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Hultin, M. & Hultberg, P. (2024). Hur bäst integrera KU-studenter med utländsk professionsutbildning som har svenska som andra språk?. In: : . Paper presented at NU2024, Umeå, Sverige, 17-19 juni, 2024.
Open this publication in new window or tab >>Hur bäst integrera KU-studenter med utländsk professionsutbildning som har svenska som andra språk?
2024 (Swedish)Conference paper, Oral presentation only (Refereed)
Abstract [sv]

Denna workshop fokuserar på hur man bäst stöttar att personer med en utländsk professionsutbildning och som har svenska som andra språk att integreras med svenska studenter då de går en kompletterande utbildning.

Problemet – integration i svenskt utbildningssystem och svensk sjukvård av studenter som behöver komplettera sin utländska utbildning och dessutom behöver det ske på ett nytt språk (svenska). 

En person som har en utländsk akademisk utbildning och examen kan gå en kompletterande utbildning för att få behörighet att utöva yrket i Sverige. Det gäller exempelvis lärare, socionomer, jurister och olika professioner inom hälso- och sjukvård som läkare, sjuksköterskor, tandläkare.

Studenterna som går en kompletterande utbildning har vanligtvis erfarenheter från utbildningssystem som skiljer sig mycket från det svenska. De har också redan en examen från annat land, många har även lång yrkeserfarenhet. 

Vi tror att heterogenitet och mångfald bidrar till undervisningen på flera sätt, både teoretisk undervisning och verksamhetsförlagd utbildning, men hur gör vi på bästa sätt för att undanröja eventuella problem som kan uppstå?

Under denna workshop fokuserar vi på utlandsutbildade läkare som behöver komplettera för att få arbeta som läkare i Sverige.

Frågeställningar som kommer att beröras:

  • Hur kan vi underlätta integrationen med svenska studenter under en kompletterande utbildning?
  • Hur påverkas undervisningen när dessa studenter möter svenska studenter i klassrummen?Hur möter vi studenterna i dessa olikheter?
  • Hur påverkas lärarna av heterogeniteten i klassrummen med äldre erfarna studenter och studenter utan yrkeserfarenhet som kommer direkt från gymnasiet?
  • Hur hanterar handledare under verksamhetsförlagd utbildning att handleda dessa olika studenter?Hur handleder man en kollega?

Hur kan vi dra nytta av heterogeniteten och mångfalden så att den bidrar till positiva värden för alla studenter som läser tillsammans?Under denna workshop kommer man gruppvis och helgrupp att diskutera:

  • Inledande språktermin för att utveckla de utlandsutbildade kompletteringsutbildningsstudenternas svenska
  • Integrerad undervisning och handledning av studenter som är skolade i vitt skilda system och som därmed har olika erfarenheter med sig i bagage
  • Stöd till studenter på kompletteringsutbildningar som läser kurser integrerat med svenska studenter och genomför praktikperioder

Resultatet av denna workshop kommer att kunna användas som underlag för att utveckla Kompletteringsutbildningar som baseras på Förordning (2008:1101) om högskoleutbildning som kompletterar avslutad utländsk utbildning.  

National Category
Educational Sciences
Identifiers
urn:nbn:se:umu:diva-227538 (URN)
Conference
NU2024, Umeå, Sverige, 17-19 juni, 2024
Available from: 2024-06-30 Created: 2024-06-30 Last updated: 2024-07-01Bibliographically approved
Bromfalk, Å., Hultin, M., Walldén, J., Myrberg, T. & Engström, Å. (2024). Perioperative staff’s experiences of premedication for children. Journal of Perianesthesia Nursing
Open this publication in new window or tab >>Perioperative staff’s experiences of premedication for children
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2024 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473Article in journal (Refereed) Accepted
National Category
Anesthesiology and Intensive Care Pediatrics
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-224419 (URN)
Available from: 2024-05-16 Created: 2024-05-16 Last updated: 2024-05-17
Bromfalk, Å., Hultin, M., Wallden, J. & Myrberg, T. (2023). Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine. Journal of Perianesthesia Nursing, 38(3), 454-460
Open this publication in new window or tab >>Cardiorespiratory response to sedative premedication in preschool children: a randomized controlled trial comparing midazolam, clonidine, and dexmedetomidine
2023 (English)In: Journal of Perianesthesia Nursing, ISSN 1089-9472, E-ISSN 1532-8473, Vol. 38, no 3, p. 454-460Article in journal (Refereed) Published
Abstract [en]

Purpose: Sedative premedication in children may negatively impact their cardiorespiratory status during the perioperative course, and no clear consensus exists on the optimal premedication treatment for pediatric patients. The objective was to compare the perioperative cardiorespiratory responses to sedation using three different sedative premedication regimens in preschool children scheduled for surgery with total intravenous anesthesia.

Design: A single-center randomized controlled trial.

Methods: This is a planned secondary analysis of a study conducted at a 200-bed tertiary referral hospital. Ninety children participated in the study. They were aged 2–6 years and scheduled for ear, nose, and throat surgery with propofol/remifentanil anesthesia. Participants were randomly assigned to receive oral midazolam 0.5 mg/kg-1 (MID), oral clonidine 4 mcg/kg–1 (CLO), or intranasal dexmedetomidine 2 mcg/kg-1 (DEX). The main outcome measures were the sedation level, based on the Ramsay Sedation Scale (RSS), and cardiorespiratory status, monitored during the perioperative period.

Findings: The final cohort had 83 children (MID, n=27; CLO, n=26; DEX, n=30), with similar intergroup patient characteristics. RSS scores were lower in the MID group than in the CLO and DEX groups before induction and within 30 min postsurgery (P<0.001 and P=0.006, respectively). A negative correlation existed between the RSS and heart rate (HR) (r=-0.570, P<0.001). Before anesthesia induction, the respiratory rate was lowest in the DEX group (MID 21.5±1.7 min–1, CLO 20.6±2.6 min–1, DEX 20.2±1.7 min–1; P=0.042). The HR was lower in the CLO and DEX groups than in the MID group (MID, 102.8±10.0 min–1; CLO, 87.4±9.6 min–1; DEX, 87.6±7.9 min–1; P<0.001). The HR was lower immediately after induction (P=0.009) and intraoperatively (P=0.025) in the CLO and DEX groups than in the MID group.

Conclusions: When used as premedication before propofol/remifentanil anesthesia, clonidine and dexmedetomidine provided deeper preoperative sedation compared to midazolam. From a clinical perspective, all three study drugs provided essentially stable cardiovascular and respiratory conditions during the entire perioperative period.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
cardiorespiratory, clonidine, dexmedetomidine, midazolam, pediatric anesthesia, premedication, sedation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-203567 (URN)10.1016/j.jopan.2022.08.009 (DOI)001001763500001 ()36604221 (PubMedID)2-s2.0-85145714015 (Scopus ID)
Available from: 2023-01-19 Created: 2023-01-19 Last updated: 2024-05-16Bibliographically approved
Gummesson, C., Alm, S., Cederborg, A., Ekstedt, M., Hellman, J., Hjelmqvist, H., . . . Tejera, A. (2023). Entrustable professional activities (EPAs) for undergraduate medical education: development and exploration of social validity. BMC Medical Education, 23(1), Article ID 635.
Open this publication in new window or tab >>Entrustable professional activities (EPAs) for undergraduate medical education: development and exploration of social validity
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2023 (English)In: BMC Medical Education, E-ISSN 1472-6920, Vol. 23, no 1, article id 635Article in journal (Refereed) Published
Abstract [en]

Background: The development of entrustable professional activities (EPAs) as a framework for work-based training and assessment in undergraduate medical education has become popular. EPAs are defined as units of a professional activity requiring adequate knowledge, skills, and attitudes, with a recognized output of professional labor, independently executable within a time frame, observable and measurable in its process and outcome, and reflecting one or more competencies. Before a new framework is implemented in a specific context, it is valuable to explore social validity, that is, the acceptability by relevant stakeholders.

Aim: The aim of our work was to define Core EPAs for undergraduate medical education and further explore the social validity of the constructs.

Method and material: In a nationwide collaboration, EPAs were developed using a modified Delphi procedure and validated according to EQual by a group consisting of teachers nominated from each of the seven Swedish medical schools, two student representatives, and an educational developer (n = 16). In the next step, social validity was explored in a nationwide survey. The survey introduced the suggested EPAs. For each EPA, the importance of the EPA was rated, as was the rater’s perception of the present graduates’ required level of supervision when performing the activity. Free-text comments were also included and analyzed.

Results: Ten Core EPAs were defined and validated. The validation scores for EQual ranged from 4.1 to 4.9. The nationwide survey had 473 responders. All activities were rated as “important” by most responders, ranging from 54 to 96%. When asked how independent current graduates were in performing the ten activities, 6 to 35% reported “independent”. The three themes of the free text comments were: ‘relevant target areas and content’; ‘definition of the activities’; and ‘clinical practice and learning’.

Conclusion: Ten Core EPAs were defined and assessed as relevant for Swedish undergraduate medical education. There was a consistent gap between the perceived importance and the certainty that the students could perform these professional activities independently at the time of graduation. These results indicate that the ten EPAs may have a role in undergraduate education by creating clarity for all stakeholders.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Entrustable professional activities, Development, Social validity
National Category
Clinical Medicine Other Medical Sciences not elsewhere specified Educational Sciences
Identifiers
urn:nbn:se:umu:diva-214135 (URN)10.1186/s12909-023-04621-6 (DOI)37667366 (PubMedID)2-s2.0-85169664954 (Scopus ID)
Funder
Malmö University
Available from: 2023-09-05 Created: 2023-09-05 Last updated: 2024-04-11Bibliographically approved
Gottfridsson, P., Law, L., Aroch, R., Myrberg, T., Hultin, M., Lindqvist, P. & Haney, M. (2023). Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans. Clinical Physiology and Functional Imaging, 43(3), 165-169
Open this publication in new window or tab >>Left atrial contraction strain during a Valsalva manoeuvre: A study in healthy humans
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2023 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 43, no 3, p. 165-169Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac mechanics are influenced by loading conditions as well as sympathetic tone. Left atrial (LA) contractile function assessed by two-dimensional (2D) strain has been described in the setting of controlled preload alterations; however, studies show conflicting findings about change or direction of change. We hypothesized that the controlled preload reduction and the sympathetic nervous system activation that occurs during a standardized Valsalva manoeuvre would bring about a change in LA contraction strain.a

METHODS: Healthy young adults of both sexes were recruited. Transthoracic echocardiographic ultrasound images were collected before and during a Valsalva manoeuvre. Standard imaging windows for LA strain assessment were used and the images were copied and stored for later offline analysis. These were assessed for adequate atrial wall visualization in 2D strain assessment. Paired comparisons were carried out using Student's T test.

RESULT: Thirty-eight participants were included and there were 22 complete studies with paired pre- and during Valsalva manoeuvre. LA contraction strain at baseline was 10.5 ± 2.8% (standard deviation) and during the Valsalva manoeuvre 10.6 ± 4.6%, p = 0.86.

CONCLUSION: The Valsalva manoeuvre, a combination of preload reduction and sympathetic nervous system activation, seems not to be associated with a change in LA contraction strain in healthy young individuals. LA contraction strain should be interpreted in the context of both atrial loading conditions and prevailing autonomic nervous system activity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
contractile function, echocardiography, left atrium, preload, speckle tracking, sympathetic nervous system
National Category
Anesthesiology and Intensive Care Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-202113 (URN)10.1111/cpf.12806 (DOI)000902530500001 ()36533722 (PubMedID)2-s2.0-85145300941 (Scopus ID)
Funder
Region Västerbotten
Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-05Bibliographically approved
Ahlberg, H., Wallgren, D., Hultin, M., Myrberg, T. & Johansson, J. (2023). Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery: A randomised controlled trial. European Journal of Anaesthesiology, 40(9), 636-642
Open this publication in new window or tab >>Less use of rescue morphine when a combined PSP/IPP-block is used for postoperative analgesia in breast cancer surgery: A randomised controlled trial
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2023 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 40, no 9, p. 636-642Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Surgery for breast cancer is common, and intravenous opioids are often used to control postoperative pain. Recently, pectoralis-2 (PECS-2) block has emerged as a promising regional anaesthetic alternative. With nomenclature recently proposed, this block is termed combined PSP/IPP-block (pectoserratus plane block/interpectoral plane block).

OBJECTIVE: We aimed to compare the need for postoperative rescue morphine between the intervention group that received a pre-operative combined PSP/IPP-block and a control group that received peri-operative long-acting opioids for postoperative analgesia.

DESIGN: A randomised controlled study.

SETTING: Operating theatres of two Swedish hospitals. The patients were recruited between May 2017 and October 2020.

PATIENTS: Among the 199 women scheduled to undergo breast cancer surgery (sector resection or radical mastectomy) who were enrolled in the study, 185 were available for follow up.

INTERVENTION: All patients received general anaesthesia. The intervention group received a combined PSP/IPP-block before surgery. The control group received intravenous morphine 30 min before emergence from anaesthesia.

MAIN OUTCOME MEASURE: The primary endpoint was the cumulative need for intravenous rescue morphine to reach a predefined level of pain control (visual analogue scale score <40 mm) during the first 48 h after surgery.

RESULTS: Data from 92 and 93 patients in the intervention and control groups, respectively, were analysed. The amount of rescue morphine administered in the 48 h after surgery was significantly lower in the intervention group than in the control group (median: 2.25 vs 3.0 mg, P  = 0.021). The first measured pain score was lower in the intervention group than in the control group (35 vs. 40 mm, P  = 0.035). There was no significant difference in the incidence of nausea between the groups (8.7 vs. 12.9%, P  = 0.357).

CONCLUSION: The use of a combined PSP/IPP-block block before breast cancer surgery reduces the need for postoperative rescue morphine, even when compared with the use of intra-operative morphine.

TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03117894.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
National Category
Anesthesiology and Intensive Care Surgery
Identifiers
urn:nbn:se:umu:diva-212747 (URN)10.1097/EJA.0000000000001795 (DOI)36633115 (PubMedID)2-s2.0-85166383951 (Scopus ID)
Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2023-08-14Bibliographically approved
Rosengren, B. & Hultin, M. (2023). Nej, det behövs inget nationellt slutprov för läkare. Läkartidningen
Open this publication in new window or tab >>Nej, det behövs inget nationellt slutprov för läkare
2023 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518Article in journal (Other (popular science, discussion, etc.)) Published
National Category
Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-204643 (URN)
Note

Publicerad 2023-02-02

Available from: 2023-02-09 Created: 2023-02-09 Last updated: 2023-02-13Bibliographically approved
Moraitis, A., Myrberg, T., Hultin, M., Nyström, H. & Walldén, J. (2023). Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery. British Journal of Anaesthesia
Open this publication in new window or tab >>Palonosetron as prophylaxis for post-discharge nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial in ambulatory surgery
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2023 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771Article in journal (Refereed) In press
Abstract [en]

BACKGROUND: Approximately 25% of ambulatory surgery patients experience post-discharge nausea and vomiting (PDNV). We aimed to investigate whether palonosetron, a long-acting anti-emetic, decreases the incidence of PDNV in high-risk patients.

METHODS: In this prospective, randomised, double-blind, placebo-controlled trial, 170 male and female patients undergoing ambulatory surgery under general anaesthesia, with a high predicted risk for PDNV, were randomised to receive either palonosetron 75 μg i.v. (n=84) or normal saline (n=86) before discharge. During the first 3 postoperative days (PODs), we measured outcomes using a patient questionanaire. The primary outcome was the incidence of a complete response (no nausea, vomiting, or use of rescue medication) until POD 2. Secondary outcomes included the incidence of PDNV each day until POD 3.

RESULTS: The incidence of a complete response until POD 2 was 48% (n=32) in the palonosetron group and 36% (n=25) in the placebo group (odds ratio 1.69 [95% confidence interval: 0.85-3.37]; P=0.131). No significant difference in the incidence of PDNV was observed between the two groups on the day of surgery (47% vs 56%; P=0.31). Significant differences in the incidence of PDNV were found on POD 1 (18% vs 34%; P=0.033) and POD 2 (9% vs 27%; P=0.007). No differences were observed on POD 3 (15% vs 13%; P=0.700).

CONCLUSIONS: Compared with placebo, palonosetron did not reduce the overall incidence of PDNV up to POD 2. The lower incidence of PDNV on POD 1 and POD 2 in the palonosetron group requires further investigation.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
5HT-3 antagonist, PDNV, PONV, ambulatory surgery, day-care surgery, palonosetron, post-discharge nausea and vomiting, prophylaxis
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-209021 (URN)10.1016/j.bja.2023.04.034 (DOI)37246062 (PubMedID)2-s2.0-85160219043 (Scopus ID)
Funder
Region VästernorrlandVisare Norr
Available from: 2023-06-02 Created: 2023-06-02 Last updated: 2023-06-07
Bromfalk, Å., Hultin, M., Myrberg, T., Engström, Å. & Walldén, J. (2023). Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine. Pediatric Anaesthesia, 33(11), 962-972
Open this publication in new window or tab >>Postoperative recovery in preschool-aged children: A secondary analysis of a randomized controlled trial comparing premedication with midazolam, clonidine, and dexmedetomidine
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2023 (English)In: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 33, no 11, p. 962-972Article in journal (Refereed) Published
Abstract [en]

Background: Preoperative anxiety in pediatric patients can worsen postoperative outcomes and delay discharge. Drugs aimed at reducing preoperative anxiety and facilitating postoperative recovery are available; however, their effects on postoperative recovery from propofol-remifentanil anesthesia have not been studied in preschool-aged children. Thus, we aimed to investigate the effects of three sedative premedications on postoperative recovery from total intravenous anesthesia in children aged 2–6 years.

Methods: In this prespecified secondary analysis of a double-blinded randomized trial, 90 children scheduled for ear, nose, and throat surgery were randomized (1:1:1) to receive sedative premedication: oral midazolam 0.5 mg/kg, oral clonidine 4 μg/kg, or intranasal dexmedetomidine 2 μg/kg. Using validated instruments, outcome measures including time for readiness to discharge from the postoperative care unit, postoperative sedation, emergence delirium, anxiety, pain, and nausea/vomiting were measured.

Results: After excluding eight children due to drug refusal or deviation from the protocol, 82 children were included in this study. No differences were found between the groups in terms of median time [interquartile range] to readiness for discharge (midazolam, 90 min [48]; clonidine, 80 min [46]; dexmedetomidine 100.5 min [42]). Compared to the midazolam group, logistic regression with a mixed model and repeated measures approach found no differences in sedation, less emergence delirium, and less pain in the dexmedetomidine group, and less anxiety in both clonidine and dexmedetomidine groups.

Conclusions: No statistical difference was observed in the postoperative recovery times between the premedication regimens. Compared with midazolam, dexmedetomidine was favorable in reducing both emergence delirium and pain in the postoperative care unit, and both clonidine and dexmedetomidine reduced anxiety in the postoperative care unit. Our results indicated that premedication with α2-agonists had a better recovery profile than short-acting benzodiazepines; although the overall recovery time in the postoperative care unit was not affected.

Place, publisher, year, edition, pages
Wiley, 2023
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:umu:diva-212532 (URN)10.1111/pan.14740 (DOI)37528645 (PubMedID)2-s2.0-85166673433 (Scopus ID)
Funder
Region Västerbotten, RV-940554Region Västerbotten, RV-865681Norrbotten County Council, NLL-485451Norrbotten County Council, NLL-486841Norrbotten County Council, RN-785981
Available from: 2023-08-02 Created: 2023-08-02 Last updated: 2024-05-16Bibliographically approved
Zickerman, C., Brorsson, C., Hultin, M., Johansson, G., Winsö, O. & Haney, M. (2023). Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children. Acta Anaesthesiologica Scandinavica, 67(6), 706-713
Open this publication in new window or tab >>Preoperative anxiety level is not associated with postoperative negative behavioral changes in premedicated children
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2023 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 67, no 6, p. 706-713Article in journal (Refereed) Published
Abstract [en]

Background: Anesthesia preinduction anxiety in children can according to some studies lead to long-term anxiety and negative behavioral changes (NBC), while other studies have not found this effect. This secondary analysis from a recent premedication trial comparing clonidine and midazolam aimed to test the relation between preoperative anxiety assessed with modified Yale Preoperative Anxiety Scale (mYPAS) and postoperative NBCs assessed with Post Hospital Behavior Questionnaire (PHBQ), regardless of premedication type.

Methods: This is a planned secondary analysis from a published premedication comparison trial in an outpatient surgery cohort, children aged 2–7 years. Participant and preoperative factors, particularly preoperative anxiety as mYPAS scores, were assessed for association with development of postoperative NBCs.

Results: Fifty-four of the 115 participants had high preinduction anxiety (mYPAS >30), and 19 of 115 developed >3 postoperative NBCs 1 week after surgery. There was no association between preinduction anxiety level as mYPAS scores and the development of postoperative NBCs at 1 week after surgery (10 of 19 had both, p =.62) nor after 4- or 26-weeks post-surgery. Only lower age was associated with development of NBCs postoperatively.

Conclusions: Based on the findings from this cohort, high preinduction anxiety does not appear to be associated with NBCs postoperatively in children premedicated with clonidine or midazolam.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
children, postoperative negative behavioral changes, postoperative recovery, preoperative anxiety
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-206762 (URN)10.1111/aas.14240 (DOI)000962252500001 ()36928794 (PubMedID)2-s2.0-85151972127 (Scopus ID)
Funder
Umeå UniversityRegion Västerbotten
Available from: 2023-05-02 Created: 2023-05-02 Last updated: 2023-12-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2935-7161

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