Sense of Coherence (SOC) in women treated for breast cancer and its relation to treatment outcome

Breast cancer incidence has, on average increased by 1.4 % annually during the last decades. Early detection and advances in treatment are the main contributing factors for the favourable outcome in terms of five- and ten-year survival rates. The biological factors that influence disease progression and mortality in breast cancer have been well studied. Comparatively less is known about the overall coping ability and their relevance for outcome in the breast cancer-population. The concept of sense of coherence (SOC) reflects a person ́s orientation to life and was established to describe why people remain healthy during times of considerable strain, and manage to make sense out of difficult experiences or situations. In the current thesis SOC is measured by the Sense of Coherence Scale (SOC-13). It contains 13 items that reflects the three core components; comprehensibility, manageability and meaningfulness. Higher SOC scores indicate higher sense of coherence. The main aim of the thesis was to evaluate the SOC scale's stability and predictive value regarding progression and mortality in breast cancer patients. This was done utilizing a prospective design with a long-term follow-up in a multicenter cohort at four different Swedish hospitals. Two studies were performed. Of the total cohort, 75% and 87% respectively, participated in the two studies. In paper I, support for the SOC scale ́s stability over time (ICC 0.68, effect size 0.06) was demonstrated. The result of the cross-sectional factor analysis revealed a modified three- factor and a second order factor model meeting criteria for goodness of fit. The longitudinal modified second-order factor model confirmed the construct stability character of the SOC scale with an acceptable goodness-of-fit criteria. In paper II, patients with high SOC had a 60% lower risk of breast cancer progression and a 80% lower risk of mortality than patients with low SOC over a median follow-up time of 10 years. The mortality risk declined by 2.3% for every one-unit increase in SOC (breast cancer mortality HR, 0.98; 95% CI, 0.96 to 0.99 and all-cause mortality HR, 0.98; 95% CI, 0.96 to 0.99). After adjusting for potential cofounders, the risk declined by 1.7% (breast cancer mortality) and 1.5% (all-cause mortality). The risk of progression declined by 1.4% for every one-unit increase in SOC (HR, 0.99; 95% CI, 0.97 to 1.00). After adjusting for potential cofounders, the decline was 0.7%. In conclusion, the results from this thesis have shown that the SOC scale and its underlying construct is stable over time when applied to women with breast cancer. In addition, the SOC scale demonstrates a predictive value for disease progression, breast cancer caused mortality and for all-cause mortality among women with breast cancer and can be a valuable instrument for assessment of women at risk

Positional Cloning of “Lisch-like”, a Candidate Modifier of Susceptibility to Type 2 Diabetes in Mice

In 404 Lepob/ob F2 progeny of a C57BL/6J (B6) x DBA/2J (DBA) intercross, we mapped a DBA-related quantitative trait locus (QTL) to distal Chr1 at 169.6 Mb, centered about D1Mit110, for diabetes-related phenotypes that included blood glucose, HbA1c, and pancreatic islet histology. The interval was refined to 1.8 Mb in a series of B6.DBA congenic/subcongenic lines also segregating for Lepob. The phenotypes of B6.DBA congenic mice include reduced β-cell replication rates accompanied by reduced β-cell mass, reduced insulin/glucose ratio in blood, reduced glucose tolerance, and persistent mild hypoinsulinemic hyperglycemia. Nucleotide sequence and expression analysis of 14 genes in this interval identified a predicted gene that we have designated “Lisch-like” (Ll) as the most likely candidate. The gene spans 62.7 kb on Chr1qH2.3, encoding a 10-exon, 646–amino acid polypeptide, homologous to Lsr on Chr7qB1 and to Ildr1 on Chr16qB3. The largest isoform of Ll is predicted to be a transmembrane molecule with an immunoglobulin-like extracellular domain and a serine/threonine-rich intracellular domain that contains a 14-3-3 binding domain. Morpholino knockdown of the zebrafish paralog of Ll resulted in a generalized delay in endodermal development in the gut region and dispersion of insulin-positive cells. Mice segregating for an ENU-induced null allele of Ll have phenotypes comparable to the B.D congenic lines. The human ortholog, C1orf32, is in the middle of a 30-Mb region of Chr1q23-25 that has been repeatedly associated with type 2 diabetes

The mobile telephone relevance in the classroom : A study about teacher’s experiences of mobile telephone with an educational purpose

Författarna av denna studie har intervjuat sju lärare om deras erfarenheter av att använda mobiltelefonen i undervisningen. Studien undersöker vilka förutsättningar som krävs för att eleverna ska kunna använda mobiltelefonen i skolarbetet samt på vilket sätt lärare och elever kan använda den i undervisningen. Syftet med studien har varit att undersöka lärares erfarenheter av att använda mobiltelefoner som stöd för elevernas lärande i undervisningen. Undersökningen har genomförts genom kvalitativa ostrukturerade intervjuer. Resultatet visade att lärares erfarenheter av att använda mobiltelefonen i undervisningen är positiva. Vidare visar resultatet att avgörande villkor för att använda mobiltelefonen i undervisningen utgörs av gemensamma regler och skolans inställning till att använda teknologiska verktyg i undervisningssyfte. Respondenterna uttrycker att kunskaper om mobiltelefonernas funktioner redan finns hos eleverna. De lärare som intervjuats anser att det är viktigt att använda teknologiska verktyg då de är en del av samhället. Mobiltelefonens multifunktionella egenskaper kan ersätta många andra mer traditionella pedagogiska hjälpmedel. I denna studie har det vidare framkommit att mobiltelefonen kan vara ett hjälpmedel för elever i behov av särskilt stöd. Studiens slutsats är att användandet av mobiltelefoner som stöd för elevernas lärande i undervisningen är en pedagogisk utmaning och ett sätt att ta in elevers vardag in i klassrummet.

Registration of 2D Histological Images of Bone Implants with 3D SRμCT Volumes

To provide better insight in bone modeling and remodeling around implants, information is extracted using different imaging techniques. Two types of data used in this project are 2D histological images and 3D SRμCT (synchrotron radiation-based computed microtomography) volumes. To enable a direct comparison between the two modalities and to bypass the time consuming and difficult task of manual annotation of the volumes, registration of these data types is desired. In this paper, we present two 2D-3D intermodal rigid-body registration methods for the mentioned purpose. One approach is based on Simulated Annealing (SA) while the other uses Chamfer Matching (CM). Both methods use Normalized Mutual Information for measuring the correspondence between an extracted 2D-slice from the volume and the 2D histological image whereas the latter approach also takes the edge distance into account for matching the implant boundary. To speed up the process, part of the computations are done on the Graphic Processing Unit. The results show that the CM-approach provides a more reliable registration than the SA-approach. The registered slices with the CM-approach correspond visually well to the histological sections, except for cases where the implant has been damaged

Excess mortality in middle-aged men with diabetes aged 15-34 years at diagnosis.

The aim of this study is to assess mortality risk and the excess of risk in patients with diabetes. Patients were 15-34 years old at diagnosis of diabetes mellitus (n = 879) in 1992 and 1993 in this national cohort from Sweden. Healthy controls were matched for gender and birth on the same day as the index cases (n = 837). The civic registration number was used to link patients and controls to the Swedish Cause of Death Registry. During follow-up, 3.3% (29/879) of patients and 1.1% (9/837; P = 0.002) of controls died. The risk for a patient with diabetes to die was almost threefold increased compared with healthy controls; hazard ratio, 2.9 (95% CI 1.4-6.2). This increased risk was significant in men; hazard ratio, 2.8 (95% CI 1.2-6.5). Diabetes as the underlying cause of death accounted for 38% (11/29) of deaths among patients. Most patients, 55% (16/29), died at home, remaining patients in hospital, 28% (8/29), or elsewhere 17% (5/29) compared to controls of whom 33% (3/9; P = 0.45) died at home, 33% (3/9; P = 1.0) in hospital, and 33% (3/9; P = 0.36) elsewhere. Only 55% (16/29) of patients had a specified day of death on death certificates compared to 100% (9/9; P = 0.016) of controls. Adult men with diabetes had an almost threefold increased risk to die within 15 years of diagnosis compared to healthy men. Most middle-aged patients with diabetes died at home and often without a specified date of death recorded

Long-term sustained autoimmune response to beta cell specific zinc transporter (ZnT8, W, R, Q) in young adult patients with preserved beta cell function at diagnosis of diabetes.

The aim of this study was to examine whether autoantibodies to: ZnT8-Tryptophan (ZnT8WA), ZnT8-Arginine (ZnT8RA) or ZnT8-Glutamine (ZnT8QA) correlated with C-peptide or other autoantibodies and to assess diagnostic sensitivity of ZnT8WRQA. Specimens from 270 newly diagnosed diabetic subjects (age 15--34 years) and after five 5 years duration of disease were examined. Four linear regression models were used to dissect the importance of different factors from diagnosis for the respective difference of (logZnT8WA), (logZnT8RA) and (logZnT8QA); A) unadjusted model for: initial C-peptide, age, BMI, gender, clinical classification, ICA, GADA, IA-2A, (ZnT8WA/ZnT8RA/ZnT8QA); B) C-peptide corrected for clinical factors; C) C-peptide corrected for autoantibodies; D) C-peptide corrected for all factors. The least decrease of ZnT8WA was observed in patients with high initial C-peptide in all models A) p = 0.054; B) p = 0.021; C) p = 0.047 and D) p = 0.017. A less statistically significant decrease of ZnT8RA was observed in patients with high initial C-peptide in A) p = 0.038 and C) p = 0.047, but this finding was not confirmed in B or D. The decrease of ZnT8QA levels was not related to C-peptide in any model but correlated to age D) p = 0.049. Furthermore, patients with unclassifiable diabetes showed the least decrease in D) p = 0.035. ZnT8WA, ZnT8RA or ZnT8QA were identified as a single autoantibody in 3.8% (10/266) of patients, thereby increasing diagnostic sensitivity from 79.3% (211/266) to 83.1% (221/266). In conclusion, high initial C-peptide was the most important factor even after adjusting for other factors in patients positive for ZnT8WA or ZnT8RA to remain autoantibody positive five 5 years after diagnosis