Objective. To explore long-term cardiovascular outcomes and mortality in patients after a first myocardial infarction (MI) compared with matched controls in a contemporary setting. Methods. During 2010–2014 the Swedish study PAROKRANK recruited 805 patients <75 years with a first MI and 805 age-, gender-, and area-matched controls. All study participants were followed until 31 December 2018, through linkage with the National Patient Registry and the Cause of Death Registry. The primary endpoint was the first of a composite of all-cause death, non-fatal MI, non-fatal stroke, and heart failure hospitalization. Event rates in cases and controls were calculated using a Cox regression model, subsequently adjusted for baseline smoking, education level, and marital status. Kaplan–Meier curves were computed and compared by log-rank test. Results. A total of 804 patients and 800 controls (mean age 62 years; women 19%) were followed for a mean of 6.2 (0.2–8.5) years. The total number of primary events was 211. Patients had a higher event rate than controls (log-rank test p < .0001). Adjusted hazard ratio (HR) for the primary outcome was 2.04 (95% CI 1.52–2.73). Mortality did not differ between patients (n = 38; 4.7%) and controls (n = 35; 4.4%). A total of 82.5% patients and 91.3% controls were event-free during the follow up. Conclusions. In this long-term follow up of a contemporary, case-control study, the risk for cardiovascular events was higher in patients with a previous first MI compared with their matched controls, while mortality did not differ. The access to high quality of care and cardiac rehabilitation might partly explain the low rates of adverse outcomes.
In this commentary piece, we argue that we must interrogate the meaning of race and examine why and how race does matter in different societies across contexts before we can even consider moving “beyond race.” We understand race as fundamentally related to power, privilege, and oppression; we discuss how we cannot go “beyond race” in the face of persistent racisms, hierarchies and maintenance of power and privilege. We address that demographic changes in itself does not bring us “beyond race” and the importance of active policies and political mobilization through addressing race as an analytical category is necessary to go “beyond racism.”
Objective The present study investigates if symptoms of COVID-19 contagion in different social contexts (cohabitants, family, acquaintances, and others) are associated with university students' own self-reported symptoms of COVID-19 contagion, mental health, and study capacity. This was investigated by a cross-sectional survey administrated in Sweden during the first wave of the COVID-19 pandemic, at the time when universities were locked down to limit viral spread and contagion. Results Mild to moderate symptoms of COVID-19 in cohabitants and family members were associated with student’s self-reported symptoms of contagion, while no associations could be seen in relation to mental health and study capacity. Symptoms of COVID-19 contagion in acquaintances and others were not associated with students’ self-reported symptoms, nor with their mental health and study capacity. To conclude, during the initial lockdown of universities students’ self-reported symptoms of contagion were mainly associated with cohabitants and family members, while symptoms of contagion in different social contexts were not associated with mental health and study capacity. Findings suggest that lockdown of universities may have contributed to limiting infection pathways, while still allowing students to focus on their studies despite significant contagion among others known to the student.
Climate change adaptation is rising on the agenda of cities. However, critics have argued that urban adaptation efforts largely focus on preserving economic growth while overlooking the root causes of unequal vulnerability to climate impacts, giving rise to climate injustices. In response, literature on transformational adaptation has politicized these issues but it has remained largely conceptual, particularly in relation to the question of which actors can define and advance transformative approaches. Furthermore, existing empirical studies focus on positive cases while ignoring why these issues more commonly are not politicized. In this article, we add empirical rigour to these debates through an investigation into Malmö's climate politics. We analyse what enables or inhibits the role of three political outsiders – disadvantaged communities, climate movements and social justice activists – in politicizing urban climate adaptation. We find that, while the most vulnerable social groups struggle with climatic impacts and experience difficulties in politicizing these issues, climate movements remain focused on climate mitigation and largely ignore local adaptation. In turn, we highlight the untapped capacity of social justice activism to act as social infrastructure for adaptation. Our findings suggest that alliances between the victims of adaptation injustices and local activist groups could support the politicization of those grievances by responding to emerging needs and by building policy-oriented pressure for transformational adaptation. However, we identify several factors that limit this potential, thereby contributing to an understanding of why social movements sometimes do not live up to their transformational potential.
Molecularly imprinted polymers (MIPs) are artificial receptors with template tailored recognition sites complementary to the targets. The versatility of this molecular imprinting technique has been hampered by the lack of practical synthetic procedures to prepare highly selective MIP nanoparticles targeting phospholipids, which are challenging to be imprinted due to their amphiphilic structure. Here, a novel sedimentation-based solid-phase imprinting strategy is introduced relying on polymerization in the presence of template-modified silica nanospheres (SNs). To demonstrate this concept, the sphingosine-1-phosphate receptor agonist fingolimod phosphate (FP) was coupled to SNs which were dispersed in the prepolymerization medium consisting of the fluorescent functional monomer 1,8-bis(N-vinylimidazol-N′-methyl)anthracene bromide and the crosslinking monomer ethyleneglycol dimethacrylate. High dilution polymerization of the dispersion under agitation followed by simple sedimentation-based separation of the SN template resulted in the isolation of surface imprinted fluorescent MIP nanoparticles (FMIP NPs) in a high yield (17 %). The FMIP NPs displayed fluorescence enhancement in response to the template with a high imprinting factor (IF=9) under the experimental conditions and good specificity, and could recognize FP in human serum with recoveries of 68–74 %. Moreover, the template-modified SNs could be recycled for reuse. Such molecular imprinting strategy opens a new approach to produce highly selective artificial receptors targeting phospholipids.
There are several measures that are, or could be, in use in relation to estimating the outcome of endodontic treatments. It is important to reflect on when and why a certain outcome measure is used; when caring for an individual patient it is obvious that the goal always should be a tooth in a healthy state, that is striving to remove any infection and aim for the tooth to have healthy periapical tissues. For patients in general and for society, it is also interesting to know if endodontic treatments will lead to retention of teeth in a functioning state. From epidemiological studies, with high prevalence of root filled teeth with periapical radiolucencies, it is implied that dentists and/or patients accept the retention of a root filled tooth with persistent apical periodontitis. However, we do not know if or how this affects the health of the individual. In conjunction with an endodontic treatment the prognosis is considered and since the prognostic factors seem to be somewhat different depending on whether one is considering for example the outcome ´healthy periapical tissues´ or ´tooth survival´ they are equally important to know. Factors affecting the outcome ´healthy periapical tissues´ probably has to do with removal of infection and reconstituting the barrier to prevent leakage whilst ´tooth survival´ is more likely associated with factors outside of the classical endodontic field such as restorability and avoidance of further destruction of tooth substance. This narrative review will focus on tooth survival after endodontic treatment and root canal treatment will be the focus. As a crude estimation, there is to be an annual loss of 2% of teeth which have received a root canal treatment. Of the pre‐, peri‐ and postoperative factors that have been studied in conjunction with root canal treatments the restoration of the tooth is the factor that has been most extensively studied. Many studies imply that root filled teeth restored with indirect restorations have a better survival than teeth restored with direct restorations, it is not possible to determine whether this indeed is a prognostic factor.
Immigrant women in Sweden often have unmet sexual and reproductive health (SRH) needs. Successful contraceptive counselling may improve their sexual and reproductive health and rights. The unique Swedish model, with midwives as the main providers of contraceptive counselling, is important for immigrant women's health at both individual and societal levels. This study explored immigrant women's perspectives on receiving contraceptive counselling from midwives in Sweden, in order to obtain deeper knowledge about the factors they perceive as important in the counselling situation. Nineteen in-depth individual interviews were conducted from December 2018 to February 2019, followed by qualitative manifest and latent content analysis. Trust emerged as the overall important factor in the contraceptive counselling meeting. Knowledge was lacking about the midwife's professional role as a contraceptive counsellor. Contraceptive counselling was seen as a private matter not easily shared with unfamiliar midwives or interpreters. Previous experiences of contraceptives and preconceptions were important considerations for contraceptive choice, but communicating these needs required trust. Women also wanted more knowledge about contraceptives and SRH care and rights. Cultural and social norms concerning when and why to use contraceptives needed to be acknowledged in the midwife encounter. Although immigrant women want more knowledge about contraception, a trustful relationship with the midwife is needed to be able to make informed contraceptive choices. Midwives may need increased awareness of the many factors influencing immigrant women's choices to ensure their contraceptive autonomy. Policy changes that promote new ways of counselling and ability to provide continuous care are needed.
Background and Aim Strategies to modify and adjust the educational setting in mainstream education for autistic students are under-researched. Hence, this review aims to identify qualitative research results of adaptation and modification strategies to support inclusive education for autistic students at school and classroom levels. Method In this systematic review, four databases were searched. Following the preferred PRISMA approach, 108 studies met the inclusion criteria, and study characteristics were reported. Synthesis of key findings from included studies was conducted to provide a more comprehensive and holistic understanding. Main Contribution This article provides insights into a complex area via aggregating findings from qualitative research a comprehensive understanding of the phenomena is presented. The results of the qualitative analysis indicate a focus on teachers' attitudes and students' social skills in research. Only 16 studies were at the classroom level, 89 were at the school level, and three studies were not categorized at either classroom or school level. A research gap was identified regarding studies focusing on the perspectives of autistic students, environmental adaptations to meet the students' sensitivity difficulties, and how to enhance the students' inclusion regarding content taught and knowledge development from a didactic perspective. Conclusions and Implications Professional development that includes autism-specific understanding and strategies for adjusting and modifying to accommodate autistic students is essential. This conclusion may direct school leaders when implementing professional development programs. A special didactical perspective is needed to support teachers' understanding of challenges in instruction that autistic students may encounter.
There is a lack of clinical placements for bachelor nursing students (BNS). Due to this, stringent educational models for clinical practice need to be developed. The aim was to describe bachelor nursing students’ and main preceptors’ experiences of the clinical learning environment during peer learning. This mixed method study was based on a joint project between the Karlstad University and the Region Värmland, Sweden, where peer learning was launched in two geriatric clinical education wards. A total of 23 bachelor nursing student and four main preceptors participated. The data were collected in parallel, qualitative data through focus group interviews and reflective journals, and quantitative data with the CLES + T scale between November 2017 and February 2018. A directed content analysis of all results was performed. The COREQ Checklist was used. The student–patient and the student–main preceptor relationships were important for the students’ development. The students described the educational atmosphere as comfortable and safe and that the staff were knowledgeable about them. Peer learning with close interaction between patients and all staff can create authenticity, which in turn drives the BNSs’ professional development. All staff should be involved in the supervision of the students and include them as members of the nursing team.
Objectives Mental health consequences and behavior change has been described in elite athletes following the vast impact of the COVID-19 pandemic on the world of sports. However, most study samples have been of limited size, and few studies have assessed student-athletes. This study aimed to analyze perceived mental health impact, measured as clinical degree of depression and anxiety, worry about one's sport and about one's career, and behavioral change with respect to video gaming behavior, in high-school athletes in Sweden. Methods Data on anxiety and depression as well as on perceived behavioral changes during COVID-19 were collected from students at sports high schools in Sweden ( N = 7,025) in February 2021, during the ongoing COVID-19 pandemic. Results Sixteen and 14% met criteria of moderate/severe depression and anxiety, respectively. Many respondents reported feeling mentally worse during the pandemic (66%), and were worried about the future of their sport (45%) or about their own future in sports (45%). Increased gaming behavior during COVID-19 was reported by 29%. All mental health variables were significantly more common in women, except increased gaming (more common in men). Being worried about one's career was less common in winter sports, more common in team sports and more common in older student-athletes, and associated with both depression and anxiety in regression analyses. Discussion Self-reported mental health impact of COVID-19 is substantial in student-athletes, and even more so in women and in team sports. The lower impact in winter athletes suggests a moderating effect of the seasons in which the COVID-19 outbreak occurred.
Background Caries and periodontitis are amongst the most prevalent diseases worldwide, leading to pain and loss of oral function for those affected. Prevention relies heavily on mechanical removal of dental plaque biofilms but for populations where this is not achievable, alternative plaque control methods are required. With concerns over undesirable side-effects and potential bacterial resistance due to the use of chlorhexidine gluconate (CHX), new antimicrobial substances for oral use are greatly needed. Here we have investigated the antimicrobial effect of hypochlorous acid (HOCl), stabilized with acetic acid (HAc), on oral biofilms and compared it to that of CHX. Possible adverse effects of stabilized HOCl on hydroxyapatite surfaces were also examined. Methods Single- and mixed-species biofilms of six common oral bacteria ( Streptococcus mutans , Streptococcus gordonii , Actinomyces odontolyticus , Veillonella parvula , Parvimonas micra and Porphyromonas gingivalis ) within a flow-cell model were exposed to HOCl stabilized with 0.14% or 2% HAc, pH 4.6, as well as HOCl or HAc alone. Biofilm viability was assessed in situ using confocal laser scanning microscopy following LIVE/DEAD® BacLight™ staining. In-situ quartz crystal microbalance with dissipation (QCM-D) was used to study erosion of hydroxyapatite (HA) surfaces by stabilized HOCl. Results Low concentrations of HOCl (5 ppm), stabilized with 0.14% or 2% HAc, significantly reduced viability in multi-species biofilms representing supra- and sub-gingival oral communities, after 5 min, without causing erosion of HA surfaces. No equivalent antimicrobial effect was seen for CHX. Gram-positive and Gram-negative bacteria showed no significant differential suceptibility to stabilized HOCl. Conclusions At low concentrations and with exposure times which could be achieved through oral rinsing, HOCl stabilized with HAc had a robust antimicrobial activity on oral biofilms, without causing erosion of HA surfaces or affecting viability of oral keratinocytes. This substance thus appears to offer potential for prevention and/or treatment of oral biofilm-mediated diseases.
The FDI World Dental Federation suggests that “dentistry, as a profession, should integrate Sustainable Development Goals into daily practice and support a shift to a green economy in the pursuit of healthy lives and wellbeing for all, through all stages of life.” This article reports on the recent activity of the Association for Dental Education in Europe Special Interest Group for Sustainability in Dentistry. Following on from the group's previous activities, which explored current educational practice, this work aimed to reach a pan‐European consensus on a number of learning outcomes for environmental sustainability, in order to (i) support institutions in designing and delivering their curriculum, and (ii) to further harmonise the delivery of oral health professional education across Europe. This article presents specific learning outcomes relating to environmental sustainability and recommendations relating to curriculum development, including methods of teaching and assessment.
The crowded environment of biological systems such as the interior of living cells is occupied by macromolecules with a broad size distribution. This situation of polydispersity might influence the dependence of the diffusive dynamics of a given tracer macromolecule in a monodisperse solution on its hydrodynamic size and on the volume fraction. The resulting size dependence of diffusive transport crucially influences the function of a living cell. Here, we investigate a simplified model system consisting of two constituents in aqueous solution, namely, of the proteins bovine serum albumin (BSA) and bovine polyclonal gamma-globulin (Ig), systematically depending on the total volume fraction and ratio of these constituents. From high-resolution quasi-elastic neutron spectroscopy, the separate apparent short-time diffusion coefficients for BSA and Ig in the mixture are extracted, which show substantial deviations from the diffusion coefficients measured in monodisperse solutions at the same total volume fraction. These deviations can be modeled quantitatively using results from the short-time rotational and translational diffusion in a two-component hard sphere system with two distinct, effective hydrodynamic radii. Thus, we find that a simple colloid picture well describes short-time diffusion in binary mixtures as a function of the mixing ratio and the total volume fraction. Notably, the self-diffusion of the smaller protein BSA in the mixture is faster than the diffusion in a pure BSA solution, whereas the self-diffusion of Ig in the mixture is slower than in the pure Ig solution.
A promise of urban gardening (UG) is allowing individuals to shape and engage with the built environment, bringing people together in public space. Municipalities may promote UG in public space for a wide variety of reasons such as enabling integration, reducing crime, or promoting area attractivity. While there is a general sense that UG can contribute to inclusive public space in these efforts, previous research provides ambiguous findings. UG in public space requires balancing inclusive and exclusive practices to create common values, as a select group of engaged members inherently shape space in their interest. UG initiatives vary considerably with respect to their aims, organisational forms, and spatial contexts – affecting inclusion in public space in different manners. The article seeks to unpack how urban settings, organisational forms, and municipal enabling affect UG practices towards inclusion in public space. To do so, the article draws on the theory of urban commons and intertwines it with research on inclusion in public space. This provides an understanding of multi-faceted UG governance and its exclusionary aspects. A framework is not only developed and applied to critically, but also constructively, to review how municipalities enable UG. A comparative analysis of UG initiatives in three Northern European municipalities explores both municipal enabling and the co-production of inclusive public space. The research abductively refines the framework for understanding the co-production of inclusive public space in UG. We argue that the findings and resulting framework have implications for research and for municipal enabling of UG towards inclusive public space.
University teachers are expected to continuously improve their practice, but research about their viewpoints of future-ready universities is scarce. The paper contributes to educational research through paired Q methodology and investigates university teachers’ shifting views of successful future learning environments, while being forced to move to fully digital solutions due to the Covid-19 pandemic. Four pre-pandemic (January 2020) and two while-pandemic viewpoints (November 2020) are qualitatively interpreted and show that lived experiences during the pandemic led to a polarization of participants’ subjective perspectives. Despite challenging conditions, university teachers view digital and distance teaching more positively, but remain skeptical concerning technologically-enhanced on-campus learning environments. Results also indicate a largely unchanged consensus regarding the importance of critical thinking and creativity. This exploratory study’s results allow forward-thinking dialogues about new policies in potentially ever more hybrid learning environments with various educational stakeholders, both within the case university in Sweden and other educational institutions.
Sex education can be described as an important part of health education in school and one way of strengthening health education could be a collaboration between different professionals in the school team. The aim of this study was to describe teachers’ and school nurses’ experiences and perspectives with regard to sex education among students aged 11–12 years and to explore potential influencing factors. We employed a qualitative design, and the teachers and school nurses were interviewed individually. A thematic analysis was conducted on the interviews and the results showed that the classroom was considered to be the teacher’s arena. Tradition and attitudes between professionals could be obstacles that affect collaboration between teachers and nurses and the study showed that there remains much to be done before collaboration at the same level between the groups can be established.
Despite the increasing popularity of studies on teachers’ national curriculum adaptations, there is no comparative study elucidating teachers’ adaptations in centralized and decentralized educational contexts through sense-making theory lenses. This paper presents a comparative case study of Turkish and Swedish senior classroom teachers’ curricular adaptations concerning sense-making theory. We get data through non-participatory lesson observations, interviews, and document analysis from two teachers teaching third-grade mathematics in each country (İzmir and Malmö). Findings reveal that both Turkish and Swedish senior teachers frequently extend, replace/revise and omit the mathematics curriculum. Turkish teachers provided extensive evidence about their adaptations and even tried explaining their reasons whereas Swedish teachers perceived the changes they made in the classroom as teaching rather than adaptations, due to different levels of centralization. Additionally, Turkish teachers responded with parallel structures and assimilation to the national curriculum, and Swedish teachers responded only with assimilation. However, a Turkish teacher’s assimilation mediated fewer adaptations while both Swedish teachers’ assimilation mediated more adaptations (extension and replacing/revising). We conclude by drawing implications for research on teachers’ adaptations and sense-making.
Though the rise of social media has provided countless advantages and possibilities, both within and without the domain of sports, recent years have also seen some more detrimental aspects of these technologies come to light. In particular, the widespread social media culture surrounding fitness – ‘fitspiration’ – warrants attention for the way it encourages self-sexualization and -objectification, thereby epitomizing a wider issue with photo-based social media in general. Though the negative impact of fitspiration has been well documented, what is less understood are the ways it potentially impacts and molds moral psychology, and how these same aspects may come to influence digital sports subcultures more broadly. In this theoretical paper, I rely on the insights of Friedrich Nietzsche to analyze the moral significance of a culture like fitspiration becoming normalized and influential in structuring and informing self-understanding, notions of value, and how to flourish in life. Using two doctrines central to Nietzsche’s philosophy—The Last Man and his conception of the ’higher self’ – I argue that fitspiration involves a form of hedonism that is potentially harmful to the pursuit and achievement of human flourishing. Through fitspiration, desire is elevated to a central moral principle, underlying the way users both consume and produce its content, catering simultaneously to their desires for external validation and instant gratification. It thereby creates conditions which foster a culture in adherence to the ethos of The Last Man. In doing so, I argue it impedes the cultivation of the virtues and higher values which define the higher individual, regarded by Nietzsche as essential for human flourishing. However, drawing on the ethical framework of the higher individual provides the philosophical and psychological resources with which resisting and overcoming the more harmful temptations of these trends may be possible.
In the context of Virtual Exchange (VE) it is often assumed that participants will be naturally prepared to interact online successfully with their international partners. However, there is ample evidence in the literature to suggest that VE participants are usually unaware of effective communicative strategies in synchronous and asynchronous online communicative contexts. Through action research, this article investigates how teachers can provide scaffolding for both these communicative modalities in online intercultural environments. It reports on a qualitative content analysis of conversational and self-reported data from a corpus of three VEs that were collected and triangulated in order to identify when, in what areas, and in what ways students could benefit from pedagogical mentoring. The article then presents key mentoring stages and strategies that were identified and provides insight into the type of scaffolding that VE teachers can provide their students to help them achieve successful (a)synchronous online intercultural interaction.
We contribute to the scientific debate by studying the storylines, discourses and related normative judgments in parliamentary motions by private members of the Swedish parliament from the time period 2010–2019. The paper makes use of an ecofeminist theoretical framework to problematize these storylines, discourses and normative judgments. We conclude that the focus in the material is on economic and technical issues, while issues of justice play a marginal role. None of the important dimensions of energy justice are adequately considered and many of the dominant storylines and discourses are based on the implicit assumption that issues of justice are insignificant.
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