Nätuniversitetet läsåret 2003/2004 - ekonomiskt stöd, kursutbud och antal sökande

Föreliggande arbetsrapport är ett led i arbetet med utvärderingen av Nätuniversitetets studentnytta. Utvärderingen genomförs vid UCER, Umeå Center for Evaluation Research, Umeå universitet. Syftet med denna rapport är att ge en bakgrund till de problem och utmaningar som Nätuniversitetet står inför och att ur ett studentperspektiv få en bild av de utbildningar som erbjuds genom den utbildningsportal som finns på Nätuniversitetets hemsida, www.netuniversity.se. Resultatet av en sökning kan variera från en dag till en annan. Samtidigt är detta är också den verklighet som möter de studenter som söker en utbildning (kurs eller program) via denna portal. Det område som står i fokus under utvärderingens första år är utbildningar inom medicin och vård. Därför är det också dessa utbildningar som står i fokus i denna arbetsrapport. En enkät som riktar sig till de studenter som läser en utbildning (kurs eller program) inom medicin och vård genomförs också under läsåret 2003/2004. Parallellt genomförs dessutom en enkätstudie av anställdas och studenters attityder till och erfarenheter av Nätuniversitetet. Denna sist nämnda studie vänder sig till samtliga ämnesområden och inte enbart till medicin och vård

Tafoxiparin, a novel drug candidate for cervical ripening and labor augmentation : results from 2 randomized, placebo-controlled studies

Background: Slow progression of labor is a common obstetrical problem with multiple associated complications. Tafoxiparin is a depolymerized form of heparin with a molecular structure that eliminates the anticoagulant effects of heparin. We report on 2 phase II clinical studies of tafoxiparin in primiparas. Study 1 was an exploratory, first-in-pregnant-women study and study 2 was a dose-finding study. Objective: Study 1 was performed to explore the effects on labor time of subcutaneous administration of tafoxiparin before onset of labor. Study 2 was performed to test the hypothesis that intravenous treatment with tafoxiparin reduces the risk for prolonged labor after spontaneous labor onset in situations requiring oxytocin stimulation because of dystocia. Study Design: Both studies were randomized, double-blind, and placebo-controlled. Participants were healthy, nulliparous females aged 18 to 45 years with a normal singleton pregnancy and gestational age confirmed by ultrasound. The primary endpoints were time from onset of established labor (cervical dilation of 4 cm) until delivery (study 1) and time from start of study treatment infusion until delivery (study 2). In study 1, patients at 38 to 40 weeks of gestation received 60 mg tafoxiparin or placebo daily as 0.4 mL subcutaneous injections until labor onset (maximum 28 days). In study 2, patients experiencing slow progression of labor, a prolonged latent phase, or labor arrest received a placebo or 1 of 3 short-term tafoxiparin regimens (initial bolus 7, 21, or 35 mg followed by continuous infusion at 5, 15, or 25 mg/hour until delivery; maximum duration, 36 hours) in conjunction with oxytocin. Results: The number of participants randomized in study 1 was 263, and 361 were randomized in study 2. There were no statistically significant differences in the primary endpoints between those receiving tafoxiparin and those receiving the placebo in both studies. However, in study 1, the risk for having a labor time exceeding 12 hours was significantly reduced by tafoxiparin (tafoxiparin 6/114 [5%] vs placebo 18/101 [18%]; P=.0045). Post hoc analyses showed that women who underwent labor induction had a median (range) labor time of 4.44 (1.2–8.5) hours with tafoxiparin and 7.03 (1.5–14.3) hours with the placebo (P=.0041) and that co-administration of tafoxiparin potentiates the effect of oxytocin and facilitates a shorter labor time among women with a labor time exceeding 6 to 8 hours (P=.016). Among women induced into labor, tafoxiparin had a positive effect on cervical ripening in 11 of 13 cases (85%) compared with 3 of 13 participants (23%) who received the placebo (P=.004). For women requiring oxytocin because of slow progression of labor, the corresponding results were 34 of 51 participants (66%) vs 16 of 40 participants (40%) (P=.004). In study 2, tafoxiparin had no positive effects on the secondary endpoints when compared with the placebo. Except for injection-site reactions in study 1, adverse events were no more common for tafoxiparin than for the placebo among either mothers or infants. There were few serious or treatment-related adverse events. Conclusion: Subcutaneous treatment with tafoxiparin before labor onset (study 1) may be effective in reducing the labor time among women undergoing labor induction and among those requiring oxytocin for slow progression of labor. Moreover, tafoxiparin may have a positive effect on cervical ripening. Short-term, intravenous treatment with tafoxiparin as an adjunct to oxytocin in patients with labor arrest (study 2) did not affect labor time or other endpoints. Both studies suggest that tafoxiparin has a favorable safety profile in mothers and their infants.Peer reviewe

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (>= 65 years; estimated glomerular filtration rate <= 20 mL/min/1.73 m(2)) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off <= 70; 0-100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73 m(2)/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men

Rooted, rootless, restless : Young mobility in time and space

The overall aim of this thesis is to survey and analyse young peoples’ geographical movements, and illustrate the similarities and differences that exist between different individuals.. The aim of the thesis is also to examine and discuss youth’s attitudes and motivation for different forms of geographical mobility. The youth focused on in this project reside in Norrland. The first phase, Mapping of the Geographical Movement of Youth, was carried out through the use of a questionnaire, sent to graduating students in upper secondary school. The second phase, Umeå  Students Abroad, was carried out by interviewing Umeå students who had either completed or were about to begin a period of foreign exchange. The third phase, Emigrants from Sweden, is based on statistics acquired from Sweden Statistics’ (SCB) and from the TOPSWING database. Home: The starting point of this thesis is the conception of “home”. The choice of path to take in life, and where students wanted to live in the future had significance for how they examined the choice between moving and staying; and the role of the home town in a longer perspective as to how the students viewed Umeå. Away: It is not just the place that a person comes from that says something about who she is, but also the place where she is going and the way in which she takes herself there. Many of the upper secondary school students that took part in the questionnaire had been abroad one or more times. Furthermore, many of the students would like to travel abroad again. At the same time, it can be said that there are also young people that do not have extensive experiences in travelling to other countries. Somewhere between home and away: The study shows that students may have very different views of their time abroad. The Tourist Student is one who chooses his/her destination in order to fulfil certain criteria and then mainly stays in the university town, “taking one day at a time.” He or she does not have a thought-out strategy for how the stay abroad should be carried out. The Travelling Student is the student who searches for a particular destination and later also has the ambition to get to know the country and the people that live there. The travelling student can be said to have a thought-out strategy for how to make the most out of his or her time in a foreign country. When away becomes home – or when home becomes home again: The interview study shows that to live abroad or to live in Sweden acquired a different meaning if you had a family. To have a family gives rise to a reason why one may choose to move back to Sweden. On the other hand there were also students for whom the home country was not important. A large portion of those who emigrated from Sweden during the study period moved back again. For those with a college or university education, a few years abroad can be a part of their choice of life path. It is something that one wants and from a career prospective, possibly should do. Rooted, rootless or restless young? The rooted are those who mainly live their entire lives in one place. The rootless represent a mobile life, where there is no home base, instead they create new ones as life passes. I would like to characterise most of the young people that in one way or another is featured in my study as restless. The restless combine, in different ways, the characteristics of both the rooted and the rootless. They are not unwilling to move, within the country, as well as to other countries, but they are at the same time rooted in their home town or in their home country

Arbete för miljön i Gävleborg - så arbetar kommunerna

Målet med det här arbetet har varit att göra en enkel utvärdering av miljömålsarbetet i Gävleborgs kommuner och att lyfta fram några goda exempel på hur man jobbar i de olika kommunerna. Utvärderingen bygger på telefonintervjuer med miljösamordnaren i respektive kommun och fokus har legat på arbetsprocessen, snarare än resultatet. Sedan miljömålsarbetets början har det gjorts två större utvärderingar av kommunernas arbete med miljömålen. Slutsatserna från dessa är bl.a. att miljöfrågorna har fått högre status och en större tyngd i och med arbetet med miljömålen. Arbetet med de regionala och lokala miljömålen har också bidragit med en tydligare struktur än i det tidigare arbetet med Agenda 21. Å andra sidan tycks delaktigheten ha minskat, såväl inom kommunen som bland olika lokala aktörer och en bredare allmänhet. Miljömålsarbetet sker främst internt inom kommunens egen organisation. Arbetet med Agenda 21 var mer inriktat på social hållbarhet t.ex. demokratifrågor och folkhälsa och annat övergripande strategiskt utvecklingsarbete. I Gävleborgs län jobbar alla kommunerna på något sätt med miljömålen men skillnaderna i arbetssätt och omfattning är stora. Fem kommuner har antagit egna kommunala miljömål och två kommuner har antagit enklare former av åtgärdsplaner. Fem av de sju kommuner som har lokala miljömål har även följt upp arbetet. Övriga två kommuner antog lokala miljömål under 2009. Energi- och klimatarbetet har fått stort genomslag i alla kommuner. Den främsta förklaringen är troligen att alla kommuner i hela landet fått statliga medel för att jobba med de frågorna Flera miljösamordnare har nämnt att miljömålen skulle behöva samordnas med kommunens övriga styrdokument. Utöver miljömålen bör det också finnas en mer övergripande miljöstrategi som tar upp hållbarhetsfrågor som inte täcks av miljömålen. Det kan till exempel gälla val av pensionsfonder eller hur stor andel ekologiska textilier som ska användas inom den kommunala verksamheten. Om det inte finns en sådan övergripande strategi är risken stor att miljöarbetet begränsas till traditionellt tillsyns- och naturvårdsarbete. En fråga som uppstått i efterhand är hur många av kommunerna i länet som, precis som Gävle och Hudiksvall, har en politiskt tillsatt styrgrupp för den övergripande miljöpolitiken, och hur detta arbete i så fall fungerar i praktiken. Om politikerna menar allvar med det miljöengagemang, som de enligt miljösamordnarna uttrycker, borde det också finnas ett forum där frågorna diskuteras parallellt med andra strategiska frågor. Precis som i andra kommuner i landet tycks också en stor del av det utåtriktade arbetet ha försvunnit. Gävle kommun är ett tydligt undantag. Där har Agenda 21 arbetet ersatts med en hållbarhetsutvecklare.Gävle,Bollnäs, Hofors, Hudiksvall, Ljusdals kommun.</p