Ultrasound assessment and risk prediction in women with endometrial cancer

Background: Endometrial cancer is the most common gynecological cancer in the industrialized world, constituting 4.5% of all cancer in Swedish women. Standard surgery is hysterectomy and bilateral salpingo-oophorectomy, with or without lymphadenectomy, depending on the estimated risk of lymph node metastases. Adjuvant therapy is given, depending on the estimated risk of adverse outcome. Numerous risk stratification systems guide the choice on lymphadenectomy, but none is associated with a high accuracy. Lymph node metastases are found in 11—22% of women. If they could be accurately predicted, many lymphadenectomies could be avoided. The aim of this thesis was to improve preoperative risk assessment in women with endometrial cancer, with regard to predicting deep (≥ 50%) myometrial invasion (MI), cervical stromal invasion (CSI), lymph node metastases and recurrence or progression. Methods: All study cohorts originate from the prospective, international, multicenter IETA (International Endometrial Tumor Analysis) 4 ultrasound study on women with endometrial cancer. In Study I agreement to histopathology and interobserver reproducibility of subjective ultrasound assessment of MI and CSI among ultrasound experts and gynecologists were compared by off-line evaluation of videoclips from 53 women from a single center cohort. In Study II sonographic features and accuracy of ultrasound assessment of MI ≥ 50% were compared in tumors with and without the microcystic elongated and fragmented (MELF) pattern of myometrial invasion and the relationship of the MELF pattern to more advanced stage (≥ IB) and lymph node metastases was assessed in 850 women with endometrioid endometrial cancer from a multicenter cohort. In Study III a risk prediction model was developed on 1501 women from a multicenter cohort, to estimate the individual risk of lymph node metastases before surgery. In Study IV demographic, sonographic and Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) variables and their ability to predict recurrence or progression was assessed in 339 women from a single center cohort. Results: Gynecologists and ultrasound experts assessed MI ≥ 50% with comparable diagnostic accuracy and interobserver reproducibility, while ultrasound experts assessed CSI with greater diagnostic accuracy and interobserver reproducibility than gynecologists. Tumors with the MELF pattern were slightly larger, the color score was higher and the multiple multifocal vascular pattern was more common, compared to tumors without the MELF pattern. The MELF pattern did not affect the diagnostic accuracy of MI assessment, however it was associated with ≥ 50% MI, CSI, higher stage and lymph node metastases. A risk model with variables from endometrial biopsy results (histotype), clinical (age and bleeding duration) and ultrasound characteristics (tumor extension and tumor size) could reliably predict the risk of lymph node metastases before surgery, and had higher clinical utility than risk stratification by combined endometrial biopsy and ultrasound. Demographic (age ≥ 65 years and waist circumference ≥ 88 cm), sonographic (ultrasound tumor extension and ultrasound AP diameter ≥ 2 cm) and ProMisE variables combined had higher ability to predict recurrence or progression than the ESMO (European Society for Medical Oncology) classification. Ultrasound tumor size < 2 cm and non-p53 abnormal status identified a large group of women (48%) with a very low risk of tumor recurrence or progression (1.8%). Conclusion: Preoperative ultrasound staging should be performed by ultrasound experts and is not negatively affected by presence of the MELF status. A risk model with variables from endometrial biopsy, clinical and ultrasound characteristics improves preoperative risk prediction of lymph node metastases. Demographic, sonographic and ProMisE variables show the potential to predict tumor recurrence or progression already before surgery

Let's work it out : aspects of the occupational situation of survivors of allogeneic haematopoietic stem cell transplantation

Background: Work is an important part of life and contributes to an individual’s physical and mental well-being. Being diagnosed with a life-threatening haematological disease that requires an allogeneic haematopoietic stem cell transplantation (allo-HSCT) disrupts patients’ occupational situation as most end up on long-term sick leave. During recent decades, overall survival has improved and transplant-related mortality has decreased due to advances in transplantation procedures and supportive care. The treatment is nevertheless intense, and many survivors end up with long-lasting late effects that negatively affect their health, quality of life and return-to-work process. However, the scientific knowledge regarding the occupa-tional situation of allo-HSCT survivors is limited. Aim: The overarching aim of this thesis was to increase knowledge and gain a deeper understanding by exploring the occupational situation of allo-HSCT survivors with special focus on factors associated with sick leave and return to work. Methods: Both quantitative and qualitative research approaches were used. Participants of working age were recruited upon admission to the allo-HSCT unit and asked to complete questionnaires at six different data collection time points up to three years after allo-HSCT. In studies I – III, descriptive statistics and logistic regression analyses were used to analyse self-reported questionnaire data together with data collected from the participants’ medical re-cords and potential associations with self-reported data on sick leave and return to work (Study I, n=189; Study II, n=122; Study III, n=104). Study IV had a qualitative approach where 15 participants from the larger study sample who were working full time prior to diagnosis and were still on some level of sick leave three years after allo-HSCT, participated in semi-structured interviews three to six years after allo-HSCT. The findings were analysed using qualitative content analysis. Findings: One year after allo-HSCT, 76% of participants were still on sick leave, of whom 39% were on full-time sick leave. In univariate logistic regression analyses, factors that were found to be significantly associated with sick leave were presence of chronic graft-versus-host disease (cGvHD) one year post-transplantation, a high symptom burden and low physi-cal activity 4 months post-treatment as well as symptoms of depression and low vocational satisfaction 7 months after allo-HSCT. All except vocational satisfaction remained significant in multivariable analyses. One year after allo-HSCT, 28% of participants had returned to work >50%, which increased to 60% two years post-treatment. In univariate analyses, factors significantly associated with return to work >50% were higher education and not being diag-nosed with cGvHD with the latter being the only factor remaining significant in multivariable analysis. Work-related factors, such as being able to work from home, flexible working hours, being part of decision-making regarding work, were also analysed for potential associ-ations but none were found. However, in the qualitative study (IV), different individual work-related factors were identified with flexibility in working schedules and opportunities to work from home emerging as key components. Participants also described how an affected health due to late effects, such as fatigue, medical consequences and stress intolerance, had a nega-tive impact on both their return-to-work process and life in general. Conclusion: This thesis contributes to an increased awareness and a deeper understanding of the occupational situation of allo-HSCT survivors in the first six years following transplantation along with factors influencing their occupational situation. Results indicate that allo-HSCT survivors often face long-term sick leave and that return to work is a lengthy process in which health status and psychosocial factors appear to play a greater role than work-related factors. Qualitative findings suggest that, on an individual basis, flexible working conditions, particularly in terms of time, place and assignments, were considered facilitating factors in the return-to-work process. Supporting allo-HSCT survivors through person-centred rehabilitation, including physical, mental and occupational aspects, is essential in order for both the healthcare system and employers to provide support in allo-HSCT survivors’ return-to-work process

Ridskolehästens hållbarhet

SUMMARY The riding school horse is the base for the riding school. Riding schools are looking for a suitable horse that meets their demands for exterior, age, education, temperament, price and sustainability. Many different aspects may define the sustainability of the riding school horse; of them is how long life the riding school horse has in riding school activity. Previous studies have shown that the riding schools requirements are 8-12 years life span in the riding school. The purpose of this study was to describe the Swedish riding school horse life span in riding schools and at what age the riding school horses were recruited, disposed and the reasons for disposal. Information about the riding school horse life span in riding schools and reasons for disposal can provide important understanding regarding the importance of health for the riding school horse, riding school economy and profitability in the riding school. The questions at issue were how many years the riding school horse remains in riding school and reasons for disposal from the riding school. Earlier study from the Swedish Equestrian Federation (SvRF) showed that the reasons stated from riding schools for disposal were old age, often ill/injured, limping, ill-temper for the activity, unsuitable as a riding school horse and condemned by a veterinarian. In the retrospective longitudinal study of recruitment and disposal, a questionnaire were sent to 15 riding schools with questions about birth, recruitment year, disposal year and disposal reason. The response rate was 33% (5 riding schools) who reported data on 454 riding school horses. As reference material were also the age distribution of riding school horses from 70 riding schools (developed from SvRFs website) studied, with a total of 1029 riding school horses in activity 2010. The riding school horse age ranged between 3-28 years. The median was 14 years. In the retrospective material, the number of years in activity ranged between <1 to 26 years. The median was 5 years and 50% of the riding school horses were in activity between 2 to 9 years. Survival Analysis from recruitment to sale showed that 50% of the riding school horses stayed 8 years in activity. The riding school horses age at recruitment showed a spread from 3 to 16 years. The median was 8 years, and 50% of the riding school horses were recruited between 6 and 9 years of age. The reasons for disposal who were given were death, sale, retirement, triangular marking, inappropriate in the business 19 and bench/returned. The causes of death given were lameness, trauma/skeletal injury, colic, illness and died of unknown cause. The most frequent reason for disposal within <1 and in year 1, was inappropriate in business (29 horses). The most frequent reason of disposal in year two or later was, death because of lameness (90 horses) and retirement (43 horses). The median sale age was 14 years and 50% of the riding school horses were sold between the ages of 10 to 17 years.REFERAT Ridskolehästen är utgångspunkten för ridskoleverksamhet. Ridskolor letar efter en lämplig häst som motsvarar deras krav på exteriör, ålder, utbildningsnivå, temperament, pris och hållbarhet. Ridskolehästens hållbarhet kan definieras utifrån många olika aspekter och en av dessa är hur lång livslängd ridskolehästen har i ridskoleverksamheten. Tidigare studier har visat att ridskolornas krav är hållbarhet på 8-12 år i ridskoleverksamheten. Syftet med denna studie var att beskriva den svenska ridskolehästens livslängd i ridskoleverksamhet och i vilken ålder ridskolehästen rekryteras respektive avyttras samt orsak till avyttring. Information om ridskolehästens livslängd i ridskoleverksamheten och orsaker till avyttring kan ge viktig förståelse med avseende på betydelsen av ridskolehästens hälsa för ridskoleekonomi och lönsamhet i ridskoleverksamheten. Frågeställningarna var hur många år stannar ridskolehästar i ridskoleverksamhet och varför avyttras ridskolehästarna från ridskoleverksamheten? Tidigare studie från Svenska Ridsportförbundet (SvRF) visade att de orsaker ridskolorna angav till avyttring var hög ålder, ofta sjuk/skadad, hälta, dåligt temperament för verksamheten, olämplig som ridskolehäst och utdömd av veterinär. I den retrospektiva longitudinella studien av rekrytering och avyttring skickades en enkät till 15 ridskolor med frågor om födelseår, rekryteringsår, avyttringsår och avyttringsorsak. Svarsfrekvensen var 33 % (5 ridskolor) som uppgav data om 454 ridskolehästar. Som jämförelsematerial studerades även åldersfördelningen för ridskolehästar på 70 ridskolor (framtagna från SvRFs hemsida), med totalt 1029 ridskolehästar i ridskoleverksamhet 2010. Ridskolehästarnas ålder varierade från 3 till 28 år. Medianvärdet var 14 år. I det retrospektiva materialet var antalet år i ridskoleverksamhet mellan < 1 till 26 år. Medianvärdet var 5 år och 50 % av ridskolehästarna var i ridskoleverksamheten mellan 2 till 9 år. Överlevnadsanalys från rekrytering till avyttring visade att 50 % av ridskolehästarna stannat 8 år i ridskoleverksamhet. Ridskolehästarnas åldersfördelning vid rekrytering visade en spridning från 3 till 16 år. Medianvärdet var 8 år och 50 % av ridskolehästarna rekryterades mellan 6 och 9 års ålder. Orsaker till avyttring som angavs var avlivning, försäljning, pensionering, triangelmärkning, olämplig i verksamheten och inbytt/tillbakalämnad. De orsaker till avlivning som angavs var hälta, trauma/skelettskada, kolik, sjukdom och avliden av okänd orsak. Den mest frekventa orsaken till avyttring inom <1 och under år 1 var olämplig i verksamhet (29 stycken). Mest frekventa orsaken till avyttring under år 2 eller senare var avlivning på grund av hälta (90 stycken) därefter pensionerad (43 stycken). Medianvärdet för avyttringsålder var 14 år och 50 % av ridskolehästarna avyttrades mellan 10 till 17 års ålder

Stereotypical behaviour – genetic and environmental factors

Det är vanligt att djur i fångenskap utvecklar stereotypa beteenden i form av till exempel krubbitning, cirkulering eller vävning. Dessa typer av beteenden är vanliga hos zoo-djur, försöksdjur och produktionsdjur men kan även ses hos sällskapsdjur. Stereotypier kan leda till problem både för djuret själv men även för ägaren. Många studier har genomförts där det fokuserats på vilken effekt miljön har, både på uppkomsten av beteendet men även på om omgivningen kan användas för att minska ett redan utvecklat stereotypt beteende. Denna litteraturstudie kommer ta upp dels miljöns påverkan, men också genetiska förutsättningar, välfärd och om avel mot ett stereotypt beteende är att rekommendera. Att avla mot stereotypier är fullt möjligt, då det finns genetiska faktorer som påverkar om en individ kommer att utveckla beteendet eller inte. Miljön har dock en väldigt stor inverkan på beteendet och även om generna finns där behöver inte beteendet uttryckas om individen vistas i en tillräckligt bra miljö. En berikad miljö kan förebygga uppkomsten av ett stereotypt beteende och det kan även minska ett redan etablerat beteende. Stereotypa beteendet kan korrelera med andra egenskaper, vilket är viktigt att ha i åtanke innan selektion mot stereotypi sker. Att ett djur uttrycker stereotypa beteenden bör inte användas som en självklar indikator på att djuret lider av dålig välfärd, och att förhindra djuret från att uttrycka detta beteende när det väl är stadgat hos djuret kan i sig leda till problem.Stereotypic behaviour is common among zoo-animals and laboratory animals but also among farm animals and pets. It can be shown in forms like crib-biting and back-flipping. There have been many studies on how the environment affects the development of stereotypic behaviour and if it is possible to decrease the behaviour by changing the environment. This review will also look into if there is a genetic background to why some individuals develop stereotypic behaviour, the welfare of stereotypic animals and if breeding against stereotypic behaviour is to recommend. Breeding against stereotypic behaviour is possible because there are genetic factors affecting if the behaviour will show or not. The environment has a very big impact on whether stereotypic behaviour will be expressed or not, and even if the genes are there, the environment can be good enough so the behaviour will not show. An enriched environment can reduce the stereotypic behaviour or even prevent the appearance. Stereotypic behaviour can correlate with other traits, which should be considered before selection against it. Just because the animal show stereotypic behaviour does not mean that the animal suffers from bad animal welfare. Preventing an animal that is already showing this kind of behaviour from doing it can cause problems in itself that affect the welfare in a negative way

Rovdjursattackers påverkan på stressnivån hos utsatta kor i Kenya

Predation on livestock affects the human-carnivore conflict and can also lead to great economical loss for farmers. Lions are the predator that attacks the most cattle in Kenya, but there are also attacks from hyenas, leopards and jackals. Predation on livestock is a worldwide problem and it is therefore of big importance to investigate how the predator attacks are affecting the cattle that survived in the exposed herd. If predator attacks leads to chronic stress in the cattle, it can affect the reproduction cycle of the animals, the health and also their productivity. In this study two herds that had been attacked by predators during the last 10 months (one herd with cows and one herd with steers), and also two control herd that had not suffer from any attacks during the same time were chosen to be analyzed for hair cortisol as an indicator of stress. Hair samples were collected from the tail switch from 10 random individuals from each of the four herds and then analyzed for cortisol, as cortisol gets deposit in the hair constantly as it grows. The result in cortisol indicates that there was no significant difference between attacked and non-attacked herds or between steers and cows. There is also no significant difference in cortisol levels between animals with different body condition scores. There was a significant difference in cortisol levels in the color of the hair, with light hair containing the highest amount of cortisol.Rovdjursattacker på produktionsdjur påverkar konflikten mellan människor och rovdjur samtidigt som det kan leda till ekonomiska förluster för djurägaren. Lejon är det rovdjur som attackerar flest kor i Kenya, men det sker även attacker av hyenor, leoparder och sjakaler. Predation på produktionsdjur som vistas utomhus är ett stort problem världen över och det är därför av stor vikt att utreda hur mycket en rovdjursattack påverkar flocken långsiktigt. Om produktionsdjuren blir kroniskt stressade efter attacken kan det påverka produktionen, hälsan och reproduktionen av djuren i flocken. I denna studie valdes två flockar med stutar ut, en flock som hade blivit rovdjursattackerad dem senaste 10 månaderna, samt en kontrollgrupp som inte hade blivit utsatta för någon attack under samma tidsperiod. Även två grupper med kor, en som blivit attackerad och en som inte hade blivit attackerad valdes ut. Alla djur i denna studie befann sig i Ol Pejeta Conservancy i Kenyas Laikipia distrikt. Hårprover togs från svanstippen på 10 slumpmässigt utvalda individer ur vardera flock och analyserades för kortisol, då kortisol lagras i hårstråna när dem växer. Resultatet tyder på att det inte finns någon signifikant skillnad i kortisolhalt mellan attackerade flockar och icke-attackerade flockar, inte heller mellan stutar och kor. Det finns heller ingen signifikant skillnad mellan djur med olika mycket hull. Det fanns en signifikant skillnad på kortisol nivåer i olika färger på håret, där ljust hår innehöll större mängd kortisol

Мотиваційний аспект діяльності учителя при вивченні фізики в школі

(uk) У статті розглянуті проблеми активізації пізнавальної діяльності учнів при вивченні фізики в середній школі.(en) The problems of students knowledge activity while learning physics in secondary school are reviled in the article

Pupil influence in Swedish compulsory schools, a way of 'learning' and 'living' democracy

Peer reviewedPublisher PD

Modified metacognitive training for negative symptoms in psychosis - a feasibility study

This thesis focuses on psychosocial interventions for psychosis. It consists of two parts: a systematic review on quality of life in forensic settings and an empirical study on negative symptoms. The systematic review follows the publication guidelines of the journal International Journal of Forensic Mental Health whilst the empirical study follows the publication guidelines of the journal Clinical Psychology and Psychotherapy. Reasonable adjustments have been made to the formatting of this thesis to enhance readability. Purpose: The systematic literature review aimed to summarise and critically appraise studies that have evaluated the effects of psychosocial interventions for psychotic disorders in forensic settings on quality of life. The empirical study aimed to evaluate the feasibility of Metacognitive Training (MCT) for negative symptoms and to identify mechanisms of change. Methods: The literature was systematically searched (using four databases) for research that included any quantitative measure of quality of life (i.e. self-esteem, quality of life, life satisfaction, and/or self-efficacy in relation to life-goals). In the empirical study, a new intervention was developed by modifying MCT for negative symptoms and four aspects of feasibility were evaluated: acceptability, practicality, demand and limited efficacy. The quantitative approach was supplemented with qualitative interviews on participants’ views of the intervention. In addition, potential mechanisms of change were evaluated using a promising new method for analysing data from case-series: multilevel modeling. Results: In total, 10 papers met the inclusion criteria in the systematic review. Significant improvements in quality of life were found in five studies. The modified version of MCT showed good feasibility as demonstrated by the attendance rate, the positive oral feedback from participants and the multidisciplinary team, and the improvements on negative symptoms that were found following the intervention. Multilevel modeling proved useful in explaining the variance attributable to three different predictors: depression, internalised stigma, and reflective functioning. Conclusions: It was found that quality of life can be improved in forensic settings using psychosocial interventions. The pilot study indicated that MCT for negative symptoms has high feasibility and that changes in negative symptoms can partially be explained by depression, stigma, and reflective functioning