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Stress & cognitive function: Exploring the impact of PTSD and breast cancer on cognition and the potential benefit of bright light therapy
Full text linkCognitive function—the ability to learn, solve problems, and effectively use stored information—is essential for everyday activities. While many factors contribute to cognitive impairment, this Thesis specifically examines the often-overlooked influence of stress. Major life stressors (e.g., war exposure, sexual violence, cancer diagnosis and treatment) can cause posttraumatic stress disorder (PTSD), and affect biological (e.g., cortisol) and psychological (e.g., depressive symptoms) stress markers known to impair cognitive function. Given the significant negative impact of cognitive impairment on individuals and society, the overarching goals of this Thesis were to a) further investigate the relationship between life stressors and cognitive impairment, b) identify potential moderators of this relationship and c) explore whether circadian-stimulating bright light therapy (BLT) can mitigate the negative effects of life stressors on stress markers, and cognitive function. The three papers listed below highlight the main aims and findings of this Thesis.
In Paper I, a multilevel random effect meta-analysis was conducted to investigate the relationship between PTSD and cognitive impairment, along with potential moderating factors. Literature search yielded 53 peer-reviewed relevant studies in which this relationship was examined. Age, study design, study population, neurocognitive outcome assessed, gender, study quality, type of PTSD measure, as well as the presence of comorbidities such as traumatic brain injury, depression, and substance use, were investigated as potential moderators. The results suggested that PTSD is associated with both cognitive impairment and neurocognitive disorder, compared to healthy controls (HC), demonstrating a consistent link that persisted across all examined moderators.
Paper II examined cancer-related cognitive impairment (CRCI) among women undergoing the life stressor of breast cancer (BC) diagnosis. Previous studies primarily examined chemotherapy's effect on CRCI, while this study aimed to assess CRCI in women with BC before any treatment and explore potential associations with stress. A population-based study with 112 treatment-naïve women with BC and 67 HC was conducted. Cognitive function was assessed via neuropsychological assessment. Cognitive complaints and psychological stress markers (i.e., cancer-related stress (related to PTSD), depressive and anxiety symptoms) were measured with a self-report battery. Biological stress markers (i.e., cortisol and α-amylase) were collected from saliva. The findings revealed that treatment-naïve women with BC had greater impairments in processing speed and verbal memory, along with more frequent cognitive complaints than HC. Multilinear regressions showed that a) steeper α-amylase slope, younger age and lower overall cancer-related stress were associated with better overall cognitive performance, and b) greater depressive symptoms were associated with more frequent cognitive complaints. These findings indicate that CRCI can start before BC treatment and that stress could contribute to it.
Paper III builds on the findings from Papers I and II, indicating that life stressors may contribute to cognitive impairment by affecting stress markers. Since the cancer itself and surgery can trigger stress responses and disrupt circadian rhythms, further increasing the risk of CRCI, Paper III explored whether BLT could mitigate the negative effects associated with BC (including BC surgery) on cognitive function and stress. A double-blind, randomized controlled trial was conducted with the same participants and measurements as in Paper II. Participants were randomly allocated to receive circadian-stimulating bright white light (BWL, N = 60) or non-circadian-stimulating dim white light (DWL, N = 57) for four weeks post-BC surgery. Linear regression and path analyses indicated that the BWL group reported significantly fewer cognitive complaints. Additionally, there were non-significant trends, with small to medium effects, for faster reaction times and fewer intrusive thoughts in the BWL group compared to the DWL group.
Overall, the results of this Thesis emphasize the importance of monitoring cognitive function in individuals exposed to major life stressors and an early intervention when needed. Future studies should further investigate BLT's potential in ameliorating cognitive impairment and stress among individuals experiencing major life stressors and explore the underlying mechanisms.Hugræn virkni, þ.e. getan til að læra, leysa vandamál og beita upplýsingum á skilvirkan hátt, er nauðsynleg fyrir daglegt líf. Margir þættir geta leitt til hugrænnar skerðingar en í þessari doktorsrannsókn voru áhrif streitu á hugræna virkni rannsökuð sérstaklega. Streituvaldandi atburðir á lífsleiðinni (t.d. stríð, kynferðislegt ofbeldi, greining brjóstakrabbameins (BK) og krabbameinsmeðferð) geta valdið áfallastreituröskun (ÁSR), ásamt því að hafa áhrif á líffræðileg (t.d. kortisól) og sálræn (t.d. einkenni þunglyndis) streitumerki sem geta skert hugræna virkni. Þar sem hugræn skerðing getur haft umtalsverð neikvæð áhrif á einstaklinga og samfélagið í heild, var markmið þessarar doktorsrannsóknar að rannsaka nánar a) sambandið á milli streituvaldandi atburða og hugrænnar skerðingar, b) hvaða þættir geta haft áhrif á þetta samband og c) hvort ljósameðferð (LM) geti dregið úr áhrifum streituvaldandi atburða á líffræðileg og sálræn streitumerki og hugræna virkni. Doktorsrannsóknin var þríþætt og er rannsóknunum þremur lýst hér á eftir.
Fyrsta rannsóknin kannaði sambandið á milli ÁSR og hugrænnar virkni ásamt hugsanlegum mótunarþáttum þessa sambands með þriggja laga slembiáhrifa safngreiningu. Heimildaleit skilaði 54 ritrýndum vísindagreinum sem uppfylltu inntökuskilyrðin. Hugsanlegir mótunarþættir þessa sambands sem skoðaðir voru í þessari rannsókn voru aldur, rannsóknarsnið, tegund úrtaks, hugræn útkoma, kyn, gæði rannsókna, mælitæki ÁSR, heilahristingur, þunglyndi og notkun vímugjafa. Niðurstöðurnar gáfu til kynna tengsl milli ÁSR og þróunar á hugrænni skerðingu og einnig á milli ÁSR og heilabilunar, miðað við heilbrigða samanburðarhópinn (HS) og að auki, að þessi tengsl væru óháð þeim mótunarþáttum sem skoðaðir voru.
Önnur rannsóknin kannaði krabbameinstengda hugræna skerðingu (KHS) meðal kvenna sem greinst höfðu með BK. Fyrri rannsóknir á KHS hafa einkum kannað áhrif lyfjameðferðar á KHS en markmið þessarar rannsóknar var að meta hvort KHS meðal kvenna með BK geti komið fram áður en BK meðferð hefst og einnig hvort streita geti mögulega spilað þar hlutverk. Rannsóknin var lýðgrunduð með 112 þátttakendum með BK (fyrir BK meðferð) og 67 þátttakendum úr HS. Hugræn virkni var metin bæði með taugasálfræðiprófum og spurningalista. Sálræn streitumerki (þ.e. krabbameinstengd streita (tengd ÁSR), þunglyndis- og kvíðaeinkenni) voru mæld með spurningalistum. Líffræðileg streitumerki (þ.e. kortisól og α-amýlasi) voru mæld í munnvatnssýnum. Niðurstöðurnar sýndu að þátttakendur með BK stóðu sig verr á taugasálfræðiprófum sem mældu vinnsluhraða og orðaminni og töldu hugræna virkni sína vera verri miðað við þátttakendur í HS. Marghliða línuleg aðhvarfsgreining sýndi að a) betri hugrænni virkni fylgdi hærri α-amýlasa-hallastuðull, yngri aldur og minni krabbameinstengd streita og að b) þátttakendur með alvarlegri þunglyndiseinkenni töldu hugræna virkni sína vera verri. Niðurstöðurnar benda til að KHS geti komið fram áður en meðferð við BK hefst og að streita getur átt sinn þátt í skerðingunni.
Þriðja rannsóknin byggir á niðurstöðum hinna tveggja sem gáfu til kynna að streituvaldandi atburðir á lífsleiðinni geti átt þátt í hugrænni skerðingu með áhrifum sínum á streitumerki. Þar sem bæði krabbameinið sjálft ásamt skurðaðgerð því tengd geta framkallað streituviðbrögð og einnig raskað dægursveiflum, og þar með enn frekar aukið hættuna á KHS, þá var í þriðju rannsókninni skoðað hvort LM geti dregið úr neikvæðum áhrifum tengdum BK (þar með skurðaðgerð við BK) á hugræna virkni og streitu. Til að skoða þetta nánar var tvíblind slembirannsókn framkvæmd á sama úrtaki og notað var í annarri rannsókninni. Þátttakendum var handahófskennt skipt í hópa þar sem íhlutunarhópurinn fékk dægursveiflu-örvandi bjart ljós (BL, N = 60) á meðan samanburðarhópurinn fékk dimmt ljós án dægursveiflu-örvunar (DL, N = 57). LM stóð yfir í fjórar vikur að skurðaðgerð lokinni. Línulegar aðhvarfsgreiningar og leiðargreiningar sýndu að BL hópurinn, í samanburði við DL hópinn, taldi hugræna virkni sína vera marktækt betri. Að auki var ómarktæk tilhneiging (með litlum til meðal áhrifastærðum) hjá BL hópnum til hraðari viðbragðstíma og færri uppáþrengjandi hugsana samanborið við DL hópinn.
Á heildina litið þá undirstrika niðurstöður þessarar doktorsrannsóknar nauðsyn þess að fylgjast með hugrænni virkni hjá einstaklingum sem hafa orðið fyrir meiriháttar streituvaldandi atburðum á lífsleiðinni en einnig mikilvægi snemmtækrar íhlutunar eftir þörfum. Framtíðarrannsóknir ættu að rannsaka nánar hvort LM geti dregið úr hugrænni skerðingu og streitu meðal einstaklinga sem hafa upplifað meiriháttar streitu á lífsleiðinni, ásamt því að skoða undirliggjandi þætti.Icelandic Research Fund [grant number 184999-051], Research Fund of the Icelandic Cancer Society and the Reykjavik University Research Fun
Modelling the Endogenous Feedback Structure of a Food System using a Qualitative System Dynamics Approach: Informing Policy Design and Supporting Sustainability Transitions in the Salmon Aquaculture Industry
Full text linkFood systems face urgent sustainability challenges that are set to escalate as the world population expands, becomes more affluent, and urbanizes at a fast rate. These challenges are deeply rooted in food systems; the technology, ways of working, interorganizational relationships and interdependencies, and the wider societal structure and culture. Therefore, their solution calls for radical, non-linear, and structural system changes (i.e., sustainability transitions). Transitions require an understanding of the dynamics of the system, including drivers of change and structural inertia, especially as food systems are characterised by concentration of power in the hands of large, profit driven businesses with vested interest in maintaining the status quo. Given the urgency of food system sustainability transitions, and the potential for using modelling to design policy to guide such transitions, the aim of this research is to map the endogenous feedback structure of the Norwegian salmon aquaculture industry, to determine if the modelling of a food system’s endogenous feedback structure using a system dynamics approach can support the system’s transition towards sustainability. The findings indicate that the endogenous structure of the Norwegian salmon aquaculture industry has impacted its development and in particular policy outcomes and thus potentially maintained resistance to change. This implies that new policy design will be important to guide transitions towards sustainability and would benefit from considering the system’s endogenous structure. These findings underscore the relevance of a systems perspective in policy design and transitions modelling.Matvælakerfi standa frammi fyrir brýnum sjálfbærniáskorunum sem eiga sér djúpar rætur í
tækni og aðferðum við frumframleiðslu, vinnslu og dreifingu matvæla,
viðskiptasamböndum, stjórnkerfinu, samfélagsgerðinni og menningunni. Lausn þeirra
krefst því róttækra kerfisbreytinga sem kallast sjálfbærniumskipti (e. sustainability
transitions). Þar sem matvælakerfi einkennast af samþjöppun valds í höndum stórra,
hagnaðardrifinna fyrirtækja sem hafa hagsmuni af óbreyttu ástandi krefjast umskipti þeirra
skilnings á innri byggingu (e. endogenous structure) þeirra, og drifkröftum breytinga og
tregðu innan slíkra kerfa. Í ljósi þess hve brýnt er að auka sjálfbærni matvælakerfa og
þeirra tækifæra sem felast í notkun líkana við stefnumótun sjálfbærniumskipta er markmið
þessarar rannsóknar að kortleggja innri byggingu norska fiskeldisiðnaðarins til að ákvarða
hvort kvikt kerfislíkan (e. system dynamics model) af innri byggingu matvælakerfis geti
stutt sjálfbærniumskipti kerfisins. Niðurstöðurnar benda til þess að innri bygging norska
laxeldisiðnaðarins hafi áhrif á þróun hans og viðbrög við stefnumörkun stjórnvalda og
viðhaldi þannig viðnámi gegn sjálfbærniumskiptum. Þessar niðurstöður fela í sér að
stefnumörkun verður mikilvægt tæki til að leiða sjálfbærniumskipti í framtíðinni og að
skilningur á innri byggingu matvælakerfa mun vera forsenda slíkrar stefnumörkunar. Þetta
undirstrikar mikilvægi kerfissjónarmiða (e. systems perspective) í stefnumótun og
sjálfbærniumskiptum
The Path of My Experience: An autoethnographic journey through the culture of education
Full text linkAbstract
For over 50 years, I have been studying, teaching, counseling, and rallying people in three distinct arenas: Engaged Buddhism, psychology, and activism. I have long referred to these as my pillars as I felt they upheld my intellectual development. I now realize that each of these pillars is fundamentally educational by nature, and that therefore, I have been both a lifelong learner as well as a teacher in a variety of settings. My initial doctoral research focused on educational transformation among learners participating in the University of Iceland´s International Studies in Education Program (ISE) in which I had been a B.A. student. I realized, however, that I was in a constant dialogue with myself; more personal and captivating topics that were part of my own journey arose, such as why was learning, formal, informal, and non-formal, such an important part of my life and what led me here? Thus, my journey in education became the main topic of my doctoral research. The purpose was to offer my personal story for further investigation and study. The present work, a heuristic autoethnography, focuses on my life in a variety of educational settings and how each of those pillars became increasingly integrated in my life.
This dissertation is in five parts: Prologue: The Accidental Heurist, Telling the Story, Framing the Story, Understanding the Story, and Epilogue: The Path of My Experience.
In The Accidental Heurist I introduce the work and the process of determining autoethnography as best suited to the research questions raised. In Telling the Story I review key aspects of my life in three roughly 20-year periods. Framing the Story serves as a bridge in the work and in it, I introduce the Three Pillars. Finally, in Understanding the Story, I use the conceptual framework created by the three pillars, plus education, to examine and understand the identified themes. I used an historical, narrative approach in presenting a reflexive chronicle of my life, describing the ways those intellectual pillars all grew out of specific experiences. I now understand that the culture being uncovered bit by bit in the study of my life is none other than the culture of education itself.
Making extensive use of photographs and stories from New York City to Japan, from Warner Bros. Pictures to hospital chaplaincy, I uncover the complex trajectory of someone whose life endured many discomfiting changes but who always retained an enthusiastic embrace of learning and a commitment to helping others learn, too. While Engaged Buddhism unites what is called activism with Buddhist principles in a unique combination, my prior studies and work in psychology also supported this journey. I realized that Buddhism, psychology, and activism were not single pillars that held aloft my development to which education was then added. Instead, these four clusters were interconnected from the very beginning, producing a combined activist - educator, I name an Activator, a reflection of the deep influence of caring and committed mentors who have played crucial roles throughout my life. My belief in this humanistic drive to assist others in becoming whole, in becoming more human, is a testament to the value of their love for me and is mirrored in my own love for the students with whom I work and whose life stories brought them here.Í meira en 50 ár hef ég verið að læra, kenna, veita ráðgjöf og hvetja fólk til þátttöku á
sviðum tengdum búddisma, sálfræði og aktívisma. Þetta eru þær megin stoðir sem
vitsmunalegur þroski minn hvílir á. Ég geri mér núna grein fyrir því að hver þessara
stoða felur í sér menntun og því hef ég alla tíð stundað bæði símenntun og verið
kennari við margvíslegar aðstæður. Doktorsrannsókn mín beindist upphaflega að
umbreytingu menntunar meðal nemenda sem taka þátt í Alþjóðlegu námi í
menntunarfræði við Háskóla Íslands þar sem ég hafði verið BA-nemandi. Í þessu ferli
tók rannsókn mín nýja stefnu. Ég áttaði mig á því að ég átti í stöðugri samræðu við
sjálfan mig. Persónuleg og grípandi umræðuefni sem voru hluti af mínu eigin
ferðalagi komu upp. Hvers vegna varð nám, formlegt og óformlegt, svona mikilvægur
hluti af lífi mínu og hvað leiddi mig hingað? Þannig varð mitt eigið ferðalag um veröld
menntunar að meginviðfangsefni doktorsrannsóknarinnar, Markmiðið var að leggja
fram mína eigin sögu til frekari rannsóknar og greiningar. Í þessari ritgerð sem byggir
á sjálfsögulegri aðferðafræði, beini ég sjónum að lífi mínu á ýmsum skeiðum ævinnar
og rýni í hvernig þessar stoðir urðu sífellt samþættari.
Þessi ritgerð er í fimm hlutum: „Formáli: The Accidental Heurist“ eða hvernig ég
sjálfur varð „óvart“ að meginviðfangsefni rannsóknarinnar, „Að segja söguna“,
„Skipulag viðfangsefnisins“, „Að skilja söguna“ og „Eftirmáli: Slóð reynslu minnar“.
Í „The Accidental Heurist“ er vinnan og ferlið kynnt, sem varð til þess að ákveðið var
að styðjast við sjálfsögulega aðferð til að leita svara við þeim rannsóknarspurningum
sem fram komu. Í formálanum kynni ég verkið og ferlið sem leiddi til þess að ég ákvað
að beita sjálfsögulegri aðferðafræði. Í kaflanum „Að segja söguna“ fer ég síðan yfir
lykilatriði í lífi mínu, sem ég skipti í þrjú, um það bil 20 ára tímabil. Þriðji kaflinn er
svo einskonar brú í ritgerðinni þar sem ég kynni stoðirnar þrjár (búddisma, sálfræði
og aktívisma). Að lokum kynni ég í kaflanum „Að skilja söguna“ hugtakarammann sem
skapaður er af stoðunum þremur, auk menntunar, og notaðar eru til að skoða og skilja
þau þemu sem ég greindi.
Ég hef stuðst við sögulega frásögn við að setja fram og íhuga annál lífs míns og
hvernig þessar vitsmunalegu stoðir eiga sér allar rætur í ákveðinni reynslu. Ég skil
núna að menningin sem er afhjúpuð smátt og smátt í rannsókn minni á eigin ævi er
engin önnur en menntunarmenningin sjálf. Með því að nota mikið af ljósmyndum og sögum frá 60+ árum, frá New York til Japan,
frá Warner Bros. kvikmyndum til sjúkrahúsprests, afhjúpa ég flókin feril manns sem
tókst á við margar óþægilegar breytingar í lífi sínu en var alltaf áhugasamur um nám
og skuldbundinn því að hjálpa öðrum.
Þó að virkur búddismi sameini það sem kallað er aktívismi við grunnreglur búddisma í
einstakri samsetningu, studdi fyrra nám mitt og starf í sálfræði einnig þennan
þroskaferil minn. Ég áttaði mig á að búddismi, sálfræði og aktívismi voru ekki einu
stoðirnar sem knúðu áfram þroska minn. Menntun kom þar einnig við sögu, einkum
þegar ég fór að gera mér betri grein fyrir að menntun var samnefnari þessara stoða.
Þessar þrjár stoðir voru samtvinnaðar menntun alveg frá upphafi og mynduðu
samsettan aktívista-kennara, sem ég nefni Virkjara, sem endurspeglar djúp áhrif
umhyggjusamra og einlægra leiðbeinenda sem hafa gegnt mikilvægu hlutverki í lífi
mínu. Trú mín á mannúð, að styðja aðra til að tileinka sér hana, ber vitni um
gagnkvæman kærleika
Áföll í æsku, geðheilbrigði og aðgengi að heilbrigðisþjónustu í heimsfaraldri COVID-19
No full textThe global spread of Coronavirus 2019 (COVID-19) posed significant threats to public health, and serious concerns have been raised about the adverse impact of the pandemic on population mental health. However, most existing studies have focused on mental health effects during the early stages of the pandemic or on specific high-risk groups, leading to a gap in understanding the long-term effects of the pandemic on mental health and health service use for the general population. Leveraging data sources from UK Biobank and the Icelandic COVID-19 National Resilience Cohort, the overarching aim of this thesis was to better understand the role of psychosocial factors in COVID-19 severity and to explore the long-term effects of the pandemic on population mental health and health service use. In Study I, we explored the link between childhood maltreatment and COVID-19 hospitalizations and deaths, examining potential mechanisms and the role of disease susceptibility. In Study II, we analysed trends in new diagnoses of anxiety and depression, as well as new prescriptions for anxiolytics and antidepressants in the UK from March 2020 to August 2021. In Study III, we identified different depressive symptom patterns in Iceland during the COVID-19 pandemic and examined their associated factors and long-term effects. In Study IV, we investigated trends in perceived disruptions in health service use in Iceland during the pandemic and how these disruptions relate to sociodemographic factors, preexisting health conditions, and overall well-being. The findings of these studies reveal resilience and vulnerability factors of COVID-19 severity, population mental health and access to health services during the COVID-19 pandemic with considerable implications for research and prevention in future pandemics
Phenotypic plasticity in Mývatn threespine stickleback (Gasterosteus aculeatus): response to temperature and diet within and across generations
No full textPhenotypic plasticity, the ability of a single genotype to produce different phenotypes in
response to environmental stimuli, can mitigate effects of adverse environmental
conditions within and across generations and be an important source of adaptation in
response to natural selection. The aim of this thesis was to study how environmental
drivers shape the phenotype of threespine stickleback, within and across generations, in the
spatio-temporally varying system, Lake Mývatn, Iceland. Firstly, my study of diet and
morphology of wild juvenile Mývatn stickleback revealed a dietary niche shift from
Cladocera to midge larvae with increasing body size and diverging head morphology in
response to varying diet composition. Secondly, I conducted a multigenerational plasticity
experiment, rearing offspring from stickleback originating from two contrasting habitats
under varying temperature and diet conditions. I analysed phenotypic information of
juveniles and sexually mature females and males across two generations. I further collected
liver samples of sexually mature experimental and wild individuals for transcriptomic
analyses, to further our understanding of the underlying molecular mechanisms. I found
clear environmental effects on traits directly associated with fitness. Thus,
transgenerational effects appear crucial in shaping biological fitness in this highly dynamic
system. I also identified differentially expressed genes in response to temperature and diet,
potentially reducing environmental stress and support habitat expansion. This thesis
enhances our understanding of phenotypic plasticity and transgenerational effects in
dynamic systems. Integrating multiple environmental factors over biologically relevant
timeframes is rare, making my findings crucial for understanding how phenotypic
plasticity contributes to biological diversity.Sveigjanlegt svipfar, geta arfgerðar til að mynda mismunandi svipgerðir sem svar við
breytilegu umhverfi, getur dregið úr áhrifum erfiðra umhverfisaðstæðna, innan og milli
kynslóða, og er mikilvægt í aðlögunarsvörun vegna náttúrulegs vals. Helsta markmið
verkefnisins var að rannsaka mótandi áhrif umhverfisþátta á svipgerð hornsíla, innan og
milli kynslóða, í tíma og rúmi. Ég rannsakaði fæðu og fæðutengt útlit hornsílaseiða í hinu
síbreytilega Mývatni. Þegar að seiðin lengdust breyttist fæða þeirra frá vatnaflóm til
mýlirfa og höfuðlögun tengdist fæðunni. Ég mældi sveigjanlegt svipfar innan og milli
kynslóða í tilraun þar sem að hornsíli frá tveimur svæðum voru alin við ólíkt hitastig og
fæðu í tvær kynslóðir og upplýsingum um svipgerð seiða og kynþroska hænga og hrygna
var safnað. Sýni til mælinga á genatjáningu voru tekin af lifur kynþroska einstaklinga úr
Mývatni og afkvæma úr tilrauninni, til að skilja betur þá erfðafræðilegu ferla sem móta
svipgerðarfjölbreytileikann sem sást. Umhverfið hafði greinileg áhrif á þætti sem tengja má
beint við hæfni. Þættir sem berast milli kynslóða eru greinilega mikilvægir fyrir
líffræðilega hæfni í þessu kvika kerfi. Nokkur gen fundust sem sýndu mismunandi tjáningu
í tengslum við hitastig og fæðu. Þau geta mögulega dregið úr streituáhrifum tengdum
umhverfi og gert einstaklingum kleift að nema ný búsvæði. Niðurstöðurnar auka skilning á
mikilvægi sveigjanlegs svipfars, innan og milli kynslóða, fyrir einstaklinga í kviku
vistkerfi. Rannsóknir þar sem skoðaðir eru margir umhverfisþættir á líffræðilega
mikilvægum tímaskala eru fáar. Því eru niðurstöður mínar sérlega mikilvægar fyrir
skilning á hvernig sveigjanlegt svipfar hefur áhrif á líffræðilega fjölbreytni
A Nationwide Study on Primary Aldosteronism in Iceland. From Detection to Immunohistochemistry and Genetic Testing.
No full textIntroduction
Primary aldosteronism (PA) is the most common cause of secondary hypertension (HT),
accounting for up to 29% of cases of resistant HT and 14% in general practice. Familial
hyperaldosteronism (FH) is a rare cause of PA. The most common presentation of PA is
HT with normal potassium levels. PA is widely underdiagnosed, and diagnostic delay
reduces treatment efficacy. Early detection and specialized treatment are crucial as PA
carries significantly higher cardiovascular risk than essential HT. Adrenal venous
sampling (AVS) is the gold standard method to differentiate between unilateral and
bilateral PA. Adrenalectomy is potentially curative for the unilateral group, while
bilateral disease is managed with mineralocorticoid receptor antagonists (MRA).
Immunohistochemistry (IHC) has advanced the histopathological diagnosis of unilateral
PA and shown potential in predicting outcomes. Standardized methods for outcome
evaluation were introduced recently.
The aims of this thesis were to investigate the incidence of PA in Iceland during the
study period and assess whether it is underdiagnosed. Additionally, to compare results
from screening and confirmatory tests between AVS subgroups and evaluate treatment
outcomes. Another objective was to assess long-term outcomes and follow-up needs by
classifying patients based on IHC. Finally, we aimed to explore the role of the posture
test (PT) and screen the appropriate patients for FH.
Methods
In 2007, an evidence-based PA work-up protocol was introduced in Landspítali
National University Hospital of Iceland. The study cohort consisted of all adults
diagnosed with PA during the 10-year period 2007–2016. Screening was performed
by measuring morning serum aldosterone, direct renin concentration and 24-hour
urinary excretion of aldosterone (UEA). PA was confirmed through the recumbent saline
infusion test. All patients underwent adrenal computed tomography (CT) and a 4-hour
PT. AVS was used for subtyping. Unilateral PA was treated with laparoscopic
adrenalectomy and bilateral PA was managed with MRA. During follow-up visits, blood
pressure (BP) was measured, need for potassium supplementation evaluated, and
antihypertensive treatment assessed.
Outcomes were evaluated based on the alterations in BP, count of antihypertensives,
and need for potassium supplementation. Clinical outcomes were further assessed
using the Primary Aldosterone Surgical Outcome criteria and the Primary
Aldosteronism Medical Outcome criteria. IHC was performed to reevaluate routinely
stained tissue samples and histopathological diagnoses using The International
Histopathology Consensus for Unilateral Primary Aldosteronism (HISTALDO). Outcomes
v
were compared between HISTALDO subgroups and the need for follow-up was
evaluated. First-degree relatives within the study cohort were screened for FH.
Results
Between 2007 and 2016, the incidence of confirmed PA in Iceland was 58 cases, 47%
(n = 27) had unilateral disease and 53% (n = 31) bilateral. All patients had
hypokalaemia at case detection or during work-up. Compared to the bilateral group,
the unilateral group had a significantly higher UEA (33,9 vs. 24,6 μg, p < 0,001), post-
infusion aldosterone levels (385 vs. 251 pmol/l, p = 0,01), and a higher frequency of
adrenal nodules (19/27 vs. 10/31, p = 0,008). The bilateral group was significantly
more responsive to posture (206% vs. 56%, p = 0,002). The PT had 81% sensitivity
and 45% specificity for detecting bilateral PA. The combination of CT and PT was 96%
specific and 32% sensitive for detecting unilateral PA. The AVS success rate was 86%
(57/66), with 7/9 failed AVS performed on women (p = 0,08). Following IHC,
classical histopathology was identified in 85% (22/26) of the unilateral group, with
23% (6/26) alteration of histopathological diagnoses. During follow-up, both the
unilateral and bilateral group experienced significant reductions in systolic BP (p <
0,001, both groups), antihypertensive use (p = 0,002, p = 0,04, respectively), and
potassium supplementation needs (p < 0,001, both groups). All patients with classical
histopathology who achieved complete clinical success at 12 months (n = 5) remained
normotensive without antihypertensives throughout the follow-up period (4–10 years).
FH screening among brothers (n = 2) within the cohort yielded negative results.
Conclusions
This study highlights the underdiagnosis of PA in Iceland as the incidence was low and
all patients in the cohort had hypokalaemia. Most cases presented with severe PA,
emphasizing the need for increased awareness and broader screening indications at
earlier stages of the disease. Unilateral PA was associated with more severe disease at
presentation and a more significant reduction in antihypertensive use during follow-up,
indicating better treatment response. The combination of PT and CT was highly specific
for detecting unilateral PA. IHC improved histopathological diagnosis and was essential
for accurate diagnosis. Additionally, follow-up could be individualized based on IHC
results, though further research is needed to confirm this. Overall, our study underlines
the need for improved screening, a simpler work-up, and personalized treatment and
follow-up strategies to optimize PA care.Frumkomið aldósterónheilkenni (FA) er algengasta orsök afleidds háþrýstings. Allt að
29% lyfjaþolins háþrýstings og 14% háþrýstings í heilsugæsluþýði orsakast af
sjúkdómnum. Arfgeng form FA eru sjaldgæf. Algengasta birtingarmynd sjúkdómsins er
háþrýstingur með eðlilegu blóðkalíumgildi. FA er víða vangreint og greiningartöf
dregur úr meðferðarárangri. Snemmgreining og sérhæfð meðferð skipta sköpum því
sjúkdómnum fylgir aukin hættu á hjarta- og æðaáföllum samanborið við frumkominn
háþrýsting. Nýrnahettubláæðaþræðing (NHBÞ) er áreiðanlegasta aðferðin til mats á því
hvort FA er í annarri eða báðum nýrnahettum (einhliða eða tvíhliða).
Nýrnahettubrottnám getur veitt lækningu ef einhliða en tvíhliða sjúkdómur er
meðhöndlaður með aldósterón-viðtakahindrum. Sértæk mótefni hafa bætt
vefjagreiningu í einhliða FA. Staðlaðar aðferðir við mat á meðferðarárangri komu fram
nýlega.
Markmið rannsóknarinnar voru að kanna nýgengi FA á rannsóknartímabilinu og meta
hvort sjúkdómurinn sé vangreindur á Íslandi. Ennfremur að gera samanburð á
niðurstöðum úr skimun og frekari uppvinnslu á milli undirhópa og meta
meðferðarsvörun. Einnig að meta áreiðanleika stöðuprófs og vægi sértækrar
mótefnalitunar með tilliti til áreiðanleika greiningar og þarfar á eftirfylgd. Loks var
kannað hvort arfgeng form FA fyndust innan þýðisins
Insights from the bone marrow: Characterization of monoclonal gammopathy of undetermined significance through flow cytometry analysis of plasma cells
No full textIntroduction and aims: Multiple myeloma (MM) is a hematological malignancy, characterized by the proliferation and accumulation of malignant plasma cells in the bone marrow (BM), leading to overproduction of monoclonal protein (M-protein) and/or free light-chains (FLC). MM is consistently preceded by monoclonal gammopathy of undetermined significance (MGUS), an asymptomatic condition common among older adults (affecting around 3-5% of individuals aged 50 or older), progressing to MM and related disorders at a rate of approximately 1% per year. Although the overall risk of progression is relatively low, MGUS is a heterogeneous condition. Some individuals exhibit rapid malignant transformation, while others may follow an indolent clinical course. Consequently, accurate risk assessment and optimal clinical management represent key challenges in MGUS care. Multiparameter flow cytometry (MFC) provides immunophenotypic characterization at the single-cell level, enabling direct detection of plasma cell clonality based on aberrant antigen expression patterns. Although not routinely used in the diagnostic work-up of MGUS, MFC can complement traditional serological markers and potentially improve diagnostic accuracy and risk stratification. The clinical utility of MFC in this context is evaluated in this thesis, based on three studies. The first study aimed to develop a predictive model for assessing hemodilution in BM aspirates, which causes underestimation of plasma cell proportions. The second study aimed to refine the use of serum FLC ratio as a surrogate marker for plasma cell clonality in light-chain MGUS (LC-MGUS). The third study investigated the frequency and clinical significance of clonal plasma cell detection in IgA and IgG MGUS.
Methods: All three studies were based on immunophenotypic analysis of BM samples from participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) population-based screening study. The EuroFlow next-generation flow (NGF) MM-minimal residual disease method was used to identify and quantify phenotypically aberrant (clonal) plasma cells and other cell populations in the BM. In the first study, first and second pull BM aspirated samples, used as references for optimal and suboptimal sample quality, were compared to identify markers of hemodilution. The most discriminatory populations were combined using linear discriminant analysis to develop the Bone Marrow Quality Index (BMQI). Validation included experimentally induced hemodilution. In the second study, the relationship between serum FLC ratio and clonal plasma cell detection by NGF was assessed to define an optimal FLC ratio cutoff. Longitudinal FLC dynamics and progression outcomes were used to evaluate the clinical relevance of the identified threshold. In the third study, NGF was used to assess clonal plasma cell detection in IgA and IgG MGUS. Clinical outcomes, including the rate of transient M-proteins and disease progression, were evaluated by clonal plasma cell detection status.
Results: In study I, 351 BM samples from 219 individuals with plasma cell disorders were included. Second pull samples showed significantly reduced plasma cell proportions relative to paired first pull samples (median ratio 0.31; p3.15 exhibited overall increasing FLC ratio and significantly higher rates of progression to smoldering or active MM. In study III, clonal plasma cells were detected in 79.1% of MGUS individuals, and more frequently in IgA MGUS (93.3%) than IgG MGUS (71.2%; p<0.05). All MGUS cases without detectable clonal plasma cell population had either transient M-protein (52.6%) or a low-level stable IgG M-proteins (47.4%), and none progressed to more advanced disease over a median follow-up of five years.
Conclusions: Altogether, MFC enables sensitive detection of clonal plasma cells and can improve diagnostic characterization in MGUS. The BMQI provides an objective, reproducible measure of BM sample quality and can inform interpretation of MFC-based plasma cell analysis. A refined FLC ratio cutoff of 3.15 improves diagnostic specificity in LC-MGUS and immunophenotypic confirmation of plasma cell clonality might be useful in borderline cases in this subgroup. Additionally, absence of clonal plasma cells identifies an MGUS subset with an indolent clinical course, characterized by transient or low-level IgG M-proteins, and no disease progression. Integrating standardized MFC methods, such as NGF, into MGUS evaluation may enhance diagnostic precision and inform individualized follow-up strategies.Mergæxli er illkynja blóðsjúkdómur sem einkennist af
stjórnlausri fjölgun og uppsöfnun einstofna plasmafrumna í beinmerg og leiðir til
offramleiðslu á einstofna mótefni (M-prótein). Þeir sem greinast með mergæxli hafa
áður verið með forstig þess, góðkynja einstofna mótefnahækkun (e. monoclonal
gammopathy of undetermined significance; MGUS), sem er einkennalaust ástand þar
sem M-prótein eða óeðlilegt hlutfall léttra keðja mælist í sermi. MGUS er algengt meðal
eldra fólks (um 3-5% einstaklinga 50 ára og eldri), en aðeins hluti þeirra þróar með sér
mergæxli eða skylda sjúkdóma á lífsleiðinni. Ein af helstu áskorunum í greiningu á
MGUS felst í því að bera kennsl á þá sem eru í aukinni áhættu á illkynja
sjúkdómsframvindu og aðgreina þá frá þeim sem hafa hægfara eða meinslausan gang.
Markmið þessa doktorsverkefnis var að meta notagildi frumuflæðisjárrannsókna á
plasmafrumum í beinmerg við greiningu á einstaklingum með MGUS. Slíkar rannsóknir
veita ítarlegar upplýsingar um ónæmissvipgerð einstakra frumuhópa og með þeim er
meðal annars hægt að meta, út frá afbrigðilegu tjáningarmynstri yfirborðssameinda,
hvort plasmafrumur séu einstofna. Þrátt fyrir að slík greining sé ekki hluti af hefðbundnu
greiningarferli MGUS, getur hún veitt frekari upplýsingar samhliða hefðbundnum
blóðrannsóknum og mögulega leitt til nákvæmari greiningar og áhættumats
The interlinkages of design and effectiveness of governing bodies in the United Nations development system
Full text linkMultilateralism is encountering strong political headwinds at both the global and national level. The high
economic, social and environmental costs of recurrent crises like the COVID-19 pandemic, the war in Ukraine,
and climate change, have led to growing questions about the performance legitimacy of multilateralism. Many
multilateral institutions are no longer felt to be able to deliver the public value which was their original
reason for being. The UN Secretary-General, Antonio Guterres, in Our Common Agenda, has called for a
reinvigoration of multilateralism, including the institutions that sustain it like the United Nations.
The dissertation focuses on governance of the UN development system, a group of 43 entities that receive
contributions for operational activities for development that collectively accounted for about 75 per cent of all
the work of the Organization in 2021. More specifically, the dissertation examines whether the design of
governing bodies in the UN development system is correlated with their performance and, if so, which
institutional rules may be particularly important in this regard.
There has been limited research on the interlinkages of design and performance of governing bodies of
international organizations like those that are part of the UN development system, and the dissertation aims to
contribute to addressing this lacunae. A mixed method approach is applied to the research process by relying
on a combination of literature review, new data collection and UN management information systems.
Since 1969, Member States, the Secretary-General and other stakeholders have regularly commissioned expert
reports and studies on reform of the UN development system. The dissertation shows that the governance related recommendations that are common to this large number of expert reports and studies and advocating
for consolidation of governance structures, more precise rules stipulating representation and participation in
governing bodies, and enhanced working methods of governing bodies, have strong support from both
academic theory and empirical evidence.
The liberalization of funding rules and practices since the 1990s, resulting in an overwhelming share of
voluntary, strictly earmarked contributions for operational activities of the UN system, has been a major causal
driver of the many governance challenges facing the Organization. While the liberalization of funding rules and
practices has led to high growth in the volume of contributions, it has also fundamentally weakened the ability
of governing bodies to perform their mandated role and functions such as providing strategic guidance and
vision, ensuring policy implementation, monitoring organizational performance and having an effective
overview of the work of both entities and the UN development system as a whole. The volume, quality,
substantive focus and destination of operational activities of the UN system are now primarily determined by
the donors individually, not Member States collectively at the level of governing bodies. As a result, most
governing bodies in the UN development system no longer retain the authority to set programme priorities,
distribute funds, create new programmes, and provide oversight and accountability of programme delivery at
the country and global level. Another corollary of the liberalization of funding rules and practices has been
increased fragmentation, overlaps and duplication of activities, as UN entities have a strong incentive to
continuously expand their mandates and functions as a strategy to reduce resource uncertainty. This has led to
rapid growth in non-core functions, i.e., those activities not directly related to the core purposes and central
mandates of UN entities.
The design of most governing bodies in the UN development system has been underpinned by the principle of
equitable geographical representation. The application of this principle, however, doesn´t enable all Member
States to contribute equitably to intergovernmental decision-making. A review of the composition of governing
bodies in the UN development system reveals that a sizeable number of Member States do not participate in
II
the work of any governing body; the least-developed countries are significantly under-represented in
governing bodies; and high-income countries are much more likely to participate in the governance of UN
entities. In addition, the top programme and donor countries, which bear almost all the cost of
intergovernmental decision-making on operational activities, account for only a small share of the seats on
governing bodies in the UN development system.
The ability of central governing bodies like the General Assembly and ECOSOC to provide effective guidance,
coordination and oversight of the UN development system, including the implementation of system-wide
mandates, is limited, as their resolutions are not automatically implemented by entity-specific governing
bodies. The non-hierarchical character of inter-agency mechanisms like the United Nations Sustainable
Development Group, relying on voluntary participation and decision-making by consensus and not formally
accountable, through the Secretary-General, to central governing bodies, has also provided little incentives for
UN entities to capitalize on opportunities for synergy in programming and operations in the delivery of
operational activities. Member States have been reluctant to make inter-agency mechanisms like the UN
Sustainable Development Group formally accountable, through the Secretary-General, to central governing
bodies such as ECOSOC for the implementation of system-wide mandates.
The performance of governing bodies in the UN development system, when measured as their engagement and
ownership of the strategic planning process, varies significantly. Of the fourteen governing bodies subject to a
performance assessment, those of ICAO, IMO, WHO and FAO stood out in terms of their engagement and
ownership of the strategic planning process. In these four entities, the strategic planning process is led and
owned by the respective governing body (principal) rather than the organizational leadership (agent). Other
governing bodies play a less influential role in this process vis-à-vis the organizational leadership. Seven
institutional rules appear to be particularly important in explaining the strong ownership and engagement of
governing bodies of the strategic planning process, namely: (a) form of funding, (b) participation by technical
experts, (c) establishment of technical subsidiary bodies, (d) a technical decision-making process, (e) decisions
adopted by majority voting, (f) technically-oriented decisions and (g) criteria-based composition.
The findings of the research and analysis conducted in the dissertation show that many governing bodies in the
UN development system are not able to perform their mandated role and functions; representation in
governing bodies is often not equitable, transparent and effective; and central governing bodies like the General
Assembly and the Economic and Social Council are not equipped to ensure that UN entities operate as a
coherent system. Looking ahead, it may be particularly important for Member States to consider establishing a
unified governance arrangement for the UN development system; adopting equitable, transparent and effective
rules for the composition of governing bodies; ensuring the participation of experts in governance processes;
and strengthening the working methods of governing bodies, including the efficiency of meetings and
documentation and the quality of secretariat support
The establishment of European flounder (Platichthys flesus) in Icelandic waters
No full textBiological invasions are a global phenomenon representing one of the biggest threats to biodiversity. Addressing species introductions, often marked by context dependency, requires the incorporation of multiple perspectives and disciplines to develop adequate management approaches. As humans are involved on multiple levels along the invasion process, this should furthermore encompass the consideration of human dimensions. European flounder (Platichthys flesus), a flatfish species native to western Europe, has been documented in Iceland since 1999. In the following years, European flounder rapidly spread and now mainly occurs in estuaries but is often encountered in freshwater habitats. Here it spatially overlaps with native salmonids which represent valuable recreational species, making the recreational angling community in Iceland an important stakeholder group. The overall goal of this thesis was to integrate interdisciplinary approaches to address specific aspects of the establishment of alien European flounder in Iceland, including its geographic origin, distribution, and public perception. Additionally, the thesis aimed at using alien European flounder in Iceland as a case study to address larger-scale questions in the field of invasion science. In this thesis, the most likely origin of European flounder was identified as the Faroe Islands, utilizing microsatellite analysis. Following these results that revealed uncertainty concerning whether the species was introduced due to human activity or arrived naturally, the views of stakeholders and specialists concerning this uncertainty were assessed, indicating that the identification of a species’ introduction pathway is considered important but not prioritized over impact assessment and the development of management strategies. Involving the recreational angling community as a representative stakeholder group in the research has shown that European flounder is perceived highly negative but has furthermore highlighted spatial and temporal fluctuations in stakeholder perceptions. Exploring the knowledge of the recreational angling community further showed that utilizing stakeholder knowledge can represent a low-cost additional source in the monitoring of alien species. This thesis furthermore highlighted the dissensus of invasion science specialists regarding the terminology used to address and classify alien species.Ágengar tegundir eru ein stærsta ógnin við líffræðilega fjölbreytni á heimsvísu. Ágengar
tegundir eru í eðli sínu þverfaglegt viðfangsefni, enda byggir landnám og fótfesta í nýjum
heimkynnum á fjölda þátta bæði náttúrulegum og tengdum mannlegri hegðun og samfélagi.
Fólk tekur þannig þátt í mögulegri fótfestu ágengra tegunda og mætir einnig afleiðingunum
af þeim. Flundra (Platichthys flesus), flatfiskategund upprunnin í Vestur-Evrópu, fannst í
fyrsta skipti á Íslandi við Ölfusárósa árið 1999. Næstu árin dreifðist flundran hratt út og
finnst nú víða við strendur landsins, oft í árósum en líka í ferskvatnsbúsvæðum. Hún nýtir
því að hluta til sömu búsvæði og íslenskir laxfiskar, lax, urriði og bleikja, en þessar tegundir gegna mikilvægu vistkerfishlutverki og eru mikilvægar til stangveiði víða um land. Þannig er stangveiðisamfélagið á Íslandi mikilvægur haghópur þegar kemur að flundru.
Heildarmarkmið þessarar ritgerðar var að samþætta þverfaglegar nálganir til að fjalla um
fjölda þátta sem tengjast landnámi flundrunnar á Íslandi, þar á meðal landfræðilegan uppruna hennar, útbreiðslu og viðhorf almennings. Að auki var ritgerðinni ætlað að nota flundru á Íslandi sem dæmi um hvernig má takast á við stærri spurningar á sviði vistfræði ágengra tegunda. Í þessari ritgerð er sýnt með stuttraðagreiningu á erfðaefni að líklegasti uppruni flundrunnar á Íslandi er Færeyjar. Það er því enn óljóst hvort flundran barst til Ísland náttúrulega eða með kjölfestuvatni. Þessi óvissa skiptir máli fyrir fræðilegar skilgreiningar
á flundru sem ágengri tegund og voru sjónarmið bæði hagsmunaaðila og sérfræðinga til
þessarar óvissu metin með spurningakönnun. Niðurstöðurnar sýndu að greining á því
hvernig flundran nam land er talin mikilvæg af báðum hópum en ekki forgangsraðað fram
yfir rannsóknir á áhrifum og þróun stjórnunaráætlana. Frekari greining á
stangveiðisamfélaginu sem lykilhóp hagaðila sýndi mjög neikvætt viðhorf til flundru en
ennfremur staðbundnar og tímabundnar sveiflur í viðhorfum. Greining á gögnum um
staðsetningu flundrunnar úr hefðbundum leiðöngrum, rannsóknum og gögnum sem berast
beint frá hagaðilum að þekking hagsmunaaðila getur verið ódýr en áhrifarík leið til að bæta við vöktun framandi tegunda. Þessi ritgerð varpaði enn fremur ljósi á misræmi á milli
sérfræðinga í vistfræði ágengra tegunda þegar kemur að hugtakanotkun til að fjalla um og
flokka framandi tegundirRannsóknasjóður (the Icelandic Research Fund, Grant number 239953-051
Inclusion of immigrant students in Iceland: Interplay of practices in compulsory schools, teacher education and research
Full text linkThe rapid growth of immigration to Iceland in the past two decades has increased diversity in schools, sparking interest in educational research on multiculturalism and inclusion. This doctoral study investigates how schools, teacher education, and research practices influence immigrant students’ experiences in educational settings. Specifically, it examines how Icelandic compulsory schools, in rural and urban environments, along with teacher education and research, address opportunities for inclusion.
The primary research question guiding this study is: How do the education system and education research engage with immigrant students to promote, develop, and sustain inclusive practices that leverage everyone’s social, linguistic, and cultural resources? This study fills a gap in existing research on inclusive and multicultural education by examining the interplay among research, teacher education, and school practices. It contributes to scholarship by offering a more inclusive perspective on cultural diversity in education.
This research employs diverse qualitative methods, including observations, semi-structured interviews with educators and immigrant students, a collaborative self-study with teacher educators, and a critical autobiography that explores the researcher’s role. The data were coded, thematically analysed, and interpreted using the frameworks of inclusion, critical pedagogy, and the ecology of equity.
Key findings highlight the critical role of teachers as agents of inclusion. Despite having limited experience and/or resources, many teachers actively engage all students in learning. Local support and caring relationships in schools further enhance students’ sense of belonging. However, systemic challenges such as resource limitations and demographic changes require broader reforms. Findings from teacher educators emphasise the importance of fostering classroom dialogue to engage diverse student groups, while the researcher’s critical autobiography underscores the necessity of reflexivity to avoid imposing personal biases.
Together, these five articles provide theoretical, empirical, and practical insights into how inclusion of immigrant students is understood and enacted in schools, teacher education, and research. This work highlights the importance of cross-sector collaboration to promote equity and inclusion within Iceland’s increasingly diverse educational landscape.Hröð fjölgun innflytjenda til Íslands undanfarna tvo áratugi hefur aukið fjölbreytni í skólum og vakið áhuga menntarannsakenda á fjölmenningu og inngildingu. Í doktorsverkefninu er rannsakað hvernig skólar, kennaramenntun og rannsóknir hafa áhrif á nám og upplifun nemenda með innflytjendabakgrunn. Skoðað var hvernig íslenskir grunnskólar, bæði í dreifbýli og þéttbýli, ásamt kennaramenntun og rannsóknum, stuðla að tækifærum til inngildandi menntunar.
Meginrannsóknarspurning rannsóknarinnar var: Hvernig taka menntakerfið og menntarannsóknir þátt í að efla, þróa og viðhalda inngildandi starfsháttum sem nýta félagslegar, tungumála- og menningarlegar auðlindir allra? Ýmsar rannsóknir á menntun án aðgreiningar og fjölmenningar hafa verið gerðar, en þessi rannsókn bætir við með því að skoða samspil rannsókna, kennaramenntunar og skólastarfs. Niðurstöður hennar leggja sitt af mörkum til fræðanna með því að bjóða upp á inngildandi sýn á menningarlega fjölbreytni í menntun.
Í rannsókninni var fjölbreyttum eigindlegum aðferðum beitt við gagnaöflun, þar á meðal vettvangsathugunum, hálfopnum viðtölum við kennara og innflytjendabörn, starfstengdri sjálfsrýni í samvinnu við kennaramenntunarkennara og gagnrýna sjálfsævisögulega nálgun þar sem rýnt er í hlutverk rannsakandans. Gögnin voru kóðuð, þemu greind og túlkuð út frá fræðilegum ramma um skóla án aðgreiningar (inngildingar), gagnrýna kennslufræði og vistkerfi réttlætis.
Helstu niðurstöður varpa ljósi á mikilvægi kennara sem hreyfiafls í innleiðingu inngildandi menntunar. Þrátt fyrir takmarkaða reynslu eða úrræði leggja margir kennarar sig fram við að virkja alla nemendur í námi. Staðbundinn stuðningur og samskipti byggð á umhyggju innan skólanna styrkja tilfinningu nemenda fyrir því að þeir tilheyri. Hins vegar krefjast kerfislægar áskoranir, eins og takmarkaðar auðlindir og lýðfræðilegar breytingar, víðtækari umbóta. Viðbrögð frá kennurum í kennaramenntun undirstrika mikilvægi þess að efla samræður í kennslustofunni til að virkja fjölbreytta nemendahópa, á meðan gagnrýnin sjálfsævisaga rannsakanda sýnir fram á nauðsyn ígrundunar til að koma í veg fyrir að persónulegar forsendur hafi áhrif á niðurstöður.
Saman mynda greinarnar fimm fræðileg og hagnýt sjónarhorn byggð á reynslu á hvernig skólar, kennaramenntun og rannsóknir skilja og framkvæma inngildandi menntun fyrir innflytjendur. Rannsóknin dregur fram mikilvægi þverfaglegrar samvinnu til að efla jöfnuð og inngildingu í sífellt fjölbreyttara menntalandslagi Íslands.South Iceland Science and Research Fund (Vísinda- og rannsóknarsjóður Suðurlands); Development Fund for Immigration Issues (Þróunarsjóður innflytjendamála); Doctoral Grants of the University of Iceland Research Fund (Doktorsstyrkur Rannsóknasjóðs Háskóla Íslands)