| 1. |
- Lind, Marcus, 1976, et al.
(författare)
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Design and Methods of a Randomized Trial of Continuous Glucose Monitoring in Persons With Type 1 Diabetes With Impaired Glycemic Control Treated With Multiple Daily Insulin Injections (GOLD Study).
- 2016
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Ingår i: Journal of diabetes science and technology. - : SAGE Publications. - 1932-2968. ; 10:3, s. 754-61
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Tidskriftsartikel (refereegranskat)abstract
- The majority of individuals with type 1 diabetes today have glucose levels exceeding guidelines. The primary aim of this study was to evaluate whether continuous glucose monitoring (CGM), using the Dexcom G4 stand-alone system, improves glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections (MDI).Individuals with type 1 diabetes and inadequate glycemic control (HbA1c ≥ 7.5% = 58 mmol/mol) treated with MDI were randomized in a cross-over design to the Dexcom G4 versus conventional care for 6 months followed by a 4-month wash-out period. Masked CGM was performed before randomization, during conventional treatment, and during the wash-out period to evaluate effects on hypoglycemia, hyperglycemia, and glycemic variability. Questionnaires were used to evaluate diabetes treatment satisfaction, fear of hypoglycemia, hypoglycemia confidence, diabetes-related distress, overall well-being, and physical activity during the different phases of the trial. The primary endpoint was the difference in HbA1c at the end of each treatment phase.A total of 205 patients were screened, of whom 161 were randomized between February and December 2014. Study completion is anticipated in April 2016.It is expected that the results of this study will establish whether using the Dexcom G4 stand-alone system in individuals with type 1 diabetes treated with MDI improves glycemic control, reduces hypoglycemia, and influences quality-of-life indicators and glycemic variability.
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| 2. |
- Nilsson, Mikael, et al.
(författare)
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Why Medical Students Choose to Use or Not to Use a Web-Based Electrocardiogram Learning Resource : Mixed Methods Study
- 2019
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Ingår i: JMIR Medical Education. - : JMIR Publications Inc.. - 2369-3762. ; 5:2, s. e12791:1-e12791:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electrocardiogram (ECG) interpretation is a core competence and can make a significant difference to patient outcomes. However, ECG interpretation is a complex skill to learn, and research has showed that students often lack enough competence. Web-based learning has been shown to be effective. However, little is known regarding why and how students use Web-based learning when offered in a blended learning situation.Objective: The aim of this paper was to study students’ use of Web-based ECG learning resources which has not previously been studied in relation to study strategies.Methods: A qualitative explanatory design using mixed methods was adopted to explore how medical students reason around their choice to use or not to use a Web-based ECG learning resource. Overall, 15 of 33 undergraduate medical students attending a course in clinical medicine were interviewed. Data on usage of the resource were obtained via the learning management system for all students. At the final examination, all the students answered a questionnaire on study strategies and questions about internet access and estimated their own skills in ECG interpretation. Furthermore, study strategies and use patterns were correlated with results from an ECG Objective Structured Clinical Examination (OSCE) and a written course examination.Results: In total, 2 themes were central in the students’ reasoning about usage of Web-based ECG: assessment of learning needs and planning according to learning goals. Reasons for using the Web resource were to train in skills, regarding it as a valuable complement to books and lectures. The main reasons for not using the resource were believing they already had good enough skills and a lack of awareness of its availability. Usage data showed that 21 students (63%) used the Web resource. Of these, 11 were minimal users and 10 were major users based on usage activity. Large variations were found in the time spent in different functional parts of the resource. No differences were found between users and nonusers regarding the OSCE score, final examination score, self-estimate of knowledge, or favoring self-regulated learning.Conclusions: To use or not to use a Web-based ECG learning resource is largely based on self-regulated learning aspects. Decisions to use such a resource are based on multifactorial aspects such as experiences during clinical rotations, former study experiences, and perceived learning needs. The students’ own judgment of whether there was a need for a Web-based resource to achieve the learning goals and to pass the examination was crucial for their decisions to use it or not. An increased understanding of students’ regulation of learning and awareness of variations in their ECG learning needs can contribute to the improvement of course design for blended learning of ECG contexts for medical students.
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| 3. |
- Poeplau, Christopher, et al.
(författare)
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Positive trends in organic carbon storage in Swedish agricultural soils due to unexpected socio-economic drivers
- 2015
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Ingår i: Biogeosciences. - : Copernicus GmbH. - 1726-4170 .- 1726-4189. ; 12, s. 3241-3251
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Tidskriftsartikel (refereegranskat)abstract
- Soil organic carbon (SOC) plays a crucial role in the global carbon cycle as a potential sink or source. Land management influences SOC storage, so the European Parliament decided in 2013 that changes in carbon stocks within a certain land use type, including arable land, must be reported by all member countries in their national inventory reports for greenhouse gas emissions. Here we show the temporal dynamics of SOC during the past 2 decades in Swedish agricultural soils, based on soil inventories conducted in 19881997 (Inventory I), 2001-2007 (Inventory II) and from 2010 onwards (Inventory III), and link SOC changes with trends in agricultural management. From Inventory I to Inventory II, SOC increased in 16 out of 21 Swedish counties, while from Inventory I to Inventory III it increased in 18 out of 21 counties. Mean topsoil (0-20 cm) SOC concentration for the entire country increased from 2.48 to 2.67% C (a relative increase of 7.7 %, or 0.38% yr(-1)) over the whole period. We attributed this to a substantial increase in ley as a proportion of total agricultural area in all counties. The horse population in Sweden has more than doubled since 1981 and was identified as the main driver for this management change (R-2 = 0.72). Due to subsidies introduced in the early 1990s, the area of long-term set-aside (mostly old leys) also contributed to the increase in area of ley. The carbon sink function of Swedish agricultural soils demonstrated in this study differs from trends found in neighbouring countries. This indicates that country-specific or local socio-economic drivers for land management must be accounted for in larger-scale predictions.
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| 4. |
- Svensson, M.K, 1965, et al.
(författare)
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The risk for diabetic nephropathy is low in young adults in a 17-year follow-up from the Diabetes Incidence Study in Sweden (DISS). Older age and higher BMI at diabetes onset can be important risk factors
- 2015
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Ingår i: Diabetes-Metabolism Research and Reviews. - : Wiley. - 1520-7560 .- 1520-7552. ; 31:2, s. 138-146
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Tidskriftsartikel (refereegranskat)abstract
- AimsThe main objective of this study was to estimate the occurrence of diabetic nephropathy in a population-based cohort of patients diagnosed with diabetes as young adults (15-34years). MethodsAll 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19years after diagnosis, and 468 (58%) participated. Analysis of islet antibodies was used to classify type of diabetes. ResultsAfter median 17years of diabetes, 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with diabetic nephropathy. Ninety-one percent had microalbuminuria and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1kg/m(2)), a near-significant predictor of development of diabetic nephropathy. Age at onset of diabetes (p=0.041), BMI (p=0.012) and HbA1c (p<0.001) were significant predictors of developing diabetic nephropathy between 9 and 17years of diabetes. At 17years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.051.12 per 1mmHg increase) were associated with DN. ConclusionsPatients with T2DM diagnosed as young adults seem to have an increased risk to develop diabetic nephropathy compared with those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers for development of diabetic nephropathy. In addition, poor glycaemic control but not systolic blood pressure at 9years of follow-up was a risk marker for later development of diabetic nephropathy. Copyright (c) 2014 John Wiley & Sons, Ltd.
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| 5. |
- Tyrberg, M., et al.
(författare)
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Overweight, hyperglycemia and tobacco use are modifiable risk factors for onset of retinopathy 9 and 17 years after the diagnosis of diabetes – A retrospective observational nation-wide cohort study
- 2017
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 133, s. 21-29
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Tidskriftsartikel (refereegranskat)abstract
- Background The aims of this study were to estimate the risk for diabetic retinopathy (DR) and to identify risk factors. We investigated a nationwide population-based cohort with diabetes diagnosed at age 15–34 years. Patients and methods Of 794 patients registered 1987–1988 in the Diabetes Incidence Study in Sweden (DISS) 444 (56%) patients with retinal photos available for classification of retinopathy participated in a follow-up study 15–19 (median 17) years after diagnosis. Mean age was 42.3 ± 5.7 years, BMI 26.1 ± 4.1 kg/m2, 62% were male and 91% had type 1 diabetes. A sub-study was performed in 367 patients with retinal photos from both the 9 and 17 year follow up and the risk for development of retinopathy between 9 and 17 years of follow up was calculated. Results After median 17 years 324/444 (73%, 67% of T1D and 71% of T2D), had developed any DR but only 5.4% proliferative DR. Male sex increased the risk of developing retinopathy (OR 1.9, 95% CI 1.2–2.9). In the sub-study obesity (OR 1.2, 95% CI 1.04–1.4), hyperglycemia (OR 2.5, 95% CI 1.6–3.8) and tobacco use (OR 2.9, 95% CI 1.1–7.3) predicted onset of retinopathy between 9 and 17 years after diagnosis of diabetes. Conclusion The number of patients with severe retinopathy after 17 years of diabetes disease was small. The risk of developing retinopathy with onset between 9 and 17 years after diagnosis of diabetes was strongly associated to modifiable risk factors such as glycemic control, obesity and tobacco use.
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