Publikationer från Umeå universitet
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Becoming whole again—caring for the self in chronic illness—a narrative review of qualitative empirical studies
No full textAim and Objectives: To explore how chronic illness transforms the self when living with and managing chronic illness and what this means for their self and identity. We also discuss how people with chronic conditions could be supported by healthcare professionals to manage illness in daily life. Background: Self-management recommendations from health care are commonly based on a biomedical understanding of the disease. People's experiences of how a condition affects them and adequate support are crucial for their outcomes in daily self-management. Design: A narrative review. Methods: A systematic search was undertaken during January 2021 across the databases MEDLINE, CINAHL, PsycINFO, Soc INDEX and Philosopher's Index. A quality appraisal of articles was performed. Our analysis was inspired by qualitative content analysis. The PRISMA Checklist 2020/EQUATOR guidelines was used to report the study. Results: Twenty-eight peer-reviewed qualitative empirical articles focusing on self in a variety of chronic illnesses with relevance to nursing published from January 2010 to December 2020 were included. The main theme, Developing from an uncertain existence to meaning and wholeness, was built up by the five themes: Walking on an unstable ground; Being stalemated; Being involved with others for better or worse; Searching for meaning; and lastly, Modifying self and integrating a new way of living. Conclusions: The results illuminate experiences that seldom are prioritized but need to be addressed by health professionals. Such experiences are oriented more towards the existential self rather than medical issues, why it is important to go beyond the medical lens. Relevance to Clinical Practice: This is important knowledge for nurses aiming to support people with chronic illnesses. Nurses supporting people in self-management need to be aware that by teaching and encouraging people to revise their daily habits, they also work on the boundaries of their self-concept. Patient or Public Contribution: No patient or public contribution
Interprofessional collaboration in the care delivery pathway for patients with COPD–experiences of nurses and physical therapists : a qualitative study
No full textIntroduction: Patients with chronic obstructive pulmonary disease (COPD) often require treatment from different healthcare professionals at different levels of care. Previous research indicates shortcomings in interprofessional collaboration and rocky transitions between primary care, specialised care and long-term care. Aim: The aim was to explore how nurses and physical therapists experience their role in interprofessional collaboration and the care delivery pathway for patients with COPD. Methods: Semi-structured interviews were conducted with nurses (n = 4) and physical therapists (n = 7) from different levels of care between October 2020 and January 2021 and analysed using qualitative content analysis. Results: Insufficient time and continuity along with unclear routines were perceived as inhibiting interprofessional collaboration and transitions within the care delivery pathway. Dialogue between healthcare professionals was considered important to increase familiarisation with other professional roles and to enhance mutual support. Insufficient competence and low priority in healthcare was perceived as placing responsibility on the silent patient group to contact healthcare for follow-ups. Conclusions: This study provides insights into the experiences of nurses and physical therapists regarding several insufficiencies in interprofessional collaboration and the care delivery pathway. It is necessary to increase COPD-related competence among healthcare professionals, develop and clarify routines and provide conditions for dialogue between healthcare professionals
Decompressive craniectomy following subarachnoid hemorrhage : a prospective Swedish multicenter study
No full textIntroduction: Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden. Research question: To explore the risk factors and functional outcome associated with DC in patients with aSAH. Material and methods: Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding. Results: During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC. Discussion and conclusion: DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC
Adverse prognosis gene expression patterns in metastatic castration-resistant prostate cancer
No full textMetastatic castration-resistant prostate cancer (mCRPC) is a heterogeneous disease. Several studies have identified transcriptional subtypes of mCRPC, but comprehensive analysis of prognostic gene expression pathways has been limited. Therefore, we aggregated a cohort of 1012 mCRPC tissue samples from 769 patients and investigated the association of gene expression-based pathways with clinical outcomes and intrapatient and intratumor heterogeneity. Survival data were obtained for 272 patients. Pathway-level enrichment was evaluated using gene set variation analysis. scRNA-seq datasets from mCRPC tissue biopsies and circulating tumor cells were used to investigate heterogeneity of adverse pathways. We identified five pathway clusters: (a) Immune response/WNT/TGF-beta signaling, (b) AR signaling/luminal signatures, (c) mTOR signaling and glycolysis, (d) cell proliferation, and (e) neuroendocrine differentiation. Proliferation, AR signaling loss, and glycolysis/mTOR signaling were independently prognostic. Adverse prognostic pathway scores decreased on treatment with AR signaling inhibitors, but not at progression, suggesting failure to permanently target these pathways. scRNA-seq datasets from mCRPC tissue biopsies and circulating tumor cells were used to investigate heterogeneity of adverse pathways. Our results suggest loss of AR signaling, high proliferation, and a glycolytic phenotype as adverse prognostic pathways in mCRPC that could be used in conjunction with clinical factors to prognosticate for treatment decisions
School equipment and teaching ideals : socio-material change in the swedish school system 1865–2010
No full textThis thesis examines how changes in school equipment relate to changes in teaching ideals in the Swedish school system between 1865 and 2010. Three cases of changes in school equipment are examined in three sub-studies. The first sub-study explores how national guidelines for school desks covering the period 1865–1981 implicitly expressed specific teaching ideals. The second sub-study examines equipment requirements that arose in connection with changes in teaching ideals during the Swedish comprehensive school reform of 1949–1972. The third sub-study analyses how teaching ideals changed in conjunction with the introduction of new media technology in schools during the 1980s and in 2010. The thesis’s overarching research question addresses the significance of the origin and direction of change initiatives when school equipment and teaching ideals change. The source materials used in these studies consist of archival material from schools and authorities, printed official documents, teacher magazines, the local daily press, and teacher interviews. The thesis’s theoretical framework is based on a socio-material perspective whereby schools are studied as socio-material networks, and teaching ideals and school equipment shape each other. Additionally, concepts such as ‘historical path dependency’, ‘the grammar of schooling’, and ‘horizontal and vertical change initiatives’ also contribute to the analysis. Methodologically, the study follows a source-pluralistic and source-critical approach, which is supplemented by discourse analysis (in one sub-study). The results indicate that school equipment should not be seen merely as passive or neutral proposals for teaching. Historically, equipment has supported specific teaching ideals and has hindered or concealed others. While many teaching ideals have clearly changed during the period of investigation, older ideals have been reproduced over time because of ‘the path-dependent use of equipment’. However, school equipment has also changed based on how it is used or the ideals it is inter-related with. The results also indicate that the significance of the origin and direction of the change initiative shifts in character if such initiatives are vertical or horizontal to the school. Vertical change initiatives tend to function primarily as boundary setters for internal change within the school. Horizontal change initiatives, on the other hand, appear to take on great significance as trendsetters for the direction these changes take
Management of children with heterozygous familial hypercholesterolaemia worldwide : a meta-analysis
No full textAims; Heterozygous familial hypercholesterolaemia (HeFH) is one of the most frequent monogenic disorders in the world, leading to premature atherosclerotic cardiovascular diseases. The aim of this meta-analysis was to evaluate the efficacy and safety of lipid-lowering therapy (LLT) and achievement of low density lipoprotein cholesterol (LDL-C) goal in children with HeFH. Methods and results: The main endpoint was efficacy of goal achievement for LDL-C and other lipid parameters: total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), apolipoprotein B, and lipoprotein(a), and the LLT safety [adverse events (AEs), including endocrine function, and growth indices]. The secondary endpoint was an effect of LLT on attainment of LDL-C goal treatment (<3.5 mmol/L/130 mg/dL). A total of 41 studies with 4667 paediatric patients at mean age 12.08 ± 2.4 years were included. Seventeen reported the efficacy and safety of LLT therapy compared to control, while the remaining assessed LLT through pre- and post-treatment. At median follow-up of 18.8 months, the group on LLT had significantly higher mean reductions of TC, LDL-C, TG, and increased HDL-C compared to control [−1.75 mmol/L (−67.7 mg/dL), −1.84 mmol/L (−71.2 mg/dL), −0.11 mmol/L (−9.74 mg/dL), 0.08 mmol/L (3.1 mg/dL), respectively, P < 0.001 for all]. In the subgroup analysis according to different types of LLT, we observed a significantly higher mean reduction of LDL-C by statin combined with ezetimibe treatment, followed by statins in monotherapy, PCSK9 inhibitors, and monotherapy with ezetimibe [−2.48 mmol/L (−95.9 mg/dL), −2.16 mmol/L (−83.5 mg/dL), −2.03 mmol/L (−78.5 mg/dL), and −1.50 mmol/L (−58 mg/dL), respectively, test for overall effect: P < 0.001]. The pooled LDL-C was reduced by 33.44% [−2.14 mmol/L (−82.8 mg/dL), P < 0.001] and failed to reach the goal treatment (<3.5 mmol/L) by 12.6% (95% CI, 12.4-12.9%). A total of 38.7% of children achieved the LDL-C goal, 23.9% fell short by up to 10%, 10.7% experienced moderate failure (were over the LDL-C target between >10% and 20%), and 26.7% failed by more than 20% to reach the LDL-C target. When comparing different regions, only Sweden and Greece achieved the LDL-C goal < 3.5 mmol/L in the follow-up. Netherlands, Norway, Poland, USA, UK, France, Spain, Belgium, and Austria required 2.2%, 3.4%, 3.5%, 8.9%, 10.2%, 11.2%, 11.2%, 15%, and 19.4% additional reduction in LDL-C respectively to achieve the LDL-C goal of < 3.5 mmol/L. All other countries required over 20% additional reduction in LDL-C to achieve the LDL-C goal. For other investigated countries, over 20% mean LDL-C reduction was required. All parameters related to endocrine function and demographic indices were unaffected by LLT therapy (P > 0.05). The AEs were not reported significantly higher when compared to the control, and the prevalence of therapy discontinuation was only 0.8%. Conclusion: Despite the efficacy of LLT in children with HeFH and the low occurrence of discontinuation-related adverse events, achieving LDL-C treatment goals was relatively rare, with large differences between the investigated countries. These results underscore the importance of considering early combination therapy of statins and ezetimibe, and PCSK9 inhibitors (if available) to attain LDL-C goals effectively
National identity and democratic trajectories
No full textThis study examines whether public attitudes of national belonging influence levels of democracy. We investigate how non-voluntary perceptions of national belonging–requirements of ancestral ties–affect the development across 63 countries over three decades. We analyze both the bottom-up effects of public attitudes and the top-down influence of political elites’ nationalist articulation. Our results show that countries where the majority holds a non-voluntary national identity tend to have lower levels of democracy. Furthermore, these challenges to democratic governance are amplified when non-voluntary national identity interacts with nationalist political articulation by elites. Longitudinal analyses reveal that countries with a stronger emphasis on non-voluntary identity experience a greater decline in formal democracy over time, suggesting an inherent incompatibility between non-voluntary national identity and democratic principles. By explicitly linking majority public attitudes about national belonging to democratic outcomes, our study offers new empirical insights into the relationship between national identity and democracy
Using fuzzy set qualitative comparative analysis to identify conditions for good performance in the decentralized health system of Tanzania
No full textBackground: Decentralization has been a prominent strategy to enhance health systems’ efficiency, service quality, autonomy and accountability in low- and middle-income countries (LMICs) like Tanzania since the 1990s. Previous studies have mainly focused on assessing how much power for decision-making on different health system functional areas is granted to local-level authorities from the central government and the interconnections between decision space, organizational capacity, and accountability mechanisms. Empirical evidence on its impact on performance remains limited. This study investigates conditions for good performance in a decentralised health system of Tanzania. Methods: We used fuzzy set qualitative comparative analysis to analyse the necessary and sufficient conditions for good health system performance. Eighteen purposively districts were chosen to capture variations in performance and geography in a multiple case study approach. Results: Functional Health Facility Governing Committees (HFGCs) emerged as a necessary condition for good performance. To achieve good performance, however, there is a need for functional decision space among managers or high accountability among managers or high capacity of staff/ okay level of staffing. Conclusion: The study underscores the importance of the interplay between decision space, organizational capacity, and accountability in improving health system performance. While decentralization aims to provide greater autonomy, effective implementation depends on the development of local capacities and oversight through accountability. Decentralization alone is not sufficient to enhance healthcare delivery; HFGCs and their local context that promote (social) accountability are essential. Further research is warranted to identify interventions supporting HFGCs in fulfilling their mandates and enhancing health service delivery.
Termokemiska egenskaper och kvalitetsmått för kalksten och bränd kalk
No full textThe quality of limestone is crucial for limestone suppliers, as is that of quicklime to its producers and their customers. Quality requirements vary depending on the industrial application, and understanding the factors affecting quality is of great importance in industry. Quicklime is produced via the calcination of limestone in high-temperature kilns—a process that emits large quantities of carbon dioxide (CO2). Increased knowledge of the factors influencing quicklime quality would help reduce the associated CO2 emissions, increase material efficiency, and reduce energy consumption, while increased knowledge of the chemical composition of the raw materials would make the mining process more efficient. A thermal decrepitation study was performed on 80 limestone samples. This involved analyzing the chemical composition, thermal decrepitation, and crack formation. The results of this study showed that thermal decrepitation does not correlate with the chemical composition of limestone. Instead, it was suggested that that thermal decrepitation can be explained by the thermally induced formation of cracks. Slaking reactivity experiments were performed on quicklimes produced in a CO2 atmosphere at various calcination times and temperatures. The specific surface areas of the quicklime samples were measured and correlated with the calcination times and temperatures. Based on statistical analysis of the experimental data, the highest-reactivity quicklime was obtained at a low calcination temperature and medium-to-long calcination time, while the quicklimes with the highest specific surface areas were obtained at low calcination temperatures and low calcination times. A carbonation study was carried out to investigate the effect of different atmospheres on the carbonation of quicklimes derived from two types of limestones: sedimentary and metamorphic. Three different carbonation atmospheres were investigated, one represented the flue gas in a conventional fuel-fired kiln and the other two an electrically heated kiln with dry and wet limestone feeds, respectively. It was found that the carbonation of quicklime varies, depending on the gas composition and limestone type. Trace element analysis was performed on stromatoporoid limestone, crinoid limestone, reef limestone, fragmentary limestone, marl consolidated, marl soft, and clay layer. Zinc (Zn) and lead (Pb) concentrations were determined by means of two different spectroscopy methods, one of which was performed on bulk samples, while the other was performed on phases within the samples. The results showed that the highest Zn and Pb concentrations were found in the silicon (Si)-rich phases of the marl soft and clay layer
Evaluation of software-optimized protocols for acoustic noise reduction during brain MRI at 7 Tesla
No full textBackground: MR-generated acoustic noise may be particularly concerning at 7-Tesla (T) systems. Noise levels can be reduced by altering gradient output using software optimization. However, such alterations might influence image quality or prolong scan times, and these optimizations have not been well characterized. Purpose: To evaluate image quality, sound pressure levels (SPLs), and perceived noise levels when using the acoustic noise reduction technique SofTone for T2-weighted fast spin echo (T2W FSE) and three-dimensional T1-weighted turbo field echo (3D T1W TFE), and to compare with conventional imaging during 7-T brain MRI. Study Type: Prospective. Subjects: Twenty-eight volunteers underwent brain MRI, with n = 26 for image quality evaluations. Field Strength/Sequence: Conventional and SofTone versions of T2W FSE and 3D T1W TFE at 7 T. Assessment: Peak SPLs (A-weighted decibels, dBA), participant-perceived noise levels (Borg CR10-scale), qualitative image assessments by three neuroradiologists (four-graded ordinal scales), interrater reliability, and percentage agreement. Statistical Test: Paired t-test, Wilcoxon's Signed-Rank Test, and Krippendorff's alpha; p < 0.05 were considered statistically significant. Results: SofTone significantly reduced peak SPLs: from 116.3 to 97.0 dBA on T2W FSE, and from 123.7 to 101.5 dBA on 3D T1W TFE. SofTone was perceived as significantly quieter than conventional scanning. T2W FSE showed no significant differences in image quality assessments (p = 0.21–1.00), except one radiologist noting significantly less artifact interference with SofTone. General image quality remained acceptable for 3D T1W TFE, though one radiologist scored it significantly lower with SofTone (mean scores: 3.08 vs. 3.65), and two radiologists observed significantly worse white and gray matter differentiation with SofTone (mean scores: 3.19 vs. 3.54; 2.27 vs. 2.81). Data Conclusion: SofTone can significantly reduce sound intensity and perceived noise levels while maintaining acceptable image quality with T2W FSE and 3D T1W TFE in brain MRI. It appears to be an effective tool for providing a safer, quieter 7-T scan environment. Evidence Level: 4. Technical Efficacy: Stage 5