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  • Public defence: 2018-03-23 10:00 Hörsal H, Umeå
    Nyström, Markus B. T.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Treating depression with activation2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to evaluate and compare four therapist-supported Internet-administered treatments for depression. Three studies were conducted. The first was a systematic review to determine the most effective mode and dose of physical activity (PA) for treating major depressive disorders (MDDs), and to suggest guidelines and recommendations for clinicians. These recommendations included that the PA needs to be individually customized, performed for at least 30 minutes, preferably under supervision, and with a frequency of at least three times per week to be effective for treating MDDs. Recommendations, however, must be viewed in light of the relatively few studies that match the inclusion criteria. The second study aimed to empirically evaluate and compare the effect of four therapist-supported Internet-administered treatments for mild to moderate depression. Two of the treatments were based on PA and two on behavioural activation (BA). One PA group was provided with a rationale; whereas, the other was not. The treatment in one BA group was based on Lewinsohn’s model and the other on Martell’s model. Results showed that all groups (including the control group) significantly reduced their depressive symptoms. Group comparisons revealed that three of the four treatment groups (all except the PA group that did not receive a rationale) had a significantly greater symptom reduction than the control group. This suggests that some sort of rationale is important for symptom reduction. The third study aimed to examine if a relapse prevention program would affect symptom change during a 24-month follow-up. We also examined if symptom change during the acute phase (AP) treatment period predicted symptom change during the follow-up period. A third and final aim was to examine if the number of symptoms post-AP treatment predicted symptom change during the follow-up period. The initial analysis indicated that the introduction of a relapse prevention program did not affect symptom change during follow-up. The symptom change during AP treatment did predict symptom change during follow-up for three of the four treatment groups (all except one of the BA groups). The number of symptoms post-AP treatment, however, did not predict symptom change during follow-up for any of the treatment groups. The main conclusion from this thesis is that PA seems to be effective for treating and preventing depressive symptoms. PA with a rationale is more effective than without one, and an understanding of the person’s situation is important for a treatment outcome. If a symptom change can be achieved during the acute phase, the likelihood for symptom change during the follow-up increases.

  • Public defence: 2018-03-28 09:00 Room 135, Umeå
    Gangane, Nitin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Breast cancer in rural India: knowledge, attitudes, practices; delays to care and quality of life2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Cancer is a major public health problem globally. The incidence of cancer is increasing rapidly in many low- and middle-income countries like India due to the epidemiological transition. At present, breast cancer is the leading cancer in females in many countries including India. In spite of all of the epidemiological evidence pointing towards a surge in breast cancer cases, the National Cancer Control Programme of India has not yet taken sufficient measures to understand the disease burden and to plan a course of action to cope with the increasing cancer burden.

    Aim: The aim of this thesis is to explore the knowledge, attitudes, and practices regarding breast cancer in a predominantly rural district of central India along with identifying the determinants of delays to care and quality of life (QoL) in breast cancer patients. This understanding may help to strengthen the health system by improving breast cancer control and management programmes and the delivery of care.

    Methods: This thesis combines findings from two cross-sectional studies in the predominantly rural district of Wardha. The first study was a population-based crosssectional survey conducted on 1000 women, in which face-to-face interviews were conducted with the help of a questionnaire covering demographic and socio-economic information, knowledge, attitudes and practices regarding breast cancer screening and breast cancer. The Chi-square test for proportions and t-test for means were used and multivariable linear regression analysis was performed to study the association between socio-demographic factors and knowledge, attitude and practices. The second study was a patient-based cross-sectional study conducted in 212 breast cancer patients. All 212 breast cancer patients were included for patient delay. However, 208 female breast cancer patients could be included for system delay, quality of life and self-efficacy, as there was some information lacking in 4 patients. Information on socio-demographic characteristics, patient and system delays and also reasons for the delays were collected. The study also utilised WHOQOL–BREF for QoL and selfefficacy measurements in breast cancer patients. Socio-demographic determinants were examined by frequencies and means and multivariable logistic and linear regression analysis to assess the relationship between exposure and outcome variables.

    Results: One third of the respondents had not heard about breast cancer, and more than 90% of women from both rural and semi-urban areas were not aware of breast self-examination. Patient delay of more than 3 months was observed in almost half of participants, while a system delay of more than 12 weeks was seen in 23% of the breast cancer patients. The late clinical stage of the disease was also significantly associated with patient delay. The most common reason for patient delay was painlessness of the breast lump. Incorrect initial diagnosis or late reference for diagnosis were the most common reasons for diagnostic delay while the high cost of treatment was the most common reason for treatment delay. Self-efficacy was positively associated with QoL, after adjusting for socio-demographic factors, patient delay and clinical stage of disease.

    Conclusions: Our research showed poor awareness and knowledge about breast cancer, its symptoms and risk factors in women in rural India. Breast self-examination was hardly practiced, although the willingness to learn was high. Although The ideal is to have no delay in diagnosis and treatment, diagnostic and treatment delays observed in the study were not much higher than those reported in the literature, even from countries with good health facilities. However, further research is needed to identify access barriers throughout the process of cancer diagnosis and treatment. The quality of life was moderately good and its strong relationship with self-efficacy makes these two dimensions of breast cancer patients relevant enough to be considered for health workers and policy makers in the future.

    Interventions focused on improving breast awareness in women and the breast cancer continuum of care should be implemented at a district level. The role of community social health activists in breast cancer prevention should be encouraged and the implementation of an operational national breast cancer program is urgently required.

  • Public defence: 2018-03-28 10:15 Hörsal B, Umeå
    Adjei, Evans Korang
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Relatedness through kinship: the importance of family co-occurrence for firm performance2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of the thesis is to analyse the effects of family co-occurrence and past familial relationships (inherited entrepreneurial abilities) on firm performance. This aim is motivated by the contemporary arguments that social relations (e.g. family ties) are important in the analysis of today’s space economy. In most studies, the point of departure in the analysis of firm performance has often been to analyse and examine the cognitive resources available in a firm, as well as a firm’s geographical closeness to related firms and industries. However, this argument has been challenged, and it is further suggested that social relations, and for that matter family relations (or family co-occurrence), may be important in the analysis of firm performance. To test this argument, the analysis is based on longitudinal data comprising various register data on the Swedish population and firms.

    To examine the aim, three different but related questions were analysed: the first analysed the prevalence of family employment across different regions and how this affects firm performance; the second examined the relationship between entrepreneurs’ familial relations (co-occurrence of different family relations) and skill variety, on one hand, and how the relationship affects firm performance on the other; and the third examined the effects of present family relations (family firms) and entrepreneurial capital (EC, past family relations) on the survival and growth of new entrants. Questions 1 and 2 were explored by applying simple ordinary least squares (OLS) and fixed effects (FE) regressions, respectively. Question 3 was explored by employing an event-history analysis (survival analysis) to determine the time to exit and OLS for the growth analysis.

    The results show that family co-occurrence in firms (be they family or non-family firms) positively affect labour productivity. At the same time, the results show that some specific family relationships are more important than others in terms of impacting labour productivity. Moreover, the results indicate that family firms, in particular, benefit the most from having family members employed in the firm, especially when this involves family relationships such as couples and/or children. The co-occurrence of couples and/or children in family firms moderates the negative impacts of similarities and unrelatedness of skills on productivity. The results show that the impacts of family co-occurrence are greater in smaller specialized regions than diverse and larger ones. Thus, while the family positively correlates with firm performance, this is mainly the case in specialized regions. The results further show that family firms are not more resilient, as the literature argues; but this effect is confounded by EC. The implication is that it is not family firms per se that are resilient but rather firms with entrepreneurial experience from parents, especially in rural regions; meanwhile, family firms create more jobs. However, the analysis could not identify a clear regional effect of the role of family firm on job creation. In this sense, the present thesis provides important insight into why the family constitutes an important part of the firm production setup. The findings show that it is necessary and important to consider the family, and family firms, in the larger regional development framework. Moreover, while reflecting on the uniqueness of the family as a social group whose shared identity and mutual trust can enhance firm performance and regional development, we should also not lose sight of the fact that there is a latent risk: it is not a problem—until it becomes a problem.

  • Public defence: 2018-04-06 09:00 Aulan, Vårdvetarhuset, Umeå
    Hörnberg, Kristina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Rheumatology.
    Aspects of physical activity in Rheumatoid Arthritis: associations with inflammation and cardiovascular risk factors2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Rheumatoid Arthritis (RA) is associated with an increased risk for cardiovascular disease (CVD), partially attributable to systemic inflammation and traditional risk factors for CVD. Since physical activity (PA) is strongly related to CVD in the general population, the aim of this thesis was to describe aspects of PA in patients with RA, and further to analyse associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis.

    Methods: In papers I and II, newly diagnosed RA patients were followed for two (n=66) and mean (SD) 16 (2) (n=25) years respectively. Disease activity and aerobic capacity were measured in both groups.​ In paper II, the 25 patients were also examined for traditional risk factors for CVD, body composition, with pulse wave analysis and carotid ultrasound. Self-efficacy was assessed using a questionnaire. In paper III, a combined heart rate and movement monitor was used to measure PA in 84 patients with early (<2 years) and 37 patients with long-standing (mean [SD] 16 [2] years) RA. Data were analysed for associations with disease activity, traditional risk factors for CVD and subclinical atherosclerosis, as above. Finally, in paper IV, a pilot study including 13 patients, median (Q1-Q3) age 57 (44-64) years, was conducted to analyse the feasibility as well as the effects of ten weeks of spinning exercise, on aerobic capacity, traditional risk factors for CVD and inflammation.

    Results: In papers I and II, aerobic capacity was maintained at follow-up. In paper I, median (Q1-Q3) aerobic capacity was 31 (27-39) ml/kg x min at baseline and 33 (25-38) ml/kg x min after two years. In paper II, median (Q1-Q3) aerobic capacity was 32 (28-42) ml/kg x min at baseline and 33 (28-39) ml/kg x min after 16 years. In multiple linear regression analyses, adjusted for baseline aerobic capacity, disease activity during the first two years after diagnosis explained 53 % of the aerobic capacity level after 16 years [b=-0.14, p<0.004]. Higher aerobic capacity was associated with more favourable measures of risk factors for CVD and self-efficacy over time and at follow-up. In paper III, 37 % of the patients with early and 43 % of the patients with long-standing RA, did not reach the national recommendations of PA. Total PA as well as more time spent in moderate to vigorous PA were associated with more favourable risk factors for CVD. Patients with higher disease activity and functional disability were less physically active. In paper IV, intensive spinning exercise proved to be a feasible method, that significantly improved aerobic capacity, systolic blood pressure and the number of tender joints.

    Conclusions: Aerobic capacity, which could be maintained despite several years of disease, was related to risk factors for CVD and to self-efficacy. Higher disease activity in early disease predicted lower aerobic capacity after 16 years. Higher PA level was associated with a more beneficial cardiovascular profile, however, an insufficient level of PA was found in a substantial proportion of patients. Furthermore, we found, that intensive spinning exercise was a feasible method for the group included, to improve aerobic capacity and blood pressure without detrimental effects on disease activity. Physical activity and aerobic capacity have roles to play in the cardio protective management and are, as other modifiable risk factors, suggested to be estimated regularly. Higher disease activity is known to increase the risk of CVD in RA, and as disease activity also seems to negatively impact future aerobic capacity, interventions and support for health enhancing PA should have high priority in these patients. 

  • Public defence: 2018-04-06 10:00 Lilla hörsalen (KB.E3.01), KBC-byggnaden, Umeå
    Tan, Biyue
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Stora Enso AB.
    Genomic selection and genome-wide association studies to dissect quantitative traits in forest trees2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The convergence of quantitative genetics of complex traits with genomic technologies is quickly becoming an innovative approach to explore fundamental genetic questions and also have practical consequences for implementations in tree breeding. In this thesis, I used genomic selection and genome-wide association studies (GWAS) to dissect the genetic basis of quantitative traits, i.e. growth, phenology and wood property traits. I also assessed the importance of dominance and epistatic effects in hybrid Eucalyptus. Both dominance and epistasis are important in hybrids, as they are the likely contributing to the genetic basis of heterosis. To successfully implement genomic selection models, several important factors have to be considered. I found that for a good model establishment, both the size and composition of the training population, as well as the number of SNPs to be important considered. Based on the optimal models, additive, dominance and epistasis genetic effects of growth and wood traits have been estimated to evaluate genetic parameters and how these influence the prediction accuracy, which can be used in selecting elite breeding individuals or clones. I also addressed the advantage of genotyping-based analyses by showing that we could accurately correct pedigree information errors. More importantly, genotyping-based analyses capture both Mendelian segregation variation within full-sib families and cryptic genetic links through unknown common ancestors, which are not available from traditional pedigree data. GWAS were used to analyse growth and phenology related traits. Using a single-trait GWAS method, we identified a region strongly associated with the timing of bud set in Populus tremula, a trait with high heritability. For the growth related traits, we found that a multi-traits GWAS approach was more powerful than single-trait analyses as it identified more associated SNPs in hybrid Eucalyptus. Moreover, many more novel associated SNPs were identified from considering over-dominance effects in the GWAS analyses. After annotating the associated SNPs I show that these functional candidate genes were related to growth and responding to abiotic and biotic stress. In summary, the results of genomic selection and GWAS provided a deeper understanding of the genetic backgrounds of quantitative traits in forest trees.