic representations and are further compared with an open-source system analysis performed by the Swedish transmission system operator (TSO). The outcome from this study is that the weighted and combined centrality measure performed the best in terms of identifying critical nodes in the Nordic transmission grid. Thus, the method can be used as a tool for assessing the structural vulnerability of a real transmission grid, even with limited access to electrical grid data. However, the results from this method should not be considered conclusive.
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| 25. |
- Forsberg, Samuel, et al.
(author)
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Resilience to extreme storm conditions : A comparative study of two power systems with varying dependencies on offshore wind
- 2024
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In: Results in Engineering (RINENG). - : Elsevier. - 2590-1230. ; 23
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Journal article (peer-reviewed)abstract
- In the next decades, the dependencies on power production from renewable energy sources are expected to increase dramatically. A transition towards large-scale offshore wind farms together with an increased electrification of the industry and transportation sectors introduces new vulnerabilities to society. Further, extreme weather events are expected to increase in intensity and frequency, driven by climate change. However, there are significant knowledge gaps concerning the impacts of severe weather conditions on the resilience of power systems with large dependencies on offshore wind. In the present study, a comparison between two different power systems’ resilience to historical extreme storm conditions has been conducted. The power systems are the IEEE39-bus New England model and the Great Britain model. The results show significant differences between the two power systems, which underlying reasons are analysed and explained. With an offshore wind penetration level of 30 %, the New England model stays intact in terms of connected load. When increasing the penetration level to 40 %, about 10 % of the total connected load gets disconnected, whereas about 33 % of the load gets disconnected with a penetration level of 50 %. The Great Britain model stays intact in terms of connected load with a penetration level of at least 49 %.
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| 26. |
- Forsberg, Samuel, et al.
(author)
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Resilience to storm conditions of power systems with large dependencies on offshore wind
- 2023
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In: Journal of Physics, Conference Series. - : Institute of Physics Publishing (IOPP). - 1742-6588 .- 1742-6596. ; 2626
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Journal article (peer-reviewed)abstract
- The ongoing transition towards large installations of offshore wind and the electrification of the transport sector and other critical infrastructures introduce new vulnerabilities to the society. Large dependencies of power production from offshore wind are expected in the next decades, but there are large knowledge gaps regarding the power production reliability under severe weather conditions. Simultaneously, weather extremes may increase in frequency and intensity, driven by climate change. In this paper we investigate the resilience of a power system subject to a hurricane event. The power system is based on the IEEE39-bus New England system but with different scenarios for increasing penetration of offshore wind. We find that an offshore wind penetration level of 30% or less results in a power system resilient to hurricane events, with no need for load disconnection. However, when increased to 40% offshore wind penetration, 650 MW corresponding to 10% of the total load demand gets disconnected during the storm peak. With a penetration of 50% offshore wind, the disconnected load ranges from 2.2 GW of load corresponding to 1/3 of the total load demand, to a total power system blackout.
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| 27. |
- Gellerstedt, Linda, et al.
(author)
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Newly-graduated nurses' experiences of a trainee programme regarding the introduction process and leadership in a hospital setting : a qualitative interview study
- 2019
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 28:9-10, s. 1685-1694
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Journal article (peer-reviewed)abstract
- AIM AND OBJECTIVES: This study aimed to describe newly-graduated nurses' experiences of introduction processes and leadership within a hospital trainee programme.BACKGROUND: For many, being a newly-graduated nurse is associated with stress, influenced by the challenge of the transition to independent nurse, coupled with the loss of mentorship due to nurse turnover and rapidly changing demands.METHODS: A qualitative design with an inductive approach was chosen and four focus groups were convened. A total of nineteen nurses were included in the study. Data were analysed using qualitative content analysis. COREQ was used as EQUATOR checklist.FINDINGS: The analysis resulted in three themes: Need for an introduction when facing a complex reality, Striving to stand on my own, and The importance of having an accessible and multi-skilled manager. The transition is a complex, dynamic and demanding process.CONCLUSIONS: The orientation process from student to becoming an independent nurse is a challenging period. A flexible manager and a readily accessible leadership facilitate the newly-graduated nurse's striving to become an independent nurse. The study demonstrates that a trainee programme and support are essential in this process. There are indications that today's newly-graduated nurses have high expectations of coaching from the manager during the orientation process.RELEVANCE TO CLINICAL PRACTICE: The hospital setting and its organisation are rapidly changing in relation to the increasing number of patients and their health status. In addition, there is a need for newly-graduated nurses to secure regrowth, to fill the ranks of experienced nurses leaving the field. Newly-graduated nurses increasingly perceive a gap between their training and clinical realities, thus necessitating changes in tutoring and their introduction to the work. This article is protected by copyright. All rights reserved.
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| 28. |
- Heiden, Marina, et al.
(author)
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Evaluation of cognitive behavioural training and physical activity for patients with stress-related illnesses : a randomized controlled study
- 2007
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:5, s. 366-373
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the effects of a cognitive behavioural training programme and a physical activity programme for patients with stress-related illnesses. DESIGN: In a randomized controlled study, patients were allocated randomly to 1 of 3 groups, where group 1 participated in a cognitive behavioural training programme, group 2 participated in a physical activity programme, and group 3, the control group, was offered usual care for the course of the study. SUBJECTS: A total of 75 patients participated in the study. They had been on sick leave for at least 50% of the time for between 1 month and 2 years due to stress-related illnesses. METHODS: Measurements of autonomic activity, pressure-pain thresholds and subjective ratings of health and behaviour were made before and after a 10-week intervention period, and at 6 and 12 months after the intervention. RESULTS: Minor differences in autonomic activity and pressure-pain thresholds were found between the groups immediately after the intervention. At the 6- and 12-month follow-up assessments, the differences were no longer present. Patients in the cognitive behavioural training group improved their ratings of general health compared with the physical activity group throughout the study. CONCLUSION: The study showed little difference in the effect of cognitive behavioural training and physical activity, compared with usual care, for patients with stress-related illnesses.
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| 29. |
- Holmberg, Katarina, et al.
(author)
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Dismantle and rebuild : The importance of preparedness and self-efficacy before, during and after allogeneic haematopoietic cell transplantation
- 2024
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In: Journal of cancer survivorship. - 1932-2259 .- 1932-2267.
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of this study was to explore patients' experiences of being prepared for allogenic haematopoietic cell transplantation and to explore their perceived self-efficacy and preparedness for self-care after allogenic haematopoietic cell transplantation.METHODS: Nine participants, who recently underwent allo-HCT, were interviewed regarding their views on preparedness, self-efficacy and self-care. The interviews were analysed using inductive qualitative content analysis.RESULTS: An overarching theme, Life is taken apart, then you have to know how to put the pieces together, and four sub-themes: Convert information into something understandable; Taking responsibility, maintaining and preparing for an uncertain time in life; Balancing vigilance with independence; and Reorientating in an altered body places new demands on self-care illustrate the dismantlement of life during treatment and how actions and approaches can build a new life.CONCLUSIONS: Both participants and healthcare professionals prioritised preparing for allo-HCT in the period before admission. However, during admission, preparation decreased and the time was not used for preparatory learning. This meant that participants were well prepared for the acute phase but unprepared for life after completion of treatment. Among the participants, self-efficacy was good. They sought information about taking care of their health before and in the aftermath of allo-HCT.IMPLICATIONS FOR CANCER SURVIVORS: This study provides insight into, and knowledge about, how patients prepare before, during and after treatment. This knowledge should primarily be directed towards healthcare professionals to be used for future patients who may need advice and support, as well as continued preparation for a life after transplantation.
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| 30. |
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| 31. |
- Holmberg, Katarina, et al.
(author)
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Nursing as a balancing act in allogeneic hematopoietic cell transplantation : Nurses' experiences through participation in workshops
- 2023
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In: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 63
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Journal article (peer-reviewed)abstract
- PurposeRegistered nurses have a key role in supporting patients during the trajectory of allogeneic hematopoietic cell transplantation (allo-HCT). However, the circumstances for performing nursing are not previously outlined therefore the purpose of this study was to explore the conditions for nursing care in allo-HCT.MethodAn explorative design, inspired by Experienced based co-design was used to gather experiences, thoughts and visions of nursing care in allo-HCT by means of workshops. Thematic analysis was applied to analyse the data.ResultAn overarching theme that was defined from the data was nursing as a balancing act and illustrating conditions for performing nursing in a highly medical-technical environment. The theme included three sub-themes: Fragmented care vs holistic care outlining how the holistic approach to care disappeared when the care became fragmented; Proximity vs distance illuminating the balance between seeing the patient as an independent person despite illness and the need for support; Teamwork vs stand-alone demonstrating the difficulties inherent in adapting to both teamwork and independence in nursing.ConclusionThis study shows that the conditions for RNs and nursing care in allo-HCT care is to balance tasks and approach towards the patient and themselves. RNs must weigh and balance what is most important in the moment and where something else often has to be put aside. It is difficult for RNs to find the time to plan each patient's care and to support the patient in the way they see as most optimal to prepare for discharge, self-care and rehabilitation.
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| 32. |
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| 33. |
- Høyer, Marie, et al.
(author)
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Change in working time in a population-based cohort of patients with breast cancer
- 2012
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In: Journal of Clinical Oncology. - : American Society of Clinical Oncology. - 0732-183X .- 1527-7755. ; 30:23, s. 2853-2860
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Journal article (peer-reviewed)abstract
- Purpose: We examined changes in working time 16 months after a breast cancer diagnosis and identified factors associated with job discontinuation and/or decreased working time.Patients and Methods:This was a population-based cohort study with 735 patients identified in the Regional Breast Cancer Quality Register of Central Sweden. The study sample consisted of 505 women (age <63 years at diagnosis) who completed questionnaires at baseline and at follow-up (on average 4 and 16 months after diagnosis, respectively). Clinical register data and questionnaire data on sociodemographic factors were obtained at baseline. Self-reported work-related data were obtained at follow-up. Odds ratios were estimated by using logistic regression models.Results:Compared with prediagnosis working time, 72% reported no change in working time, 2% reported an increase, 15% reported a decrease, and 11% did not work at follow-up. Chemotherapy increased the likelihood (odds ratio [OR], 2.45; 95% CI, 1.38 to 4.34) of job discontinuation/decreased working time. Among chemotherapy recipients, associated factors included full-time work prediagnosis (OR, 3.25; 95% CI, 1.51 to 7.01), cancer-related work limitations (OR, 5.26; 95% CI, 2.30 to 12.03), and less value attached to work (OR, 3.69; 95% CI, 1.80 to 7.54). In the nonchemotherapy group, older age (OR, 1.09; 95% CI, 1.02 to 1.17) and less value attached to work (OR, 5.00; 95% CI, 2.01 to 12.45) were associated with the outcome.Conclusion: The majority of women treated for breast cancer returned to their prediagnosis working time. Chemotherapy and cancer-related work limitations are important factors to take into account in identifying women in need of support. Moreover, it is important to consider the woman’s own valuation of labor market participation.
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| 34. |
- Høyer, Marie, et al.
(author)
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Health-related quality of life among women with breast cancer : a population-based study
- 2011
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In: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 50:7, s. 1015-1026
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Journal article (peer-reviewed)abstract
- Background: High incidence rates of breast cancer emphasize the importance of increased knowledge about the health-related quality of life (HRQoL) in this patient group. The aim of the present study was to describe and compare HRQoL among breast cancer patients shortly after diagnosis with normative data from the general population, and to investigate how clinical, demographic, and socio-economic factors and social support are associated with HRQoL. Material and methods:Participants were identified in a population-based Breast Cancer Quality Register in central Sweden. Of 1573 women newly diagnosed with breast cancer during a one-year period (2007 – 2008), 69% (n =1086) completed a questionnaire including the EORTC QLQ-C30, BR23 and the HADS.Results: Compared to age-adjusted normative data, breast cancer patients (mean age 62 years, range 25–94), especially younger women (<50 years), experienced clinically meaningful poorer HRQoL. Clinically significant levels of anxiety and depressive symptoms were found among 14% and 6% of the patients, respectively. Factors associated with more problems/symptoms among study participants included chemotherapy, lack of social support, sick leave and a poor financial situation. Adding socio-economic factors diminished the association between age and HRQoL (p > 0.05).Conclusion:Recently diagnosed breast cancer patients reported poorer HRQoL in several dimensions compared to normative data. In addition to clinical and demographic factors, an unfavorable socio-economic standing was associated with more problems/symptoms. The present findings emphasize the importance of taking a variety of factors into account when assessing HRQoL in the clinical setting.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
- Kisch, Annika M., et al.
(author)
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A person-centred intervention remotely targeting family caregivers' support needs in the context of allogeneic hematopoietic stem cell transplantation : A feasibility study
- 2022
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In: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 30:11, s. 9039-9047
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Journal article (peer-reviewed)abstract
- PURPOSE: Allogeneic hematopoietic stem cell transplantation (HSCT) is an intensive curative treatment that increases family caregivers' burden. The aim of this study was to explore the feasibility of remotely assessing and addressing family caregivers' support needs in terms of demand and acceptability using the Carer Support Needs Assessment Tool Intervention (CSNAT-I) in the HSCT context.METHODS: CSNAT-I consists of an evidence-based tool and a five-stage person-centred process. The intervention was performed remotely by two designated nurses from two HSCT centres, one before HSCT and the second 6 weeks after (November 2020 to March 2021). To capture the experiences of using CSNAT-I, interviews were conducted with family caregivers and reflections were gathered from the designated nurses.RESULTS: Of 34 eligible family caregivers, 27 participated, 70% were partners and the rest children, siblings or other relatives. The main support needs were knowing what to expect in the future and dealing with your feelings and worries. The most frequent support actions according to CSNAT-I were psychological support and medical information. Four categories summarised family caregivers and designated nurses' experiences: CSNAT-I was relevant and became an eye opener; nurses' experiences were important for enabling trustful CSNAT-I conversations; CSNAT-I provided family caregivers with support and a sense of security; and CSNAT-I gave family caregivers insight and enabled change.CONCLUSION: Both family caregivers and designated nurses experienced that using CSNAT-I in an HSCT context was feasible and had the potential to provide valuable support for most of the participating family caregivers.
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| 39. |
- Kisch, Annika M., et al.
(author)
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Family caregivers' support needs during allo-HSCT-a longitudinal study
- 2021
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In: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 29, s. 3347-3356
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Journal article (peer-reviewed)abstract
- Purpose The study aimed to explore family caregivers' support needs prior to allo-HSCT, how these change over time and whether they are associated with demographic factors and caregiver outcome. Methods This longitudinal repeated measure study included 87 family caregivers of allo-HSCT recipients: 63% were partners, 74% women, 65% lived with the recipient, and their mean age was 54 years. They completed the 14-item Carer Support Needs Assessment Tool (CSNAT) and caregiver outcome measures (caregiver burden, anxiety, depression, preparedness for caregiving and general health) prior to allo-HSCT and 3, 6 and 16 weeks later. Results The two top support needs prior to allo-HSCT were 'knowing what to expect in the future' (79%) and 'dealing with your own feelings' (70%). Several support needs were associated with younger age and not being a partner, while higher needs implied worse caregiver outcomes for at least one of the outcomes prior to transplantation. Most support needs remained the same at the last follow-up. Conclusion The findings that high support needs are often associated with worse caregiver outcomes and most support needs do not diminish over time indicate that more attention should be placed on the situation of family caregivers.
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| 40. |
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| 41. |
- Lundh, Marie Høyer, et al.
(author)
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Changes in health-related quality of life by occupational status among women diagnosed with breast cancer--a population-based cohort study
- 2013
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In: Psycho-Oncology. - : John Wiley & Sons. - 1057-9249 .- 1099-1611. ; 22:10, s. 2321-2331
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate whether longitudinal changes in health-related quality of life (HRQoL) among breast cancer patients vary by prediagnosis occupational status or postdiagnosis changes in working time.METHODS: We identified 1573 patients in the Breast Cancer Quality Register of Central Sweden and asked them to participate in a longitudinal questionnaire study. A total of n = 841 women completed three questionnaires within a mean time of 4, 16, and 38 months postdiagnosis. Generalized estimating equation models were used to examine changes in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and the Breast Cancer-Specific Quality of Life Questionnaire subscales stratified by prediagnosis occupational status and postdiagnosis changes in working time.RESULTS: Over time, the proportion of employed women reporting good functioning increased more, and the proportion reporting a high level of symptoms decreased more compared with women on sick leave/disability pension and retirement pensioners (p < 0.001). The latter two also showed a worsening in several subscales (p < 0.05). Among employed women, more consistent improvements in role and social functioning were observed among those with an increase/no change in working time than among those who had decreased it or stopped working (p < 0.05). A decrease in the proportion reporting pain was observed among women with an increase/no change in working time compared with women with decreased working time, among whom the proportion reporting pain increased (p = 0.008).CONCLUSIONS: Being employed prediagnosis and resuming work to the same extent as prior to the breast cancer diagnosis are associated with consistent improvements in HRQoL. These results highlight the importance of interventions to improve HRQoL and policies to support return to work following diagnosis.
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| 42. |
- Lundh, Marie Høyer, et al.
(author)
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Sickness absence and disability pension following breast cancer - A population-based matched cohort study
- 2014
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In: Breast. - : Churchill Livingstone. - 0960-9776 .- 1532-3080. ; 23:6, s. 844-851
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Journal article (peer-reviewed)abstract
- Purpose: To compare sickness absence and disability pension in a population-based cohort of women with breast cancer (n = 463) from 1 year pre-diagnosis until 3 years post-diagnosis with a matched control group (n = 2310), and to investigate predictors of sickness absence during the 2nd and 3rd year post-diagnosis.Results: Following breast cancer, the proportion of disease-free women with sickness absence decreased post-diagnosis (1st-3rd year; 78%-31%-19%), but did not reach the pre-diagnostic level (14%; P < 0.05). Post-diagnosis, patients were more likely than controls to be sickness absent (1st-3rd year; P < 0.001). No between-group differences were observed for disability pension post-diagnosis (P > 0.05). Among patients, chemotherapy, baseline fatigue and pre-diagnosis sick days predicted sickness absence during the 2nd, 3rd, and 2nd and 3rd year post-diagnosis, respectively (P < 0.05).Conclusions: Breast cancer is associated with increased sickness absence 3 years post-diagnosis. In a clinical setting, prevention and treatment of side effects are important in reducing long-term consequences.
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| 43. |
- Mattsson, Jan, et al.
(author)
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Sentinel node biopsy in malignant melanoma : Swedish experiences 1997-2005
- 2008
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In: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 47:8, s. 1519-1525
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Journal article (peer-reviewed)abstract
- The sentinel node biopsy (SNB) procedure is a multidisciplinary technique, invented to gain prognostic information in different malignant tumors. The aim of the present study was to study the cohort of patients with malignant melanoma, operated with SNB, from the introduction of the technique in Sweden, concerning the prognostic information retrieved and the outcome of the procedures. In Sweden all patients with malignant melanoma are registered at regional Oncological Centers. From these databases ten centers were identified, treating malignant melanoma and performing sentinel node biopsy. Consecutive data concerning tumor characteristics, outcome of the procedure and disease related events during the follow-up time were collected from these ten centers. All cases from the very first in each centre were included. The SNB procedure was performed in 422 patients with a sentinel node (SN) detection rate of 97%, the mean Breslow thickness of the primary tumors was 3.2 mm (median 2.4 mm) and the proportion of ulcerated melanomas 38%. Metastasis in the SN was found in 19% of the patients but there was a wide range in the proportion of SN metastases between the different centers (5-52%). After a follow-up of median 12 months of 361 patients, SN negative patients had better disease-free survival than SN positive (p<0.0001). A false negative rate of 14% was found during the follow-up time. In this study the surgical technique seemed acceptable, but the non-centralized pathology work-up sub-optimal. However, SNB was still found to be a significant prognostic indicator, concerning disease free survival.
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| 44. |
- Michels, Karin B., et al.
(author)
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Coffee, tea, and caffeine consumption and breast cancer incidence in a cohort of Swedish women
- 2002
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In: Annals of Epidemiology. - 1047-2797 .- 1873-2585. ; 12:1, s. 21-6
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Journal article (peer-reviewed)abstract
- PURPOSE: Coffee, caffeinated tea, and caffeine have been suggested to play a role in breast carcinogenesis or in the promotion or inhibition of tumor growth. Prior epidemiologic evidence has not supported an overall association between consumption of caffeinated beverages and risk of breast cancer, but consumption in some studies was low. METHODS: We studied this relation in the Swedish Mammography Screening Cohort, a large population-based prospective cohort study in Sweden comprising 59,036 women aged 40-76 years. Sweden has the highest coffee consumption per capita in the world. RESULTS: During 508,267 person-years of follow-up, 1271 cases of invasive breast cancer were diagnosed. Women who reported drinking 4 or more cups of coffee per day had a covariate-adjusted hazard ratio of breast cancer of 0.94 [95% confidence interval (CI) 0.75-1.28] compared to women who reported drinking 1 cup a week or less. The corresponding hazard ratio for tea consumption was 1.13 (95% CI 0.91-1.40). Similarly, women in the highest quintile of self-reported caffeine intake had a hazard ratio of beast cancer of 1.04 (95% CI 0.87-1.24) compared to women in the lowest quintile. CONCLUSIONS: In this large cohort of Swedish women, consumption of coffee, tea, and caffeine was not associated with breast cancer incidence.
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| 45. |
- Michels, Karin B., et al.
(author)
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Dietary antioxidant vitamins, retinol, and breast cancer incidence in a cohort of Swedish women
- 2001
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In: International Journal of Cancer. - 0020-7136 .- 1097-0215. ; 91:4, s. 563-567
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Journal article (peer-reviewed)abstract
- Dietary antioxidant vitamins and retinol have been proposed to be protective against breast cancer on the basis of their ability to reduce oxidative DNA damage and their role in cell differentiation. Epidemiologic studies have not been convincing in supporting this hypothesis, but women with high exposure to free radicals and oxidative processes have not been specifically considered. We explored these issues in the Swedish Mammography Screening Cohort, a large population-based prospective cohort study in Sweden that comprised 59,036 women, 40-76 years of age, who were free of cancer at baseline and who had answered a validated 67-item food frequency questionnaire. During 508,267 person-years of follow-up, 1,271 cases of invasive breast cancer were diagnosed. Cox proportional hazards models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs). There was no overall association between intake of ascorbic acid, beta-carotene, retinol or vitamin E and breast cancer incidence. High intake of ascorbic acid was inversely related to breast cancer incidence among overweight women (HR=0.61; 95% CI 0.45-0.82, for highest quintile of intake among women with body mass index>25 kg/m(2)) and women with high consumption of linoleic acid (HR=0.72; 95% CI 0.52-1.02, for highest quintile of ascorbic acid intake and average consumption of more than 6 grams of linoleic acid per day). Among women with a body mass index of 25 or below, the hazard ratio for breast cancer incidence was 1.27 (95% CI 0.99-1.63), comparing the highest to the lowest quintile of ascorbic acid intake. Consumption of foods high in ascorbic acid may convey protection from breast cancer among women who are overweight and/or have a high intake of linoleic acid.
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| 46. |
- Rosenblad, Andreas, Fil. dr, docent, 1973-, et al.
(author)
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Differences in health-related quality of life between native and foreign-born gynaecological cancer patients in Sweden : a five-year cross-sectional study
- 2024
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In: Quality of Life Research. - : Springer Nature. - 0962-9343 .- 1573-2649. ; 33, s. 667-678
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Journal article (peer-reviewed)abstract
- Purpose: To examine differences in health-related quality of life (HRQoL) between native and foreign-born gynaecological cancer patients in Sweden, taking into account clinical, demographic, and socioeconomic factors.Methods: The 30-item European Organisation for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) and a study-specific questionnaire covering demographic and socioeconomic factors were answered by 684 women aged ≥ 18 years old, diagnosed in 2014, 2016, or 2018 with gynaecological cancer in the Stockholm-Gotland health care region, Sweden. Clinical data were obtained from the Swedish Cancer Register. Data were analysed using the Kruskal–Wallis test and linear regression.Results: The women had a mean age of 65.4 years, with 555 (81.1%) born in Sweden, 54 (7.9%) in other Nordic countries (ONC), 43 (6.3%) in other European countries (OEC), and 32 (4.7%) in non-European countries (NEC). HRQoL differed significantly between the four groups for 14 of the 15 QLQ-C30 scales/items. On average, Swedish-born women scored 2.0, 15.2, and 16.7 points higher for QoL/functioning scales/items and 2.2, 14.1, and 18.7 points lower for symptom scales/items, compared with ONC-, OEC-, and NEC-born women, respectively. In adjusted analyses, none of the differences between Swedish-born and ONC-born women were significant, while for OEC- and NEC-born women the differences were significant for most QLQ-C30 scales/items.Conclusion: HRQoL differs between native and foreign-born gynaecological cancer patients in Sweden, with lower HRQoL the further from Sweden the women are born. A more individualised cancer care, with tailored support to optimize HRQoL is needed for this vulnerable group of patients.
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| 47. |
- Terry, Paul, et al.
(author)
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Fruit, vegetables, dietary fiber, and risk of colorectal cancer
- 2001
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In: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 93:7, s. 525-533
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Several recent large prospective cohort studies have failed to demonstrate the presumed protective effect of fruit, vegetable, and dietary fiber consumption on colorectal cancer risk. To further explore this issue, we have examined these associations in a population that consumes relatively low amounts of fruit and vegetables and high amounts of cereals. METHODS: We examined data obtained from a food-frequency questionnaire used in a population-based prospective mammography screening study of women in central Sweden. Women with colorectal cancer diagnosed through December 31, 1998, were identified by linkage to regional cancer registries. Cox proportional hazards models were used to estimate relative risks. All statistical tests were two-sided. RESULTS: During an average 9.6 years of follow-up of 61 463 women, we observed 460 incident cases of colorectal cancer (291 colon cancers, 159 rectal cancers, and 10 cancers at both sites). In the entire study population, total fruit and vegetable consumption was inversely associated with colorectal cancer risk. Subanalyses showed that this association was due largely to fruit consumption. The association was stronger, however, and the dose-response effect was more evident among individuals who consumed the lowest amounts of fruit and vegetables. Individuals who consumed less than 1.5 servings of fruit and vegetables per day had a relative risk for developing colorectal cancer of 1.65 (95% confidence interval = 1.23 to 2.20; P(trend) =.001) compared with individuals who consumed more than 2.5 servings. We observed no association between colorectal cancer risk and the consumption of cereal fiber, even at amounts substantially greater than previously examined, or of non-cereal fiber. CONCLUSIONS: Individuals who consume very low amounts of fruit and vegetables have the greatest risk of colorectal cancer. Relatively high consumption of cereal fiber does not appear to lower the risk of colorectal cancer.
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| 48. |
- Ullgren, Helena, et al.
(author)
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Exploring health care professionals’ perceptions regarding shared clinical decision-making in both acute and palliative cancer care
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:23
-
Journal article (peer-reviewed)abstract
- Developments in cancer care have resulted in improved survival and quality of life. Integration of acute and palliative cancer care is desirable, but not always achieved. Fragmented care is associated with sub-optimal communication and collaboration, resulting in unnecessary care transitions. The aim of this study was to explore how health care professionals, from both acute and palliative care, perceive clinical decision-making when caring for patients undergoing active cancer treatment in parallel with specialized palliative care at home. Methods: Qualitative explorative design, using online focus-group interviews, based on patient-cases, among health care professionals (physicians and nurses) and Framework Analysis. Results: Six online focus-group interviews were performed. Few signs of systematic integration were found, risking fragmented care, and putting the patients in a vulnerable situation. Different aspects of uncertainty related to mandates and goals-of-care impacted clinical decision-making. Organizational factors appeared to hinder mutual clinical decision-making as well as the uncertainty related to responsibilities. These uncertainties seemed to be a barrier to timely end-of-life conversations and clinical decisions on optimal care, for example, the appropriateness of transfer to acute care. Conclusions: Lack of integration between acute and palliative care have negative consequences for patients (fragmented care), health care professionals (ethical stress), and the health care system (inadequate use of resources).
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| 49. |
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| 50. |
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