Long-term perspectives on hypospadias

Hypospadias, a multifactorial condition and one of the most common congenital malformations, has an incidence of 1/125 boys born. The infants are born with an ectopic meatus placed ventrally on the penis varying from a glanular to a perineal position, a cleaved prepuce, and often a penile curvature. The treatment is surgical and aims to achieve a satisfactory cosmetic result, an ability to void normally, and to have satisfactory sexual functions. The aim of this thesis was to evaluate the long-term outcome of men born with hypospadias. All the studies were based on a questionnaire sent to 167 patients and 169 age-matched controls, as well as 47 circumcised controls operated for phimosis. A subgroup of patients and controls came for a clinical exam, which included uroflowmetry and a psychiatric screening. Study I, investigating the urological outcome and cosmetic result after surgery, revealed that patients had more voiding dysfunction and a lower maximal urinary flow rate. They also had a shorter penile length and were less satisfied with the cosmetic appearance than controls. Patients with proximal hypospadias had a shorter penile length and were less satisfied than the other patients. Study II, focusing on the psychosocial long-term outcome, revealed that patients with hypospadias have a comparable psychosocial situation to controls and a good quality of life. Patients with proximal hypospadias had a history of more medical follow-up and psychological support than patients with more distal hypospadias and also expressed a need for more psychological support in the future. The aim of Study III was to investigate the fertility and psychosexual function. A comparable fertility and a favourable psychosexual function were revealed, with 80% of both patients and controls expressing satisfaction with their sexual life. Patients with proximal hypospadias had a lower reported fertility compared with controls and with patients with more distal hypospadias. Proximal hypospadias decreased the odds of a man being satisfied with his sexual life. Study IV assessed the prevalence of psychiatric symptoms of ADHD, affective disorders and other common psychiatric diagnoses. The results did not identify an increased psychiatric morbidity in men with hypospadias. In conclusion, the long-term outcome in men born with hypospadias is, in general, good. However, genital appraisal is impaired in all groups with a risk of causing both psychosocial and psychosexual impairment. Patients with proximal hypospadias need more follow-up and support, and transitional care is important

The case for modelled democracy

The fact that most of us are ignorant on politically relevant matters presents a problem for democracy. In light of this, some have suggested that we should impose epistemic constraints on democratic participation, and specifically that the franchise be restricted along competency lines—a suggestion that in turn runs the risk of violating a long-standing condition on political legitimacy to the effect that legitimate political arrangements cannot be open to reasonable objections. The present paper therefore outlines a way to solve the problem of public ignorance without restricting the franchise. The proposal involves filtering the electoral input of a universal franchise through a statistical model that simulates what the public’s political preferences would have been, had they been informed on politically relevant matters. The result is modelled democracy. A case is made that such democracy both solves the problem of public ignorance and satisfies the aforementioned condition on legitimacy

The effect of bright light on sleep in nursing home patients with dementia

Background: Up to 70% of nursing home patients with dementia suffer from disrupted sleep, often characterized by multiple awakenings at night and excessive daytime sleep. Sleep disruption may have negative effects on the cognition, mood, behaviour, and well-being of nursing home patients, while also representing a challenge for nursing home staff. However, few sleep scales are developed and validated specifically for the nursing home setting. Sleep problems among nursing home patients are frequently treated by medications, which are associated with severe side effects, including daytime sleepiness, and an increased risk of falls. Thus, there is a need for non-pharmacological interventions to improve sleep in this population. Bright light treatment (BLT) may represent such an intervention, providing increased light exposure aiming to impact sleep, circadian rhythmicity, mood, and/or behaviour. Light is the most important zeitgeber to the circadian system, and consequently has a significant impact on sleep-wake behaviour. Unfortunately, studies have reported low indoor light levels in nursing homes, which in combination with dementia-related neuropathology and age-related reductions in light sensitivity, are likely to contribute to sleep problems in this population. The aim of this thesis was to investigate whether increasing daytime light exposure, by means of BLT, can improve sleep in nursing home patients with dementia, and also to address methodological challenges in this field of research. Methods: Paper 1 is a systematic review of the literature, focusing on the methodological features of the included studies, in addition to their findings. Paper 2 and 3 are based on data from the DEM.LIGHT trial; a cluster-randomized placebo-controlled trial conducted in Norwegian nursing homes, including 69 patients. The intervention comprised a diurnal cycle of ambient light with a maximum of 1,000 lux and 6,000 Kelvin (K) from 10:00-15:00, administered using light emitting diode (LED) light. Before and after this interval, the light levels gradually increased/decreased in lux and K. In the placebo condition, standard light levels were maintained at 150-300 lux and approximately 3,000 K throughout the day. The intervention and placebo lights were installed in the common rooms of the included nursing home units. Outcomes were measured at baseline and at follow-up at week 8, 16, and 24. Paper 2 was a validation study of a proxy-rated sleep scale, using the baseline data from the DEM. LIGHT trial. Actigraphy was used as the reference standard. Paper 3 reported on the sleep outcomes of the trial, which were the primary outcomes. Results: Paper 1 found that there are promising, though inconsistent, results regarding the effect of BLT on sleep and circadian rhythmicity in dementia. Large heterogeneity in terms of interventions, study designs, population characteristics, and outcome measurement tools may explain some of the inconsistencies of results across studies. Paper 2 showed that the proxy-rated Sleep Disorder Inventory (SDI) had satisfactory internal consistency and convergent validity. Using actigraphy as the reference standard, the SDI was termed clinically useful, and we suggested a cut-off score of five or more as defining disrupted sleep in nursing home patients with dementia. These results should be interpreted keeping in mind that actigraphy have some important weaknesses, such as underestimating wake time. Paper 3 evaluated the effects of the BLT on sleep and found an improvement in sleep according to the SDI scores in the intervention group, as compared to the control group, from baseline to week 16 and baseline to week 24. There was no effect in terms of sleep measured by actigraphy. Conclusion: In summary, this thesis found that the evidence for an effect of BLT on sleep in nursing home patients with dementia is promising, but equivocal. Importantly, the research field faces some important methodological challenges, such as accurately measuring sleep. The SDI may represent a valid tool to measure sleep in the nursing home setting, which may be used both by researchers and by practitioners. Although the results of this thesis are not conclusive regarding the effect of BLT on sleep in nursing home patients with dementia, it may represent a step forward in understanding the potential value of BLT in this population, and may lay the ground for further investigation. The lack of an improvement on the SDI at week 8 indicates that the effect of BLT may take a long time to manifest in this population.Doktorgradsavhandlin

Comparative Analysis of Student Learning: Technical, Methodological and Result Assessing of PISA-OECD and INVALSI-Italian Systems .

PISA is the most extensive international survey promoted by the OECD in the field of education, which measures the skills of fifteen-year-old students from more than 80 participating countries every three years. INVALSI are written tests carried out every year by all Italian students in some key moments of the school cycle, to evaluate the levels of some fundamental skills in Italian, Mathematics and English. Our comparison is made up to 2018, the last year of the PISA-OECD survey, even if INVALSI was carried out for the last edition in 2022. Our analysis focuses attention on the common part of the reference populations, which are the 15-year-old students of the 2nd class of secondary schools of II degree, where both sources give a similar picture of the students