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1.	Abboud, Amina, et al. (author) Årsbok 2018 : Socialhögskolan, Lunds universitet 2019 Reports (other academic/artistic)abstract Socialhögskolans årsbok ger en liten inblick i vad vi gör och vi hoppas att den bidrar till att presentera utsnitt från vår verksamhet på ett trevligt och samlat sätt. Årsboken som är Socialhögskolans tredje uppmärksammar inte bara det som skett på Socialhögskolan under 2018. Den uppmärksammar även att 2018 var året då svensk äldreomsorg fyllde 100 år. Årsbokens gästredaktör Per Gunnar Edebalk inleder därför bokens forskningsavsnitt med att i år skriva om just hundraåringens historia. Det är inledningen på ett avsnitt där flera forskare vid Socialhögskolan bjuder på bidrag som lyfter fram aspekter av äldreomsorg och åldrande.Håkan Jönson och Tove Harnett resonerar om de begrepp som omgärdar äldreomsorgens möten och organisering sett i ett socialt arbetets perspektiv. De två har även skrivit en artikel om huruvida behov ska ses annorlunda mellan grupper bara för att man passerat en viss ålder.Däremellan presenteras en text av Erika Werner som låter oss möta frågor kring en sviken generation, här genom ett möte med Agnes, som hamnade mitt i skarven när pensionssystemet reformerades. Elisabeth Carlstedt presenterar en text om hur äldreomsorgens särskilda boenden arbetar i relation till Socialtjänstlagens direktiv om meningsfullhet och värdighet, och hur svårt det är. Lars Harrysson presenterar därefter ett avsnitt om två forskningsprojekt som han och Erika Werner gjort där fokus har legat dels på pensioner för personer i ekonomiskt utsatta grupper, speciellt med migrantbakgrund, dels om hur tro och äldreomsorg samspelar, eller inte. Äldreomsorgsavsnittet avslutas sedan med en intervju som Patrik Hekkala gjort med Peter Andersson som startade kursen socialt arbete med äldre och med Tove Harnett som tagit över och fortsatt utvecklingsarbetet till dags datum.Årsboken avslutas sedan med fyra texter. En av Amina Abboud, snart färdig socionom, som skriver om sina erfarenheter av och i uppsatsskrivandet. Sedan en där vi får möta Carina Olsson som arbetat hos oss länge, men som faktiskt arbetat vid universitetet i 40 år 2018. Emelie Dahlström, Joakim Grina och Jan Abrahamsson ger sedan en bakgrundsteckning till en hos Socialhögskolan verksam social accelerator, SoPact. Som avrundning finner du sedan lite mer information om vår verksamhet här vid Socialhögskolan.
2.	Andrén, Anna, 1970- (author) Freezing Temperature Flows in Railway Tunnels and its Consequence on the Rock Supporting Structure, the Rock and the Reinforcing Elements 2023 Doctoral thesis (other academic/artistic)abstract Water in the surrounding rock mass flows into the tunnel via naturally occurring joints and via cracks caused by the blasting used to excavate the tunnel. The most common method in Sweden to reduce or prevent leakage problems are first and foremost the use of grouting. However, experience shows that despite extensive pre-grouting and supplementary post-grouting, it is difficult to seal the rock mass so that drips and moisture are completely eliminated. Although the water itself causes degradation of the tunnel, the degradation process increases dramatically when the water is exposed to freezing temperatures. Water expands during freezing and due to water migration, which occurs in rock in a similar way as in soil, the ice causes frost shattering of the interface between rock and shotcrete and also to the shotcrete and the rock itself. This can damage the main load-bearing system. The ice formation itself is a maintenance problem, as the tunnels must be kept clear of icicles, ice pillars and ice layers in the tracks or on the roads. One of the main tasks in this research project has been to identify which problems cause the most maintenance work and where and when these problems occur in the tunnel.During the field observations carried out as part of this doctoral study, many problems with water and ice were discovered, all of which contribute to increased maintenance. Many ice problems are directly linked to frost insulated drain mats. Leakage and ice formations occur at the edge of the drains, in mat splices and when brackets for cable racks, handrails or other installations puncture a drain and it has not been properly sealed. In drains covered with shotcrete, frost shattering and cracking in the shotcrete can be a problem. Frost cycles in the tunnel cause the water to freeze and thaw alternately, allowing more water to reach the freezing area due to water migration, resulting in frost shattering of the rock and the shotcrete. If not anchored with bolts, the reinforcing effect and the stability of shotcrete in a tunnel is dependent on the adhesion to the rock surface. It is, therefore, important to take all available measures to ensure good adhesion. Poor adhesion in itself is not a degradation problem, but a void can form in the interface between rock and shotcrete as a result of poor adhesion. If this void is filled with water that cannot drain away, ice pressure can occur in the layer between rock and shotcrete. The ice pressure can cause cracking and degradation of the shotcrete if the pressure exceeds the tensile strength of the adjacent material. In some of the reported fall-outs of rock and shotcrete, an ice layer was discovered between the rock surface and the edges of the remaining shotcrete layer. Therefore, frost shattering is a likely cause of the fall-outs. Many frost cycles combined with water leakage can cause frost shattering. The field measurements conducted as a part of the doctoral study have shown that most frost cycles do not occur closest to the tunnel entrances, but instead about 100 to 200 m into the longer tunnels. The results from the laboratory tests performed as part of the doctoral study showed that the adhesive strength between rock and shotcrete decreased significantly when the test panels were subjected to freeze-thaw cycles. Furthermore, more of the micro seismic events (AE - acoustic emission monitoring) occurred in the test panels that had access to water during freezing. Therefor, maintenance personnel and inspectors should pay particular attention to water leakage in sections that have an increased number of frost cycles, to avoid future problems with frost shattering of rock or shotcrete. In the longer tunnels studied in this work, a greater number of ice formations occurred in the inner parts of the tunnel, than close to the entrances. The rock mass emits heat, which heats up the cold outside air that enters the tunnel. Due to the heat transfer from the rock mass, leakage points located further along the tunnels can remain unfrozen. A leak that is closer to the tunnel entrances in the longer tunnels or a leak in a shorter tunnel are exposed to higher freezing rates. The entire rock mass freezes and the leak ‘freezes dry’, that is, ice forms in the water-bearing fracture, preventing further water leakage.Where and when ice problems occur along a tunnel depends on many factors. Besides the obvious water leakage, the length of frost penetration into the tunnel is the main reason for where and when ice problems occur. The predominant cause of frost penetration in most of the tunnels is the thermally induced airflow. In the longer tunnels, the inclination of the tunnel affects frost penetration the most. The field observations showed that there was a difference in where and when leakage points appear during the year and also in terms of variation in the amount of leakage water. There was also a variation over different years. The conclusions of the field observations are that it is difficult to estimate where the insulated drain mats should be located along a tunnel. Based on experience from this survey, the location of the drains should be determined only after several inspections and especially after a winter period, when the main problems with ice formation occur. Previous perception regarding ice problems have been that ice formation only occurs at the tunnel entrances and in the outer parts of the tunnel. A proposed measure has, therefore, been to cover the first 300 m from each entrance with frost insulated drains to try to completely eliminate the ice problems. However, this is not an effective solution to the problem. The insulation not only prevents the cold from reaching the leakage point, but it also prevents the rock mass from emitting heat that warms up the cold outside air entering the tunnel. Thus, the frost can penetrate further into the tunnel and the problems with ice formation are only moved further into the tunnel. As the amount and location of the frost insulation affects frost penetration, the dimensioning of insulation must, therefore, be carried out in several iterations, where each new distribution of insulation along the tunnel is calculated separately.For the tunnels that have been studied as part of this doctoral study, the following has emerged. The central and southern parts of Sweden have shorter cooling periods and the tunnels are exposed to many temperature fluctuations around 0°C during the winter. The frost does not have time to penetrate as far here as in the tunnels in the northern parts of Sweden. Therefore, more ice problems arise around the entrances of the tunnels in the southern parts of Sweden than for those in the northern parts. For northern parts of Sweden, the problem of growing ice formations in sections near the tunnel entrance usually occurs only during the autumn and spring, but not in winter. The field observations showed that the problems with ice growth and temperature fluctuations around 0°C occur further along the longer tunnels in the northern parts of Sweden. This is because the temperature of the tunnel air is higher due to heat transfer from the rock mass. For shorter tunnels that adopt the same temperatures as the outside air, ice formations can occur along the entire length of the tunnel in the sections that have leakage problems. The Swedish Transport Administration’s regulations are currently being updated and the observations and measurements carried out in this doctoral work are now being used to evaluate new requirements regarding frost penetration in tunnels.
3.	Brunström, Mattias, et al. (author) Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease 2022 In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 31:1, s. 31-39 Journal article (peer-reviewed)abstract Purpose Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. Materials and Methods Individuals >= 18 years with a blood pressure (BP) recording in Vasterbotten or Sodermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Vasterbotten County (intervention) compared with Sodermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. Results A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. Conclusions This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.
4.	Brunström, Mattias, et al. (author) Association of physician education and feedback on hypertension management with patient blood pressure and hypertension control 2020 In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 3:1 Journal article (peer-reviewed)abstract Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.
5.	Brunström, Mattias, et al. (author) From efficacy in trials to effectiveness in clinical practice : The Swedish Stroke Prevention Study 2016 In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 25:4, s. 206-211 Journal article (peer-reviewed)abstract Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Vasterbotten, using Sodermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.
6.	Makubi, Abel, et al. (author) Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF) 2016 In: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 220, s. 750-758 Journal article (peer-reviewed)abstract Background: Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. Methods: A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1: 3 by gender and age +/- 5 years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. Results: In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [inter-quartile range] 55 [40-68] vs. 77 [64-84] years, p amp;lt; 0.001) and more commonly women (51% vs. 40%, p amp;lt; 0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p amp;lt; 0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p amp;lt; 0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p = 0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. Conclusions: Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
7.	Mossmark, Fredrik, 1975, et al. (author) Aggressive groundwater chemistry caused by underground constructions 2008 In: Proceedings of the 33rd International Geological Congress, Oslo, Norway, August 2008. Conference paper (peer-reviewed)abstract When considering the degradation process and lifetime of the support system and equipment in underground facilities, the selection of materials is (normally) based on established criteria for the chemical composition of the groundwater. This is important for decisions regarding the steel quality and protection of reinforcement bolts, as well as the material used for the waterproofing system and lining. The criteria are imposed through groundwater sampling and analysis of groundwater prior to the construction of an underground facility. However, studies of the impact on groundwater chemistry from the construction of underground structures and experiments with groundwater extraction indicate that the groundwater chemistry is likely to change over time. Underground facilities are known to cause hydrological changes, especially during the construction phase. However, extensive monitoring programmes of groundwater chemistry are unusual. To further investigate possible changes of water chemistry due to hydrological changes, an experiment with groundwater extraction has been carried out. The experiment was conducted through the constant extraction of groundwater for a period of five years (between the years 2000 and 2005) from within a small watershed (28000 m2) at Lake Gårdsjön, located 50 km north of Gothenburg in Sweden. The area was also monitored during a few years before the extraction started and during the recovery phase. The area of the experiment is characterized by Precambrian crystalline bedrock covered by a thin overburden of glacial till and organic soils. The extraction caused the runoff from the watershed to decrease by nearly 50 % and the groundwater level to fluctuate more than at a nearby reference area. The hydrological impact of the experiment, with increased groundwater recharge, lead to changes and increased seasonal variations in the chemical composition of the groundwater in the bedrock. The hydrochemical variations were caused by seasonal variations in both the amount of water available for groundwater recharge and the chemical composition of the recharging water. Compared to the reference area, the seasonal variations were observed to increase for all the parameters included in the criteria used by the Swedish authorities for selection of construction materials (pH, hardness (Ca), alkalinity, salinity (EC)). An established method to assess the impact of the water composition on the corrosion of steel materials is the use of Langeliers index. The experiment with groundwater extraction caused a larger fluctuation of Langeliers index in the test area compared to the reference area. The results from the experiment confirm the observations from previous tunnelling projects, and show that the methods commonly used to assess the expected future aggressivity of the groundwater in the planning for underground facilities should be reviewed.
8.	Agvall, Björn, 1963-, et al. (author) Cost of heart failure in Swedish primary healthcare 2005 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23, s. 227-232 Journal article (peer-reviewed)abstract Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647
9.	Agvall, Björn, 1963- (author) Heart failure in primary care with special emphasis on costs and benefits of a disease management programme 2014 Doctoral thesis (other academic/artistic)abstract Background and aim. Heart failure (HF) is a common condition associated with poor quality of life (QoL), high morbidity and mortality and is frequently occurring in primary health care (PHC). It involves a substantial economic burden on the health care expenditure. There are modern pharmacological treatments with evident impact on QoL, morbidity, mortality, and proved to be cost-effective. Despite this knowledge, the treatment of HF is considered somewhat insufficient. There are several HF management programmes (HFMP) showing beneficial effects but these studies is predominantly based in hospital care (HC).The first aim of this thesis was to describe patients with HF in the PHC regarding gender differences, diagnosis, treatment and health related costs (I, II).The second aim was to evaluate whether HFMP have beneficial effects in the PHC regarding cardiac function, quality of life, health care utilization and health care-related costs (III,IV).Methods. The initial study involved retrospective collection of data from 256 patients with symptomatic HF in PHC (I). The data collected were gender, age, diagnostics and ongoing treatment. The second study was an economic calculation performed on 115 patients (II). The economic data was retrospectively retrieved as the number of hospital days, visits to nurses and physicians in HC and PHC, prescribed cardiovascular drugs and performed investigation during retrospectively for one year. The third and fourth study was based on a randomized, prospective, open-label study which was subsequently performed (III,IV). The study enrolled 160 patients with systolic HF who were randomized to either an intervention or a control group. The patients in the intervention group retrieved follow-up of HF qualified nurses and physicians in the PHC, involving education about HF and furthermore, optimizing the treatment according to guidelines if possible. The patients in the control group had a followup performed by their regular general practitioner (GP) receiving customary management according to local routines but there was no contact with HF nurses. The primary endpoint of the study was a composite endpoint consisting of changes in survival, hospitalization, heart function and quality of life (QoL) and to compare differences in resource utilization and costs (III,IV).Results. In the first study, the prevalence was 2% and the average age was 78 years (I). The most frequent cause of HF was IHD followed o hypertension. The diagnosis in the study population was based on clinical criteria and only 31% had been subjected to echocardiography. The most common treatment was diuretics (84%) and angiotensin converting enzyme inhibitors (ACEI) were used in 56% of patients. In the following prospective study, the intervention group had significant improvements in composite endpoints. There were in the intervention group more patients with reduced levels of NTproBNP (p=0.012) and improved cardiac function (p=0.03). No significant changes were found in New York Heart Association (NYHA) functional class or QoL. The intervention involved less health care contacts (p=0.04), less emergency ward visits (p=0.002) and hospitalizations (p=0.03). The total cost for HC and PHC was EUR 4471 in the intervention group and EUR 6638 in the control group which implies a cost reduction of EUR 2167 (33%).Conclusions. HF is common in PHC with a prevalence of 2% the study population had an average age of 78 years. Only 31 % of the HF patients have performed an echocardiographic investigation. Treatment with ACEI occurred in 56 %. Differences were found between genders since women had performed significantly fewer echocardiographic investigations and, had less treatment with ACEI. When implementing HFMP in PHC, beneficial effects were found regarding cardiac function and health care-related costs in patients with systolic HF. These findings indicate that HFMP might be used even in PHC.
10.	Ahlsén, Bertil, et al. (author) Ombyggnad Torslanda 1990 Reports (other academic/artistic)abstract Consumer report for the company in question (the Volvo Automobile Company and the Volvo Torslanda plant) which is financed by the company and partly also by a research foundation. It is a matter of a work that in this particular case were carried out during nine years in a number of experimental workshops located outside the Chalmers University of Technology. These workshops were financed by the Volvo Automobile and Truck companies. This achievement, as the final contribution to the Swedish automotive industry after having already treated this research field/problem area for more than two decades before this particular period if time (involving several junior and senior research competencies, as well as industrial and governmental foundings).
11.	Ahmad, Tariq, et al. (author) Machine Learning Methods Improve Prognostication, Identify Clinically Distinct Phenotypes, and Detect Heterogeneity in Response to Therapy in a Large Cohort of Heart Failure Patients 2018 In: Journal of the American Heart Association. - : WILEY. - 2047-9980. ; 7:8 Journal article (peer-reviewed)abstract Background-Whereas heart failure (HF) is a complex clinical syndrome, conventional approaches to its management have treated it as a singular disease, leading to inadequate patient care and inefficient clinical trials. We hypothesized that applying advanced analytics to a large cohort of HF patients would improve prognostication of outcomes, identify distinct patient phenotypes, and detect heterogeneity in treatment response. Methods and Results-The Swedish Heart Failure Registry is a nationwide registry collecting detailed demographic, clinical, laboratory, and medication data and linked to databases with outcome information. We applied random forest modeling to identify predictors of 1-year survival. Cluster analysis was performed and validated using serial bootstrapping. Association between clusters and survival was assessed with Cox proportional hazards modeling and interaction testing was performed to assess for heterogeneity in response to HF pharmacotherapy across propensity-matched clusters. Our study included 44 886 HF patients enrolled in the Swedish Heart Failure Registry between 2000 and 2012. Random forest modeling demonstrated excellent calibration and discrimination for survival (C-statistic=0.83) whereas left ventricular ejection fraction did not (C-statistic=0.52): there were no meaningful differences per strata of left ventricular ejection fraction (1-year survival: 80%, 81%, 83%, and 84%). Cluster analysis using the 8 highest predictive variables identified 4 clinically relevant subgroups of HF with marked differences in 1-year survival. There were significant interactions between propensity-matched clusters (across age, sex, and left ventricular ejection fraction and the following medications: diuretics, angiotensin-converting enzyme inhibitors, )i-blockers, and nitrates, Pamp;lt;0.001, all). Conclusions-Machine learning algorithms accurately predicted outcomes in a large data set of HF patients. Cluster analysis identified 4 distinct phenotypes that differed significantly in outcomes and in response to therapeutics. Use of these novel analytic approaches has the potential to enhance effectiveness of current therapies and transform future HF clinical trials.
12.	Ahmadzadeh, Azadeh, et al. (author) Första året i BITA (Barn i Tandvården) - Svarsfrekvens och bortfallsanalys 2009 In: Odontologisk Riksstämma, 2009-11-13, Stockholm. Conference paper (other academic/artistic)
13.	Alehagen, Urban, et al. (author) Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of greater than= 50% 2015 In: Circulation Heart Failure. - : LIPPINCOTT WILLIAMS and WILKINS. - 1941-3289 .- 1941-3297. ; 8:5, s. 862-870 Journal article (peer-reviewed)abstract Background The pathophysiology of heart failure with preserved ejection fraction is poorly understood, but may involve a systemic proinflammatory state. Therefore, statins might improve outcomes in patients with heart failure with preserved ejection fraction defined as 50%. Methods and Results Of 46 959 unique patients in the prospective Swedish Heart Failure Registry, 9140 patients had heart failure and ejection fraction 50% (age 7711 years, 54.0% women), and of these, 3427 (37.5%) were treated with statins. Propensity scores for statin treatment were derived from 40 baseline variables. The association between statin use and primary (all-cause mortality) and secondary (separately, cardiovascular mortality, and combined all-cause mortality or cardiovascular hospitalization) end points was assessed with Cox regressions in a population matched 1:1 based on age and propensity score. In the matched population, 1-year survival was 85.1% for statin-treated versus 80.9% for untreated patients (hazard ratio, 0.80; 95% confidence interval, 0.72-0.89; Pless than0.001). Statins were also associated with reduced cardiovascular death (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P=0.026) and composite all-cause mortality or cardiovascular hospitalization (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96; P=0.003). Conclusions In heart failure with ejection fraction 50%, the use of statins was associated with improved outcomes. The mechanisms should be evaluated and the effects tested in a randomized trial.
14.	Alehagen, Urban, et al. (author) Association Between Use of Statins and Outcomes in Heart Failure With Reduced Ejection Fraction Prospective Propensity Score Matched Cohort Study of 21 864 Patients in the Swedish Heart Failure Registry 2015 In: Circulation Heart Failure. - : American Heart Association. - 1941-3289 .- 1941-3297. ; 8:2, s. 252-260 Journal article (peer-reviewed)abstract Background-In heart failure (HF) with reduced ejection fraction, randomized trials of statins did not demonstrate improved outcomes. However, randomized trials may not always be generalizable. The aim was to determine whether statins are associated with improved outcomes in an unselected nationwide population of patients with HF with reduced ejection fraction overall and in relation to ischemic heart disease (IHD). Methods and Results-In the Swedish Heart Failure Registry, 21 864 patients with HF with reduced ejection fraction (age +/- SD, 72+/-12 years; 29% women), of whom 10 345 (47%) were treated with statins, were studied. Propensity scores for statin use were derived from 42 baseline variables. The associations between statin use and outcomes were assessed with Cox regressions in a population matched 1: 1 based on propensity score and age and in the overall population with adjustment for propensity score and age. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular mortality; HF hospitalization; and combined all-cause mortality or cardiovascular hospitalization. Survival at 1 year in the matched population was 83% for statin-treated versus 79% for untreated patients (hazard ratio, 0.81; 95% confidence interval, 0.76-0.86; Pless than0.001). In the unmatched population, 1-year survival was 85% for statin-treated versus 79% for untreated patients, hazard ratio after adjustment for propensity score and age was 0.84 (95% confidence interval, 0.80-0.89; Pless than0.001). No examined baseline variables interacted with statin use except for IHD (P=0.001), with a hazard ratio of 0.76 (95% confidence interval, 0.70-0.82, Pless than0.001) with IHD and 0.95 (95% confidence interval, 0.85-1.07; P=0.430 without IHD. Statin use was also associated with reduced risk for all 3 secondary outcomes. Conclusions-In an unselected nationwide population of patients with HF with reduced ejection fraction, statins were associated with improved outcomes, specifically in the presence of IHD. This contrasts with previous randomized controlled trials. Additional randomized controlled trials with more generalized inclusion or focused on IHD may be warranted.
15.	Alehagen, Urban, et al. (author) Results from a 6-year follow-up of a Swedish population in primary care regarding b-type natriuretic peptide (bnp) and the aminoterminal fragment of proBNP (n-terminal proBNP) and risk for cardiovascular death in elderly patients with possible heart failure. Other publication (other academic/artistic)abstract AbstractHeart failure is common in the elderly population and carries a serious prognosis. Identification of risk factors for cardiovascular mortality among primary care patients is important.AimTo evaluate EDTA-plasma brain natriuretic peptide (BNP) and the aminoterminal fragment of proBNP (N-terminal proBNP) as prognostic markers in elderly with symptoms of mild to moderate heart failure.MethodsFrom 474 patients attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema blood was sampled in plastic tubes containing EDTA in order to measure BNP by non-extraction immunoradiometric assay and of N-terminal proBNP by non-extraction radioimmunoassay. Patients were evaluated with respect to history and clinical- and laboratory examinations with particular reference to cardiac structure and function. Follow-up time was 6 years. A Cox regression analysis was performed to identify the weight of risk variables.ConclusionDuring the follow-up period of 6 years the total mortality was 16 % (75 patients out of 474), and cardiovascular mortality was 11% (52 patients). Cardiovascular mortality increased with increased plasma concentration of BNP or N-terminal proBNP. Both pep tides were useful prognostic markers for cardiovascular mortality in patients with heart failure. In those with the highest quartile of plasma concentration of BNP and N=terminal proBNP, 9.9 times and 5.0 times increased risk for CV death were identified respectively.
16.	Alehagen, Urban, 1951-, et al. (author) Risk of cardiovascular death in elderly patients with possible heart failure. B-type natriuretic peptide (BNP) and the aminoterminal fragment of ProBNP (N-terminal proBNP) as prognostic indicators in a 6-year follow-up of a primary care population 2005 In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 100:1, s. 125-133 Journal article (peer-reviewed)
17.	Alehagen, Urban, 1951-, et al. (author) The risk of cardiovascular death in elderly patients with possible heart failure. Results from a 6-year follow-up of a Swedish primary care population 2005 In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 100:1, s. 17-27 Journal article (peer-reviewed)
18.	Andin, Josefine (author) Dealing with Digits : Arithmetic, Memory and Phonology in Deaf Signers 2014 Doctoral thesis (other academic/artistic)abstract Deafness has been associated with poor abilities to deal with digits in the context of arithmetic and memory, and language modality-specific differences in the phonological similarity of digits have been shown to influence short-term memory (STM). Therefore, the overall aim of the present thesis was to find out whether language modality-specific differences in phonological processing between sign and speech can explain why deaf signers perform at lower levels than hearing peers when dealing with digits. To explore this aim, the role of phonological processing in digit-based arithmetic and memory tasks was investigated, using both behavioural and neuroimaging methods, in adult deaf signers and hearing non-signers, carefully matched on age, sex, education and non-verbal intelligence. To make task demands as equal as possible for both groups, and to control for material effects, arithmetic, phonological processing, STM and working memory (WM) were all assessed using the same presentation and response mode for both groups. The results suggested that in digit-based STM, phonological similarity of manual numerals causes deaf signers to perform more poorly than hearing non-signers. However, for digit-based WM there was no difference between the groups, possibly due to differences in allocation of resources during WM. This indicates that similar WM for the two groups can be generalized from lexical items to digits. Further, we found that in the present work deaf signers performed better than expected and on a par with hearing peers on all arithmetic tasks, except for multiplication, possibly because the groups studied here were very carefully matched. However, the neural networks recruited for arithmetic and phonology differed between groups. During multiplication tasks, deaf signers showed an increased reliance on cortex of the right parietal lobe complemented by the left inferior frontal gyrus. In contrast, hearing non-signers relied on cortex of the left frontal and parietal lobes during multiplication. This suggests that while hearing non-signers recruit phonology-dependent arithmetic fact retrieval processes for multiplication, deaf signers recruit non-verbal magnitude manipulation processes. For phonology, the hearing non-signers engaged left lateralized frontal and parietal areas within the classical perisylvian language network. In deaf signers, however, phonological processing was limited to cortex of the left occipital lobe, suggesting that sign-based phonological processing does not necessarily activate the classical language network. In conclusion, the findings of the present thesis suggest that language modality-specific differences between sign and speech in different ways can explain why deaf signers perform at lower levels than hearing non-signers on tasks that include dealing with digits.
19.	Andrén, Anna, et al. (author) Degradation of the Reinforcing Effect of Shotcrete : Freeze-Thaw Tests on Shotcrete-Rock Panels 2020 In: The Electronic journal of geotechnical engineering. - : Mete Öner. - 1089-3032 .- 1089-3032. ; 25:1, s. 1-30 Journal article (peer-reviewed)abstract In rock tunnels in regions with colder climates, the load-bearing structure, including the rock and the reinforcing elements, is exposed to repeated destructive freezing and thawing cycles during the winter. If water accumulates in cracks or in the interface between rock and shotcrete, frost shattering may occur. If there is adequate adhesion between the rock and shotcrete, degradation of the shotcrete as a reinforcement element due to frost shattering should not present a problem. However, if adhesion is poor, a small void will form between the rock and the shotcrete where water can accumulate. If the water in these voids is subjected to freeze-thaw cycles, ice will develop, thus exerting pressure on the interface and causing the shotcrete to crack and degrade. In tunnel sections with complex water conditions, for example, relatively water-bearing open joints and weak zones, the adhesion of the shotcrete and its stability and reinforcing effect may be strongly affected when exposed to freezing temperatures. This article describes a laboratory study that comprised freeze-thaw tests on shotcreterock panels with the objective of studying how water migration affects the growth of ice and the ice pressure in the shotcrete-rock interface to better understand the degradation of the reinforcing effect of shotcrete
20.	Andrén, Anna, et al. (author) Evaluation of a laboratory model test using field measurements of frost penetration in railway tunnels 2022 In: Cold Regions Science and Technology. - : Elsevier. - 0165-232X .- 1872-7441. ; 204 Journal article (peer-reviewed)abstract Despite extensive grouting efforts to prevent water from leaking into tunnels, water seepages remain. When exposed to freezing temperatures, ice formations occur. During the winter, the Swedish Transport Administration's railway tunnels are affected by major problems caused by ice, such as icicles from roof and walls, ice loads on installations, ice-covered tracks and roads, etc. To ensure safety and prevent traffic disruptions, many tunnels require extensive maintenance. Improved knowledge about frost penetration in tunnels is required to reduce maintenance of the tunnels. Frost insulated drain mats are often used at leakage spots to prevent ice formation along the tunnels. To find out which parts of a tunnel are exposed to freezing temperatures, the University of Gävle and the Royal Institute of Technology in Stockholm conducted a laboratory model test on behalf of the Swedish National Rail Administration (now the Swedish Transport Administration). The laboratory model test aimed to find a method to determine the expected temperature conditions along a tunnel to decide which parts of the tunnel require frost insulation to protect the drainage system from freezing and prevent ice formation. To evaluate the laboratory model test, the Swedish Transport Administration in collaboration with Luleå University of Technology have performed field surveys in two Swedish railway tunnels. The field measurements involved monitoring temperatures in air, rock surfaces and rock mass, as well as measuring wind direction, wind and air velocity and air pressure. The measurements in the tunnels show that the frost penetrates further into the tunnels than was expected from the laboratory model test, which was based on a completely uninsulated tunnel. Frost insulated drains do not only prevent the cold air from reaching the rock mass, but also prevent the rock from emitting geothermal heat that warms up the cold tunnel air. Consequently, the frost penetrates further into the tunnel than it would do if the heat from the rock mass was allowed to warm up the outside air on its way into the tunnel. The number of frost insulated drains and how much of the tunnel walls and roof are covered thereby affect the length of the frost penetration.
21.	Andrén, Anna, et al. (author) Field Observations of Water and Ice Problems in Railway Tunnels from a Maintenance Perspective 2023 In: Journal of Earth Sciences and Geotechnical Engineering. - : Scientific Press International Limited. - 1792-9040 .- 1792-9660. ; 13:1, s. 11-54 Journal article (peer-reviewed)abstract During the winter season, ice causes major problems in many Swedish railway tunnels. Ice, rock and shotcrete in the roof and on the walls may come loose and fall down, installations and cables can break due to ice loads and the tracks can become covered with ice. To maintain safety and prevent traffic disturbances, many tunnels require frequent maintenance. The removal of ice, loose rock and shotcrete is expensive and potentially risky work for the maintenance workers. To reduce maintenance costs, it is important to improve our knowledge of frost penetration inside tunnels and investigate the effect of ice pressure and frost shattering on loadbearing constructions. The aim of this investigation was to gather information about the problems caused by water leakage and its effect on the degradation of a rock tunnel when subjected to freezing temperatures. There are many factors that determine whether frost or ice formations will appear in tunnels. To collect information on ice formation problems, field observations were undertaken in five of Sweden’s railway tunnels between autumn 2004 and summer 2005. For one of the tunnels, follow-up observations also took place in March during the years 2005, 2006 and 2007.
22.	Andrén, A., et al. (author) Frost shattering and ice problems in rock tunnels from a maintenance perspective 2012 In: ISRM International Symposium - EUROCK 2012. Conference paper (peer-reviewed)abstract Every winter a number of railway tunnels in Sweden are affected by problems with ice. When ice is allowed to form in the rock fracture network and interface between the rock and shotcrete, degradation of both materials occur which can cause fall-outs of rock debris and shotcrete. To reduce maintenance costs it is necessary to improve knowledge of frost penetration along tunnels and the effect of frost shattering on the load bearing structures. Temperature measurements in Swedish railway tunnels have shown that frost penetrates much deeper into tunnels than previously assumed. By field observations it has been confirmed that ice problems often occur throughout the entire tunnel, even for longer tunnels (>1.5 km). If the load bearing structures are subjected to alternating freezing and thawing the shotcrete can be exposed to frost shattering. In a similar manner as frost action in soil, water tends to migrate in rock and cause ice bodies to grow inside pores and cracks. Laboratory tests show that when a rock/shotcrete sample has access to water during the freezing process, degradation occurs that affects adhesion between the materials. Therefore the load bearing structures exposed to water leakage should be designed for freezing temperatures along the entire length of the tunnel.
23.	Andrén, Anna, et al. (author) Temperature Flows in Railway Tunnels : Field Measurements of Frost Penetration 2020 In: Journal of Earth Sciences and Geotechnical Engineering. - : Scientific Press International Limited. - 1792-9040 .- 1792-9660. ; 10:5, s. 161-194 Journal article (peer-reviewed)abstract Even though extensive pre-grouting is carried out during the construction of tunnels, certain leakages and drips remain. These remaining leakages are remedied by a combination of post-injection and drainage measures with, for example, frost insulated drain mats, whose function is to prevent the cold tunnel air from reaching a leakage spot and causing water to freeze. Despite these measures, some water may still enter the tunnels and cause problems during winter with ice formations and frost shattering. Icicles, ice pillars and ice-covered roads and railway tracks require constant maintenance. If ice occurs in the fracture network close to the tunnel contour or in the interface between the rock and shotcrete, it can cause degradation of the load-bearing capacity of the tunnel and fall-outs of both materials. In tunnel sections with water leakage problems it is common to protect the load-bearing structure from freezing with insulated drainage systems. To determine where along the tunnel efforts must be made to prevent ice formation, the temperature conditions of tunnels must be investigated. This article presents parts of the results from field measurements in two Swedish railway tunnels. The measurements involves monitoring of air and rock temperatures, air pressure and air velocity.
24.	Andrén, Anna, et al. (author) Temperaturflöden i järnvägstunnlar – Glödberget 2011 Reports (other academic/artistic)abstract During the winter ice is causing major problems in several of the Swedish Transport administrations railway tunnels. Freezing water is forming icicles and pillars that can fall down at track, and grow so large that they intrude on the clearance gauge. Lighting equipment and cables can be broken because of the ice load and tracks can become cowered with ice Periodic freezing can cause frost shattering and this process can cause fall-outs of rock and shotcrete. In order to maintain safety and prevent traffic disruption, many tunnels requiring extensive maintenance. In order to reduce maintenance of the tunnels, improved knowledge about frost penetration and the effects of ice pressure on the load-bearing capacity of the tunnel is required. 2002 the University of Gävle and KTH performed a model study to determine the temperature conditions in tunnels. To verify the model study field measurements are carried out in collaboration between the Transport Administration and Luleå University of Technology. This technical report describes the tests conducted so far in the Glödberget tunnel at Nyåker, 80 km south-west of Umeå. Measurements show that the developed models underestimate the frost penetration. Although the tunnel is 1680 meters long, the frost penetrates the entire length of the tunnel even if the temperature outside the tunnel is just a few degrees below zero. A contributing factor to why the field measurements and model do not conform can be that the model study is based on a completely uninsulated tunnel. In the Glödberget tunnel a large part of the walls and roof are covered the frost insulated drains. The function of the frost insulated drains is to prevent the cold tunnel air from reaching a leakage point and causing water to turn into ice. However, the insulation does not only prevent the cold air from reaching the rock, but also prevents the heat from the rock mass from entering the tunnel and warming up the cold tunnel air. Consequently, the frost penetrates further into the tunnel than it would do if the heat from the rock mass were allowed to warm up the outside air on its way into the tunnel. The amount of frost insulated drains and how much of the tunnel walls and roof that are covered are thereby affecting the length of the frost penetration. Temperature measurements has been carried out down into the ballast bed. To eliminate the risks with freezing drainage water, the drainage pipes are located at a depth of 2 m under the level of the rails. Measurements show that the temperature does not penetrate as far down as earlier feared and the depth of the pipes in the middle parts of the tunnel could be made shallower, with respect to risk of frost. Temperature measurements behind a frost insulated drain in the middle of the track tunnel, has shown that drains are able to smooth out the temperature changes that occur in the tunnel air. But when the temperature is negative for a longer period, the temperature behind the drain drops below 0ºC. Then the drainage ability is reduced due to icing and it can cause frost damage to the drain. Measurements of air temperature in the adjacent service tunnel shows how frost penetration is affected by air movement. The service tunnel is closed with gates at both ends. When the air in a tunnel is not exposed to movement, it is heated by geothermal heat and adopt the same temperature as the rock. Rock temperatures usually coincide with the average annual temperature applicable to the area where the tunnel is located. For the Glödberget tunnel there is a very good agreement between the average annual temperature for the area and the measurements performed in the service tunnel.
25.	Andrén, Anna, et al. (author) Temperaturflöden i järnvägstunnlar och konsekvenser för drift och underhåll 2008 In: Bergmekanikdag. - : Stiftelsen bergteknisk forskning - Befo. Conference paper (other academic/artistic)
26.	Arnesson, Annika, et al. (author) Forskningsverksamhet och försöksstallar inom nöt- och lammköttsproduktion i Wales, Irland, Skottland och Danmark : erfarenhetsutbyte - 2009 2010 Reports (other academic/artistic)abstract SLU:s forskningsstation för nöt- och lammköttsproduktion är belägen på Götala gård utanför Skara. Här bedrivs utfodringsförsök till nöt och lamm baserat på vall och bete kompletterat med huvudsakligen inhemska kraftfodermedel, där syftet är att ta fram nöt- och lammkött av hög kvalitet. Djurens välfärd och lantbrukarens ekonomi står i centrum för vår forskning. Under 2010 kommer projektering utföras för nya försöksstallar för nöt och får. För att utbyta erfarenheter med forskare inom nöt- och lammproduktion och få idéer till smarta byggnadslösningar och utfodringsanläggningar i försöksstallar besökte vi under 2009 IBERS, Aberystwyth i Wales, Teagasc Grange Beef Research Centre på Irland och SAC Animal Breeding & Development Team i Skottland. I Danmark besökte vi Tjele gods, Forskningscenter Foulum och Kvaegbrugets Forsogscentrum (KFC). Forskningen i Wales, Irland och Skottland hade blivit mer inriktad mot mera tvärvetenskaplig forskning med klimat och miljö som viktiga faktorer. De nybyggda stallarna på IBERS och SAC var stora ljusa, luftiga fribärande hallar, där större delen av väggarna bestod av vindvävsgardiner. Man hade satsat på breda foderbord, flexibla boxstorlekar och fantastiska hanteringsanläggningar för sortering, vägning och behandling av djur. Det var imponerande att se deras foderhantering med många silor i olika storlekar och allt under tak. Fullfoder var vanligt och medförde en rationell utfodring. De datastyrda utfodringskrubborna, av både den holländska och brittiska modellen, krävde både tillsyn och skötsel för att fungera. Det blir också en stor mängd data att hantera vid användning av dem. På Tjele gods i Danmark hade man satsat på en enkel byggnad, med djurhantering i fokus. Mycket av arbetet gjordes maskinellt för att spara arbetskraft. Foderanläggningen på Foulum gav möjlighet till stor flexibilitet när det gäller att hantera många fodermedel och olika foderblandningar. Fodret utfodrades i de olika stallarna med hjälp av förarlösa robottruckar. Försöksstallet för mjölkkor var isolerat och inrett med liggbås och skrapade fodergångar. Här gavs möjlighet att genomföra försök med många behandlingar under exakt samma stallbetingelser. Stallet var utrustat med individuell utfodring av grovfoder. Kraftfoder fanns i automater där de kunde ha fyra olika foder samtidigt. Den dammsugare som användes för att tömma foderkrubborna ansågs helt nödvändig för en rationell foderhantering. All data från försöksstallarna registrerades automatiskt och samlades in till en gemensam databank, varifrån forskarna kunde hämta information. All datafiltrering sysselsatte fem datatekniker. Det som forskarna på Foulum skickade med oss som råd inför vår projektering, var att tänka på att ta till ordenligt när det gäller utrymmen, så att foder- och djurhantering blir rationell. KFC var en mycket välskött försöksgård som ägdes av näringen. Eftersom de höll på att slutföra en om- och tillbyggnation av ladugården var det extra intressant för oss att se och höra hur de tänkt vid projekteringen. De hade t.ex. gått ifrån gummimattor i mjölkkostallets fodergångar och satsat på betongspalt och gödselrobot, för att få torrare miljö och därmed bättre klövhälsa. Efter att ha prövat många olika sorter liggunderlag i liggbåsen hade man satsat på en 18 cm tjock madrass med små luftfyllda gummibollar, vilken höll formen bra. En självgående strövagn på räls för spån över liggbåsen, samt även en för halm i ungdjurs-avdelningen sparade mycket arbete. Även på KFC tillämpades individuell utfodring till alla mjölkkor och de hade 2-2,5 kor/ fodertråg. Utfodring gjordes fyra gånger per dag. I ungdjursstallet var det två fodertråg per tio djur och utfodringen gjordes två gånger per dag. Fodergrindar vid varje fodertråg var nödvändigt hos ungdjuren för att inte djuren skulle bli undanknuffade när de åt. Personalen påpekade att den individuella utfodringen kräver mycket datatekniskt arbete för att installation och funktion ska bli användarvänlig. Diskussionen med forskare och försökspersonal har varit oerhört värdefull och gett oss mycket att tänka på inför vår egen planering av nya försöksstallar. Det viktigaste att tänka på vid projektering, enligt våra kollegor både på Brittiska öarna och i Danmark, är flexibilitet, väl tilltagna ytor och en genomtänkt logistik. Det ger förutsättningar för stallar med god forsknings- och arbetsmiljö samt en god djurvälfärd
27.	Bank, Ingrid E. M., et al. (author) Prevalence and Clinical Significance of Diabetes in Asian Versus White Patients With Heart Failure 2017 In: JACC. Heart failure. - : ELSEVIER SCI LTD. - 2213-1779 .- 2213-1787. ; 5:1, s. 14-24 Journal article (peer-reviewed)abstract OBJECTIVES The study sought to compare the prevalence, clinical correlates and prognostic impact of diabetes in Southeast Asian versus white patients with heart failure (HF) with preserved or reduced ejection fraction. BACKGROUND Diabetes mellitus is common in HF and is associated with impaired prognosis. Asia is home to the majority of the worlds diabetic population, yet data on the prevalence and clinical significance of diabetes in Asian patients with HF are sparse, and no studies have directly compared Asian and white patients. METHODS Two contemporary population-based HF cohorts were combined: from Singapore (n 1,002, median [25th to 75th percentile] age 62 [54 to 70] years, 76% men, 19.5% obesity) and Sweden (n =19,537, 77 [68 to 84] years, 60% men, 24.8% obesity). The modifying effect of ethnicity on the relationship between diabetes and clinical correlates or prognosis (HF hospitalization and all-cause mortality) was examined using interaction terms. RESULTS Diabetes was present in 569 (57%) Asian patients versus 4,680 (24%) white patients (p amp;lt; 0.001). Adjusting for clinical covariates, obesity was more strongly associated with diabetes in white patients (odds ratio [OR]: 3.45;. 95% confidence interval [CI]: 2.86 to 4.17) than in Asian patients (OR: 1.82; 95% CI: 1.13 to 2.96; P-interaction = 0.026). Diabetes was more strongly associated with increased HF hospitalization and all-cause mortality in Asian patients (hazard ratio: 1.50; 95% CI: 1.21 to 1.87) than in white patients (hazard ratio: 1.29; 95% CI: 1.22 to 1.36; P-interaction = 0.045). CONCLUSIONS Diabetes was 3-fold more common in Southeast Asian compared to white patients with HF, despite younger age and less obesity, and more strongly associated with poor outcomes in Asian patients than white patients. These results underscore the importance of ethnicity-tailored aggressive strategies to prevent diabetes and its complications. (C) 2017 by the American College of Cardiology Foundation.
28.	Batra, Gorav, et al. (author) Association between heart failure quality of care and mortality : a population-based cohort study using nationwide registries 2022 In: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 24:11, s. 2066-2077 Journal article (peer-reviewed)abstract AIMS: To evaluate the quality of heart failure (HF) care using the European Society of Cardiology (ESC) quality indicators (QIs) for HF and to assess whether better quality of care is associated with improved outcomes.METHODS AND RESULTS: We performed a nationwide cohort study using the Swedish HF registry, consisting of patients with any type of HF at their first outpatient visit or hospitalization. Independent participant data for quality of HF care was evaluated against the ESC QIs for HF, and association with mortality estimated using multivariable Cox regression. In total, 43 704 patients from 80 hospitals across Sweden enrolled between 2013-2019 were included, with median follow-up 23.6 months. Of the 16 QIs for HF, 13 could be measured and 5 were inversely associated with all-cause mortality during follow-up. Higher attainment (≥50% vs. <50% attainment) of the composite opportunity-based score (combination of QIs into a single score) for patients with reduced ejection fraction was associated with lower all-cause mortality (adjusted hazard ratio 0.81; 95% confidence interval 0.72-0.91). Attainment of the composite score was less in the outpatient than inpatient setting (adjusted odds ratio 0.85; 95% confidence interval 0.72-0.99). Quality of care varied across hospitals, with assessment of health-related quality of life being the indicator with the widest variation in attainment (interquartile range 61.7%).CONCLUSION: Quality of HF care may be measured using the ESC HF QIs. In Sweden, attainment of HF care evaluated using the QIs demonstrated between and within hospital variation, and many QIs were inversely associated with mortality.
29.	Becher, Peter Moritz, et al. (author) Eligibility for sotagliflozin in a real-world heart failure population based on the SOLOIST-WHF trial enrolment criteria: data from the Swedish heart failure registry 2023 In: European Heart Journal - Cardiovascular Pharmacotherapy. - : OXFORD UNIV PRESS. - 2055-6837 .- 2055-6845. ; 9:4, s. 343-352 Journal article (peer-reviewed)abstract Aims The SOLOIST-WHF trial demonstrated efficacy of sotagliflozin in patients with type 2 diabetes mellitus (T2DM) and recent worsening heart failure (HF) regardless of ejection fraction (EF). Selection criteria in trials may limit their generalizability. Therefore, we aimed to investigate eligibility for sotagliflozin based on the SOLOIST-WHF criteria in a real-world HF population. Methods and results SOLOIST-WHF criteria were applied to patients stabilized after HF hospitalization in the Swedish HF Registry according to (i) literal scenario (all inclusion/exclusion criteria) or (ii) pragmatic scenario (only criteria likely to influence treatment decisions). Of 5453 inpatients with T2DM and recent worsening HF, 51.4% had reduced EF (HFrEF), 19.1% mildly reduced (HFmrEF), and 29.5% preserved EF (HFpEF). Eligibility (literal) was: 27.2% (32.4% in HFrEF, 24.7% in HFmrEF, 19.7% in HFpEF) and eligibility (pragmatic) was 62.8% (69.1%, 60.3%, 53.4%, respectively). In the literal scenario, criteria limiting eligibility were HF duration <3 months, eGFR <30 ml/min/1.73 m(2), age >85 years, acute coronary syndrome <3 months, and insufficiently high N-terminal pro-B-type natriuretic peptide levels. Eligible vs. non-eligible patients had more severe HF, higher cardiovascular (CV) comorbidity burden, higher use of HF treatments, and higher event rates (all-cause death 30.8 vs. 27.2 per 100 patient-years, CV death 19.1 vs. 16.6, and HF hospitalization 36.7 vs. 24.0). Conclusion In this large, real-world HF cohort with T2DM, similar to 1/3 of patients were eligible for sotagliflozin in the literal and similar to 2/3 of patients in the pragmatic scenario. Eligible patients had more severe HF and higher event rates, in particular CV and HF events.
30.	Becher, Peter Moritz, et al. (author) Phenotyping heart failure patients for iron deficiency and use of intravenous iron therapy : data from the Swedish Heart Failure Registry 2021 In: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 23:11, s. 1844-1854 Journal article (peer-reviewed)abstract Aims Iron deficiency (ID) is associated with poor prognosis regardless of anaemia. Intravenous iron improves quality of life and outcomes in patients with ID and heart failure (HF) with reduced ejection fraction (HFrEF). In the Swedish HF registry, we assessed (i) frequency and predictors of ID testing; (ii) prevalence and outcomes of ID with/without anaemia; (iii) use of ferric carboxymaltose (FCM) and its predictors in patients with ID. Methods and results We used multivariable logistic regressions to assess patient characteristics independently associated with ID testing/FCM use, and Cox regressions to assess risk of outcomes associated with ID. Of 21 496 patients with HF and any ejection fraction enrolled in 2017-2018, ID testing was performed in 27%. Of these, 49% had ID and more specifically 36% had ID-/anaemia-, 15% ID-/anaemia+, 29% ID+/anaemia-, and 20% ID+/anaemia+ (48%, 39%, 13%, 30% and 18% in HFrEF, respectively). Risk of recurrent all-cause hospitalizations was higher in patients with ID regardless of anaemia. Of 1959 patients with ID, 19% received FCM (24% in HFrEF). Important independent predictors of ID testing and FCM use were anaemia, higher New York Heart Association class, having HFrEF, and referral to HF specialty care. Conclusion In this nationwide HF registry, ID testing occurred in only about a quarter of the patients. Among tested patients, ID was present in one half, but only one in five patients received FCM indicating low adherence to current guidelines on screening and treatment.
31.	Becher, Peter M., et al. (author) Use of sodium-glucose co-transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus : data from the Swedish Heart Failure Registry 2021 In: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 23:6, s. 1012-1022 Journal article (peer-reviewed)abstract Aims Use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in real-world heart failure (HF) is poorly characterised. In contemporary patients with HF and type 2 diabetes mellitus (T2DM) we assessed over time SGLT2i use, clinical characteristics and outcomes associated with SGLT2i use. Methods and results Type 2 diabetes patients enrolled in the Swedish HF Registry between 2016-2018 were considered. We performed multivariable logistic regression models to assess the independent predictors of SGLT2i use and Cox regression models in a 1:3 propensity score-matched cohort and relevant subgroups to investigate the association between SGLT2i use and outcomes. Of 6805 eligible HF patients with T2DM, 376 (5.5%) received SGLT2i, whose use increased over time with 12% of patients on treatment at the end of 2018. Independent predictors of SGLT2i use were younger age, HF specialty care, ischaemic heart disease, preserved kidney function, and absence of anaemia. Over a median follow-up of 256 days, SGLT2i use was associated with a 30% lower risk of cardiovascular (CV) death/first HF hospitalisation (hazard ratio 0.70, 95% confidence interval 0.52-0.95), which was consistent regardless of ejection fraction, background metformin treatment and kidney function. SGLT2i use was also associated with a lower risk of all-cause and CV death, HF and CV hospitalisation, and CV death/myocardial infarction/stroke. Conclusion In a contemporary HF cohort with T2DM, SGLT2i use increased over time, was more common with specialist care, younger age, ischaemic heart disease, and preserved renal function, and was associated with lower mortality and morbidity.
32.	Bilchick, Kenneth C., et al. (author) Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter-Defibrillator Generator Changes 2022 In: Journal of the American Heart Association. - : Wiley. - 2047-9980. ; 11:13 Journal article (peer-reviewed)abstract Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter-defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non-cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post-GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) >35%, and the probability that a patients death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7 +/- 12.0 years, 24.5% women, 34.1% with LVEF >35%), Seattle Heart Failure Model-predicted annual mortality had the greatest effect size for decreased post-GC survival (P<0.0001). Patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs with LVEF >35% had a lower Seattle Heart Failure Model-adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11-1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF <= 35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD 65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre-GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF >35% alone or both LVEF <= 35% and PRAD <43% had worse survival versus controls without ICDs.
33.	Bondarchuk, Alexander, et al. (author) Hydromechanical numerical analysis of rock mass behavior under a Swedish embankment hydropower dam 2009 In: Long Term Behaviour of Dams. - Graz : Verl. der Techn. Univ. Graz. - 9783851250701 ; , s. 113-118 Conference paper (peer-reviewed)
34.	Bondarchuk, Alexander, et al. (author) Numerical analysis of rock mass behavior under hydropower embankment dams 2009 In: Föredrag vid Bergmekanikdag i Stockholm 9 mars 2009. - : Stiftelsen bergteknisk forskning - Befo. ; , s. 149-158 Conference paper (other academic/artistic)abstract Numeriska analyser av bergmassans beteende under fyllningsdammar för vattenkraftproduktion.
35.	Bondarchuk, Alexander, et al. (author) Rock mass behavior under hydropower embankment dams : a two-dimensional numerical study 2012 In: Rock Mechanics and Rock Engineering. - : Springer Science and Business Media LLC. - 0723-2632 .- 1434-453X. ; 45:5, s. 819-835 Journal article (peer-reviewed)abstract Sweden has more than 190 large hydropower dams, of which about 50 are pure embankment dams and over 100 are concrete/embankment dams. This paper presents results from conceptual analyses of the response of typical Swedish rock mass to the construction of a hydropower embankment dam and its first stages of operation. The aim is to identify locations and magnitudes of displacements that are occurring in the rock foundation and grout curtain after construction of the dam, the first filling of its water reservoir, and after one seasonal variation of the water table. Coupled hydro-mechanical analysis was conducted using the two-dimensional distinct element program UDEC. Series of the simulations have been performed and the results show that the first filling of the reservoir and variation of water table induce largest magnitudes of displacement, with the greatest values obtained from the two models with high differential horizontal stresses and smallest spacing of sub-vertical fractures. These results may help identifying the condition of the dam foundation and contribute to the development of proper maintenance measures, which guarantee the safety and functionality of the dam. Additionally, newly developed dams may use these results for the estimation of the possible response of the rock foundation to the construction
36.	Bounyasone, Keophouthong, 1961-, et al. (author) Cultivating educational research in Lao PDR : For a better future? 2011 Doctoral thesis (other academic/artistic)abstract This thesis looks at the introduction of educational action research as part of the national education reforms in Lao PDR. National policies on education emphasise concepts such as ‘education for all’ and ‘student-centred education’ taken from the globalised education reform agenda. Action research became a tool to implement the new pedagogy of student-centred education that was labelled ‘the five-pointed star’. The thesis contributes to the field of global policy studies. It combines global and contextual aspects in order to analyse how action research travelled from policy to practice. This process was part of a Lao national education reform that developed after the introduction of the new economic mechanism, when the previous socialist planned-economy system was replaced by a globalised market-oriented system. Data were collected from national policy documents, international donor documents, instructional material, and interviews with Lao educators involved with action research in different ways. Furthermore, we carried out action research as part of our own teaching duties in Lao PDR, which were subsequently documented and analysed. In this study of educational reform in Lao PDR we have found that an educational approach like action research that is introduced as part of a taken-for-granted global agenda of change, is reduced to a technical rationality and practices that resemble previous experiences. Our findings are explained from the theoretical perspectives of hidden policy ensembles and policy backlashes. Hidden policy ensembles reduce action research to a technical rationality due to their alien cultural and social connections that are not brought into the open at the reform arena. Policy backlashes become a way for practitioners to create meaning based on previous contextual practices, conceptions, and discourses as a consequence of the technical rationality created by the hidden policy ensembles and the use of the cascade model. The thesis concludes with an outline of a possible future educational development in the form of a critical and educative action research network in Lao PDR that is inspired by cross-cultural dialogue, a critical pedagogy of place, and our own action research experiences.
37.	Braunschweig, Frieder, et al. (author) New York Heart Association functional class, QRS duration, and survival in heart failure with reduced ejection fraction : implications for cardiac resychronization therapy. 2017 In: European Journal of Heart Failure. - : Wiley-Blackwell. - 1388-9842 .- 1879-0844. ; 19:3, s. 366-376 Journal article (peer-reviewed)abstract AIMS: Symptom severity assessed by NYHA functional class and QRS duration are essential criteria for selection of heart failure (HF) patients for CRT. This study assessed the relationship between NYHA class, QRS duration, and survival in a nationwide HF registry.METHODS AND RESULTS: We studied 13 423 patients with HF in NYHA class II-IV and LVEF <40% in the Swedish Heart Failure Registry. Survival was followed via the Swedish Population Registry. Of 12 534 patients without CRT (age 71 ± 12 years, 29% women), 51% and 49% were in NYHA class II and III-IV, respectively. Patients in NYHA class II compared with class III-IV were younger (69 vs. 73 years), and had a better systolic function (49% vs. 58% with LVEF <30%), P <0.001 for all, and a favourable co-morbidity profile. QRS duration was 116 ± 29 ms in NYHA class II and 119 ± 29 ms in NYHA class III-IV with QRS ≥120 ms found in 37% vs. 44%, and an LBBB in 23% vs. 28% (P < 0.001 for all). Upon multivariable Cox regression adjusting for 40 clinically relevant variables, mortality risk was higher in NYHA class III-IV vs. class II, with a hazard ratio (HR) of 1.31, 95% confidence interval (CI) 1.23-1.40. Mortality was also higher with QRS prolongation ≥120 ms vs. narrow QRS. The HR in NYHA class II patients with non-LBBB was 1.19 (95% CI 1.05 - 1.36) and in those with LBBB it was 1.16 (95% CI 1.03-1.41). The corresponding HRs in NYHA class III-IV were 1.33 (95% CI 1.21-1.47) and 1.12 (95% CI 1.02-1.22). There was no significant interaction between the effects of NYHA class and QRS duration or morphology on mortality. Applying different scenarios to estimate guideline adherence, fewer patients with NYHA class II (range 14.4-42.6%) compared with NYHA class III-IV (18.0-45.4%) had received a CRT device when indicated.CONCLUSIONS: In HF with reduced LVEF, QRS prolongation is common and independently linked to worse survival. The increase in mortality risk associated with QRS prolongation of both LBBB and non-LBBB morphology is similar in NYHA class II and III-IV.
38.	Brodin, Lars-Ake, et al. (author) [Echocardiography refines the diagnosis in heart failure] 2007 In: Lakartidningen. - 0023-7205. ; 104:34, s. 2338-44 Journal article (other academic/artistic)
39.	Brodin, Lars-Åke, et al. (author) Ekokardiografi förfinar diagnostiken vid hjärtsvikt 2007 In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 104:34, s. 2338-2344 Journal article (peer-reviewed)
40.	Bäck, Karin, et al. (author) Occurrence of signs of osteoarthritis/arthrosis in the temporomandibular joint on panoramic radiographs in Swedish women 2017 In: Community Dentistry and Oral Epidemiology. - : Wiley. - 0301-5661. ; 45:5, s. 478-484 Journal article (peer-reviewed)abstract Objectives: To determine the prevalence and incidence of radiographic signs of osteoarthritis/osteoarthrosis (OA) in the temporomandibular joint (TMJ) among middle-aged and older women. Methods: Data were collected from ongoing representative, longitudinal and repeated cross-sectional studies in Gothenburg, Sweden. Panoramic radiographs (PAN) have been taken regularly since 1968. The cohorts were systematically selected from the female population at the ages of 38, 50, 62 and 74. Condylar alterations indicative of OA (flattening/osteophyte/erosion) were evaluated in a total of 5234 PANs by one examiner under standardized conditions. Intra-examiner reliability was good. Sensitivity was poor, and specificity was acceptable in relation to computed tomography. Results: The prevalence of signs of OA in the TMJ was 18% on panoramic radiographs at the age of 38, gradually increasing with age. At the age of 62, the prevalence was 38%, and it was stable around 45% in the older age groups. The highest incidence rate of OA was between the ages of 55 and 65. Bilateral OA was uncommon. Flattening was the most prominent finding. Conclusion: The prevalence of signs of OA in the TMJ, including remodeling, evaluated on panoramic radiographs in representative cohorts of women, increases substantially with age. Around one in every five middle-aged women and almost every second woman of older ages can be expected to have some radiographic alteration in the TMJ. The highest proportion with new findings of OA is to be found among older middle-aged women.
41.	Bäck, Karin, et al. (author) Orofacial pain and its relationship with oral health-related quality of life and psychological distress in middle-aged women. 2020 In: Acta odontologica Scandinavica. - : Informa UK Limited. - 1502-3850 .- 0001-6357. ; 78:1, s. 74-80 Journal article (peer-reviewed)abstract Objective: To investigate the relationship between subjective symptoms of orofacial pain and oral health-related quality of life (OHRQoL), as well as psychological distress in population-based middle-aged women. Material and methods: The two study samples comprised 1059 women, 38 and 50years old, in representative cross-sectional studies. Women with long-lasting, frequent pain or headaches, related to temporomandibular disorders (TMD), with moderate-to-high estimates were analysed in relation to the non-case group. OHRQoL was measured using the Oral Health Impact Profile (OHIP-5). Psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS) and Sense of Coherence (SOC-13). Results: Women with orofacial pain (n=82, 7.7%) had a significantly higher mean score on the OHIP-5, HADS-A and HADS-D and a lower mean score for SOC-13. In a multivariable logistic regression, orofacial pain was statistically significantly associated with poorer OHRQoL (OR = 1.2) and signs of depression (HADS-D) (OR = 2.0). A higher score for SOC-13 protected from the experience of orofacial pain (OR = 0.95). Conclusion: Orofacial pain was associated with poorer OHRQoL and signs of psychological distress. In interpreting the value of SOC, women with orofacial pain also appear to have a poorer adaptive capacity.
42.	Bäck, Karin, et al. (author) Relation between osteoporosis and radiographic and clinical signs of osteoarthritis/arthrosis in the temporomandibular joint: a population-based, cross-sectional study in an older Swedish population. 2017 In: Gerodontology. - : Wiley. - 1741-2358 .- 0734-0664. ; 34:2, s. 187-194 Journal article (peer-reviewed)abstract The aim was to elucidate the relation between osteoporosis and osteoarthritis/arthrosis (OA) in the temporomandibular joint (TMJ).General epidemiological data support the hypothesis that osteoporosis and OA are inversely correlated but is not conclusively investigated in the TMJ.A group of 114 representative elderly women and men, randomised from a comprehensive population study in Gothenburg, Sweden, had bone mineral density established with whole-body, dual-energy X-ray absorptiometry (DXA) as part of a health survey. In addition, dental examinations were performed, including panoramic radiographs exposed as an overview of the TMJ's and jaws. In 88 of the 80-year-old participants (48 women and 40 men), a clinical orofacial examination according to the RDC/TMD system was performed.A diagnosis of osteopenia/osteoporosis was found in 36% of the 114, with a statistically different greater proportion of women. Condylar alterations evaluated from panoramic radiographs were observed in 34%, with no significant gender difference. No significant differences were found in the proportion of individuals with osteopenia/osteoporosis and any condylar radiographic alteration or not. Forty-one of the clinically examined subjects, 47%, fulfilled the criteria for an RDC/TMD diagnosis with no gender difference. All participants graded the orofacial pain as low chronic pain. An opening capacity of <40 mm denoted a higher risk of having pain in the temporomandibular system. No association was found between clinical diagnosis of RDC/TMD and osteopenia/osteoporosis.The prevalence of osteopenia/osteoporosis appears not to be of importance for radiological or clinical findings of OA in the TMJ.
43.	Bäcktorp, Ann-Louise, 1971- (author) When the first-world-north goes local : Education and gender in post-revolution Laos 2007 Doctoral thesis (other academic/artistic)abstract This thesis is a study of three global issues – development cooperation, education and gender - and their transformation to local circumstances in Lao People’s Democratic Republic (PDR), a landlocked country in Southeast Asia. Combining post-colonial and post-structural perspectives, it sets out to understand how discourses of education and gender in Laos intersect with discourses of education and gender within development cooperation represented by organisations such as the World Bank and the Swedish International Development Cooperation Agency (Sida). Through field observations, analysis of national and donor policies on education and gender, and interviews with Lao educationalists, this thesis offers an analysis that shows the complexities arising at the intersection where the first-world-north meets the local in the context of development cooperation. Foucault’s notion of the production and reproduction of discourses through different power-knowledge relations is used to show that the meanings accorded to education and gender within development cooperation, indeed are historically, culturally and contextually constructed. Within development cooperation policy, first-world-north discourses appear to have a hegemonic status in defining education and gender. Thus ‘Education for All’ and ‘Gender Mainstreaming’ become privileged discourses that also take root in Lao national policy-making. Development cooperation further brings with it discourses defining the cooperation itself. Partnership is one such privileged donor discourse. These policy discourses are however interpreted by Lao educationalists that are not influenced by policy alone; rather, contextual discourses also affect how policies are understood and negotiated. It is when these discourses intersect that structures of power and preferential rights of interpretation become visible. The analysis points to how the perspectives of international development cooperation organisations representing the first-world-north are in positions to set the agenda for development cooperation within policy. This position of power can, from a post-colonial perspective, be traced back to how former colonial structures created a privileged position for first-world-north knowledge that still prevails. This is to some extent acknowledged by development cooperation organisations through the emphasis on partnership. However, in the local context, partnership is not experienced as a discourse which has the effects of redistributing power. Partnership is rather transformed into a discourse of superiority and subordination where development cooperation organisations monitor and evaluate and local actors adjust and implement. Lao education officials however express alternative interpretations of partnership that are based on face-to-face collaboration and collective effort. These strategies have closer links to local practices and also reflect contextual discourse-power-knowledge relations which the education officials are well aware of. These strategies of negotiation also extend to the issues of education and gender. Discourses of ‘Education for All’ and ‘Gender Mainstreaming’ are acknowledged among the education officials as policy goals which to some extent also extend into practice. These discourses are however renegotiated to accommodate local circumstances. ‘Education for All’ is thus replaced by the ‘5-pointed star’ which serves as an operationalisation of the concept of ‘learner-centred education’. ‘Gender Mainstreaming’ has to co-exist with local discourses that on the one hand build on patriarchal organisations of society and on the other hand build on local strategies for access which weaken patriarchal structures. The analysis ultimately stresses the importance of incorporating local, contextual knowledge in educational development cooperation processes, both among international and national stakeholders. This process can be supported by a willingness to deconstruct taken-for-granted understandings and value systems; and in doing so, recognising the normative aspects operating both in the areas of education and gender.
44.	Cahlin, Birgitta Johansson, 1959, et al. (author) A randomised, open-label, crossover study of the dopamine agonist, pramipexole, in patients with sleep bruxism 2017 In: Journal of Sleep Research. - : Wiley. - 0962-1105. ; 26:1, s. 64-72 Journal article (peer-reviewed)abstract Sleep bruxism bears several similarities to restless legs syndrome, and a link to changes in central dopamine activity has been considered in both conditions. The dopamine agonist pramipexole is currently indicated for the symptomatic treatment of restless legs. The effect of pramipexole on sleep bruxism was investigated in subjects with 'probable bruxism' recruited at the Orofacial Pain Clinic. Thirteen patients underwent polysomnographic recordings, including bilateral masseter electromyographic activity. Following habituation to the recording equipment, a baseline registration was used to confirm bruxism [total episodes per hour, mean 11.3 (6.3)]. Following randomisation, subjects received no treatment or pramipexole titrated from 0.09 to 0.54 mg, o. d., for 3 weeks according to a crossover procedure. A polysomnographic- electromyographic registration was performed at the end of each period. Pramipexole was associated with more frequent awakenings and a reduction in rapid eye movement sleep (both P = 0.02). Sleep apnea decreased marginally after pramipexole (apnea- hypopnea index 17.1 compared with control 21.5, P = 0.05). The number of bruxism episodes, phasic, tonic and mixed per hour, remained unchanged after pramipexole [total episodes per hour 12.7 (8.5) and 9.8 (5.2) during pramipexole and control conditions, respectively]. It is concluded, from this pilot study, that sleep bruxism is not affected by the dopaminergic agent, pramipexole.
45.	Cahlin, Birgitta Johansson, 1959, et al. (author) Cerebral palsy and bruxism: Effects of botulinum toxin injections—A randomized controlled trial 2019 In: Clinical and Experimental Dental Research. - : Wiley. - 2057-4347. ; 5:5, s. 460-468 Journal article (peer-reviewed)abstract Objective: Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX-A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX-A injections in subjects with CP and bruxism. Methods: A prospective, parallel, randomized, placebo-controlled, and double-blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX-A or corresponding placebo injections. Matched, healthy references were also evaluated. Results: The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX-A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX-A was requested by the majority of the patients. Conclusion: The evidence is unable to support the use of BTX-A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials. ©2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.
46.	Cahlin, Birgitta Johansson, 1959, et al. (author) No effect of glucosamine sulfate on osteoarthritis in the temporomandibular joints-a randomized, controlled, short-term study. 2011 In: Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. - : Elsevier BV. - 1528-395X .- 1079-2104. ; 112:6, s. 760-6 Journal article (peer-reviewed)abstract The aim of this study was to evaluate the clinical effects of oral glucosamine sulfate, compared with placebo, on osteoarthritis in the temporomandibular joints (TMJs).
47.	Cahlin, Birgitta Johansson, 1959, et al. (author) Utilization of pharmaceuticals among patients with temporomandibular disorders: a controlled study. 2006 In: Acta odontologica Scandinavica. - : Informa UK Limited. - 0001-6357 .- 1502-3850. ; 64:3, s. 187-92 Journal article (peer-reviewed)abstract Pharmaceuticals are among factors that might be associated with temporomandibular disorders (TMDs), but knowledge about their utilization is limited. The purpose was to systematically register the regular use of medication in general among TMD patients and matched controls to enable comparisons to be made.Three hundred consecutive patients referred for diagnosis and treatment of TMDs and fulfilling the Research Diagnostic Criteria were examined prospectively and any medication recorded. Matched controls were registered parallel in time. The pharmaceuticals used were categorized according to the Anatomical Therapeutic Chemical Classification System (ATC).Forty-four percent of the patients received a main diagnosis of "muscle disorder", 39% "disk disorder", and 17% "joint disorder". Fifty-one percent of all patients used some medication on a regular basis compared to 36% of the controls (p<0.001). The average number of ATC categories used among all patients was 0.9 and among controls 0.5 (p<0.001). Of the female patients with the diagnosis "muscle disorder", 23% used antidepressants (N06A), 6% tranquilizers (N05B), and 7% sleep medication or sedatives (N05C) significantly more frequently than controls. Of the female patients diagnosed with a "joint disorder", 26% used antidepressants (N06A) significantly more frequently than controls. All other ATC categories differed non-significantly.The results suggest that the use of pharmaceuticals differs between patients and controls. TMD patients, particularly women diagnosed with "muscle" or "joint" disorders, appear to use drugs for depression more frequently than ordinary dental patients.
48.	Cappelletto, Chiara, et al. (author) Use of and association between heart failure pharmacological treatments and outcomes in obese versus non-obese patients with heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry 2023 In: European Journal of Heart Failure. - : WILEY. - 1388-9842 .- 1879-0844. ; 25:5, s. 698-710 Journal article (peer-reviewed)abstract Aims To investigate the use of guideline-directed medical therapies (GDMT) and associated outcomes in obese (body mass index >= 30 kg/m(2)) versus non-obese patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods and results Patients with HFrEF from the Swedish HF Registry were included. Of 16 116 patients, 24% were obese. In obese versus non-obese patients, use of treatments was 91% versus 86% for renin-angiotensin system inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi), 94% versus 91% for beta-blockers, 53% versus 43% for mineralocorticoid receptor antagonists. Obesity was shown to be independently associated with more likely use of each treatment, triple combination therapy, and the achievement of target dose by multivariable logistic regressions. Multivariable Cox regressions showed use of RASi/ARNi and beta-blockers being independently associated with lower risk of all-cause/cardiovascular death regardless of obesity, although, when considering competing risks, a lower risk of cardiovascular death with RASi/ARNi in obese versus non-obese patients was observed. RASi/ARNi were associated with lower risk of HF hospitalization in obese but not in non-obese patients, whereas beta-blockers were not associated with the risk of HF hospitalization regardless of obesity. At the competing risk analysis, RASi/ARNi use was associated with higher risk of HF hospitalization regardless of obesity. Conclusion Obese patients were more likely to receive optimal treatments after adjustment for factors affecting tolerability, suggesting that perceived beyond actual tolerance issues limit GDMT implementation. RASi/ARNi and beta-blockers were associated with lower mortality regardless of obesity, with a greater association between RASi/ARNi and lower cardiovascular death in obese versus non-obese patients when considering competing risk.
49.	Carlsson, Anja M, et al. (author) Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment in Tanzanian children with acute uncomplicated malaria 2011 In: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 10, s. 380- Journal article (peer-reviewed)abstract BACKGROUND:This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa.METHODS:A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 h after initiation of treatment. Parasite population dynamics were assessed using nested polymerase chain reaction (PCR)-genotyping of merozoite surface protein (msp) 1 and 2.RESULTS:PCR-analyses from nine sequential blood samples collected after initiation of treatment identified 20 and 21 additional genotypes in 15/50 (30%) and 14/50 (28%) children with msp1 and msp2, respectively, non-detectable in the pre-treatment samples (-2 and 0 h combined). Some 15/20 (75%) and 14/21 (67%) of these genotypes were identified within 24 h, whereas 17/20 (85%) and 19/21 (90%) within 48 h for msp1 and msp2, respectively. The genotype profile was diverse, and varied considerably over time both within and between patients, molecular markers and their respective families.CONCLUSION:PCR analyses from multiple blood samples collected during the early treatment phase revealed a complex picture of parasite sub-populations. This underlines the importance of interpreting PCR-outcomes with caution and suggests that the present use of PCR-adjustment from paired blood samples in anti-malarial drug trials may overestimate assessment of drug efficacy in high transmission areas in Africa.The study is registered at http://www.clinicaltrials.gov with identifier NCT00336375.
50.	Carstens, Bodil B., et al. (author) Isolation, characterization, and synthesis of the Barrettides : disulfide-containing peptides from the marine sponge Geodia barretti 2015 In: Journal of Natural Products. - : American Chemical Society (ACS). - 0163-3864 .- 1520-6025. ; 78:8, s. 1886-1893 Journal article (peer-reviewed)abstract Two disulfide-containing peptides, barrettides A (1) and B (2), from the cold-water marine sponge Geodia barretti are described. Those 31 amino acid residue long peptides were sequenced using mass spectrometry methods and structurally characterized using NMR spectroscopy. The structure of 1 was confirmed by total synthesis using the solid-phase peptide synthesis approach that was developed. The two peptides were found to differ only at a single position in their sequence. The three-dimensional structure of 1 revealed that these peptides possess a unique fold consisting of a long β-hairpin structure that is cross-braced by two disulfide bonds in a ladder-like arrangement. The peptides are amphipathic in nature with the hydrophobic and charged residues clustered on separate faces of the molecule. The barrettides were found not to inhibit the growth of either Escherichia coli or Staphylococcus aureus but displayed antifouling activity against barnacle larvae (Balanus improvisus) without lethal effects in the concentrations tested. (Figure Presented).

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