Från konferensrum till skogsglänta

Syftet med studien är att undersöka vilken betydelse grön miljö har för neurologisk rehabilitering i form av en diagnoskurs ur ett behandlarperspektiv. Studien är gjord mot bakgrund att diagnoskurser är en viktig del inom neurologisk rehabilitering för att öka patienters självtillit, där den gröna miljöns påverkan inte är klarlagd. Ett multimodalt team bestående av sjuksköterska, fysioterapeut, arbetsterapeut, kurator, neuropsykolog och två rehabassistenter har genomfört en diagnoskurs för patienter med multipel skleros i valfri grön miljö och därefter intervjuats genom semisstrukturerad intervju. Resultatet visar att aktiviteter och vistelse i grön miljö ger nya möjligheter i form av andra aktiviteter, delaktighet i gruppen, ökad känsla av pigghet och ett bättre samtalsklimat. Det behandlande teamet ser även möjligheter att använda den gröna miljön som ytterligare ett verktyg utifrån de olika professionerna. Detta kan påverka neurologisk rehabilitering genom att under diagnoskurser öka gemenskapen i gruppen, underlätta inlärningen och göra deltagare och behandlare mer jämbördiga, vilket kan ses som förbättrade förutsättningar för ökad självtillit hos kursdeltagarna.The objective of this study was to examine the significance of green environment in neurological rehabilitation, here in the form of self-management education, from a caregiver perspective. Selfmanagement education plays an important part in rehabilitation when it comes to increasing a patients' self-efficacy. The impact of green surroundings is not fully understood. A multimodal team consisting of a nurse, a physiotherapist, an occupational therapist, a counselor, an clinical neuropsychologist and two rehabilitation assistants have carried out a self-management education for patients diagnosed with Multiple Sclerosis in a green surrounding and then been interviewed by semi structured interview. The results show that a green surrounding during a self-management education facilitate participation, increases alertness and result in a more easy-going conversation between practitioners and participants. The practitioners also sees opportunities to use the green surrounding as a tool in their different professions. This can affect neurological rehabilitation during self-management education by increasing participation in the group, facilitate learning and make the participants and team members more equal, which can be seen as improved conditions for increased self-efficacy

Patients' preferences for subcutaneous trastuzumab versus conventional intravenous infusion for the adjuvant treatment of HER2-positive early breast cancer: final analysis of 488 patients in the international, randomized, two-cohort PrefHer study

PrefHer revealed compelling and consistent patient preference for subcutaneous (s.c.) trastuzumab, regardless of delivery by single-use injection device or hand-held syringe. s.c. trastuzumab was well-tolerated and safety data, including immunogenicity, were consistent with previous reports. No new safety signals were identified compared with the known intravenous trastuzumab profile in early breast cance

Risk of ischemic heart disease after radiotherapy for ductal carcinoma in situ

The use of adjuvant radiotherapy (RT) in the management of ductal carcinoma in situ (DCIS) is increasing. Left-sided breast irradiation may involve exposure of the heart to ionising radiation, increasing the risk of ischemic heart disease (IHD). We examined the incidence of IHD in a population-based cohort of women with DCIS. The Breast Cancer DataBase Sweden (BCBase) cohort includes women registered with invasive and in situ breast cancers 1992-2012 and age-matched women without a history of breast cancer. In this analysis, 6270 women with DCIS and a comparison cohort of 31,257 women were included. Through linkage with population-based registers, data on comorbidity, socioeconomic status and incidence of IHD was obtained. Hazard ratios (HR) for IHD with 95% confidence intervals (CI) were analysed. Median follow-up time was 8.8 years. The risk of IHD was not increased for women with DCIS versus women in the comparison cohort (HR 0.93; 95% CI 0.82-1.06), after treatment with radiotherapy versus surgery alone (HR 0.77; 95% CI 0.60-0.98) or when analysing RT by laterality (HR 0.85; 95% CI 0.53-1.37 for left-sided versus right-sided RT). The risk of IHD was lower for women with DCIS allocated to RT compared to non-irradiated women and to the comparison cohort, probably due to patient selection. Comparison of RT by laterality did not show any over-risk for irradiation of the left breast.Peer reviewe

The relationship between radiation doses to coronary arteries and location of coronary stenosis requiring intervention in breast cancer survivors

Abstract Background To assess the relationship between radiation doses to the coronary arteries (CAs) and location of a coronary stenosis that required intervention after three-dimensional conformal radiotherapy (3DCRT) for breast cancer (BC). Methods The study population consisted of 182 women treated for BC in Sweden between 1992 and 2012. All women received 3DCRT and subsequently underwent coronary angiography due to a suspected coronary event. CA segments were delineated in the patient’s original planning-CT and radiation doses were recalculated based on the dose distribution of the original radiotherapy (RT) plan. The location of the CA stenosis that required intervention was identified from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Logistic regression analysis was used to assess the relationship between CA radiation doses and risk of a later coronary intervention at this specific location. Results The odds ratio (OR) varied by radiation dose to the mid left anterior descending artery (LAD) (p = 0.005). Women receiving mean doses of 1–5 Gray (Gy) to the mid LAD had an adjusted OR of 0.90 (95% CI 0.47–1.74) for a later coronary intervention compared to women receiving mean doses of 0–1 Gy to the mid LAD. In women receiving mean doses of 5–20 Gy to the mid LAD, an adjusted OR of 1.24 (95% CI 0.52–2.95) was observed, which increased to an OR of 5.23 (95% CI 2.01–13.6) for mean doses over 20 Gy, when compared to women receiving mean doses of 0–1 Gy to the mid LAD. Conclusions In women receiving conventional 3DCRT for BC between 1992 and 2012, radiation doses to the LAD remained high and were associated with an increased requirement of coronary intervention in mid LAD. The results support that the LAD radiation dose should be considered in RT treatment planning and that the dose should be kept as low as possible. Minimising the dose to LAD is expected to diminish the risk of later radiation-induced stenosis

En jämförande studie av automatisk textsammanfattning med användning av mänsklig utvärdering och automatiska mått

Automatic text summarization has emerged as a promising solution to manage the vast amount of information available on the internet, enabling a wider audience to access it. Nevertheless, further development and experimentation with different approaches are still needed. This thesis explores the potential of combining extractive and abstractive approaches into a hybrid method, generating three types of summaries: extractive, abstractive, and hybrid. The news articles used in the study are from the Swedish newspaper Dagens Nyheter(DN). The quality of the summaries is assessed using various automatic measures, including ROUGE, BERTScore, and Coh-Metrix. Additionally, human evaluations are conducted to compare the different types of summaries in terms of perceived fluency, adequacy, and simplicity. The results of the human evaluation show a statistically significant difference between attractive, abstractive, and hybrid summaries with regard to fluency, adequacy, and simplicity. Specifically, there is a significant difference between abstractive and hybrid summaries in terms of fluency and simplicity, but not in adequacy. The automatic measures, however, do not show significant differences between the different summaries but tend to give higher scores to the hybrid and abstractive summarie

Att klara livets vardagsaktiviteter : Förändringen av fysisk och kognitiv funktionsförmåga hos personer med misstänkt eller diagnostiserad demens.

Demenssjukdom innebär en successiv förlust av såväl fysiska som kognitiva funktioner som har betydelse för den enskilde personens vardagsliv. Syftet med studien var att beskriva den fysiska och kognitiva funktionsförmågan hos personer med misstänkt eller diagnostiserad demens och hur den förändras över en period av tre år. Vidare var syftet att jämföra den förändrade funktionsförmågan hos dessa personer med en motsvarande grupp ur en normalpopulation av äldre. Materialet till denna studie hämtades från två forsknings- och utvecklingsprojekt, Demensvård i Blekinge (DIBS) och The Swedish National Study on Aging and Care (SNAC). I studien användes instrumenten ADL-trappan, Bergerskalan samt MMT. Från DIBS medverkade 41 personer och från SNAC 108 personer. Analysen visade att personerna i DIBS försämrades i såväl den fysiska som den kognitiva förmågan. De utvecklade under de tre åren ett ökat beroende av hjälp från andra i instrumentella dagliga aktiviteter samt till viss del även i personliga aktiviteter. De personer som ingick i SNAC däremot försämrades inte nämnvärt i sin fysiska eller kognitiva funktionsförmåga under motsvarande tidsperiod. De behöll sin förmåga att klara dagliga livets aktiviteter och förblev alltså oberoende av hjälp från andra. För såväl närstående som professionella vårdare, är kunskap kring den förändrade aktivitetsförmågan, en grund för att ge bästa möjliga stöd och anpassning till denna i den enskilde personens vardagsliv

En jämförande studie av automatisk textsammanfattning med användning av mänsklig utvärdering och automatiska mått

Automatic text summarization has emerged as a promising solution to manage the vast amount of information available on the internet, enabling a wider audience to access it. Nevertheless, further development and experimentation with different approaches are still needed. This thesis explores the potential of combining extractive and abstractive approaches into a hybrid method, generating three types of summaries: extractive, abstractive, and hybrid. The news articles used in the study are from the Swedish newspaper Dagens Nyheter(DN). The quality of the summaries is assessed using various automatic measures, including ROUGE, BERTScore, and Coh-Metrix. Additionally, human evaluations are conducted to compare the different types of summaries in terms of perceived fluency, adequacy, and simplicity. The results of the human evaluation show a statistically significant difference between attractive, abstractive, and hybrid summaries with regard to fluency, adequacy, and simplicity. Specifically, there is a significant difference between abstractive and hybrid summaries in terms of fluency and simplicity, but not in adequacy. The automatic measures, however, do not show significant differences between the different summaries but tend to give higher scores to the hybrid and abstractive summarie

Att klara livets vardagsaktiviteter : Förändringen av fysisk och kognitiv funktionsförmåga hos personer med misstänkt eller diagnostiserad demens.

Demenssjukdom innebär en successiv förlust av såväl fysiska som kognitiva funktioner som har betydelse för den enskilde personens vardagsliv. Syftet med studien var att beskriva den fysiska och kognitiva funktionsförmågan hos personer med misstänkt eller diagnostiserad demens och hur den förändras över en period av tre år. Vidare var syftet att jämföra den förändrade funktionsförmågan hos dessa personer med en motsvarande grupp ur en normalpopulation av äldre. Materialet till denna studie hämtades från två forsknings- och utvecklingsprojekt, Demensvård i Blekinge (DIBS) och The Swedish National Study on Aging and Care (SNAC). I studien användes instrumenten ADL-trappan, Bergerskalan samt MMT. Från DIBS medverkade 41 personer och från SNAC 108 personer. Analysen visade att personerna i DIBS försämrades i såväl den fysiska som den kognitiva förmågan. De utvecklade under de tre åren ett ökat beroende av hjälp från andra i instrumentella dagliga aktiviteter samt till viss del även i personliga aktiviteter. De personer som ingick i SNAC däremot försämrades inte nämnvärt i sin fysiska eller kognitiva funktionsförmåga under motsvarande tidsperiod. De behöll sin förmåga att klara dagliga livets aktiviteter och förblev alltså oberoende av hjälp från andra. För såväl närstående som professionella vårdare, är kunskap kring den förändrade aktivitetsförmågan, en grund för att ge bästa möjliga stöd och anpassning till denna i den enskilde personens vardagsliv

Long-term side effects of radiotherapy in breast cancer : studies in ischemic heart disease and lung cancer

Breast cancer (BC) is the most common cancer in women worldwide. Due to early detection and advances in adjuvant therapies, most women diagnosed with early BC will be cured of their disease, and issues of survivorship are of great importance. Adjuvant radiotherapy (RT) in BC is well established and significantly reduces local recurrences and BC mortality. Still, it usually involves some accidental irradiation to the heart and lungs, which may lead to long-term side effects, mainly ischemic heart disease (IHD) and lung cancer (LC). The overall aim with this thesis was to study IHD and radiation-induced LC in women receiving RT for BC from the early 1990s until recently. In paper I and paper II a cohort of women (n=182) receiving computed tomography (CT)-based RT (3DCRT) for BC during 1992 to 2012, who subsequently were referred to a coronary angiography and treated for coronary stenosis, was studied. Paper I was a reproducibility study with the aim to examine the inter-observer variation in delineation of the coronary arteries (CAs) in CT scans used for 3DCRT planning. All patients treated at one of the participating RT departments (n=32), were selected from the larger cohort, and the CAs were delineated in the patients’ CT-scans by three oncologists independently, with a validated CT-based heart atlas as guideline. Spatial difference between the different delineations, and variance in radiation dose was calculated. The median distance between the centers of the arteries was 2-8 mm for the right coronary artery (RCA), and 1-4 mm for the left main coronary artery (LMCA) and the left anterior descending artery (LAD). The intraclass correlation coefficient (ICC) was derived to quantify the variance in estimated doses. The ICC for mean doses varied from 0.76 to 0.98 for LMCA-LAD, and from 0.73 to 0.92 for RCA, indicating that variation in radiation doses was mainly due to interpatient variation. In conclusion, the study showed high consistency in contouring the CAs in the patients’ planning CTs, in particular the LMCA-LAD. In paper II, the aim was to examine the relationship between radiation dose to the CAs and subsequent coronary stenosis that required a coronary intervention at this location. The CAs were delineated and divided into segments in the 182 patients’ planning-CTs and doses were recalculated based on the dose distribution of the original RT plans. The location of the CA stenosis was identified from the Swedish Coronary Angiography and Angioplasty Register (SCAAR). Mean doses to the heart and the LAD were substantially higher in women receiving left-sided RT compared to right-sided RT. Segment-wise analyses were performed to assess the risk of developing a coronary stenosis that required an intervention at a certain radiation dose. Segments receiving radiation doses < 1 Gray (Gy) were used as reference. The main finding was a five-fold increase in risk of a clinically relevant coronary stenosis in the mid LAD at mean doses over 20 Gy, compared to doses of 0-1 Gy (odds ratio 5.23; 95 % CI (confidence interval) 2.01-13.6). There were iv too few events to calculate increase in risk per Gy. Still, the result of this study supports that the radiation dose to the LAD should be considered at RT planning and kept as low as possible. In paper III and IV, the BcBaSe cohort was used to examine risk of IHD, and radiation-induced LC after adjuvant RT for BC. The BCBaSe consists of 68089 women diagnosed with BC during 1992 to 2012, and 340352 age-matched women without BC diagnosis. In paper III, Cox regression analyses were performed to estimate risk of IHD, by comparing women with BC to women without BC diagnosis, and by comparing left-sided BC to right-sided BC. Kaplan-Meier analysis was performed to assess cumulative incidence of IHD. Women with BC had a lower risk of IHD compared to women without BC diagnosis at follow-up (hazard ratio (HR) 0.91; 95 % CI 0.88-0.95). Women irradiated for left-sided BC had a higher risk of IHD compared to women irradiated for right-sided BC (HR 1.18; 95 % CI 1.06-1.31). The HRs increased with more extensive lymph node involvement and with addition of systemic therapy. The cumulative IHD incidence was increased in women receiving left-sided RT compared to rightsided RT, starting from the first years after RT and sustained with longer followup. In paper IV, Kaplan-Meier analyses were performed to assess cumulative incidence of LC and LC-specific survival. Cox regression analyses were performed to estimate risk of LC after adjuvant RT for BC, comparing women with BC to women without BC diagnosis. Women with BC receiving RT had a higher cumulative incidence of LC compared both to women with BC not receiving RT and women without BC. This became apparent 5 years after RT and increased with longer follow-up. Women with BC receiving RT had a higher risk of LC compared to women without BC diagnosis (HR 2.35; 95 % CI 1.54-3.59). LCspecific survival was significantly higher in women with a prior BC compared to women without a prior BC diagnosis. In paper III and paper IV information on individual dosimetry data was not available. Most women likely received 3DCRT given with tangential fields and were treated before breathing adaption techniques were implemented in Sweden. The results of these studies emphasize the importance of further development and implementing of RT techniques and regimens that lower the cardiac and lung doses. In conclusion, we found that radiation doses to the LAD remained high in women receiving 3DCRT for BC between 1992 and 2012, and were associated with an increased risk of clinically relevant CA stenosis. Delineating the LAD was feasible and the results of these studies support that the LAD radiation dose should be considered in RT treatment planning. The register-based studies confirmed that the risk of IHD was significantly increased in women receiving left-sided RT and that the risk of LC after BC RT was significantly increased in this large cohort of women with BC

"No man is an island" : A qualitative interview study of perceived safety regarding social phenomena's

Begreppet trygghet är flerdimensionellt och innefattar många olika definitioner. På grund av dennakomplexitet används begreppet (o)trygghet i denna studie som en ihopsatt definition, då trygghetoch otrygghet inte går att separera. Studier visar att en människas upplevda otrygghet kan vara starkäven under omständigheter när den faktiska risken att utsättas för brott är relativt låg. I dennastudie jämförs den upplevda (o)tryggheten hos nio personer som bor i två mindre samhällen iÖrnsköldsviks kommun; Husum och Själevad. Detta görs utifrån teorierna Kollektiv styrka ochIgenkänning men även med hjälp av begreppsdefinitioner samt tidigare forskning om olika aspekterav (o)trygghet. Den valda metoden är semistrukturerade intervjuer för att få en djupare förståelseav de utvalda respondenternas upplevelser av (o)trygghet i närområdet. Deras svar har varierat därbåde likheter och skillnader har kunnat identifieras mellan samhällena. Gemensamt för utsagorna ibåda områdena är vikten av gemenskap och en relation till grannar för att känna trygghet. Även attvara del av ett större sammanhang samt att respondenterna uttrycker att de upplever mer omfattande trygghet under dagtid. Det som skiljer svaren åt är främst den upplevda rädslan för brottsamt arbetsmigranters påverkan på respondenternas (o)trygghet. Fortsättningsvis har även frågorom hur de upplever “det andra” området ställts där respondenternas svar generellt visar att känslanav trygghet i det egna området är starkare då de känner till personerna och omgivningen. Respondenternas skildringar stämmer på det hela taget överens med tidigare forskning samt går i enlighetmed det teoretiska ramverket. The concept of safety is multidimensional and includes many different definitions. Because of thiscomplexity, the word (un)safety is used in this essay instead as a combined definition, since safetyand unsafety cannot be separated. Studies show that people's perceived unsafety can be strongduring times even when the actual risk of being exposed to crimes is relatively low. In this studythe perceived (un)safety is compared amongst nine people living in two smaller communities inÖrnsköldsvik municipality: Husum and Själevad. This will be done based on the theories Collectivestrength and Familiarity but also with help from concept definitions as well as previous researchon different aspects of (un)safety. The chosen method is semi structured interviews to gain a deeperunderstanding of the chosen respondents’ experiences of perceived (un)safety in their local areas.Their responses have varied where both similarities and differences have been identified betweenthe communities. Common to both areas is the importance of togetherness as well as a relationshipto neighbors in order to feel safe, but also to be part of a bigger context. Another similarity is thatthe respondents feel safer during daytime. What differs the answers is first and foremost the perceived fear of crime and the guest workers' effect on the participants' (un)safety. Furthermore,questions about how they perceive “the other” community have been asked where the respondentsanswers generally show that the feeling of safety in their own area is stronger since they know thepeople and the surroundings. The respondents' descriptions are generally in line with previousresearch and are in accordance with the theoretical framework.