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  • 2651.
    Carling, Kenneth
    et al.
    Dalarna University, School of Technology and Business Studies, Statistics.
    Rönnegård, Lars
    Dalarna University, School of Technology and Business Studies, Statistics.
    Roszbach, Kasper
    Is Firm Interdependence within Industries Important for Portfolio Credit Risk?2004Report (Other academic)
    Abstract [en]

    A drawback of available portfolio credit risk models is that they fail to allow for default risk dependency across loans other than through common risk factors. Thereby, thesemodels ignore that close ties can exist between companies due to legal, financial and business relations. In this paper, we integrate the insights from theoretical models of default correlation into a commonly used model of default and portfolio credit risk by allowing for dependency between firm default risk through both common factors and industry specific errors in a duration model. An application using pooled data from two Swedish banks’ business loan portfolios over the period 1996-2000 shows that estimates of individual default risk are little affected by including industry specific errors. However, accounting for these industry effects increases VaR estimates by 50-200 percent. A traditional model with only systematic factors, although able to fit the broad trends in credit losses, cannot match these fluctuations because it fails to capture credit losses in bad times, when banks are typically hit by large unexpected credit losses. The model we propose manages to follow both the trend in credit losses and produce industry driven, time-varying, fluctuations in losses around that trend. Consequently, this model will better aid banks and regulators in determining the appropriate size of economic capital requirements. Capital buffers derived from our model will be larger for periods with large ”aggregate” disturbances and smaller in better times, and avoid both overcapitalization in good times and undercapitalization in bad times.

  • 2652.
    Carlos Marelli, Ezequiel
    Dalarna University, School of Humanities and Media Studies, Spanish.
    Noche, mar y soledad: Representaciones metafóricas en Veinte poemas de amor y una canción desesperada de Pablo Neruda2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2653.
    Carlos Valladares Segovia, Juan
    Dalarna University, School of Humanities and Media Studies, Spanish.
    APORTACIONES DIDÁCTICAS EN LOS LIBROS DE TEXTO Y SU RELACIÓN CON LA ANSIEDAD ANTE EL APRENDIZAJE DE UNA LENGUA EXTRANJERA: Una exploración cualitativa de tres libros de texto de español como lengua extranjera paso 1 de educación secundaria2016Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study is to identify the construct of communicative competence promoted in three textbooks of Spanish as a foreign language and to determine its relationship with the emotional variable of anxiety. To achieve our research approaches, we conduct a qualitative investigation, employing the questionnaire analysis NAKIBAR 2004 developed by Joseba Ezeiza Ramos (2004). The results show that the three teaching materials analyzed satisfy the communicative teaching approach in various degrees. However, all three books are the externalization of the communicative model, with the specific purpose of supporting students to develop the ability to put in function communication processes. This strong tendency to use oral language can in some cases lead to feelings of anxiety.

  • 2654.
    Carlqvist, Anneli
    Dalarna University, School of Technology and Business Studies, Environmental Engineering.
    Impact of heating system design on the performance of a solar combisystem2006Independent thesis Advanced level (degree of Master (Two Years))Student thesis
    Abstract [en]

    A solar combisystem is to replace a non-solar heating system in a single family house during 2006. It consist of two 60*60 units; a water storage tank and a technical unit. This solar combisystem was developed during the REBUS-project that aims to develop solar combisystem for Nordic conditions. The water storage tank has a solar storage volume and a hot water stand-by volume. The technical unit contains a condensing gas boiler, heat exchangers, pumps, switching valves, expansion vessel and control components. To work optimally, the REBUS solar combisystem needs low temperature strategy (<60°C). Both the solar collector and the natural condensing gas boiler benefit from low temperatures. This is mainly provided by having a low temperature Space Heating system. The Domestic Hot Water draw offs are at high temperature but during short periods. Space Heating is demanded continuously during a larger part of the year and was 85 % of the total annual heating energy consumption year 2005. To get a better understanding of the heating system’s impact on the REBUS solar combisystem, evaluation of measurement data from the single family house heating system was carried out during spring 2006. The interaction between the different components of the heating system was characterized. To get a view of the energy demand, losses and savings, a pre-study of different temperature and flow control strategies that could meet the space heating energy load was done with Trnsys simulations. The evaluation showed the importance of having a good control strategy for interaction between the Domestic Hot Water heating, the gas boiler, correct adjustment of the Space Heating, and the inhabitants living conditions. A bad adjusted heating system might give higher energy consumption and irregular heating. The simulations showed that it is possible to use lower temperature and flow rates and still fulfil the Space Heating load. In addition, the natural gas energy consumption could be reduced by 15%. The solar saving fractions calculated gave a range of 12-16% depending on control strategy.

  • 2655.
    Carlson, Per
    Stockholms universitet.
    Självskattad hälsa och vådliga beteenden i transitionens Ryssland2000In: Sociologisk forskning, ISSN 0038-0342, Vol. 37, no 1, p. 150-179Article in journal (Refereed)
    Abstract [en]

    In this paper it is hypothesised that individuals’ ability to cope with the Russian transition is socially structured and will give rise to health differences and differences in ‘risk behaviours’. Since self-rated health and mortality represent different dimensions of public health and since risk behaviours have been closely related to mortality, we wanted to examine whether (poor) self-rated health on the one hand and risk behaviours on the other can be attributed to different causes. The Taganrog household survey was conducted in the form of face-to face interviews and included 1009 individuals and their families.The survey was carried out January to December 1998. To estimate health differences and differences in risk behaviours between groups, logistic regressions were performed. In Taganrog between 1993/94 and 1998, changes in public health, (here self-rated health), seem to have been much more dramatic than changes in smoking and different in direction than changes in heavy alcohol consumption. Moreover, self-rated ‘poor’ health was more common among those whose economic situation was worse 1998 than ten years before. However, having a poorer economy during the period 1988-1998, does not seem to have affected drinking or smoking habits significantly. In general, self-rated health seems to be more closely related to three indicators of economic circumstances. Risk behaviours are certainly im portant for the poor state of public healthin Russia, but may be not closely connected to the economic aspects of the transition.

  • 2656.
    Carlson, Per
    et al.
    Stockholms universitet.
    Mäkinen, Ilkka
    Stockholms universitet.
    Vågerö, Denny
    Stockholms universitet.
    Självmord, mord och kultur. En jämförelse av tio länder i Europa1994In: Sociologisk forskning, ISSN 0038-0342, Vol. 31, no 4, p. 78-89Article in journal (Refereed)
    Abstract [en]

    Suicide, homicide and culture. A comparison of ten european countries

    The present study investigates the way in which the homicide and suicide rates of ten European countries are related to each other. Is there empirical support for a psychoanalytically based hypothesis of a reverse relationship between homicide and suicide? Or are certain cultural values and patterns more important for such links? Rank correlations and regressions of age-standardised suicide and homicide rates, for men and women in the European countries were conducted. Similar analyses in relation to values as defined by World Values Survey were also performed. There was a slight tendency for countries with high homicide rates to have low suicide rates, and vice versa (among men). For women, however, the relationship was found to be positive and stronger throughout. Countries with high female homicide rates often also had high female suicide rates. The cultural values which could be associated most closely with suicide and homicide rates were religiously and sexually coloured moral attitudes. Suicide rates were lower in countries where God plays a greater role in peoples’ consciousness. Countries where attitudes to abortion, euthanasia, divorce etc were negative, usually also had lower suicide rates for both sexes. The relationship between homicide rates and these attitudes was, for men, the opposite. In countries with a strong belief in God and low religious and sexual tolerance the male but not the female risk of being murdered is higher than in countries with a weaker belief in God. The hypothetical relation between homicide and suicide rates, suggested by psychoanalytically inspired theories, seems to be more readily explained by cultural patterns, in particular a complex of attitudes towards religious and sexual matters.

  • 2657.
    Carlson, Åsa
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Söderström, Monica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Vuxna personers upplevelser av att leva med diabetes typ 2: En litteraturöversikt2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Diabetes mellitus will be the seventh leading cause of death in 2030 and 422 million adults in the world are currently living with diabetes. Type 2 diabetes account for the vast majority of people affected with the disease. Diabetes can result in a variety of serious complications. Making lifestyle changes is a central part of the treatment and the patient’s ability to self-manage the disease is therefore emphasised. Nurses are responsible for providing high quality nursing care, and this includes collecting information about the patient and strengthening the patient’s ability for self-care.

    Aim:

    To describe adult persons’ experiences of living with diabetes type 2.

    Method:

    A literature review of 16 qualitative articles, which were critically reviewed, analyzed and compiled.

    Result:

    The persons’ experiences are presented in three main categories with associated subcategories. The emotional aspects of living with diabetes were prominent and many had difficulties adapting to a new lifestyle. Relationships were affected and social support was seen as important.

    Conclusion:

    Living with diabetes can cause emotional reactions and making lifestyle changes is a struggle for many. The social support from family and friends is important and receiving feedback, information and support from doctors and nurses regarding self-care is also of great importance.

  • 2658. Carlsson, A. C.
    et al.
    Riserus, U.
    Engstrom, G.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Melander, O.
    Leander, K.
    Gigante, B.
    Hellenius, M-L
    de Faire, U.
    Novel and established anthropometric measures and the prediction of incident cardiovascular disease: a cohort study2013In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 37, no 12, p. 1579-1585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to compare novel and established anthropometrical measures in their ability to predict cardiovascular disease (CVD), and to determine whether they improve risk prediction beyond classical risk factors in a cohort study of 60-year-old men and women. We also stratified the results according to gender to identify possible differences between men and women. Furthermore, we aimed to replicate our findings in a large independent cohort (The Malmo Diet and Cancer study-cardiovascular cohort).

    METHODS: This was a population-based study of 1751 men and 1990 women, aged 60 years and without CVD at baseline, with 375 incident cases of CVD during 11 years of follow-up. Weight, height, waist circumference (WC), hip circumference and sagittal abdominal diameter (SAD) were measured at baseline. Body mass index (BMI), waist-hip ratio (WHR), waist-hip-height ratio (WHHR), WC-to-height ratio (WCHR) and SAD-to-height ratio (SADHR) were calculated.

    RESULTS: All anthropometric measures predicted CVD in unadjusted Cox regression models per s.d. increment (hazard ratios, 95% confidence interval), while significant associations after adjustments for established risk CVD factors were noted for WHHR 1.20 (1.08-1.33), WHR 1.14 (1.02-1.28), SAD 1.13 (1.02-1.25) and SADHR 1.17 (1.06-1.28). WHHR had higher increases in C-statistics, and model improvements (likelihood ratio tests (P<0.001)). In the replication study (MDC-CC, n = 5180), WHHR was the only measure that improved Cox regression models in men (P = 0.01).

    CONCLUSION: WHHR, a new measure reflecting body fat distribution, showed the highest risk estimates after adjustments for established CVD risk factors. These findings were verified in men but not women in an independent cohort.

  • 2659.
    Carlsson, A C
    et al.
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
    Riserus, Ulf
    Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Public Health and Caring Sciences/Section of Geriatrics Uppsala University, Uppsala, Sweden.
    Borné, Y
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Leander, K
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gigante, B
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hellénius, M-L
    Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Bottai, M
    Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Sweden.
    de Faire, U
    Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
    Prediction of cardiovascular disease by abdominal obesity measures is dependent on body weight and sex: results from two community based cohort studies2014In: NMCD. Nutrition Metabolism and Cardiovascular Diseases, ISSN 0939-4753, E-ISSN 1590-3729, Vol. 24, no 8, p. 891-899Article in journal (Refereed)
    Abstract [en]

    AIM: To study waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), and waist-hip-height ratio (WHHR) as predictors of CVD, in men and women stratified by BMI (cut-off ≥25).

    METHODS AND RESULTS: A cohort of n = 3741 (53% women) 60-year old individuals without CVD was followed for 11-years (375 CVD cases). To replicate the results, we also assessed another large independent cohort; The Malmö Diet and Cancer study - cardiovascular cohort (MDCC, (n = 5180, 60% women, 602 CVD cases during 16-years). After adjustment for established risk factors in normal-weight women, the hazard ratio (HR) per one standard deviation (SD) were; WHR; 1.91 (95% confidence interval (CI) 1.35-2.70), WC; 1.81 (95% CI 1.02-3.20), SAD; 1.25 (95% CI 0.74-2.11), and WHHR; 1.97 (95% CI 1.40-2.78). In men the association with WHR, WHHR and WC were not significant, whereas SAD was the only measure that significantly predicted CVD in men (HR 1.19 (95% CI 1.04-1.35). After adjustments for established risk factors in overweight/obese women, none of the measures were significantly associated with CVD risk. In men, however, all measures were significant predictors; WHR; 1.24 (955 CI 1.04-1.47), WC 1.19 (95% CI 1.00-1.42), SAD 1.21 (95% CI 1.00-1.46), and WHHR; 1.23 (95% CI 1.05-1.44). Only the findings in men with BMI ≥ 25 were verified in MDCC.

    CONCLUSION: In normal weight individuals, WHHR and WHR were the best predictors in women, whereas SAD was the only independent predictor in men. Among overweight/obese individuals all measures failed to predict CVD in women, whereas WHHR was the strongest predictor after adjustments for CVD risk factors in men.

  • 2660. Carlsson, A. C.
    et al.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Sundström, J.
    Michaëlsson, K.
    Byberg, L.
    Lind, L.
    Physical activity, obesity and risk of cardiovascular disease in middle-aged men during a median of 30 years of follow-up2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 4, p. 359-365Article in journal (Refereed)
    Abstract [en]

    Background: We aimed to investigate associations between combinations of body mass index (BMI)-categories, levels of physical activity and long-term risk of cardiovascular disease.

    Method and results: At age 50 years, cardiovascular risk factors were assessed in 2196 participating men of the ULSAM-study. This investigation was repeated at age 60, 70, 77 and 82 years. Being physically active (PA) was defined as three hours of recreational or hard physical training per week. The men were categorized according to BMI/PA-status, as PA/normal weight (n = 593 at baseline), non-PA/normal weight (BMI &lt; 25 kg/m2, n = 580), PA/overweight (n = 418), non-PA/overweight (BMI 25-30 kg/m2, n = 462), PA/obese (n = 62), non-PA/obese (BMI &gt;30 kg/m2, n = 81). We used updated data on BMI and physical activity obtained at all examinations. During follow-up (median 30 years) 850 individuals suffered a cardiovascular disease (myocardial infarction, stroke or heart failure). Using updated data on BMI/PA categories, an increased risk for cardiovascular disease was seen with increasing BMI, but a high physical activity was associated with a lower risk of cardiovascular disease within each BMI category: non-PA/normal weight (hazard ratio (HR) 1.31, 95% confidence interval (CI) 1.04-1.66), PA/overweight (HR 1.52, 95% CI 1.20-1.94), non-PA/overweight (HR 1.65, 95% CI 1.31-2.07) PA/obese (HR 2.05, 95% CI 1.44-2.92) and non-PA/obese (HR 2.39, 95% CI 1.74-3.29), using PA/normal weight men as referent.

    Conclusions: Although physical activity was beneficial at all levels of BMI regarding the risk of future cardiovascular disease, there was still a substantial increased risk associated with being overweight or obese during 30 years of follow-up. 

  • 2661. Carlsson, A C
    et al.
    Östgren, C J
    Länne, T
    Larsson, A
    Nystrom, F H
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    The association between endostatin and kidney disease and mortality in patients with type 2 diabetes2016In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 42, no 5, p. 351-357Article in journal (Refereed)
    Abstract [en]

    AIM: Circulating endostatin, a biologically active derivate of collagen XVIII, is considered to be a marker of kidney disease and a risk factor for its related mortality. However, less is known of the role of endostatin in diabetes and the development of diabetic nephropathy. For this reason, our study investigated the associations between circulating endostatin and the prevalence and progression of kidney disease, and its mortality risk in patients with type 2 diabetes (T2D).

    METHODS: This was a cohort study of 607 patients with T2D (mean age: 61 years, 44% women). Estimated glomerular filtration rate (eGFR), calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation, was used to assess the patients' kidney function decline and mortality.

    RESULTS: Of the total study cohort, 20 patients declined by ≥20% in eGFR over 4 years, and 44 died during the follow-up (mean duration: 6.7 years). At baseline, participants with diabetic nephropathy (defined as eGFR<60mL/min/1.73m(2)) and/or microalbuminuria [defined as a urinary albumin-to-creatinine ratio (ACR)>3g/mol] had higher median levels of endostatin than those without nephropathy (62.7μg/L vs 57.4μg/L, respectively; P=0.031). In longitudinal analyses adjusted for age, gender, baseline eGFR and ACR, higher endostatin levels were associated with a higher risk of decline (≥20% in eGFR, OR per 1 SD increase: 1.73, 95% CI: 1.13-2.65) and a higher risk of mortality (HR per 1 SD increase: 1.57, 95% CI: 1.19-2.07).

    CONCLUSION: In patients with T2D, circulating endostatin levels can predict the progression of kidney disease and mortality independently of established kidney disease markers. The clinical usefulness of endostatin as a risk marker in such patients merits further studies.

  • 2662.
    Carlsson, Alexander
    et al.
    Dalarna University, School of Education and Humanities, Educational Work.
    Rydén, Emelie
    Dalarna University, School of Education and Humanities, Educational Work.
    En högpresterande elevs situation i skolan: En jämförande studie mellan pedagoger och högpresterande elever2008Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Syftet med examensarbetet är att undersöka vad pedagoger har för attityder till högpresterande elever och hur de upplever att ha högpresterande elever i skolan både ur ett pedagogiskt perspektiv samt ett socialt perspektiv. Hur de anpassar sin undervisning för dessa elevers behov och vilka metoder de använder sig av i sin undervisning. Vidare har uppsatsen som mål är att göra en jämförelse mellan detta och hur högpresterande elever själva, i årskurserna fyra till sex, upplever sin situation i skolan idag. Att hitta likheter och skillnader mellan forskning och aktörer i skolans verksamhet. För att få reda på detta har vi valt att genomföra djupintervjuer med pedagoger och en enkätundersökning med högpresterande elever. Utifrån rådande forskning har vi sökt information om inlärningsstilar, intelligens, individualisering och resursfördelning. Vi har dragit följande slutsatser; att vissa resultat pekar i motsatt riktning mot vad tidigare forskning och tidigare undersökningar kommit fram till. Tidigare forskningen menar att resurserna fördelas ojämnt och att de högpresterande eleverna inte får alls samma mängd som sina klasskamrater. De pedagoger vi intervjuat menar däremot att eleverna visst får sin resursdel men i en annan form, nämligen i förberedelserna till undervisningen då dessa elever i regel är mer självgående och klarar av större och mer långsiktiga mål. Vidare pekar vår undersökning på att det finns en tillräckligt hög procent av elever för att enligt oss ses som oroväckande hög, som upplever sig orättvist behandlade i skolan. Avslutningsvis så ställer vi oss efter denna undersökning frågande till hur pedagoger egentligen ser på ett individualiserat arbetssätt för en högpresterande elev.

  • 2663.
    Carlsson, Alexandra
    et al.
    Dalarna University, School of Technology and Business Studies, Graphic Arts Technology.
    Tängerfors, Daniel
    Dalarna University, School of Technology and Business Studies, Graphic Arts Technology.
    Framtagning av Rockmotion Films visuella identitet2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The use of moving pictures has become far more common. Since more people

    use moving pictures it has become more important for film producers to

    distinguish themselves from their competitors with a visual identity. This study

    has been conducted in collaboration with Rockmotion Film HB, a company

    specialized in making videos for music and entertainment businesses. Since the

    beginning Rockmotion Film have been missing a complete visual identity

    which for a company is necessary to be seen as serious.

    The purpose with this study was to create a new visual identity and redesign the

    existing logotype based on Rockmotion Film’s core values and vision. The

    study began with a semi-structured interview with the company to gather

    necessary information about the company. In addition, a visual content analysis

    was made to gain perception of the competitors' visual identities. Through

    surveys and a focus group, the produced material has been tested to obtain a

    final suggestion.

    The result of this thesis is a simple and catching visual identity that complies

    with the core values, personal, youthful and professional as well as the client's

    vision of the visual identity.

  • 2664.
    Carlsson, Amanda
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Lindström, Camilla
    Dalarna University, School of Education, Health and Social Studies, Sport and Health Science.
    Skador inom svensk judo: Skadade strukturer, skadefrekvens, köns- och åldersskillnader.2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Judo is a complex sport that places great demands on the judoka, which means there is a risk for injuries in judo.

    The aim of this study is to analyze how male and female judokas experience injuries and mechanisms where injuries appear in Swedish judo. This was done by publishing a survey on a judo group on Facebook.com. Previously collected data and data from Provins Insurance AB was used.

    Most injuries happened during exercise and usually under tachi waza and mainly tachi waza randori. Achi waza was the mechanism that caused the most injuries to women and for men it was achi waza and te waza.

    The technics that caused the most injuries were O soto gari, which caused ligament damage in the knee, and Seoi Nage caused various types of injuries.

    On competition the most common mechanism for injuries for both men and women was te waza. The technics were Seoi nage and Tai Otoshi.

    With this study results, previous data and statistics from Provins Insurance AB in combination with previous studies, some conclusions can be reached on the most frequent injuries and how they occur. It is also possible to draw conclusions about how participants were affected in their daily life after the injury.

    This can provide an insight as to what injuries the sports movement should focus on trying to counteract.

  • 2665.
    Carlsson, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Andersson, Linda
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Faktorer som bidrar till ett stabilare mående hos patienter med emotionellt instabil personlighetsstörning i heldygnsvård: en kvalitativ intervjustudie ur ett patientperspektiv2016Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Patients with emotional unstable personality disorder is experienced as a

    difficult to treat patient population in inpatient care. Nursing staff knowledge surrounding the

    introduction and the treatment of this patient population is diverse, which means that the care

    is different. This can result in increased suffering of the patient and frustration in the staff

    group.

    Aim: The aim of the study was to describe factors that contribute to a more stable mood in

    patients with emotionally unstable personality disorder.

    Method: The method that has been used is a qualitative design with inductive approach. The

    study was based on six interviews with informants that who were patients diagnosed with

    emotionally unstable personality disorder. The interviews were analyzed using content

    analysis.

    Result: The results showed that the hospitality and commitment of the staff was of great

    importance. Structure and participation were other important factors for achieving a stable

    mood. It was revealed that inpatient care could contribute to an interruption of everyday life

    and meaningful activities were another important factor that emerged.

    Conclusion: Patients experienced to be treated as an individual by committed staff and to be

    involved in their care was part of the process towards a stable mood. Inpatient care structure

    and change of environment support for recovery and an opportunity to regain routines. There

    was a desire for more meaningful activities such as physical activity and psycho education to

    best take advantage of the period of care

  • 2666.
    Carlsson, Anna
    et al.
    Dalarna University, School of Technology and Business Studies, Business Administration and Management.
    Hebert, Julia
    Dalarna University, School of Technology and Business Studies, Business Administration and Management.
    Digitalisering: En studie om organisationers lärande och effektivitet2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Digitalization has affected organizations and many work activities have changed as a result, there including how members of organizations share knowledge between each other. Knowledge is one of the most important resource in an organization whereof digital knowledge more easily can be accessed, utilized and spread to members of the organization. It is important to take charge of the knowledge already existing within the organization and share it between members of the organization as it can result in competitive advantages.

    The purpose of the study has been to develop an understanding of how knowledge sharing within organizations is affected by digitalization. To achieve the purpose of the study, a qualitative method was used and interviews were carried out with respondents in higher positions of a selected organization, within the construction industry. The conclusion indicates that digitalization has made knowledge more effective to share. Since knowledge is available in digital form it has contributed to better accessibility, where several members of the organization can utilize the knowledge at the same time. In addition, the knowledge can be shared more quickly and across geographical distances, which has led to that knowledge can be shared less costly and more time efficiently.

  • 2667.
    Carlsson, Anneli
    Dalarna University, School of Languages and Media Studies, Spanish.
    "¡Cáncer es una mujer pegada como una sanguijuela sesenta años succionándole el alma!": Un examen de los rasgos misóginos en la novela El desbarrancadero de Fernando Vallejo2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    El desbarrancadero, published in 2001 by Colombian author Fernando Vallejo is foremost a moving story about brotherly love, but it is also a highly critical novel that lashes out on a number of phenomena such as the catholic church, the Pope and the very idea of religion. It also addresses the poverty of Colombia, its corrupt politicians, the drug trade, viral diseases and animal abuse to mention a few more subjects. This essay however, does not aim to explore any of the above mentioned matters but rather examine how women are portrayed in this novel. The objective of this investigation, based on feminist theories, is to establish the very clear presence of misogyny attitudes.

  • 2668.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden ; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Calamia, Michael
    Landstinget Dalarna, Falun, Sweden.
    Risérus, Ulf
    Department of Public Health and Caring Sciences/Section of Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Kidney injury molecule (KIM)-1 is associated with insulin resistance: results from two community-based studies of elderly individuals2014In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 103, no 3, p. 516-21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Insulin resistance has been shown to be closely associated with glomerular filtration rate and urinary albumin/creatinine ratio, even prior to the development of diabetes. Urinary kidney injury molecule 1 (KIM-1) is a novel, highly specific marker of kidney tubular damage. The role of insulin resistance in the development of kidney tubular damage is not previously reported. Thus, we aimed to investigate the associations between insulin sensitivity (assessed by HOMA) and urinary KIM-1.

    DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Two community-based cohorts of elderly individuals were investigated: Prospective Investigation of the vasculature in Uppsala seniors (PIVUS, n=701; mean age 75 years, 52% women); and Uppsala Longitudinal Study of adult men (ULSAM, n=533; mean age 78 years).

    RESULTS: Lower insulin sensitivity was associated with higher urinary KIM-1 in both cohorts after adjustments for age, BMI, blood pressure, antihypertensive treatment, glomerular filtration rate, and urinary albumin-creatinine ratio (PIVUS: regression coefficient for 1-SD higher HOMA-IR 0.11, 95% CI 0.03-0.20, p=0.009, and ULSAM: 0.13, 95% CI 0.04-0.22, p=0.007). Results were similar in individuals without diabetes, with normal kidney function and normo-albuminuria.

    CONCLUSIONS: Our findings in elderly individuals support the notion that the interplay between an impaired glucose metabolism and renal tubular damage is evident even prior to the development of diabetes and overt kidney disease.

  • 2669. Carlsson, Axel C.
    et al.
    Carrero, Juan-Jesus
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Endostatin, cathepsin S, and cathepsin L, and their association with inflammatory markers and mortality in patients undergoing hemodialysis2015In: Blood Purification, ISSN 0253-5068, E-ISSN 1421-9735, Vol. 39, no 4, p. 259-265Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Although both endostatin and cathepsins S have been associated with higher mortality, data in patients with end-stage renal disease (ESRD) are scarce.

    Methods: A longitudinal cohort study of 207 prevalent patients undergoing hemodialysis.

    Results: Cathepsins S and L were associated with soluble receptors for tumor necrosis factor (sTNFR1 and sTNFR2, rho between 0.28 and 0.43, p < 0.001 for all). Weaker or absent associations between endostatin, cathepsins S and L were seen with other inflammatory biomarkers, that is, CRP, interleukin 6, pentraxin 3, and TNF. In Cox and Laplace regression models adjusted for age, sex, dialysis vintage, and diabetes: standard deviation increments of endostatin was associated with a lower mortality (hazard ratio 0.75, 95% confidence interval (CI) 0.57-0.98), and with 6.8 months longer median survival.

    Conclusions: The high levels of endostatin, cathepsins S and L, and their associations with sTNFR1 and sTNFR2 warrant further studies exploring mortality, and the angiogenic and inflammatory pathways in ESRD. (C) 2015 S. Karger AG, Basel

  • 2670. Carlsson, Axel C.
    et al.
    Carrero, Juan-Jesus
    Stenvinkel, Peter
    Bottai, Matteo
    Barany, Peter
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    High levels of soluble tumor necrosis factor receptors 1 and 2 and their association with mortality in patients undergoing hemodialysis2015In: CardioRenal Medicine, ISSN 1664-3828, Vol. 5, no 2, p. 89-95Article in journal (Refereed)
    Abstract [en]

    Objective: Circulating soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and 5TNFR2) are associated with chronic kidney disease (CKD) progression in patients with CKD or diabetes, and with higher mortality. However, data in patients with end-stage renal disease are scarce. Therefore, we analyzed serum levels of sTNFR1 and sTNFR2 and investigated their association with inflammatory markers and mortality in dialysis patients. Research Design and Methods: This was a longitudinal cohort study of 207 prevalent patients (median age 66 years, 56% men) undergoing hemodialysis in Stockholm, Sweden. Demographics, clinical characteristics, including comorbidities and laboratory data, were obtained at baseline, together with prospective follow-up for mortality.

    Results: The median sTNFR1 and sTNFR2 levels were 17,680 ng/l [95% confidence interval (CI) 17,023-18,337] and 24,450 ng/l (95% CI 23,721-25,179), respectively. During a follow-up of 31 months (interquartile range, 21-38), 77 patients died. There was no association between the levels of sTNFRs and mortality in Cox regression models, and no consistent trend towards higher or lower mortality was seen in Laplace regression models. sTNFR1 and sTNFR2 levels were highly associated with other inflammatory markers including interleukin-6, pentraxin 3 and TNF-alpha. Conclusions:Prevalent hemodialysis patients have several-fold higher levels of sTNFRs compared to previous studies in CKD stage 4 patients. As no consistent association between TNFR and mortality was observed, clinical implications of measuring these receptors to predict outcome end-stage renal disease patients provide limited results.

  • 2671. Carlsson, Axel C
    et al.
    Ingelsson, Erik
    Sundström, Johan
    Carrero, Juan Jesus
    Gustafsson, Stefan
    Feldreich, Tobias
    Stenemo, Markus
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Use of proteomics to investigate kidney function decline over 5 years2017In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 12, no 8, p. 1226-1235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Using a discovery/replication approach, we investigated associations between a multiplex panel of 80 circulating proteins associated with cardiovascular pathology or inflammation, and eGFR decline per year and CKD incidence.

    DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used two cohorts, the Prospective Investigation of the Vasculature in Uppsala Seniors Study (PIVUS; n=687, mean age of 70 years, 51% women) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=360 men, mean age of 78 years), with 5-year follow-up data on eGFR. There were 231 and 206 incident cases of CKD during follow-up in the PIVUS and ULSAM studies, respectively. Proteomic profiling of 80 proteins was assessed by a multiplex assay (proximity extension assay). The assay uses two antibodies for each protein and a PCR step to achieve a high-specific binding and the possibility to measure multiple proteins in parallel, but gives no absolute concentrations.

    RESULTS: In the discovery cohort from the PIVUS Study, 28 plasma proteins were significantly associated with eGFR decline per year, taking into account the multiple testing. Twenty of these proteins were significantly associated with eGFR decline per year in the replication cohort from the ULSAM Study after adjustment for age, sex, cardiovascular risk factors, medications, and urinary albumin-to-creatinine ratio (in order of significance: TNF-related apoptosis-inducing ligand receptor 2*, CD40L receptor, TNF receptor 1*, placenta growth factor*, thrombomodulin*, urokinase plasminogen activator surface receptor*, growth/differentiation factor 15*, macrophage colony-stimulating factor 1, fatty acid-binding protein*, cathepsin D, resistin, kallikrein 11*, C-C motif chemokine 3, proteinase-activated receptor 1*, cathepsin L, chitinase 3-like protein 1, TNF receptor 2*, fibroblast growth factor 23*, monocyte chemotactic protein 1, and kallikrein 6). Moreover, 11 of the proteins predicted CKD incidence (marked with * above). No protein consistently predicted eGFR decline per year independently of baseline eGFR in both cohorts.

    CONCLUSIONS: Several circulating proteins involved in phosphate homeostasis, inflammation, apoptosis, extracellular matrix remodeling, angiogenesis, and endothelial dysfunction were associated with worsening kidney function. Multiplex proteomics appears to be a promising way of discovering novel aspects of kidney disease pathology.

  • 2672. Carlsson, Axel C
    et al.
    Jansson, Jan-Håkan
    Söderberg, Stefan
    Ruge, Toralph
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Levels of soluble tumor necrosis factor receptor 1 and 2, gender, and risk of myocardial infarction in Northern Sweden2018In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 272, p. 41-46Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: Soluble receptors for tumor necrosis factor alpha (sTNFR1 and sTNFR2) have been associated with cardiovascular diseases, and some evidence points towards a difference in associated risk between men and women. We aimed to study the association between sTNFR1 and sTNFR2 and incident myocardial infarctions (MI) and to explore the influence of established cardiovascular risk factors in men and women.

    METHODS: We conducted a nested case control study in three large Swedish cohorts, including 533 myocardial infarction cases, and 1003 age-, sex- and cohort-matched controls. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.

    RESULTS: An association between circulating sTNFR1 and sTNFR2 and an increased risk for MI was found when comparing cases and controls. The odds ratios were significant after adjustment for established cardiovascular risk factors and C-reactive protein in women (OR 1.44, 95% CI 1.08-1.93 for TNFR1, and 1.61, 95% CI 1.11-2.34 for TNFR2), but was abolished in men. Women with a combination of elevated CRP and values in the upper quartile of TNFR1 or TNFR2 had a 5-fold higher risk of myocardial infarction versus those with normal CRP and values in the lower three quartiles of TNFR1 or TNFR2.

    CONCLUSIONS: As the risk estimates for TNFR1 and TNFR2 were higher and remained significant after adjustments for established cardiovascular risk factors in women but not in men, a potential role for TNFR1 and TNFR2 in identifying women with a higher MI risk is possible. The future clinical role of TNFR1 and TNFR2 in combination with CRP to identify high risk patients for coronary heart disease has yet to be determined.

  • 2673. Carlsson, Axel C
    et al.
    Juhlin, C Christofer
    Larsson, Tobias E
    Larsson, Anders
    Ingelsson, Erik
    Sundström, Johan
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Soluble tumor necrosis factor receptor 1 (sTNFR1) is associated with increased total mortality due to cancer and cardiovascular causes: findings from two community based cohorts of elderly2014In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 237, no 1, p. 236-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experimental evidence support soluble receptors for tumor necrosis factor alpha as important mediators of the underlying pathology leading to cardiovascular disease and cancer. However, prospective data concerning the relation between circulating soluble tumor necrosis factor receptor-1 (sTNFR1) and mortality in humans are lacking. We aimed to explore and validate the association between sTNFR1 and mortality, and to explore the influence of other established risk factors for mortality, including other inflammatory markers.

    METHODS: The association between serum sTNFR1and the risk for mortality was investigated in two community-based cohorts of elderly: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 50%, n = 1005, mean age 70 years, median follow-up 7.9 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 775, mean age 77 years, median follow-up 8.1 years).

    RESULTS: In total, 101 participants in PIVUS and 274 in ULSAM died during follow-up. In multivariable Cox regression models adjusted for inflammation, lifestyle and established cardiovascular risk factors, one standard deviation (SD) higher sTNFR1 was associated with a hazard ratio (HR) for mortality of 1.37, 95% confidence interval (CI) 1.17-1.60, in PIVUS and HR 1.22, 95% CI 1.10-1.37 in ULSAM. Moreover, circulatingsTNFR1 was associated with cardiovascular mortality (HR per SD of sTNFR1, 1.24, 95% CI 1.07-1.44) and cancer mortality (HR per SD of sTNFR1, 1.32, 95% CI 1.11-1.57) in the ULSAM cohort. High levels of sTNFR1 identified individuals with increased risk of mortality among those with high as well as low levels of systemic inflammation.

    CONCLUSIONS: An association between circulating sTNFR1 and an increased risk for mortality was found and validated in two independent community-based cohorts. The future clinical role of sTNFR1 to identify high risk patients for adverse outcomes and mortality has yet to be determined.

  • 2674.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Huddinge, Sweden; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ingelsson, Erik
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Tobias E
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Bottai, Matteo
    Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Sundström, Johan
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Urinary kidney injury molecule-1 and the risk of cardiovascular mortality in elderly men2014In: American Society of Nephrology. Clinical Journal, ISSN 1555-9041, E-ISSN 1555-905X, Vol. 9, no 8, p. 1393-1401Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVES: Kidney injury molecule-1 (KIM-1) has been suggested as a clinically relevant highly specific biomarker of acute kidney tubular damage. However, community-based data on the association between urinary levels of KIM-1 and the risk for cardiovascular mortality are lacking. This study aimed to investigate the association between urinary KIM-1 and cardiovascular mortality.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a prospective study, using the community-based Uppsala Longitudinal Study of Adult Men (N=590; mean age 77 years; baseline period, 1997-2001; median follow-up 8.1 years; end of follow-up, 2008).RESULTS: During follow-up, 89 participants died of cardiovascular causes (incidence rate, 2.07 per 100 person-years at risk). Models were adjusted for cardiovascular risk factors (age, systolic BP, diabetes, smoking, body mass index, total cholesterol, HDL cholesterol, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, and history of cardiovascular disease) and for markers of kidney dysfunction and damage (cystatin C-based eGFR and urinary albumin/creatinine ratio). Higher urinary KIM-1/creatinine (from 24-hour urine collections) was associated with a higher risk for cardiovascular mortality (hazard ratio per SD increase, 1.27; 95% confidence interval [95% CI], 1.05 to 1.54; P=0.01). Participants with a combination of high KIM-1/creatinine (upper quintile, ≥175 ng/mmol), low eGFR (≤60 ml/min per 1.73 m(2)), and microalbuminuria/macroalbuminuria (albumin/creatinine ratio≥3 g/mol) had a >8-fold increased risk compared with participants with low KIM-1/creatinine (<175 ng/mmol), normal eGFR (>60 ml/min per 1.73 m(2)), and normoalbuminuria (albumin/creatinine ratio<3 g/mol) (hazard ratio, 8.56; 95% CI, 4.17 to 17.56; P<0.001).CONCLUSIONS: These findings suggest that higher urinary KIM-1 may predispose to a higher risk of cardiovascular mortality independently of established cardiovascular risk factors, eGFR, and albuminuria. Additional studies are needed to further assess the utility of measuring KIM-1 in the clinical setting.

  • 2675. Carlsson, Axel C
    et al.
    Larsson, Anders
    Helmersson-Karlqvist, Johanna
    Lind, Lars
    Ingelsson, Erik
    Larsson, Tobias E
    Sundström, Johan
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Urinary kidney injury molecule 1 and incidence of heart failure in elderly men2013In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 15, no 4, p. 447-446Article in journal (Refereed)
    Abstract [en]

    AIMS: There is growing recognition of the clinical importance of cardiorenal syndrome-the bidirectional interplay between kidney and cardiac dysfunction. Yet, the role of kidney tubular damage in the development of heart failure is less studied. The objective of this study was to investigate whether urinary kidney injury molecule (KIM)-1, a specific marker of tubular damage, predisposes to an increased heart failure risk.

    METHODS AND RESULTS: This was a community-based cohort study [Uppsala Longitudinal study of Adult Men (ULSAM)] of 565, 77-year-old men free from heart failure at baseline. Heart failure hospitalizations were used as outcome. During follow-up (median 8.0 years), 73 participants were hospitalized for heart failure. In models adjusted for cardiovascular risk factors (age, systolic blood pressure, diabetes, smoking, body mass index, LDL/HDL ratio, antihypertensive treatment, lipid-lowering treatment, aspirin treatment, LV hypertrophy, and prevalent cardiovascular disease) and markers of kidney dysfunction and damage [cystatin C-based glomerular filtration rate (GFR) and urinary albumin/creatinine ratio], a higher urinary KIM-1/creatinine ratio was associated with higher risk for heart failure (hazard ratio upper vs. lower tertile, 1.81; 95% confidence interval 1.01-3.29; P < 0.05). Participants with a combination of low GFR (<60 mL/min/1.72 m(2)) and high KIM-1/creatinine (>128 ng/mmol) had a 3-fold increase in heart failure risk compared with participants with normal GFR and KIM-1 (P < 0.001).

    CONCLUSION: Our findings suggest that kidney tubular damage predisposes to an increased risk for heart failure in the community. Further studies are needed to clarify the causal role of KIM-1 in the development of heart failure, and to evaluate the clinical utility of urinary KIM-1 measurements.

  • 2676.
    Carlsson, Axel C
    et al.
    Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden ; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Larsson, Tobias E
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Helmersson-Karlqvist, Johanna
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Larsson, Anders
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Lind, Lars
    Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Soluble TNF receptors and kidney dysfunction in the elderly2014In: Journal of the American Society of Nephrology, ISSN 1046-6673, E-ISSN 1533-3450, Vol. 25, no 6, p. 1313-1320Article in journal (Refereed)
    Abstract [en]

    The importance of TNF-α and its soluble receptors (sTNFR1 and sTNFR2) in the development of kidney disease is being unraveled. Yet, community-based data regarding the role of sTNFRs are lacking. We assessed serum sTNFRs and aspects of kidney damage cross-sectionally in two independent community-based cohorts of elderly participants: Prospective Investigation of the Vasculature in Uppsala Seniors (n=815; mean age, 75 years; 51% women) and Uppsala Longitudinal Study of Adult Men (n=778; mean age, 78 years). Serum sTNFR1 correlated substantially with different aspects of kidney pathology in the Uppsala Longitudinal Study of Adult Men cohort (R=-0.52 for estimated GFR, R=0.22 for urinary albumin-to-creatinine ratio, and R=0.17 for urinary kidney injury molecule-1; P<0.001 for all), with similar correlations in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort. These associations remained significant after adjustment for age, sex, inflammatory markers, and cardiovascular risk factors and were also evident in participants without diabetes. Serum sTNFR2 was associated with all three markers in the Prospective Investigation of the Vasculature in Uppsala Seniors cohort (P<0.001 for all). Our findings from two independent community-based cohorts confirm and extend results of previous studies supporting circulating sTNFRs as relevant biomarkers for kidney damage and dysfunction in elderly individuals, even in the absence of diabetes.

  • 2677. Carlsson, Axel C
    et al.
    Li, Xinjun
    Holzmann, Martin J
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institute.
    Wändell, Per
    Gasevic, Danijela
    Sundquist, Jan
    Sundquist, Kristina
    Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden.2017In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 12, no 8, p. 815-826Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years.

    Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated.

    Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23).

    Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.

  • 2678.
    Carlsson, Axel C.
    et al.
    Karolinska Institutet.
    Nordquist, Lina
    Uppsala Universitet.
    Larsson, Tobias E.
    Karolinska Institutet.
    Carrero, Juan-Jesus
    Karolinska Institutet.
    Larsson, Anders
    Uppsala Universitet.
    Lind, Lars
    Uppsala university hospital.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Soluble tumor necrosis factor receptor 1 is associated with glomerular filtration rate progression and incidence of chronic kidney disease in two community-based cohorts of elderly individuals2015In: CardioRenal Medicine, ISSN 1664-3828, Vol. 5, no 4, p. 278-288Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to explore and validate the longitudinal associations between soluble tumor necrosis factor receptor 1 (sTNFR1), glomerular filtration rate (GFR) progression, and chronic kidney disease (CKD) incidence in two independent community-based cohorts of elderly individuals with prespecified subgroup analyses in individuals without prevalent diabetes.

    Research design and methods: Two community-based cohorts of elderly individuals were used with 5-year follow-up data on estimated GFR: the Uppsala Longitudinal Study of Adult Men (ULSAM; n = 437 men; mean age: 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 703; mean age: 70 years; 51% women). GFR categories were defined as >= 60, 30-60, and <30 ml/min/1.73 m(2).

    Results: In longitudinal multivariable logistic regression models adjusted for inflammatory markers and established cardiovascular risk factors, higher serum sTNFR1 was significantly associated with an increased risk to progress to a lower GFR category in both ULSAM and PIVUS [odds ratio (OR) per standard deviation (SD) increase 1.28 (95% CI 1.03-1.60) and OR 1.56 (95% CI 1.30-1.87), respectively]. Also, in subgroup analyses in individuals with a GFR >= 60 ml/min/1.73 m(2) at baseline, higher sTNFRs were associated with incident CKD after 5 years in both cohorts [ULSAM: OR per SD increase 1.49 (95% CI 1.16-1.9) and PIVUS: OR 1.84 (95% CI 1.50-2.26)]. Associations were similar in individuals without diabetes.

    Conclusions: Higher circulating sTNFR1 independently predicts the progression to a worse GFR category and CKD incidence in elderly individuals even in the absence of diabetes. Further studies are warranted to investigate the underlying mechanisms, and to evaluate the clinical relevance of our findings. 

  • 2679. Carlsson, Axel C.
    et al.
    Riserus, Ulf
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hypertriglyceridemic waist phenotype is associated with decreased insulin sensitivity and incident diabetes in elderly men2014In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 22, no 2, p. 526-529Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between hypertriglyceridemic waist (HTGW) and insulin sensitivity (assessed by euglycemic clamp method), and the development of diabetes in a longitudinal community-based cohort of elderly men without diabetes at baseline.

    Design and Methods: The present cross-sectional study comprised 1,026, 70-year-old men without diabetes. The gold standard euglycaemic-hyperinsulinaemic clamp technique was used. Six-year follow-up on diabetes status were available in n = 667. The HTGW phenotype was defined as having waist circumference >= 90 cm, and triglycerides >= 2 mmol L-1. The men were stratified into those having normal WC and TG (n = 299), one HTGW component (n = 606), and HTGW (n = 121).

    Results: The association between insulin sensitivity and one HTGW component as well as HTGW was highly significant (P < 0.001) in the whole sample, as well as in individuals with high/low BMI (stratified at >= 25). In longitudinal analyses, participants with HTGW was associated with a more than fourfold increased risk for diabetes (Odds ratio 4.64, 95% CI 1.61-13.4, P = 0.004) compared to those with normal WC and TG.

    Conclusion: The present study both confirm and extend previous research suggesting that the HTGW-phenotype portrays an increased glucometabolic risk, also in lean individuals.

  • 2680. Carlsson, Axel C
    et al.
    Ruge, Toralph
    Kjøller, Erik
    Hilden, Jørgen
    Kolmos, Hans Jørn
    Sajadieh, Ahmad
    Kastrup, Jens
    Jensen, Gorm Boje
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet.
    10-year associations between tumor necrosis factor receptors 1 and 2 and cardiovascular events in patients with stable coronary heart disease: a CLARICOR (effect of clarithromycin on mortality and morbidity in patients with ischemic heart disease) trial substudy2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 9, article id e008299Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We aimed to assess the associations and predictive powers between the soluble receptors for tumor necrosis factor (TNF)-α (TNFR1 and TNFR2) and cardiovascular outcomes in patients with stable coronary heart disease.

    METHODS AND RESULTS: <0.001 for TNFR2). The associations were similar in the replication sample. The associations with the composite outcome were mainly driven by acute myocardial infarction, cardiovascular mortality, and noncardiovascular mortality. The addition of TNFR1 and TNFR2 to established cardiovascular risk factors improved prediction only modestly (<1%).

    CONCLUSIONS: Increased concentrations of circulating TNFR1 and TNFR2 were associated with increased risks of cardiovascular events and mortality in patients with stable coronary heart disease. Yet, the utility of measuring TNFR1 and TNFR2 to improve risk prediction in these patients appears limited.

    CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00121550.

  • 2681. Carlsson, Axel C
    et al.
    Ruge, Toralph
    Sundström, Johan
    Ingelsson, Erik
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Association between circulating endostatin, hypertension duration, and hypertensive target-organ damage2013In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 62, no 6, p. 1146-1151Article in journal (Refereed)
    Abstract [en]

    Our aim is to study associations between circulating endostatin, hypertension duration, and hypertensive target-organ damage. Long-term hypertension induces cardiovascular and renal remodeling. Circulating endostatin, a biologically active derivate of collagen XVIII, has been suggested to be a relevant marker for extracellular matrix turnover and remodeling in various diseases. However, the role of endostatin in hypertension and hypertensive target-organ damage is unclear. Serum endostatin was measured in 2 independent community-based cohorts: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; women 51%; n=812; mean age, 75 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n=785; mean age, 77.6 years). Retrospective data on blood pressure measurements and antihypertensive medication (PIVUS >5 years, ULSAM >27 years), and cross-sectional data on echocardiographic left ventricular mass, endothelial function (endothelium-dependent vasodilation assessed by the invasive forearm model), and urinary albumin/creatinine ratio were available. In PIVUS, participants with ≥5 years of history of hypertension portrayed 0.42 SD (95% confidence interval, 0.23-0.61; P<0.001) higher serum endostatin, compared with that of normotensives. This association was replicated in ULSAM, in which participants with 27 years hypertension duration had the highest endostatin (0.57 SD higher; 95% confidence interval, 0.35-0.80; P<0.001). In addition, higher endostatin was associated with higher left ventricular mass, worsened endothelial function, and higher urinary albumin/creatinine ratio (P<0.03 for all) in participants with prevalent hypertension. Circulating endostatin is associated with the duration of hypertension, and vascular, myocardial, and renal indices of hypertensive target-organ damage. Further studies are warranted to assess the prognostic role of endostatin in individuals with hypertension.

  • 2682. Carlsson, Axel C
    et al.
    Sundström, Johan
    Carrero, Juan Jesus
    Gustafsson, Stefan
    Stenemo, Markus
    Larsson, Anders
    Lind, Lars
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala University.
    Use of a proximity extension assay proteomics chip to discover new biomarkers associated with albuminuria.2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 4, p. 340-348Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The underlying mechanisms for the development of albuminuria and the increased cardiovascular risk in patients with elevated albuminuria levels are incompletely understood. We therefore investigated the associations between 80 cardiovascular proteins and the urinary albumin to creatinine ratio (ACR).

    METHODS: We used a discovery/replication approach in two independent community-based cohorts of elderly patients: the Uppsala Longitudinal Study of Adult Men (n = 662; mean age 78 years) and the Prospective Investigation of the Vasculature in Uppsala Seniors (n = 757; mean age 75 years; 51% women). A proteomic chip with a panel of 80 plasma proteins associated with different aspects of cardiovascular disease was analysed. In the discovery cohort, we used a false discovery rate of 5% to take into account the multiple statistical testing. Nominal p values were used in the replication.

    RESULTS: Higher levels of T-cell immunoglobulin mucin-1, placenta growth factor, growth/differentiation factor-15, urokinase plasminogen activator surface receptor and kallikrein-11 were robustly associated with a higher ACR in both cohorts in multivariable linear regression models adjusted for sex, established cardiovascular risk factors, antihypertensive treatment, prevalent cardiovascular disease and glomerular filtration rate (p < 0.02 for all). All associations were also significant in separate analyses of patients without diabetes.

    CONCLUSIONS: We discovered and replicated associations between ACR and five cardiovascular proteins involved in tubular injury, atherosclerosis, endothelial function, heart failure, inflammation, glomerulosclerosis and podocyte injury. Our findings put forward multiplex proteomics as a promising approach to explore novel aspects of the complex detrimental interplay between kidney function and the cardiovascular system.

  • 2683. Carlsson, Axel C
    et al.
    Wändell, Per
    Riserus, Ulf
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Borné, Yan
    Engström, Gunnar
    Leander, Karin
    Gigante, Bruna
    Hellénius, Mai-Lis
    de Faire, Ulf
    Differences in anthropometric measures in immigrants and Swedish-born individuals: results from two community-based cohort studies2014In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 69, p. 151-156Article in journal (Refereed)
    Abstract [en]

    AIM: To study differences in body mass index (BMI), waist-hip ratio (WHR), waist circumference (WC), sagittal abdominal diameter (SAD), waist-hip-height ratio (WHHR) and percent body fat in immigrants and Swedish-born men and women in two large population-based samples.

    METHODS: A cross-sectional analysis of 60-year-old individuals, n=4 232. To replicate the results, we also assessed another large independent cohort cross-sectionally, the Malmö Diet and Cancer Study (MDC, n=26 777). The data from both cohorts were collected in the 1990s in Sweden.

    RESULTS: Significant differences between Finnish-born, Middle Eastern and women from the rest of the world were seen for all anthropometric measures, using Swedish-born women as referent. However, WHHR was the only anthropometric measure that identified all these three groups of immigrant women as different from Swedish-born women with high statistical certainty (p<0.001). Apart from WHHR that identified differences in anthropometry in all immigrant groups of men using Swedish-born men as referent, few significant differences were seen in anthropometry among groups of immigrant men. These finding were observed in both cohorts, and remained after adjustments for smoking, physical activity and educational level.

    CONCLUSION: The present study confirms previous findings of more obesity among immigrants and is the first to report that WHHR measurements may detect anthropometric differences between different ethnic groups better than other anthropometrical measures.

  • 2684. Carlsson, Axel C
    et al.
    Östgren, Carl Johan
    Nystrom, Fredrik H
    Länne, Toste
    Jennersjö, Pär
    Larsson, Anders
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Uppsala universitet.
    Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes2016In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, article id 40Article in journal (Refereed)
    Abstract [en]

    AIMS/HYPOTHESIS: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease.

    METHODS: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used.

    RESULTS: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p < 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p < 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p < 0.01 for all). Both sTNFRs were associated with mortality.

    CONCLUSIONS/INTERPRETATIONS: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

  • 2685.
    Carlsson, Bo
    Malmö högskola.
    Idrottens normativa förändringsprocesser2005In: Sociologisk forskning, ISSN 0038-0342, Vol. 42, no 1, p. 11-16Article in journal (Other academic)
  • 2686.
    Carlsson, Caroline
    Dalarna University, School of Humanities and Media Studies, Moving Image Production.
    Förändringar i berättelsen från bok till film: En jämförelse mellan de viktigaste scenerna i boken Cirkeln och dess filmadaption2015Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Uppsatsens syfte är att jämföra boken Cirkeln och dess filmadaption med samma namn för att undersöka hur filmens ändringar kan påverka berättelsen för, de eventuellt, nästkommande filmerna. I slutdiskussionen kommer uppsatsen även att diskutera vilken sorts adaption filmen kan ses som utifrån Geoffrey Wagners tre adaptionstyper. Först kommer berättelsernas första vändpunktsscen att jämföras med varandra för att belysa skillnaderna mellan de två scenversionerna. Därefter kommer andra viktiga scener i berättelserna att jämföras på samma sätt. Dessa undersökningar kommer att använda Richard J. Hands analysmetod för att jämföra scenerna och ta reda på vad som har förändrats, behållits eller tagits bort under adaptionsprocessen. Jämförelserna utgår främst från de skillnader som skett i filmen, men nämner även likheter som uppsatsen anser vara viktiga. Sist kommer dessa skillnader att diskuteras, framförallt de konsekvenser som förändrar filmens berättelse mest och därefter vilken adaptionstyp filmen kan ses som på grund av dessa skillnader.

  • 2687.
    Carlsson, Cecilia
    Dalarna University, School of Education and Humanities, Social and Political Studies.
    Retorik mot rasism: - En studie om hur läromedel och pedagoger behandlar rasism och främlingsfientlighet2007Independent thesis Advanced level (degree of Master (Two Years))Student thesis
  • 2688.
    Carlsson, Daniel
    Dalarna University, School of Education, Health and Social Studies.
    Uppmärksamhetsfokus. En studie som undersöker om fotbollstränare i Dalarna ger verbal feedback som är riktad mot antingen internt eller externt uppmärksamhetsfokus2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 2689. Carlsson, E
    et al.
    Ehrenberg, A
    Ehnfors, M
    Recording of nursing assessment and interventions for stroke patients with eating difficulties.2006In: Studies in health technology and informatics, Seoul, Korea, 2006, Vol. 122Conference paper (Refereed)
    Abstract [en]

    A standardised language is a necessary condition for successful development and implementation of electronic patient records. In the present study a record audit was performed at a Swedish stroke unit. The aims were to analyse how the nursing process on eating difficulties after stroke was represented in nursing documentation and to describe the information that was transferred to the next care provider at discharge. Data were analysed using descriptive statistics and content analysis. Results show that care planning and nursing interventions were not visible in patient records. Furthermore, the language proved vague and expressed in a "non-professional" manner.

  • 2690. Carlsson, E
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, M
    Long term experiences of living with eating difficulties after stroke2004In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 13, p. 825-834Article in journal (Refereed)
  • 2691. Carlsson, E
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, M
    Long-term experiences of living with eating difficulties after stroke2004In: The Tenth Annual Qualitative Health Research Conference, Banff, Alberta, Canada, 2004Conference paper (Other academic)
  • 2692.
    Carlsson, Emelie
    Dalarna University, School of Education, Health and Social Studies, Educational Work.
    Motorik i förskoleklass: En kvalitativ intervjustudie om pedagogers beskrivningar i arbetet med att stimulera barns motoriska utveckling2017Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien är att undersöka och få en fördjupad kunskap om vad pedagoger anser som viktiga faktorer i arbetet med barns motorik i förskoleklassen. Med tillhörande frågeställningar: Vad beskriver pedagogerna som viktiga faktorer i arbetet med att stimulera barns motorik i förskoleklassen? Vilka möjligheter och hinder beskriver pedagogerna i arbetet med att stimulera barns motorik, då daglig fysisk aktivitet ska ske? Metodvalet för studien är kvalitativa intervjuer där sex pedagoger har medverkat. De teorier som ligger till grund för studien är dynamisk systemteori och några valda begrepp inom den sociokulturella teorin. Det framkommer i studiens resultatdel att pedagogerna beskriver att de arbetar medvetet för att barnen ska ges möjligheter att utveckla sin motorik. Pedagogerna tar dock upp olika aspekter i arbetet med barnen, vilket kan tänkas bero på deras egna erfarenheter och kunskaper. De hinder som pedagogerna beskriver är bland annat miljön barnen befinner sig i, och de möjligheter de ser är att skolan kan bli ett komplement för hemmet där barnen ges möjligheter till daglig fysisk aktivitet.

  • 2693. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Multidisciplinary recording and continuity of care for stroke patients with eating difficulties2010In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, no 3, p. 298-310Article in journal (Refereed)
    Abstract [en]

    Eating difficulties after stroke are common and can, in addition to being a risk for serious medical complications, impair functional capability, social life and self-image. Stroke unit care entails systematic multidisciplinary teamwork and continuity of care. The purpose of this study was to describe (i) multidisciplinary stroke care as represented in patient records for patients with eating difficulties, and (ii) the written information that was transferred from hospital to elderly care. Data from 59 patient records were analysed with descriptive statistics and by categorization of phrases. Signs of multidisciplinary collaboration to manage eating problems were scarce in the records. While two notes from physiotherapists were found, nurses contributed with 78% of all notes (n=358). Screening of swallowing and body weight was documented for most patients, whereas data on nutritional status and eating were largely lacking. The majority of notes represented patients' handling of food in the mouth, swallowing and lack of energy. Care plans were unstructured and few contained steps for managing eating. Discharge summaries held poor information on care related to eating difficulties. The language of all professionals was mostly unspecific. However, notes from speech-language therapists were comprehensive and entailed information on follow-up and patient participation.

  • 2694. Carlsson, Eva
    et al.
    Ehnfors, Margareta
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet, Örebro university.
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Accuracy and continuity in discharge information for patients wtih eating difficulties after stroke2012In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 2, p. 21-31Article in journal (Refereed)
    Abstract [en]

    Aims. To describe the accuracy and continuity of discharge information for patients with eating difficulties after stroke. Design. Prospective, descriptive. 

    Methods. The study investigated a sample of 15 triads, each including one patient with stroke along with his patient record and discharge summary and two nursing staff in the municipal care to whom the patient was discharged. Data were collected by observations of patients' eating, record audits and interviews with nurses. Data were analysed using content analysis and descriptive statistics. 

    Results. Accuracy of recorded information on patients' eating difficulties and informational continuity were poor, as was accuracy in the transferred information according to nursing staff's perceptions. All patients were at risk of undernutrition and in too poor a state to receive rehabilitation. Nevertheless, patients' eating difficulties were described in a vague and unspecific language in the patient records. Co-ordinated care planning and management continuity related to eating difficulties were largely lacking in the documentation. Despite their important role in caring for patients with eating difficulties, little information on eating difficulties seemed to reach licensed practical nurses in the municipalities. 

    Conclusions. Comprehensiveness in the documentation of eating difficulties and accuracy of transferred information were poor based on record audits and as perceived by the municipal nursing staff. Although all patients were at risk of undernutrition, had multiple eating difficulties and were in too poor a state for rehabilitation, explicit care plans for nutritional problems were lacking. Relevance to clinical practice. Lack of accuracy and continuity in discharge information on eating difficulties may increase risk of undernutrition and related complications for patients in continuous stroke care. Therefore, the discharge process must be based on comprehensive and accurate documentation.

  • 2695. Carlsson, Eva
    et al.
    Ehrenberg, Anna
    Dalarna University, School of Health and Social Studies, Caring Science/Nursing.
    Ehnfors, Margareta
    Stroke patients with eating difficulties – findings from an audit of multi-disciplinary patient records2007In: 6th European Conference of the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO), Amsterdam, Netherlands, 2007Conference paper (Refereed)
  • 2696. Carlsson, Eva
    et al.
    Eldh, Ann Catrine
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ehnfors, Margareta
    Ehrenberg, Anna
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Information transfer and continuity of care for stroke patients with eating difficulties from the perspective of nursing staff in Swedish elderly care2012In: AMIA proceedings, Montreal, Kanada, 2012Conference paper (Refereed)
  • 2697. Carlsson, Eva
    et al.
    Stålnacke, Katri
    Persenius, Mona
    Olai, Lena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hägg, Mary
    Aspects of eating and quality of care among elderly in short-term accommodations - before and after an intervention.2014Conference paper (Other academic)
  • 2698.
    Carlsson, Eva-Lena
    Dalarna University, School of Education and Humanities, Educational Work.
    Begåvad och bortglömd?: Lärare om bemötandet av elever som är begåvad i matematik2009Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    Syftet med denna uppsats är att försöka ta reda på hur skolan bemöter de matematiskt begåvade eleverna. Utifrån detta syfte har två frågeställningar uppställts: Vad gör lärarna för att stimulera de begåvade eleverna? Anser sig lärarna ha tillräckliga resurser för att kunna tillgodose de begåvade elevernas behov? En kvalitativ intervjuundersökning med samtliga matematiklärare på en 7-9-skola har genomförts. På skolan har man nivåindelat eleverna genom att göra tre grupper av halva årskurser. Härigenom har även de duktiga grupperna kommit att innehålla elever som behöver mycket hjälp och undervisningsnivån är därför inte så hög. Schematekniska skäl har medfört att indelningen av eleverna inte har kunnat göras utifrån hela årskurser och i en årskurs inte alls. Innehållet i och upplägget av undervisningen ser olika ut hos de olika lärarna. Lärarna ställer sig positiva till att de begåvade eleverna får utgöra en egen grupp. De anser att tiden inte räcker till för dessa elever samt även att lokalerna lämnar en del övrigt att önska. Tänkbart är att ekonomiska orsaker ligger bakom den rådande situationen. Genom undersökningen har jag kommit fram till att lärarna med hänsyn till omständigheterna gör sitt bästa.

  • 2699.
    Carlsson, Git
    Dalarna University, School of Education and Humanities, Swedish as Second Language.
    Med annat modersmål: Nyanländas skolsituation inom grundskolans verksamhet2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Huvudsyftet med denna uppsats är att beskriva mottagandet för nyanlända elever, i år 6-9, vad gäller utbildning i en kommun i Sverige. Studiens avsikt har därmed varit att belysa, med utgångspunkt i tidigare forskning, vilka förutsättningar för en positiv skolutveckling som den nuvarande organisationen erbjuder. För att uppnå detta syfte har jag genomfört en kvalitativ studie som baserats på intervjuer med fem informanter från skolans kontext, en rektor, en modersmålslärare, en lärare i förberedelseklass samt två kärnämneslärare. Resultaten från de genomförda intervjuerna har tolkats och analyserats och visar att förutsättningar för positiv skolutveckling finns i form av medvetenhet bland undervisande lärare samt rektor om vad som behövs för detta. Det finns behöriga lärare i svenska som andraspråk som försöker se till de nyanlända elevernas utbildningsbehov samtidigt som det finns andra lärare som har svårt att anpassa undervisningen för dessa elever. För att kunna diagnostisera utbildningsbehovet genomförs kartläggningar av lärare i syfte att få så mycket information om elevens skolbakgrund som möjligt. Dessvärre framkommer inte exakt hur och vad man kartlägger eller vad man gör med resultaten men det visar sig att det är kunskaper i matematik och engelska som främst testas, och det på svenska, vilket är tvärtemot vad Skolverket rekommenderar. Skolverket menar att det är viktigt att man inte bara tittar på elevens kunskaper i svenska språket utan att man även ska titta på elevens kunskaper från hemlandet. Studiehandledning förekommer inte på skolan utan de lärare som undervisar de nyanlända eleverna och då främst i svenska som andraspråk får därför fungera som studiehandledare, på svenska, vid språkproblem som uppstår. När eleverna anses vara mogna för klassundervisning sker en övergång dit. Detta äger rum efter kunskapstester och när läraren i förberedelseklassen anser att elevens språkkunskaper är tillräckliga för att klara av den undervisningen. Eleverna slussas ut till övriga ämnen successivt i syfte att integreras med klassen vilket är en bra förutsättning för positiv skolframgång. Den sammanfattande helhetsbilden av resultaten, på den undersökta skolan, visar att det finns förutsättningar för positiv skolutveckling för de nyanlända eleverna, medan det även framkommer att det finns mer att göra för att förbättra skolsituationen för dessa elever.

  • 2700.
    Carlsson, Henrik
    Dalarna University, School of Languages and Media Studies, Sound and Music Production.
    Analog eller digital summering vid mixning av ljud: Blir det någon skillnad i slutresultatet?2007Independent thesis Basic level (degree of Bachelor)Student thesis
    Abstract [sv]

    I denna uppsats undersöks huruvida en lyssnare kan skilja på två ljudmixar som är mixade på samma sätt men summerade på olika sätt. Den ena summeras analogt och den andra digitalt. Om så är fallet, hur tycker lyssnaren att dessa skillnader yttrar sig? Som metod fick en testpanel i ett blindtest lyssna på två olika mixar, en rocklåt och en jazzlåt, som båda fanns i både analogt och digitalt summerade versioner. Dessa fick testsubjekten sedan besvara några frågor kring och tycka till om dessa olika versioner i en kvalitativ enkätundersökning Det visade sig att skillnader uppfattades av merparten av lyssnarna. Den vanligast förekommande beskrivningen var att det var skillnad på stereobredd, djup och dynamik i mixarna beroende på hur de summerats. Även ord som klarhet, värme och tydlighet förekom. Testpanelen var överlag även väldigt bra på att gissa vilken version som var summerad på vilket sätt. Dessa gissningar verkar i på många fall vara baserad på den förutfattade meningen att analogt borde vara bättre. Det är ganska tydligt att detta forskningsarbete i mångt och mycket är en fallstudie för just de variabler som förekom (märke på den analoga summeraren, ljudkvalité på de inspelade ljudet, programmaterial med mera). Fler tester och undersökningar behövs för att kunna dra generella slutsatser.

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