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  • Håglin, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Törnkvist, Birgitta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Bäckman, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention2020In: PLoS ONE, E-ISSN 1932-6203, Vol. 15, no 1, article id e0227692Article in journal (Refereed)
    Abstract [en]

    Background: Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown.

    Objectives: This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), and serum phosphate (S-P) levels.

    Methods: Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels.

    Results: High BMI (>34,2 kg/m2), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108–2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461–2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140–5.740 and [HR] 1.536; 95% CI 1.058–2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211–2.424). In non-smokers, low BMI (<27.6 kg/m2) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179–0.937, respectively).

    Conclusions: High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females.

  • Andersson, Josefin
    et al.
    Umeå University, Faculty of Social Sciences, Department of Education.
    Christoffersson, Linda
    Umeå University, Faculty of Social Sciences, Department of Education.
    Flickor med svårigheter inom essence: Vilka signaler sänder de ut och hur tolkar vi dem?2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Flickor med svårigheter inom området Essence kan vara svåra att upptäcka då deras signaler kan misstolkas och förringas med konsekvenser som psykisk ohälsa, skolfrånvaro och utanförskap i förlängningen. Studiens syfte var att synliggöra och analysera fyra pedagogers och fyra vårdnadshavares erfarenheter och upplevelser omkring de signaler som flickor uppvisar, kopplat till konstaterade eller misstänkta svårigheter inom Essenceområdet. Förhoppningen var att kunna bidra till ökad kunskap om vikten av tidig identifikation och därigenom ökad möjlighet till lämplig stöttning av dessa flickor på deras väg genom livet. Med intervju som metod genomfördes en kvalitativ studie där resultatet bland annat visade att återkommande signaler hos flera flickor visat sig som stora svårigheter i relationsskapande, samt att behärska många av de vardagliga moment som livet och skolan innebär. Resultatet visar också att vårdnadshavarna ofta tidigt identifierar svårigheter medan pedagoger i de flesta fall avvaktar, kompenserar och i vissa fall fördröjer utredningar.

  • Nguyen, Hong Hanh
    et al.
    Ho, Dang Phuc
    Vu, Thi Lan Huong
    Tran, Khanh Toan
    Tran, Thanh Do
    Nguyen, Thi Kim Chuc
    van Doorn, H Rogier
    Nadjm, Behzad
    Kinsman, John
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
    Wertheim, Heiman
    "I can make more from selling medicine when breaking the rules": understanding the antibiotic supply network in a rural community in Viet Nam2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1560Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As in many other low and middle income countries (LIMCs), Vietnam has experienced a major growth in the pharmaceutical industry, with large numbers of pharmacies and drug stores, and increasing drug expenditure per capita over the past decade. Despite regulatory frameworks that have been introduced to control the dispensing and use of prescription-only drugs, including antibiotics, compliance has been reported to be strikingly low particularly in rural parts of Vietnam. This qualitative study aimed to understand antibiotic access and use practices in the community from both supplier and consumer perspectives in order to support the identification and development of future interventions.

    METHODS: This qualitative study was part of a project on community antibiotic access and use (ABACUS) in six LMICs. The focus was Ba Vi district of Hanoi capital city, where we conducted 16 indepth interviews (IDIs) with drug suppliers, and 16 IDIs and 6 focus group discussions (FGDs) with community members. Drug suppliers were sampled based on mapping of all informal and formal antibiotic purchase or dispensing points in the study area. Community members were identified through local networks and relationships with the field collaborators. All IDIs and FGDs were audio-taped, transcribed and analysed using content analysis.

    RESULTS: We identified a large number of antibiotic suppliers in the locality with widespread infringements of regulatory requirements. Established reciprocal relationships between suppliers and consumers in drug transactions were noted, as was the consumers' trust in the knowledge and services provided by the suppliers. In addition, antibiotic use has become a habitual choice in most illness conditions, driven by both suppliers and consumers.

    CONCLUSIONS: This study presents an analysis of the practices of antibiotic access and use in a rural Vietnamese setting. It highlights the interactions between antibiotic suppliers and consumers in the community and identifies possible targets for interventions.

  • Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Living in the shadow of unemployment -an unhealthy life situation: a qualitative study of young people from leaving school until early adult life.2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1661Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite the magnitude of youth unemployment there is a lack of studies, which explore the relations between health experiences and labour market position in various contexts. The aim of this paper was to analyse health experiences among young people in NEET (not in education, employment or training) in relation to labour market position from leaving school until early adult life.

    METHOD: The population consists of everyone (six women, eight men) who became unemployed directly after leaving compulsory school in a town in Northern Sweden. Repeated personal interviews were performed from age 16 until age 33. The interviews were analysed using qualitative content analysis.

    RESULTS: Health experiences can be viewed as a contextual process, related to the different phases of leaving school, entering the labour market, becoming unemployed and becoming employed. Perceived relief and hope were related to leaving compulsory school, while entering the labour market was related to setbacks and disappointments as well as both health-deteriorating and health-promoting experiences depending on the actual labour market position. Our overarching theme of "Living in the shadow of unemployment - an unhealthy life situation" implies that it is not only the actual situation of being unemployed that is problematic but that the other phases are also coloured by earlier experiences of unemployment .

    CONCLUSION: A focus on young people's health experiences of transitions from school into the labour market brings a new focus on the importance of macroeconomic influence on social processes and contextualised mechanisms from a life-course perspective.

  • Strandh, Victoria
    et al.
    Umeå University, Faculty of Arts, Department of language studies.
    Löfroth, Frida
    Umeå University, Faculty of Arts, Department of language studies.
    Språkutvecklande arbetssätt för elever med språkstörning: En kvalitativ studie där några lärare och speciallärare beskriver sitt arbete2020Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to investigate what efforts some teachers and special needs teachers at primary schools think are needed at the organizational, group and individual levels to provide support for students with Developmental Language Disorder (DLD). Furthermore, it was investigated which supportive strategies and teaching methods teachers and special needs teachers applied and how the learning environment could be favourably designed. The study was based on a qualitative method with semi structured interviews and observations. The result shows that principals' priorities and the presence of speech therapists at schools affect what support participants experienced they received. The participants are guided by a relational perspective where the focus is on how the linguistic and physical learning environment can support the students. To provide that support, students with DLD should be carefully charted and they are favored by a clarifying pedagogy. The adjustments aimed at students with DLD benefit all students.

  • Vennberg, Erika
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Nyberg, Carolina
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Professionellas hanteringsstrategier för hållbarhet inom socialt arbete2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    “... jag blir väl halshuggen ibland när man säger, det här är bara ett jobb, det måste inte vara ett kall”. Socialt arbete har genom historien förknippats med uppoffringar och att åsidosätta sig själv. Tidigare forskning på området visar att det är ett utsatt yrke där de professionella själva riskerar att hamna i ohälsa, mestadels på grund av de organisatoriska belastningarna. Det lämnar den professionelle till att själv många gånger hantera de krav och påfrestningar som yrket innebär. Det blir då viktigt för professionella att ha ett sätt att hantera sin tillvaro för att nå en hållbar fysisk och psykisk hälsa.

    Som socionomstudenter ser vi genom utbildningen en avsaknad gällande tydliga och fungerande verktyg för de professionella i mötet med klienter. Vår upplevelse är att det inte förs tillräckliga resonemang kring vikten av den professionellas hälsa genom yrkeslivet. Syftet med studien är därmed att undersöka hur professionella i klientnära socialt arbete beskriver att de använder sig av hanteringsstrategier i sin yrkesroll för att vara hållbar genom ett helt arbetsliv. De frågor studien syftar att besvara är vad professionella har för synsätt om sin egen hälsa ur ett hållbarhetsperspektiv, hur de använder sig av hanteringsstrategier för ett varaktigt yrkesliv samt hur de professionella reflekterar över sin yrkesroll. Studien bygger på kvalitativ metod där fem professionella inom klientnära socialt arbete intervjuats. Genom konventionell innehållsanalys bearbetades materialet där det i empirin kan utläsas följande kategorier: hållbar hälsa, kognitiva hanteringsstrategier, praktiska hanteringsstrategier, professionsrollen, energiförtjänster och energiförluster. Föregående kategorier analyseras i studien både som risk- och skyddsfaktorer för ett hållbart yrkesliv, vilket är det genomgående temat i resultatet.

  • Rauschning, Mimmi
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    "Det tar lika lång tid att gå ut ur skogen som att gå in i den": Att ta sig ur ett alkoholberoende2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Studiens syfte är att få en djupare förståelse för hur vägen från alkoholberoende till nykterhet kan se ut. Studien har en narrativ utgångspunkt och insamlandet av material har skett med öppna intervjuer. Tidigare studier visar på att det finns olika perspektiv på alkoholism och behandling för det. Olika behandlingsformer ger olika resultat. Formell behandling kan vara ett sätt att komma ur beroendet. Det har däremot framkommit att olika typer av informell behandling, exempelvis Anonyma Alkoholister kan ha större betydelse när det handlar om att förbli nykter. Tidigare forskning pekar också på att sluta dricka är en förändring som kan bidra till flera olika positiva följder. Men vad är det som gör att en alkoholist väljer att sluta dricka? Resultatet i den här studien visar på att sådana omständigheter som gör att man tar beslutet om att söka hjälp är när man äventyrar familjesituationen och arbetet, när en allvarlig olycka inträffar eller när känslan av outhärdlighet uppstår. Studien synliggör också att vägen från alkoholberoende till nykterhet inte är rak och det tar tid men den ger mycket i gengäld, till exempel stolthet, positivitet och trygghet. Studiens resultat visar också på att Anonyma Alkoholister spelar en betydande roll i processen.

  • Hedman, Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Johansson, Olivia
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Att upphöra med kriminalitet: En kvalitativ studie av livsstilskriminellas resa mot en livsstilsförändring2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    I denna studie har fyra före detta livsstilskriminella intervjuats för att ta reda på vad som föranledde deras beslut att upphöra med en kriminell livsstil, hur respondenternas resa mot förändring sett ut samt vilka avgörande faktorer som funnits under processens gång. 

    Det är en kvalitativ studie där semistrukturerade intervjuer har gjorts med personer som själva identifierat sig som före detta livsstilskriminella. Materialet har analyserats utifrån en modell utvecklad av Antonovskys (1991) teori Känsla av Sammanhang, begreppet Rock Bottom och teorier om Sociala Band (Hirschi, 1969; Sampson och Laub, 1993). 

    Analysen följer en kronologisk ordning, vilket i studien benämns som resan mot en livsstilsförändring. Resan startar vid en avgörande tid i livet där respondenterna har nått botten, vilket kan jämföras med Rock Bottom. Detta är vad respondenterna själva valt att kalla vändpunkten och blev startskottet på en lång resa. När respondenterna nått botten var de sociala banden till det konventionella samhället nästintill obefintliga och de hade därmed en avsaknad av social kontroll. Under tiden för förändringen förbättrades de sociala banden till det konventionella samhället successivt. Nya sociala sammanhang, sysselsättningar och nära relationer byggdes upp och de sociala banden ledde till att respondenterna inte längre ville begå brott. I krisen, som skulle föranleda vändpunkten, hade respondenterna en låg känsla av sammanhang, vilket har visat sig vara starkt sammankopplat med svaga sociala band till det konventionella samhället. Allt eftersom tiden gick och de sociala banden förstärktes ökade även känslan av sammanhang. Analysmodellen visar att alla dessa faktorer samverkar med varandra och är under förändring i uppbrottsprocessen. Den här processen övergår efter ett tag till att bara vara en del av livsloppet, som pågår för resten av livet. Utöver detta har studien visat att en individ som ska kunna upphöra med brott behöver också upphöra med droger.

  • Mulubwa, Chama
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health, University of Zambia, Lusaka, Zambia; Zambart Project, University of Zambia, Lusaka, Zambia.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Zulu, Joseph Mumba
    Michelo, Charles
    Sandøy, Ingvild Fossgard
    Goicolea, Isabel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia.2020In: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 17, no 1, article id 1Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights' needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) 'ordinary' community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents.

    METHODS: This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention-Context-Actors-Mechanism-Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories.

    RESULTS: We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification', which was also expected would lead to individuals developing a 'supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages.

    CONCLUSION: The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform 'ordinary' community-based health systems into systems that are responsive to adolescents.

  • Chamoun, Mario-Christofer
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    An Alzheimer-type cerebrospinal fluid profile in early Parkinson's disease2019Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    In recent years, several studies have discovered traces of Alzheimer's (AD) biomarkers in a large portion of patients with Parkinson's disease (PD), which have been associated with subsequent dementia (PDD). However, the manifestation of AD biomarkers in PD is not fully understood. At present, few studies have investigated how common AD biomarkers are in newly diagnosed and unmedicated patients with PD. This cross-sectional cohort study investigated whether AD biomarkers were present in unmedicated and newly diagnosed patients with PD and patients with PD and overlapping clinical symptoms (cognitive impairment, depression, olfactory dysfunction). Cerebrospinal fluid (CSF) levels of AD biomarkers Amyloid-β-42 (Aβ42), phosphorylated-tau (p-tau), and total-tau (t-tau) were assessed in 343 patients with the mean age of 68,69 (SD=9,60), including 31 healthy controls with the mean age of 68,90 (SD=5,64). The participants were recruited from The New Parkinson Patient in Umea (NYPUM & PARKNY). The results showed a significant difference in CSF AD biomarkers between patients with PD and healthy controls, but not in patients with PD and overlapping clinical symptoms. The results point to the presence of AD pathology in early PD; however, the presence of AD pathology could not be further strengthened by the clinical overlapping symptoms. More prospective studies on newly diagnosed patients with PD need to be carried out to investigate the prognostic values of the presence of AD pathology found in PD.

  • Public defence: 2020-02-07 09:00 Hörsal D by 1A, 9tr, Umeå
    Kverneng Hultberg, Daniel
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
    Surgery for rectal cancer: the impact of perioperative factors2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Rectal cancer is one of the most common and deadly cancer forms worldwide. A large proportion of rectal cancer patients are surgically treated with curative intention, with anterior resection being the most frequently used method today. During surgery, the inferior mesenteric artery is either ligated proximal (high tie) or distal to the left colic artery (low tie). It is not known whether the tie level affects the oncologic nor the functional outcome. Postoperatively, about one in ten patients develop an anastomotic leakage. It is unclear whether treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) affects the risk of leakage, or whether having a leakage influences the functional outcome. 

    The general aims of this dissertation were to increase the knowledge of intra- and postoperative treatment for rectal cancer, with the goal of improving the oncologic and functional outcomes, as well as reducing postoperative complications. National registers, predominantly the Swedish Colorectal Cancer Registry, were used in all of the dissertation’s four retrospective cohort studies to identify and retrieve information regarding patients. Various statistical methods have been used in all studies with the aim of eliminating bias, including confounding.

    In Study I, high tie slightly increased the total number of harvested lymph nodes in the included 8287 patients, as compared with low tie, while the primary outcome cancer-specific survival, as well as secondary oncologic outcomes, were not affected. This indicates that the oncologic outcome does not have to be considered when the surgeon determines the level of tie.

    In Study II, investigating the effect of tie level on the functional outcome, the outcome was any defecatory or urogenital symptoms two years after anterior resection, assessed with a mailed questionnaire. With a response rate of 86%, 805 patients were included. High tie did not, except for increasing the need of defecation at night, influence the risk of major dysfunction. Again, this would facilitate the choice of tie level.

    Study III used the same outcome, and in part the same study population, as Study II, but instead with the exposure anastomotic leakage. With a response rate of 82%, 1180 patients were included. We found that anastomotic leakage increased the risk of reduced sexual activity and increased the use of aid products for fecal incontinence after anterior resection, while the risk of urinary incontinence was unexpectedly decreased. Other outcomes were not clearly affected. 

    In Study IV, in addition to the register, information was gathered from patient records. In the included 1495 patients who had undergone anterior resection, postoperative NSAID treatment was not found to increase the risk of symptomatic anastomotic leakage. There were no differences between non-selective and COX-2 selective NSAIDs. This study does not support that NSAID treatment increases the risk of anastomotic leakage after such surgery.

  • Public defence: 2020-02-07 09:15 N460, Umeå
    Vidman, Linda
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    cancer subtype identification using cluster analysis on high-dimensional omics data2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Identification and prediction of cancer subtypes are important parts in the development towards personalized medicine. By tailoring treatments, it is possible to decrease unnecessary suffering and reduce costs. Since the introduction of next generation sequencing techniques, the amount of data available for medical research has increased rapidly. The high dimensional omics data produced by various techniques requires statistical methods to transform data into information and knowledge.

    All papers in this thesis are related to distinguishing of disease subtypes in patients with cancer using omics data. The high dimension and the complexity of sequencing data from tumor samples makes it necessary to pre—process the data.  We carry out comparisons of feature selection methods and clustering methods used for identification of cancer subtypes. In addition, we evaluate the effect that certain characteristics of the data have on the ability to identify cancer subtypes. The results show that no method outperforms the others in all cases and the relative ranking of methods is very dependent on the data. We also show that the benefit of receiving a more homogeneous data by analyzing genders separately can outweigh the possible drawbacks caused by smaller sample sizes. One of the major challenges when dealing with omics data from tumor samples is that the patients are generally a very heterogeneous group. Factors that lead to heterogeneity include age, gender, ethnicity and stage of disease. How big the effect size is for each of these factors might affect the ability to identify the subgroups of interest.

    In omics data, the feature space is often large and how many of the features that are informative for the factors of interest will also affect the complexity of the problem. We present a novel clustering approach that can identify different clusters in different subsets of the feature space, which is applied on methylation data to create new potential biomarkers. It is shown that by combining clinical data with methylation data for patients with clear cell renal carcinoma, it is possible to improve the currently used prediction model for disease progression.  

    Using unsupervised clustering techniques, we identify three molecular subtypes of prostate cancer bone metastases based on gene expression profiles. The robustness of the identified subtypes is confirmed by applying several clustering algorithms with very similar results.

     

  • Enebjörk, Sara
    et al.
    Umeå University, Faculty of Social Sciences, Department of Education.
    Lindström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Education.
    Pojkars lägre måluppfyllelse i skolan: En intervjustudie med lärare2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Through the purpose of the study, which is to investigate how special educators and educators in compulsory school perceived causes of differences in goal achievement for boys and girls, as well as the working methods used to counteract this problem, we wanted to contribute to increased knowledge. Background and previous research dealt with various control documents, how the concept of gender could be understood in pedagogy, gender differences in goal fulfillment as well as various explanations and successful methods for countering these differences. Socioculturally perspective on learning was used as an overall theoretical framework. The study's empirical data was collected through semi-structured interviews with five educators and five special education teachers at a few differentschools and stages in two municipalities. The result showed that both special educators and educators found explanations for gender differences in goal achievement in both individuals and the environment. To reduce gender differences in goal attainment suggestions were, working with enhancing reading, a more formative approach and cooperative learning emerged. Most participants did not feel that this was a priority field. In regards to how the informants perceived that the field was noticed in everyday work at the schools, it was found that it was not very frequent and that it was not included in the systematic quality work at any of the schools surveyed. However, almost half of the informants were positive about continuing education in the area, although some thought that continuing education in other areas was more important at the present time.

  • Borgh Westin, Angelica
    et al.
    Umeå University, Faculty of Arts, Department of language studies.
    Andersson, Linn
    Umeå University, Faculty of Arts, Department of language studies.
    Intensiv lästräning genom metoden upprepad läsning med högstadieelever i lässvårigheter: En interventions- och enkätstudie2020Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This study investigates to what extent an intensive reading intervention of two weeks, based on repeated reading, can improve the reading fluency for students with reading difficulties in secondary school. The study also investigates how the students evaluated the intervention based on repeated reading. Nineteen students with reading difficulties in secondary school were selected and divided into two comparable groups, an intervention group and a control group. Ten students in the intervention group were given daily one to one tutorial training in decoding and fluency by reading lists with words, nonwords and texts repeatedly times. Visual as well as spoken feedback were given between every set of reading. The control group received ordinary classroom teaching. Tests before and after the intervention with all students were done. The intervention students completed a questionnaire about their evaluation of the intervention and how they estimated their reading ability after the training period. The results of the study showed that most students in the intervention group increased their test results in terms of decoding words and text reading compared to the control group. The results of the questionnaire showed that the students experienced that they had increased their reading ability and that they had become more self-confident about their reading.

  • Bergius, Madeleine
    et al.
    Umeå University, Faculty of Arts, Department of language studies.
    Asplund, Viktoria
    Umeå University, Faculty of Arts, Department of language studies.
    Rätt stöd i rätt tid?: – En studie om lärares och speciallärares uppfattningar om skrivande för yngre elever i skrivsvårigheter2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Today´s society demands that every individual is able to communicate in writing. It is the school's responsibility to provide the students with the conditions to succeed. Teachers and special needs teachers need to identify students in need of support as early as possible and provide them with the appropriate instruction to become proficient writers. The purpose of this study is to investigate several teachers' and special needs teachers' perceptions on teaching writing for younger pupils who are at risk of not attaining the goals of writing for grade 3. We interviewed 3 teachers and 3 special needs teachers about their writing knowledge, what instructional methods they use, what efforts are being made in regards to pupils with writing difficulties and what challenges and opportunities they see. The results show that teachers and special needs teachers can detect struggling students early, however, the origin of the difficulties and the right support are often difficult to determine. The support these students receive are mainly extra adaptations in the classroom. Both teachers and special needs teachers use many different working methods in their teaching for these students, but express that there is a lack of knowledge and research on writing and that time and group size are challenges in providing a good writing instruction. 

  • Holmgren, Martin
    et al.
    Umeå University, Faculty of Arts, Department of language studies.
    Ekström, Lizette
    Umeå University, Faculty of Arts, Department of language studies.
    Hittar "Hitta språket" språket?: Identifiering av riskfaktorer för sen läsinlärning i förskoleklass - en metodjämförelse2020Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The purpose of this study was to investigate to which extent the criterion-related national assessment aid, ”Hitta språket” for preschool classes, identifies students with weak phonological awareness, in comparison with norm-related screening materials. The study also conducted a survey to examine how preschool teachers conducted their observations, how they interpreted the results and to what extent they considered the assessment aid purposeful. The results of the study show that the low set requirements of ”Hitta språket” in combination with unclear instructions for implementation and results analysis, means that students in need of adjustments and / or special support regarding their reading development are at risk of being missed. The majority of the teachers in the study questioned the assessment aid’s ability to identify students with weak phonological awareness.

  • Yekkalam, Negin
    et al.
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, Huddinge, Sweden.
    Coello, Ekaterina
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, SE 14104 Huddinge, Sweden.
    Mikaela, Eklund
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, SE 14104 Huddinge, Sweden.
    Hajer, Jasim
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, SE 14104 Huddinge, Sweden.
    Nikolaos, Christidis
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, SE 14104 Huddinge, Sweden.
    Ernberg, Malin
    Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and Scandinavian Center for Orofacial Neuroscience, SE 14104 Huddinge, Sweden.
    Could Reported Sex Differences in Hypertonic Saline-induced Muscle Pain be a dose Issue?2019In: Dental Oral Biology and Cranofacial Research, ISSN 2613-4950, Vol. 2, no 5, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Higher levels of experimental muscle pain induced by injection of the same volume of noxious substances have been reported by women compared to men. This could hypothetically be related to the difference in muscle volume between men and women. The aim of this study was to investigate if the sex differences reported by intramuscular injection of hypertonic saline would disappear if a larger dose is given to men than women under similar conditions.

    Methods: Fifty-six healthy volunteers (25 men and 31 women) received hypertonic saline injection into the masseter muscle, 0.5 mL for men and 0.3 mL for women, to evoke pain. Pain intensity was assessed with 0-100 mm visual analogue scale (VAS) every 15 seconds until pain subsided or maximum 300s. VAS was also used to assess perceived unpleasantness and anxiety. Pain drawings were used to assess maximal pain distribution, and the McGill pain questionnaire to assess pain quality.

    Results: There was no sex difference in maximum pain intensity, unpleasantness, anxiety or pain drawing area, but the evoked pain had larger total pain area (p=0.005), and longer duration (p<0.001) in the men than women. The sexes also used some different pain descriptors.

    Conclusions: This study shows that the previously reported higher pain levels in women were abolished when a lower dose of hypertonic saline was injected into the masseter muscle of the women than men. This might indicate that the sex differences reported to hypertonic-induced muscle pain may be a dose issue. Further studies are required to validate these results

  • Engström, Ebba
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lampa, Emma
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Inställning till betydelsen av empati i relation till polisyrket bland polisstuderande och verksamma poliser2020Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    An empathic ability has been proven to be of great importance in professions where contact with other people constitutes a large part of the work, such as in caregiving professions and in police work. However, previous studies of caregiving professions have shown that empathy or attitudes towards the importance of empathy in occupational situations can decline with education or experience. No such studies have been found regarding police work. Therefore, the aim of this study was to investigate attitudes towards the importance of empathy among police students and police officers. Using a self-report questionnaire inspired by Jefferson Scale of Physician Empathy Student version (JSPE-S) and modified to fit a police context, two research questions were formulated, related to the aim. The first research question was whether there is a difference between police students in the beginning and in the end of their education, and also police officers, regarding their attitudes towards the importance of empathy. The second research question was whether there are gender differences regarding attitudes towards the importance of empathy. The sample of the study consisted of 219 participants from three groups: police students in term one (n=73) and term five (n=65), and police officers (n=81). A two-way ANOVA was used to answer the research questions. Police students in first term rated higher than those in last term as well as police officers. A bit unexpected, and not in accordance with previous studies, no significant difference in attitudes towards the importance of empathy was found between men and women. In summary, the result indicates that attitudes towards the importance of empathy in occupational situations may decrease during police education in a similar way as in education of caregiving professions.   

  • Coe, Anna-Britt
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Social Processes Underlying Movement Influence: Young Adult Feminist Activists’ Interactions with Professionalized Feminist Organizations in Ecuador and Peru2020In: The Sociological Quarterly, ISSN 0038-0253, E-ISSN 1533-8525Article in journal (Refereed)
    Abstract [en]

    Despite extensive research on the influence between social movements, knowledge remains limited to the basic social processes by which this occurs. This article locates these social processes in the accounts among young adult feminist activists in Ecuador and Peru. Qualitative interviews were conducted and analyzed among 21 young adult feminist activists from eight groups. The findings show how their feminist mobilizing was influenced by interactions with professionalized feminist organizations that were simultaneously inclusive and exclusionary. Three in/exclusionary interactions captured basic social processes whereby young adult feminist activists struggled to define modes of participation, organizational practices, and targets of engagement.

  • Eriksson, Kajsa
    Umeå University, Faculty of Arts, Department of language studies.
    Symboler som komplement - stödjande eller störande?: Hur elever upplever att symbolstöd i undervisningen påverkar deras förståelse av muntlig information2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim of this study is to examine students’ experiences of how graphic symbols as a visual support affects their understanding of oral verbal information. Students with a typical language development as well as students with language difficulties regarding the understanding of vocabulary were included in the study, in total 43 students from two different classes in grade 5 participated. The students answered a questionnaire conducted at the end of two lessons without graphic symbols and two lessons with graphic symbols in order to explore how usage of graphic symbols affected their experienced understanding. The results were compared through a paired samples t-test and an independent samples t-test. The results showed that both the linguistic vulnerable students and the students with typical linguistic development experienced an increased understanding of the teachers lecture during the lessons with graphic symbols. However, the results indicated no positive effect for the linguistic vulnerable students regarding the understanding of the teacher’s vocabulary or how clear the teacher’s explanations were. The results also showed that the linguistic vulnerable students, in comparison to the students with typical linguistic development, experienced greater difficulties regarding the understanding of both the vocabulary and the symbols used by the teacher. 

  • Warde, Paul
    et al.
    Faculty of History, University of Cambridge.
    Lindmark, Magnus
    Umeå University, Faculty of Social Sciences, Centre for Environmental and Resource Economics (CERE). Umeå University, Faculty of Social Sciences, Unit of Economic History.
    Heat in a Cold Climate: Household Energy Choices in the Scandinavian North, 1890–19702019In: Journal of Northern Studies, ISSN 1654-5915, Vol. 3, no 1, p. 61-91Article in journal (Refereed)
    Abstract [en]

    This article examines the timing, scale and cause of transitions between different kinds of household energy use and especially heating in northern Sweden, with a focus on Norrbotten, between the late nineteenth century and 1970. It examines the related but separate histories of the adoption of new heating technologies, such as stoves and boilers, and the choice of fuels, such as firewood, coke, oil, and electricity, providing new data on the scale of consumption and timing of transition. The article demonstrates the important linkage between domestic fuel choice and labour markets, whether labour in farm and forest affecting stove use in the nineteenth century, or increased female labour participation outside the home and rising wages in the twentieth. The article goes beyond discussions of price and technology to consider the wider contexts of domestic use not only in terms of home life, but also industrial development and labour markets in northern Sweden.

  • Linden, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Granåsen, Gabriel
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Salzer, Jonatan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Svenningsson, Anders
    Sundström, Peter
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences.
    Inflammatory activity and vitamin D levels in an MS population treated with rituximab2019In: Multiple Sclerosis Journal, Experimental, Translational and Clinical, E-ISSN 2055-2173, Vol. 5, no 1, article id 2055217319826598Article in journal (Refereed)
    Abstract [en]

    Background: Most multiple sclerosis patients on disease-modifying treatment at Umeå University Hospital are treated with rituximab and the prevalence of vitamin D supplementation has increased over time. Follow-up studies of these off-label treatments are needed.

    Objective: To study inflammatory activity and adverse effects in rituximab-treated multiple sclerosis patients, and associations with 25-hydroxy-vitamin D levels.

    Methods: Retrospectively collected data on repeated estimates of relapses, disability, side effects, magnetic resonance imaging, laboratory measures including 25-hydroxy-vitamin D levels and self-perceived health.

    Results: In 272 multiple sclerosis patients with a mean follow-up of 43 months, we identified seven possible relapses during active rituximab treatment. On magnetic resonance imaging examination, new T2 lesions were seen in 1.3% (10 out of 792 scans), and 0.25% (two out of 785 scans) showed contrast enhancement. Adjusted 25-hydroxy-vitamin D levels in samples drawn close to all magnetic resonance images with new T2 lesions were lower compared to the remainder (62 vs. 81 nmol/l; P = 0.030). Levels of 25-hydroxy-vitamin D were associated with self-perceived health (r = 0.18, P = 0.041, n = 130) and C-reactive protein (r = -0.13, P = 0.042) but not with the risk of side effects.

    Conclusion: The inflammatory activity in this rituximab-treated multiple sclerosis population that increasingly used vitamin D supplementation was extremely low. Higher 25-hydroxy-vitamin D levels were associated with beneficial outcomes.

  • Johansson, Patrik
    et al.
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Saati, Abrak
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Different Methods for Analyzing Varieties of Peace2020Report (Refereed)
    Abstract [en]

    Peace can take many different forms and be expressed in a myriad of different ways that go well-beyond “peace as the absence of war”. Though recent scholarly contributions within this vein of research acknowledge the empirical reality of a variety of “peaces”, we are yet to understand how – methodologically – researchers can go about the endeavor of developing tools that allow us to describe and classify varieties of peace.  Our effort in this paper addresses this knowledge gap. We bring attention to different methods for empirically capturing varieties of peace when peace is approached as a situation, as a relationship or as an idea. Though our purpose is to illustrate a “smorgasbord of methods” for analyzing varieties of peace, we also argue that any effort to approach such an analysis ought to be based on theoretically coherent sets of types. This is so because it will allow the researcher to provide a more nuanced picture of different varieties of peace.

  • Segerholm, Christina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Education.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Olovsson, Tord Göran
    Umeå University, Faculty of Social Sciences, Department of Education.
    Lindström, Gunnar
    Umeå University, Faculty of Social Sciences, Department of Education.
    Almerud, Mårten
    Umeå University, Faculty of Social Sciences, Department of Education.
    Konsekvenser av prestationsbaserad ekonomistyrning i högre utbildning: Lärarhögskolan vid Umeå universitet som exempel2020Report (Other academic)
  • Public defence: 2020-01-31 11:00 S 213h, Samhällsvetarhuset, Umeå
    Bäckström, Peter
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Economics.
    Essays on military labour supply in the era of voluntary recruitment2020Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis consists of an introductory part and two self-contained chapters related to the supply of volunteers to the Swedish Armed Forces.

    Chapter [I] represents the first effort to explore the relationship between civilian labour market conditions and the supply of labour to the military in the all-volunteer environment that Sweden entered after the abolishment of the peacetime draft in 2010. The effect of civilian unemployment on the rate of applications from individuals aged 18 to 25 to initiate basic military training is investigated using panel data on Swedish counties for the years 2011 through 2015. A linear fixed-effects model is estimated to investigate the relationship, while controlling for a range of socio-demographic covariates and unobserved heterogeneity on the regional level, as well as aggregate trends on the national level. The results indicate a positive and statistically significant relationship between the unemployment rate and the application rate. The results are robust to non-linear form specifications, as well as allowing the civilian unemployment rate to be endogenous. As such, the results suggest that the civilian labour market environment in Sweden can give rise to non-trivial fluctuations in the supply of applications to initiate basic military training within the Swedish Armed Forces.

    Chapter [II] studies how local labour market conditions influence the quality composition of those who volunteer for military service in Sweden. A fixed-effects regression model is estimated on a panel data set containing IQ scores for those who applied for military basic training across Swedish municipalities during the period 2010 to 2016. The main finding is that low civilian employment rates at the local level tend to increase the mean IQ score of those who volunteer for military service, whereas the opposite is true if employment rates in the civilian labour market move in a more favourable direction. As such, the results suggest that the negative impact of a strong civilian economy on recruitment volumes is reinforced by a deterioration in recruit quality.

  • Eriksson, Linnéa
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Englund, William
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    MINDRE RÖTT KÖTT - MILJÖ ELLER HÄLSOFRÅGA?: En enkätstudie om konsumenters upplevda kunskap om livsmedels påverkan på miljön.2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    SAMMANFATTNING

    Bakgrund Den svenska befolkningen äter nästan dubbelt så mycket rött kött än

    livsmedelsverkets rekommendationer. Då rött kött har stor påverkan på miljön kan ökad

    livsmedelskunskap leda till förbättrade matvanor ur ett miljöperspektiv.

    Syfte Syftet med denna studie var att undersöka den upplevda kunskapen kring olika

    livsmedels påverkan på miljön. Detta gjordes genom att undersöka konsumenter som ur

    ett miljöperspektiv aktivt valt att minska konsumtionen av rött kött. Vidare var syftet att

    undersöka vilka livsmedel som konsumeras istället för rött kött samt om den upplevda

    kunskapen och hur livsmedelsvalen skiljde sig beroende på kön eller utbildningsnivå.

    Metod Undersökningen gjordes med en webbenkät som publicerades på Facebook hösten

    2019. Inklusionskriterierna för studien var att personerna skulle vara 18 år eller äldre, vara

    bosatta i Sverige samt under det senaste året valt att minska på rött kött av miljöskäl.

    Resultat Samtliga respondenter skattade i högst utsträckning att kyckling hade störst

    påverkan på miljön. Vid minskad konsumtion av rött kött hade kvinnor i större

    utsträckning valt att konsumera baljväxter medan män valt fisk. Den upplevda

    livsmedelskunskapen hos respondenterna visade sig vara måttlig och visade ingen

    signifikant skillnad mellan kvinnor och män samt låg- och högutbildade.

    Slutsats Trots att studien inriktade sig till de som av miljöskäl valt att minska på rött kött

    var det intressant att se att majoriteten även gjorde det av hälsoskäl. Studien bestod till

    största delen av kvinnor som visade sig främst välja baljväxter medan män valde fisk. En

    större andel av respondenterna var högutbildade som även de valde att äta framförallt

    baljväxter. Ett ökat intag av vegetabilier tros vara korrelerat med bättre hälsa men även till

    mindre miljöpåverkan.

  • Biström, Martin
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Alonso-Magdalena, Lucia
    Andersen, Oluf
    Jons, Daniel
    Gunnarsson, Martin
    Vrethem, Magnus
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Sundström, Peter
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    High serum concentration of vitamin D may protect against multiple sclerosis2019In: Multiple sclerosis journal - experimental, translational and clinical, ISSN 2055-2173, Vol. 5, no 4Article in journal (Refereed)
    Abstract [en]

    Background: High 25-hydroxyvitamin D concentrations have been associated with a reduced risk of multiple sclerosis, with indications of a stronger effect among young individuals.

    Objective: Investigate the 25-hydroxyvitamin D association with multiple sclerosis and test if this association is age dependent.

    Methods: Prospectively drawn blood samples from individuals later developing relapsing-remitting multiple sclerosis and controls matched for biobank, sex, age and date of sampling, were analysed with liquid chromatography tandem mass spectrometry.

    Results: High levels of 25-hydroxyvitamin D (top quintile) were associated with a reduced multiple sclerosis risk (odds ratio 0.68, 95% confidence interval 0.50-0.93).

    Conclusion: These findings further support a role for vitamin D in MS aetiology.

  • Birnefeld, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Wåhlin, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
    Malm, Jan
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Cerebral arterial pulsatility is associated with features of small vessel disease in patients with acute stroke and TIA: a 4D flow MRI study2019In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459Article in journal (Refereed)
    Abstract [en]

    Cerebral small vessel disease (SVD) is a major cause of stroke and cognitive impairment. However, the underlying mechanisms behind SVD are still poorly understood. High cerebral arterial pulsatility has been suggested as a possible cause of SVD. In population studies, arterial pulsatility has been linked to white matter hyperintensities (WMH), cerebral atrophy, and cognitive impairment, all features of SVD. In stroke, pulsatility data are scarce and contradictory. The aim of this study was to investigate the relationship between arterial pulsatility and SVD in stroke patients. With a cross-sectional design, 89 patients with acute ischemic stroke or TIA were examined with MRI. A neuropsychological assessment was performed 1 year later. Using 4D flow MRI, pulsatile indices (PI) were calculated for the internal carotid artery (ICA) and middle cerebral artery (M1, M3). Flow volume pulsatility (FVP), a measure corresponding to the cyclic expansion of the arterial tree, was calculated for the same locations. These parameters were assessed for associations with WMH volume, brain volume and cognitive function. ICA-FVP was associated with WMH volume (β = 1.67, 95% CI: [0.1, 3.24], p = 0.037). M1-PI and M1-FVP were associated with decreasing cognitive function (β = - 4.4, 95% CI: [- 7.7, - 1.1], p = 0.009 and β = - 13.15, 95% CI: [- 24.26, - 2.04], p = 0.02 respectively). In summary, this supports an association between arterial pulsatility and SVD in stroke patients, and provides a potential target for further research and preventative treatment. FVP may become a useful biomarker for assessing pulsatile stress with PCMRI and 4D flow MRI.

  • Li, You
    et al.
    Reeves, Rachel M.
    Wang, Xin
    Bassat, Quique
    Brooks, W. Abdullah
    Cohen, Cheryl
    Moore, David P.
    Nunes, Marta
    Rath, Barbara
    Campbell, Harry
    Nair, Harish
    RSV Global Epidemiology Network,
    RESCEU investigators,
    Kahn, Kathleen (Contributor)
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Respiratory Syncytial Virus Global Epidemiology Network; Medical Research Council–Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
    Global patterns in monthly activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus: a systematic analysis2019In: The Lancet Global Health, E-ISSN 2214-109X, Vol. 7, no 8, p. e1031-e1045Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus are the most common viruses associated with acute lower respiratory infections in young children (<5 years) and older people (≥65 years). A global report of the monthly activity of these viruses is needed to inform public health strategies and programmes for their control.

    METHODS: In this systematic analysis, we compiled data from a systematic literature review of studies published between Jan 1, 2000, and Dec 31, 2017; online datasets; and unpublished research data. Studies were eligible for inclusion if they reported laboratory-confirmed incidence data of human infection of influenza virus, respiratory syncytial virus, parainfluenza virus, or metapneumovirus, or a combination of these, for at least 12 consecutive months (or 52 weeks equivalent); stable testing practice throughout all years reported; virus results among residents in well-defined geographical locations; and aggregated virus results at least on a monthly basis. Data were extracted through a three-stage process, from which we calculated monthly annual average percentage (AAP) as the relative strength of virus activity. We defined duration of epidemics as the minimum number of months to account for 75% of annual positive samples, with each component month defined as an epidemic month. Furthermore, we modelled monthly AAP of influenza virus and respiratory syncytial virus using site-specific temperature and relative humidity for the prediction of local average epidemic months. We also predicted global epidemic months of influenza virus and respiratory syncytial virus on a 5° by 5° grid. The systematic review in this study is registered with PROSPERO, number CRD42018091628.

    FINDINGS: We initally identified 37 335 eligible studies. Of 21 065 studies remaining after exclusion of duplicates, 1081 full-text articles were assessed for eligibility, of which 185 were identified as eligible. We included 246 sites for influenza virus, 183 sites for respiratory syncytial virus, 83 sites for parainfluenza virus, and 65 sites for metapneumovirus. Influenza virus had clear seasonal epidemics in winter months in most temperate sites but timing of epidemics was more variable and less seasonal with decreasing distance from the equator. Unlike influenza virus, respiratory syncytial virus had clear seasonal epidemics in both temperate and tropical regions, starting in late summer months in the tropics of each hemisphere, reaching most temperate sites in winter months. In most temperate sites, influenza virus epidemics occurred later than respiratory syncytial virus (by 0·3 months [95% CI -0·3 to 0·9]) while no clear temporal order was observed in the tropics. Parainfluenza virus epidemics were found mostly in spring and early summer months in each hemisphere. Metapneumovirus epidemics occurred in late winter and spring in most temperate sites but the timing of epidemics was more diverse in the tropics. Influenza virus epidemics had shorter duration (3·8 months [3·6 to 4·0]) in temperate sites and longer duration (5·2 months [4·9 to 5·5]) in the tropics. Duration of epidemics was similar across all sites for respiratory syncytial virus (4·6 months [4·3 to 4·8]), as it was for metapneumovirus (4·8 months [4·4 to 5·1]). By comparison, parainfluenza virus had longer duration of epidemics (6·3 months [6·0 to 6·7]). Our model had good predictability in the average epidemic months of influenza virus in temperate regions and respiratory syncytial virus in both temperate and tropical regions. Through leave-one-out cross validation, the overall prediction error in the onset of epidemics was within 1 month (influenza virus -0·2 months [-0·6 to 0·1]; respiratory syncytial virus 0·1 months [-0·2 to 0·4]).

    INTERPRETATION: This study is the first to provide global representations of month-by-month activity of influenza virus, respiratory syncytial virus, parainfluenza virus, and metapneumovirus. Our model is helpful in predicting the local onset month of influenza virus and respiratory syncytial virus epidemics. The seasonality information has important implications for health services planning, the timing of respiratory syncytial virus passive prophylaxis, and the strategy of influenza virus and future respiratory syncytial virus vaccination.

    FUNDING: European Union Innovative Medicines Initiative Respiratory Syncytial Virus Consortium in Europe (RESCEU).

  • Vidman, Linda
    et al.
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Källberg, David
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Rydén, Patrik
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Cluster analysis on high dimensional RNA-seq data with applications to cancer research: An evaluation study2019In: PLoS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0219102Article in journal (Refereed)
    Abstract [en]

    Background: Clustering of gene expression data is widely used to identify novel subtypes of cancer. Plenty of clustering approaches have been proposed, but there is a lack of knowledge regarding their relative merits and how data characteristics influence the performance. We evaluate how cluster analysis choices affect the performance by studying four publicly available human cancer data sets: breast, brain, kidney and stomach cancer. In particular, we focus on how the sample size, distribution of subtypes and sample heterogeneity affect the performance.

    Results: In general, increasing the sample size had limited effect on the clustering performance, e.g. for the breast cancer data similar performance was obtained for n = 40 as for n = 330. The relative distribution of the subtypes had a noticeable effect on the ability to identify the disease subtypes and data with disproportionate cluster sizes turned out to be difficult to cluster. Both the choice of clustering method and selection method affected the ability to identify the subtypes, but the relative performance varied between data sets, making it difficult to rank the approaches. For some data sets, the performance was substantially higher when the clustering was based on data from only one sex compared to data from a mixed population. This suggests that homogeneous data are easier to cluster than heterogeneous data and that clustering males and females individually may be beneficial and increase the chance to detect novel subtypes. It was also observed that the performance often differed substantially between females and males.

    Conclusions: The number of samples seems to have a limited effect on the performance while the heterogeneity, at least with respect to sex, is important for the performance. Hence, by analyzing the genders separately, the possible loss caused by having fewer samples could be outweighed by the benefit of a more homogeneous data.

  • Marklund, Ludvig
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Musik för språkutveckling: En studie om vikten av didaktiskt arbete med musik i förskolan2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie är att fördjupa kunskapen om förskollärares uppfattning om musik som didaktiskt verktyg i förskolan, med fokus på att stimulera språkutvecklingen hos barn. Frågeställningarna var riktade emot hur förskollärare uppfattar att de arbetar med musik som ett didaktiskt verktyg i förskolan med inriktning på språkutveckling och vilka faktorer som kan komma att påverka musikens roll som didaktiskt verktyg för språkstimulering. Informanterna var från fyra olika förskolor och data samlades in genom semi-strukturerade intervjuer med dessa informanter. Resultatet visade att majoriteten av informanterna arbetade aktivt med musik som ett didaktiskt verktyg för språkutveckling. Detta gjorde de i planerade aktiviteter och även spontana. För att kunna arbeta med musik som ett didaktiskt verktyg visar resultatet att intresse och kunskap om ämnet är centralt för framgång. Ett ytterligare resultat var att en kombination av material, intresse och läromiljö var viktigt för att kunna utforma relevanta aktiviteter.

  • Sehlin MacNeil, Kristina
    et al.
    Umeå University, Faculty of Arts, Centre for Sami Research. Umeå University, Faculty of Arts, Department of culture and media studies.
    Inga, Niila
    Laevas čearru .
    Extraktivt våld och urfolks koppling till mark2019In: Kulturella perspektiv - Svensk etnologisk tidskrift, ISSN 1102-7908, Vol. 28, no 1-2, p. 42-51Article in journal (Other academic)
    Abstract [sv]

    Denna artikel är en omarbetad version av en presentation som hölls av författarna vid konferensen La Responsabilité de Protéger. Écologie et Dignité (The responsibility to protect. Ecology and dignity) vid Université Laval i Quebec i början av oktober 2017. Kristina Sehlin MacNeil och Niila Inga lärde känna varandra som forskare och forskningsdeltagare under Kristinas avhandlingsarbete, vilket avslutades i februari 2017. De har sedan dess inbjudits att tala tillsammans vid en rad olika konferenser. Detta är deras första gemensamma publikation, samt den första artikeln på svenska som behandlar Sehlin MacNeils resultat från hennes avhandling Extractive Violence on Indigeneous Country (2017), där hon med utgång i begreppet ”Extraktivt våld” diskuterar om urfolks perspektiv på marken och på kopplingen mellan människa och mark.

  • Sagranden, Ida
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Högläsning som språkutveckling: En intervjustudie om förskollärares uppfattning om arbetet med språkutveckling i relation till högläsning2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att öka kunskapen om hur förskollärare arbetar med språkutveckling i relation till högläsning. Frågeställningar som berörts är i vilken utsträckning högläsning förekommer i verksamheten, hur förskollärare arbetar med språkutveckling i relation till högläsning och vilka former av samverkan finns i relation till högläsning. Utifrån syfte och frågeställningar genomfördes intervjuer med förskollärare för att ta reda på om förskollärare använder sig av högläsning med syfte på språkutveckling.Den metod som användes för att genomföra intervjuerna var kvalitativ form av intervju. Informanterna var erfarna förskollärare och leder barngrupper i åldrarna tre till fem år.Resultatet visar att arbetet med språkutveckling finns i verksamheterna men inget som förekommer i relation till högläsning. Arbetet med språkutveckling nämns i relation till lekar, matsituationer, ramsor och tecken som stöd. Högläsning förekommer i allra högsta grad som avkoppling, vilket skapar olika krav på barnen. Samarbete med bibliotek förekommer vid två av tre förskolor, genom bokbuss och närhet till bibliotek.Digitalisering förekommer vid alla tre förskolor genom digital bilderbokstjänst.

  • Westin, Lars
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Westin, Jonas
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Bylund, Rebecca
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Trafikflöden längs den svenska delen av Blå vägen TNT-E12: En rapport från det nordiska forskningsprojektet E12 Atlantica BA3NET2019Report (Other academic)
    Abstract [sv]

    I rapporten presenteras data över genomsnittlig årsdygnstrafik (ÅDT) längs TEN-T E12 stråket. Utvecklingen över tiden jämförs med andra vägar. Här rapporteras även mätningar från fyra fasta mätstationer placerade längs E12. Här påbörjas även en analys av var brister i transportstråket finns i relation till stråkets förbättringspotential.

  • Cronvald, Kristofer
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    An introduction to Multilevel Monte Carlo with applications to options.2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    A standard problem in mathematical finance is the calculation of the price of some financial derivative such as various types of options. Since there exists analytical solutions in only a few cases it will often boil down to estimating the price with Monte Carlo simulation in conjunction with some numerical discretization scheme. The upside of using what we can call standard Monte Carlo is that it is relative straightforward to apply and can be used for a wide variety of problems. The downside is that it has a relatively slow convergence which means that the computational cost or complexity can be very large.

    However, this slow convergence can be improved upon by using Multilevel Monte Carlo instead of standard Monte Carlo. With this approach it is possible to reduce the computational complexity and cost of simulation considerably.

    The aim of this thesis is to introduce the reader to the Multilevel Monte Carlo method with applications to European and Asian call options in both the Black-Scholes-Merton (BSM) model and in the Heston model. To this end we first cover the necessary background material such as basic probability theory, estimators and some of their properties, the stochastic integral, stochastic processes and Ito’s theorem. We introduce stochastic differential equations and two numerical discretizations schemes, the Euler–Maruyama scheme and the Milstein scheme. We define strong and weak convergence and illustrate these concepts with examples. We also describe the standard Monte Carlo method and then the theory and implementation of Multilevel Monte Carlo. In the applications part we perform numerical experiments where we compare standard Monte Carlo to Multilevel Monte Carlo in conjunction with the Euler–Maruyama scheme and Milsteins scheme.

    In the case of a European call in the BSM model, using the Euler–Maruyama scheme, we achieved a cost O(ε-2(log ε)2) to reach the desired error in accordance with theory in comparison to the O(ε-3) cost for standard Monte Carlo. When using Milsteins scheme instead of the Euler–Maruyama scheme it was possible to reduce the cost in terms of the number of simulations needed to achieve the desired error even further. By using Milsteins scheme, a method with greater order of strong convergence than Euler–Maruyama, we achieved the O(ε-2) cost predicted by the complexity theorem compared to the standard Monte Carlo cost of order O(ε-3). In the final numerical experiment we applied the Multilevel Monte Carlo method together with the Euler–Maruyama scheme to an Asian call in the Heston model. In this case, where the coefficients of the Heston model do not satisfy a global Lipschitz condition, the study of strong or weak convergence is much harder. The numerical experiments suggested that the strong convergence was slightly slower compared to what was found in the case of a European call in the BSM model. Nevertheless, we still achieved substantial savings in computational cost compared to using standard Monte Carlo.

  • Mellberg, Simon
    Umeå University, Faculty of Science and Technology, Department of Applied Physics and Electronics.
    Omarbetning utav PHP-skript och databasintegritet2019Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This report describes the work that is done at Techsam AB to eliminate or at least lower the risk of dataloss or change of data. The project purpose is to uncover problematic areas and fix these issues. Problematic areas are everywhere where data is sent och updated in the database. The projects main assignment is to update the system that is already in use. Databaseintegrity is an important topic in this article, and there the possibilities to check data are greater the further down the line you get. Therefore other solutions have been used to aid the user. Those solutions are visual aids and warnings to help make correct decisions. Since the system is only used in-house there are no demands on the apperance nor security outwards, the demands are on the function and integrity towards the database. The appereance have not been altered.

  • Westin, Jonas
    et al.
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Westin, Lars
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Strandberg, Filip
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM).
    Uneklint, Oscar
    Umeå University, Faculty of Social Sciences, Centre for Regional Science (CERUM). Umeå University.
    Godsdatabas för Kvarken och Botnia-Atlantica regionen: erfarenheter och utvecklingsmöjligheter2019Report (Other academic)
  • Kleyko, Denis
    et al.
    Osipov, Evgeny
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Vector-Based Analysis of the Similarity Between Breathing and Heart Rate During Paced Deep Breathing2018In: 2018 Computing in Cardiology Conference (CinC), IEEE, 2018, article id 8743692Conference paper (Refereed)
    Abstract [en]

    The heart rate (HR) response to paced deep breathing (DB) is a common test of autonomic function, where the scoring is based on indices reflecting the overall heart rate variability (HRV), where high scores are considered as normal findings but can also reflect arrhythmias. This study presents a method based on hyperdimensional computing for assessment of the similarity between feature vectors derived from the HR and breathing signals. The proposed method was used to identify subjects where HR did not follow the paced breathing pattern in recordings from DB tests in 174 healthy subjects and 135 patients with cardiac autonomic neuropathy. Subjects were classified in 4 similarity classes, where the lowest similiarity class included 35 patients and 3 controls. In general, the autonomic function cannot be evaluated in subjects in the lowest similarity class if they also present with high HRV scores, since this combination is a strong indicator of the presence of arrhythmias. Thus, the proposed vector-based similarity analysis is one tool to identify subjects with high HRV but low cardiorespiratory synchronization during the DB test, which falsely can be interpreted as normal autonomic function.

  • Johansson, Emma
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Tecken som stöd – ett stöd för livet?: En intervjustudie med förskolepedagoger om tecken som stöd för barns språkutveckling2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med den här studien har varit att utveckla kunskap om hur tecken som stöd kan användas i förskolan för att stödja barns språkutveckling. Frågeställningarna har innefattat pedagogers beskrivning av arbetet med tecken som stöd samt pedagogernas uppfattning om betydelsen av tecken som stöd för barns språkutveckling. Urvalet var kriteriebaserat och data samlades in genom kvalitativa forskningsintervjuer där tre verksamma förskolepedagoger deltog. I resultatet framkom det att pedagogerna framför allt använder tecken som stöd i samlingar, sånger, rutinsituationer samt i situationer där barn är i behov av tecken för att förstå det som verbalt kommuniceras. Den vardagliga kommunikationen framkom som betydelsefull för barns språkutveckling, även sånger och böcker var en del av det språkutvecklande arbetet, enligt pedagogerna. Ytterligare ett resultat var att tecken som stöd användes för att hjälpa barnen att förstå samt att ge barnen en möjlighet att göra sig förstådda.

  • Boman, Emelina
    et al.
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Bozaghian, Somayeh
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Språklig sårbarhet i förskolan: Pedagogers upplevelser av barn i språklig sårbarhet och tillgängliga lärmiljöer2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Språkets utveckling är en av de stora förändringarna i livet. När vi kan kommunicera med varandra och göra oss förstådda blir händelser i livet meningsfulla. Ett nytt begrepp, språklig sårbarhet, kommer att presenteras och lyftas genomgående under arbetet. Syftet med denna studie är att tolka och förstå hur barn i språklig sårbarhet uppmärksammas och ges stöd i förskolan, samt hur pedagoger skapar tillgängliga lärmiljöer i arbetet med att stödja barn i språklig sårbarhet. Kvalitativa intervjuer med åtta verksamma pedagoger har genomförts och resultatet har tolkats och analyserats utifrån en hermeneutisk teori och den sociokognitiva teorin. Resultatet i studien beskriver hur pedagoger upptäcker och stödjer barn i språklig sårbarhet, samt vilka resurser pedagoger har och saknar i arbetet med språkstimulering. Pedagogerna i studien visar vikten av att arbeta språkstödjande i förskolan. Flertalet pedagoger beskriver lek och samspel som viktiga områden att utgå ifrån i upptäckandet av barn i språklig sårbarhet och i hur de arbetar språkstödjande. Resurser och hur mycket stöd varje verksamhet får beskriver pedagogerna olika. Några beskriver att de har resurser, medan andra påpekar tydligt vad de saknar och är i behov av. När det handlar om tillgängliga lärmiljöer menar pedagogerna att de använder sig av olika lärmiljöer beroende på vilket sätt språkstimulering ska ske. Inne- och utemiljö som tillgängliga lärmiljöer beskrivs olika och används i olika utsträckning av pedagogerna. Pedagogerna är överens om att lyhördhet, tydlighet och att barnet uppmärksammas är viktiga delar i ett språkstimulerande arbetssätt.

  • Lopatko Lindman, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Weidung, Bodil
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Department of Public Health and Caring Sciences, Geriatric Medicine, Uppsala University, Uppsala, Sweden.
    Olsson, Jan
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Josefsson, Maria
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Kok, Eloise
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Elgh, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Section of Virology.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    A genetic signature including apolipoprotein Eε4 potentiates the risk of herpes simplex-associated Alzheimer's disease2019In: Alzheimer's & dementia, ISSN 1552-5279, Vol. 5, p. 697-704Article in journal (Refereed)
    Abstract [en]

    Introduction: Herpes simplex virus type 1 (HSV1) in combination with genetic susceptibility has previously been implicated in Alzheimer's disease (AD) pathogenesis.

    Methods: Plasma from 360 AD cases, obtained on average 9.6 years before diagnosis, and their age- and sex-matched controls, were analyzed for anti-HSV1 immunoglobulin (Ig) G with enzyme-linked immunosorbent assays (ELISAs). APOE genotype and nine other selected risk genes for AD were extracted from a genome-wide association study analysis by deCODE genetics, Reykjavik, Iceland.

    Results: The interaction between APOEε4 heterozygosity (APOEε24 or ε3/ε4) and anti-HSV1 IgG carriage increased the risk of AD (OR 4.55, P = .02). A genetic risk score based on the nine AD risk genes also interacted with anti-HSV1 IgG for the risk of developing AD (OR 2.35, P = .01).

    Discussion: The present findings suggest that the APOEε4 allele and other AD genetic risk factors might potentiate the risk of HSV1-associated AD.

  • Sundström, Olivia
    Umeå University, Faculty of Social Sciences, Department of applied educational science.
    Förskollärares möte med barns olika socioekonomiska förutsättningar2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Studiens syfte är att öka kunskapen kring hur förskollärare uppmärksammar och agerar utifrån barns skilda socioekonomiska förutsättningar. Frågeställningarna ramar in arbetet ytterligare och fokuserar på tre delar, vilka skillnader som förskollärarna ser utifrån barns skilda socioekonomiska förutsättningar, hur de bemöter dem samt om förskolan reproducerar skillnader. I bakgrunden får läsaren en sammanfattning av förskolans styrdokument som pekar mot att förskolan ska kompensera för barns skilda hemförhållanden. Bakgrunden belyser att barns hemförhållanden har inverkan på hur deras liv formas och att konsekvenserna kan bli stora. Den teoretiska utgångspunkten tas i Bourdieus teori om hur socioekonomin befästs inom familjen men också inom skolväsendet. Studien har genomförts med intervju som metod där fyra förskollärare har intervjuats. Studien visade att alla förskollärare uppmärksammade skillnader i barns socioekonomiska förutsättningar, de gav exempel på skillnader i material, tillgång till socialt kontaktnät samt brister i barns omvårdnad, de berättade också om barns förmåga att samspela och vilka värderingar som barnen fått med sig från hemmet samt barns tillgång till upplevelser och erfarenheter. Studien visade att förskollärarna använde sig av strategier såsom att erbjuda barnen lånematerial, vara närvarande i barnens samspel och på så vis förankra förskolans värdegrund samt att skapa förtroendefulla relationer till hemmen. Det framkom att förskollärarnas uppfattningar skilde sig ifrågan om förskolan reproducerar barns skilda förutsättningar, några hävdade att deras verksamhet inte förstärkte barnens skilda förutsättningar medan andra ansåg att deras verksamhet absolut kan förstärka skillnaderna, särskilt i stressiga miljöer. De framkom exempel på lekmiljöer som reproducerar samt hur pedagogers förhållningssätt kan förstärka skillnader hos barnen. De berättade också om barn som hörs och syns mycket som tenderar att tillåtas ta mer plats och att förskolan på så vis förstärker de skillnader som uppstår utifrån skilda socioekonomiska förutsättningar.En slutsats som framkommit under studien är att förskollärarna är medvetna om skillnaderna mellan barns skilda socioekonomiska förutsättningar och utifrån det aktivt arbetar för att kompensera för skillnaderna. Resultatet visade också att förskollärare vittnar om att stress och brist på tid för reflektion skapar omständigheter som kan förstärka och reproducera skillnader mellan barns socioekonomiska förutsättningar.

  • Koskinen, Lars-Owe D.
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Sundström, Nina
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Hägglund, Linda
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Eklund, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Olivecrona, Magnus
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience. Department of Anaesthesia and Intensive Care, Section for Neurosurgery, Faculty of Health and Medicine, Department for Medical Sciences, Örebro University, Örebro, Sweden. .
    Prostacyclin Affects the Relation Between Brain Interstitial Glycerol and Cerebrovascular Pressure Reactivity in Severe Traumatic Brain Injury2019In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Vol. 31, no 3, p. 494-500Article in journal (Refereed)
    Abstract [en]

    Background: Cerebral injury may alter the autoregulation of cerebral blood flow. One index for describing cerebrovascular state is the pressure reactivity (PR). Little is known of whether PR is associated with measures of brain metabolism and indicators of ischemia and cell damage. The aim of this investigation was to explore whether increased interstitial levels of glycerol, a marker of cell membrane damage, are associated with PR, and if prostacyclin, a membrane stabilizer and regulator of the microcirculation, may affect this association in a beneficial way.

    Materials and Methods: Patients suffering severe traumatic brain injury (sTBI) were treated according to an intracranial pressure (ICP)-targeted therapy based on the Lund concept and randomized to an add-on treatment with prostacyclin or placebo. Inclusion criteria were verified blunt head trauma, Glasgow Coma Score <= 8, age 15-70 years, and a first measured cerebral perfusion pressure of >= 10 mmHg. Multimodal monitoring was applied. A brain microdialysis catheter was placed on the worst affected side, close to the penumbra zone. Mean (glycerol(mean)) and maximal glycerol (glycerol(max)) during the 96-h sampling period were calculated. The mean PR was calculated as the ICP/mean arterial pressure (MAP) regression coefficient based on hourly mean ICP and MAP during the first 96 h.

    Results: Of the 48 included patients, 45 had valid glycerol and PR measurements available. PR was higher in the placebo group as compared to the prostacyclin group (p = 0.0164). There was a positive correlation between PR and the glycerol(mean) (rho = 0.503, p = 0.01) and glycerol(max) (rho = 0.490, p = 0.015) levels in the placebo group only.

    Conclusions: PR is correlated to the glycerol level in patients suffering from sTBI, a relationship that is not seen in the group treated with prostacyclin. Glycerol has been associated with membrane degradation and may support glycerol as a biomarker for vascular endothelial breakdown. Such a breakdown may impair the regulation of cerebrovascular PR.

  • Segerholm, Christina
    Umeå University, Faculty of Social Sciences, Department of Education.
    Appendix2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren, Linda Rönnberg, Dordrecht: Springer, 2019, p. 201-208Chapter in book (Refereed)
    Abstract [en]

    This appendix serves the purpose of informing readers about the design, the overall theoretical approach and methodology, and the different sub-studies, methods and materials in the research project that is reported in the book: Governing by evaluation in higher education in Sweden, 2013–2018. Two particular issues concerning our research process are also included: the redirection of one sub-study due to unforeseen policy developments, and the problem of denied access. Both, we believe, may be concerns for researchers in the social sciences in general, that can open possibilities or restrict the knowledge generation process so vital for democratic societies.

  • Segerholm, Christina
    Umeå University, Faculty of Social Sciences, Department of Education.
    Relaunching national evaluation and quality assurance: expectations and preparations2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren, Linda Rönnberg, Dordrecht: Springer, 2019, p. 139-156Chapter in book (Refereed)
    Abstract [en]

    In this chapter, we describe and analyse the design of the evaluation and quality assurance system decided by the Swedish Parliament in 2016. Particular stress is put on how one part of this system – the institutional reviews of the higher education institutions’ internal quality assurance processes – was set up by the Swedish Higher Education Authority (SHEA). The aim was to explore governing of higher education in the signals expressed through the design and requirements decided by the SHEA. The SHEA public reports, guidelines, criteria, and templates for the higher education institutions and evaluators, and interviews with SHEA staff were used for this purpose. The analysis shows that the Standards and Guidelines for Quality Assurance in the European Higher Education Area were important influences in the design work. It also shows that the design supports the governing by objectives and outcomes logic and a notion of “quality” in higher education as equivalent to work with internal quality assurance systems at higher education institutions. We argue that this design forms the basis for constitutive effects like an instrumental notion of higher education.

  • Pettersson, Hans
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Olsson, David
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Occupational exposure to noise and cold environment and the risk of death due to myocardial infarction and stroke2020In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The present study examined a possible association between occupational exposure to noise, working and living in cold conditions, and the risk of mortality in myocardial infarction and stroke.

    METHODS: The present cohort study consists of 194,501 workers in the Swedish construction industry that participated in health examinations between 1971 and 1993. Noise exposure was defined on a job-exposure matrix based on a survey of the working conditions carried out during the mid 1970s. All workers were categorised into three main regions of Sweden, differing in temperature: Reference (Götaland), colder (Svealand), and coldest (Norrland). Relative risks (RR) were analysed by negative binomial regression adjusting for age, BMI, and smoking habits.

    RESULTS: Moderate and high noise exposure was associated with increased risk of myocardial infarction (RR 1.10-1.13 with 95% CI over unit) and stroke mortality (RR 1.15 to 1.19 with 95% CI over unit). There was an increased risk for myocardial infarction (RR 1.10, 95% CI 1.01-1.20), but not for stroke mortality (RR 1.09, 95% CI 0.94-1.25) associated with living and working in the coldest region. There was an interaction on the risk of myocardial infarction mortality between different regions and noise exposure (p = 0.016), but not for stroke mortality (p = 0.88).

    CONCLUSIONS: The study indicates an interaction between working at hazardous noise levels and living and working in cold conditions for increased mortality in myocardial infarction.

  • Ng, Nawi
    et al.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Santosa, Ailiana
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Malmberg, Gunnar
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography.
    Living alone and mortality among older people in Västerbotten County in Sweden: a survey and register-based longitudinal study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 7Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Living alone is increasingly common and has been depicted as an important cause of mortality. We examined the association between living alone and mortality risks among older men and women in northern Sweden, by linking two unique longitudinal datasets.

    METHODS: We used the Linnaeus database, which links several population registers on socioeconomic and health. This register-based study included 22,226 men and 23,390 women aged 50 and 60 years in Västerbotten County who had participated in the Västerbotten Intervention Program (VIP) during 1990-2006, with a total of 445,823 person-years of observation. We conducted Cox-proportional hazard regression to assess the risk of living alone on the mortality that was observed between 1990 and 2015, controlling for socio-demographic factors, chronic disease risk factors and access to social capital.

    RESULTS: Older men and women who lived alone with no children at home were at a significantly higher risk of death compared to married/cohabiting couples with children at home (with an adjusted hazard ratio of 1.38, 95% CI of 1.26-1.50 in men and 1.27, 95% CI of 1.13-1.42 in women). Living alone was an even stronger factor than the well-established chronic disease risk factors and a lack of access to social capital.

    CONCLUSIONS: A significant association between living alone and mortality among the older adult population in Sweden was observed. Providing good social support for older people is important in preventing the negative health impact of living alone.

  • Oja, Fanny
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Moström, Sara
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Socialtjänstens och mödravårdens arbete med drogberoende gravida kvinnor: En studie om upptäckt, insats och samverkan2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med den här studien är att undersöka hur man arbetar med drogberoende gravida kvinnor inom Socialtjänsten och mödravården. Intervjuer har genomförts med en socialsekreterare och fyra barnmorskor, alla yrkesverksamma inom Västerbottens län. Studien tar upp hur drogberoende hos gravida upptäcks, vilka typer av insatser som finns samt hur Socialtjänsten och mödravården samverkar inom ramen för sitt arbete med dessa kvinnor. Studien visar att både mödravården och Socialtjänsten fokuserar sitt arbete på att bygga en bra relation till sina klienter så att de ska våga vara ärliga om sitt eventuella bruk av droger. Genom en bra relation och att klienten har tillit till den professionelle kan den professionelle på ett bättre sätt hjälpa sin klient. Barnmorskorna upplever att drogberoende gravida kvinnor är ärliga om deras användande av droger och att de snabbt berättar det för sin barnmorska. Den socialsekreterare som intervjuades sa sig ha kännedom om sina klienters droganvändning och att hon fick vetskap om en klients graviditet genom orosanmälningar från den personens närstående. Studien visar samtidigt att det finns brister i samverkan mellan Socialtjänsten och mödravården i ärenden kring gravida kvinnor som befinner sig i ett drogberoende. Socialsekreteraren upplever att man inte arbetar med klientens olika problem samtidigt och därför inte löser dem. Barnmorskorna upplever att de inte delges information från Socialtjänsten om sina patienter som är av vikt för deras arbete, trots att samtycke finns, vilket försvårar deras arbete. Att det brister i samverkan försvårar alltså arbetet kring den här gruppen kvinnor. Studien visar även att det är brist på resurser och insatser för personer som är drogberoende. Det saknas insatser som kan anpassas efter de gravida kvinnornas olika livssituationer och familjekonstellationer, vilket försvårar tillgången till effektiv drogbehandling och andra stödinsatser för kvinnorna. Bristen på resurser gör att socialsekreterarnas arbete försvåras. Studiens slutsats är att samverkan mellan Socialtjänsten och mödravården behöver förbättras både för att förbättra de yrkesverksammas arbetssituation och för att ge kvinnorna bästa möjliga stöd.

  • Lugnet, Einar
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Användbara behandlingsmetoder för sexmissbruk: Useful methods of treatment for sex addiction2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie är att i forskningslitteraturen hitta evidensbaserade behandlingsmetoder och terapier för sexmissbruk samt ta reda på hur de fungerar och varför de används. För att öka förståelse och kunskap inom ämnet har tre intervjuer med behandlare för sexmissbruk utförts. Intervjuempirin och forskningen visar sammantaget att det saknas definition på sexmissbruk. Beroendet yttrar sig på olika sätt, varav de vanligaste symptomen är förlust av impulskontroll, svår psykisk påfrestning, försämrat familje- och arbetsliv, skam och otrohet. Skam, uppgivenhet och ekonomiska förutsättningar gör att många undviker att söka hjälp tills beroendet har orsakat krisartad skada och förluster i livet. De som kommer till behandling har ofta blivit avslöjade av en nära anhörig och givits ett ultimatum. Behandling är bristfällig och dyr i Sverige vilket gör att mörkertalet är stort och att många inte söker hjälp överhuvudtaget. Forskningen visar att det finns ett stort utbud av terapier och behandlingsmetoder för sexmissbruk. Dessa behandlingsmetoder har styrkor och svagheter i sin effektivitet för att lindra och bota de problem och utmaningar som beroendet innefattar. Motivation, kontroll, skam, relationsproblem, anknytning och förvrängda tankar utgör kärnan i sexmissbruk och behandlas med varierande resultat utifrån behandlingsmetod och individuella förutsättningar. 

  • Segerholm, Christina
    et al.
    Umeå University, Faculty of Social Sciences, Department of Education.
    Hult, Agneta
    Umeå University, Faculty of Social Sciences, Department of Education.
    Europe in Sweden2019In: The Governing-Evaluation-Knowledge Nexus: Swedish Higher Education as a Case / [ed] Christina Segerholm, Agneta Hult, Joakim Lindgren, Linda Rönnberg, Dordrecht: Springer, 2019, p. 43-63Chapter in book (Refereed)
    Abstract [en]

    The increased importance given to European policy concerning evaluation and quality assurance in higher education in the Swedish national policy context is explored in this chapter. The description rests on interviews with what here is labelled policy brokers and on the material from the European Association for Quality Assurance in Higher Education (ENQA), as well as government bills, parliamentary minutes, national agency reports, and university teachers’ union journals. The results show that ENQA membership requirements played a significant role in the Swedish policy debate on the design of the 2016 national evaluation and quality assurance system. Dissemination channels between Europe and Sweden are populated by individuals with similar functions and positions, e.g. that ministers often meet ministers. Within Sweden, European policy is disseminated by and through individuals who move between different positions within the ministry of education, national agencies, and higher education institutions. Different organisations also communicate with each other within Sweden, ensuring European policies reaching into higher education institutions. Such European governing attempts are carried out in activities like networks, conferences, papers, guidelines, and by using different forms of knowledge, both inscribed, embodied, and enacted.