The construction of facts: preconditions for meaning in teaching energy in Swedish classrooms

This article investigates the mechanisms that govern the processes of inclusion and exclusion of knowledges. It draws on three cases from Swedish classrooms about how energy is created as an area of knowledge. We are interested in how knowledge is made valid and legitimate in a school context, and in defining and finding tools to identify structures that govern potential meanings in a certain situation. To do this we develop a theoretical model that explains the preconditions for meaning. The purpose is to understand why certain knowledges are legitimated in the classroom and to explain how this happens. The analysis is based on participatory observations in classrooms, audio recordings of students engaged in group projects, educational materials and the students’ own work. The apparatuses of the school offer a wide range of possible meanings concerning energy. At the same time there are forces evolved in the school practice that effectively sift out what counts as values from what counts as facts and valid knowledge. These forces create a certain order and certain effects for what counts as truth. The article investigate the nature of the correlations between the different preconditions identified that makes one discourse more likely and “true” than another

Prevention of cardiovascular disease and diabetes on a population level

Background: Cardiovascular disease and diabetes are responsible for just over half of the global mortality, and these diseases are expected to increase. The upsurge is due to increased longevity and a westernisation of the global lifestyle. Preventive efforts have proven effective and are believed to be the only way to curb the rapid increase of these diseases. Still the implementations of preventive measures are reported as underused. Aims: To study prevention by 1. Investigating the perception of key policymakers on cardiovascular disease 2. Examining if screening for diabetes online is feasible using FINDRISC 3. Assessing management of patients with coronary artery disease and diabetes 4. Determining the best screening test for dysglycaemia in patients with coronary artery disease Policymakers’ perception of cardiovascular disease Policymakers in Europe agreed that national patterns of cardiovascular disease and its prevention are far from satisfactory. A similar rating of the perceived proximity to a specific target in two countries did not necessarily reflect a similar national situation when compared to available statistics on the actual situation. Policymakers had diverging opinions on what actions to take and what obstacles to overcome to improve population health.Feasibility of using FINDRISC as an online questionnaire It was feasible to incorporate a diabetes risk score such as FINDRISC in an online survey. A reasonable response rate was achieved and a group that could benefit from preventive intervention programs was identified. Management of patients with coronary artery disease and diabetes A large proportion of the patients are far from guideline recommended evidence based treatment targets for blood pressure, LDL-cholesterol and HbA1c. A potential reason is a consistent, relatively low combined use of four selected cardioprotective drug therapies and/or lack of dose titration. There was, however, some improvement over time. Screening for dysglycaemia in patients with coronary artery disease Screening by means of an oral glucose tolerance test (OGTT) identified the largest number of patients with undetected diabetes. The overlap in case-detection between fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG) and HbA1c was small. Screening with HbA1c alone would have left 83% of those with diabetes undetected. The total proportion of patients identified with diabetes and other forms of dysglycaemia varied from 90% using the American Diabetes Association’s criteria for FPG + HbA1c, which may be an overestimate, to 73% using WHO criteria for OGTT = FPG + 2hPG, which may be more realistic. Conclusion: Creating a coherent knowledge base and action agenda regarding prevention among key policy- makers should be given high priority in future population based prevention programmes. The online questionnaire FINDRISC is a feasible way to identify high-risk individuals as well as risk typing populations. Despite some improvement, patients with coronary artery disease and diabetes are not managed according to best available knowledge. Efforts to improve this are needed to improve their still dismal prognosis. An oral glucose tolerance test has the best capacity to screen-detect dysglycaemia in patients with coronary artery disease

Struggling for access to appropriate healthcare services: A qualitative content analysis of patient complaints

Aim: This study aimed to describe circumstances concerning access for patients and relatives to take part in patient health and safety in a hospital setting. Design: This study used a qualitative descriptive design and was conducted at a Swedish university hospital. Method: The 79 complaints reported by patients and relatives included in this study were registered between January 2017 and June 2019. These complaints were classified as concerning access to healthcare services. Data were analysed using qualitative content analysis. Results: The overarching theme, struggling for access as a human being in the healthcare system, encompassed three themes describing patients\u27 and relatives\u27 needs. The three themes were (1) navigating through the healthcare organization, (2) making sense of self and what is going on and (3) being acknowledged as having needs. Conclusion: Patients and relatives continuously participate in various ways in healthcare to promote health and prevent patient harm. Our findings contribute important knowledge about the meaning of access from a broad healthcare system perspective. Access was restricted in terms of appropriateness in how patients\u27 needs were met. This restriction of access risked the deterioration of patient health and safety. Impact: Patients and relatives play an active part in patient health and safety, although their attempts are sometimes hindered. Restrictions in the appropriateness of access prevented patients and relatives from taking part in patient health and safety, which appeared to mean that they had to adapt and expend effort to the point that it negatively affected their health and everyday life. These findings concern all patients, relatives and healthcare professionals in hospital-associated settings. Patient or Public Contribution: No patient or public contribution

Pay for disease or invest in health?

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Hjärt–kärlsjukdom är den ledande enskilda orsaken till död och ohälsa i vår del av världen. Den medicinska och ekonomiska bördan av dessa sjukdomar är enorm. Även om nyinsjuknandet och dödligheten i tex hjärtinfarkt har minskat i vårt land, liksom i många europeiska länder, är antalet människor som insjuknar i förtid och som lever med resttillstånd efter olika hjärt–kärlsjukdomar snarast i stigande, vilket sammanhänger med att vi lever längre och att överlevnaden efter hjärtinfarkt och slaganfall har ökat. Största delen av dessa sjukdomar liksom av andra kroniska, icke-smittsamma sjukdomar (cancer, lungsjukdom, diabetes osv) sammanhänger med påverkbara, livsstilsrelaterade riskfaktorer. Hälsosamma val, dvs bra mat, fysisk aktivitet, frånvaro av tobaksbruk och undvikande av överkonsumtion av alkohol, kan förhindra eller i vart fall fördröja ett insjuknande. Den medicinska professionen bör ta som sin uppgift att i samverkan med politiker, hälsovårdsadministratörer och medier upplysa allmänheten om dessa enkla fakta. Genom kloka policybeslut kan man underlätta för befolkningen att göra hälsosamma val redan från de tidiga barnaåren och genom hela livscykeln

Undetected dysglycaemia common in primary care patients treated for hypertension and/or dyslipidaemia: On the need for a screening strategy in clinical practice. A report from EUROASPIRE IV a registry from the EuroObservational Research Programme of the European Society of Cardiology

Background: Dysglycaemia defined as type 2 diabetes (T2DM) and impaired glucose tolerance (IGT), increases the risk of cardiovascular disease (CVD). The negative impact is more apparent in the presence of hypertension and/or dyslipidaemia. Thus, it seems reasonable to screen for dysglycaemia in patients treated for hypertension and/or dyslipidaemia. A simple screening algorithm would enhance the adoption of such strategy in clinical practice. Objectives: To test the hypotheses (1) that dysglycaemia is common in patients with hypertension and/or dyslipidaemia and (2) that initial screening with the Finnish Diabetes Risk Score (FINDRISC) will decrease the need for laboratory based tests. Methods: 2395 patients (age 18-80 years) without (i) a history of CVD or TDM2, (ii) prescribed blood pressure and/or lipid lowering drugs answered the FINDRISC questionnaire and had an oral glucose tolerance test (OGTT) and HbA1c measured. Results: According to the OGTT 934 (39%) had previously undetected dysglycaemia (T2DM 19%, IGT 20%). Of patients, who according to FINDRISC had a low, moderate or slightly elevated risk 20, 34 and 41% and of those in the high and very high-risk category 49 and 71% had IGT or T2DM respectively. The OGTT identified 92% of patients with T2DM, FPG + HbA1c 90%, FPG 80%, 2hPG 29% and HbA1c 22%. Conclusions: (1) The prevalence of dysglycaemia was high in patients treated for hypertension and/or dyslipidaemia. (2) Due to the high proportion of dysglycaemia in patients with low to moderate FINDRISC risk scores its initial use did not decrease the need for subsequent glucose tests. (3) FPG was the best test for detecting T2DM. Its isolated use is limited by the inability to disclose IGT. A pragmatic strategy, decreasing the demand for an OGTT, would be to screen all patients with FPG followed by OGTT in patients with IFG

The Prognostic Value of Fasting Plasma Glucose, Two-Hour Postload Glucose, and HbA 1c in Patients With Coronary Artery Disease: A Report From EUROASPIRE IV

OBJECTIVE Three tests are recommended for identifying dysglycemia: fasting glucose (FPG), 2-h postload glucose (2h-PG) from an oral glucose tolerance test (OGTT), and glycated hemoglobin A1c (HbA1c). This study explored the prognostic value of these screening tests in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS FPG, 2h-PG, and HbA1c were used to screen 4,004 CAD patients without a history of diabetes (age 18–80 years) for dysglycemia. The prognostic value of these tests was studied after 2 years of follow-up. The primary end point included cardiovascular mortality, nonfatal myocardial infarction, stroke, or hospitalization for heart failure and a secondary end point of incident diabetes. RESULTS Complete information including all three glycemic parameters was available in 3,775 patients (94.3%), of whom 246 (6.5%) experienced the primary end point. Neither FPG nor HbA1c predicted the primary outcome, whereas the 2h-PG, dichotomized as <7.8 vs. ≥7.8 mmol/L, was a significant predictor (hazard ratio 1.38, 95% CI 1.07–1.78; P = 0.01). During follow-up, diabetes developed in 78 of the 2,609 patients (3.0%) without diabetes at baseline. An FPG between 6.1 and 6.9 mmol/L did not predict incident diabetes, whereas HbA1c 5.7–6.5% and 2h-PG 7.8–11.0 mmol/L were both significant independent predictors. CONCLUSIONS The 2h-PG, in contrast to FPG and HbA1c, provides significant prognostic information regarding cardiovascular events in patients with CAD. Furthermore, elevated 2h-PG and HbA1c are significant prognostic indicators of an increased risk of incident diabetes

Time trends in lifestyle, risk factor control, and use of evidence-based medications in patients With coronary heart disease in Europe: results from 3 EUROASPIRE surveys, 1999-2013

Background: The EUROASPIRE (European Action on Secondary and Primary Prevention by Intervention to Reduce Events) cross-sectional surveys describe time trends in lifestyle and risk factor control among coronary patients between 1999 and 2013 in Belgium, Czech Republic, Finland, France, Ireland, the Netherlands, Poland, Slovenia, and the United Kingdom as part of the EuroObservational Research Programme under the auspices of European Society of Cardiology. Objectives: This study sought to describe time trends in lifestyle, risk factor control, and the use of evidence-based medication in coronary patients across Europe. Methods: The EUROASPIRE II (1999 to 2000), III (2006 to 2007), and IV (2012 to 13) surveys were conducted in the same geographical areas and selected hospitals in each country. Consecutive patients (≤70 years) after coronary artery bypass graft, percutaneous coronary intervention, or an acute coronary syndrome identified from hospital records were interviewed and examined ≥6 months later with standardized methods. Results: Of 12,775 identified coronary patients, 8,456 (66.2%) were interviewed. Proportion of current smokers was similar across the 3 surveys. Prevalence of obesity increased by 7%. The prevalence of raised blood pressure (≥140/90 mm Hg or ≥140/80 mm Hg with diabetes) dropped by 8% from EUROASPIRE III to IV, and therapeutic control of blood pressure improved with 55% of patients below target in IV. The prevalence of low-density lipoprotein cholesterol ≥2.5 mmol/l decreased by 44%. In EUROASPIRE IV, 75% were above the target low-density lipoprotein cholesterol <1.8 mmol/l. The prevalence of self-reported diabetes increased by 9%. The use of evidence-based medications increased between the EUROASPIRE II and III surveys, but did not change between the III and IV surveys. Conclusions: Lifestyle habits have deteriorated over time with increases in obesity, central obesity, and diabetes and stagnating rates of persistent smoking. Although blood pressure and lipid management improved, they are still not optimally controlled and the use of evidence-based medications appears to have stalled apart from the increased use of high-intensity statins. These results underline the importance of offering coronary patients access to modern preventive cardiology programs

Measures of Insulin Resistance as a Screening Tool for Dysglycemia in Patients With Coronary Artery Disease: A Report From the EUROASPIRE V Population

The optimal screening strategy for dysglycemia (including type 2 diabetes and impaired glucose tolerance) in patients with coronary artery disease (CAD) is debated. We tested the hypothesis that measures of insulin resistance by HOMA indexes may constitute good screening methods. Insulin, C-peptide, glycated hemoglobin A1c, and an oral glucose tolerance test (OGTT) were centrally assessed in 3,534 patients with CAD without known dysglycemia from the fifth European Survey of Cardiovascular Disease Prevention and Diabetes (EUROASPIRE V). Three different HOMA indexes were calculated: HOMA of insulin resistance (HOMA-IR), HOMA2 based on insulin (HOMA2-ins, and HOMA2 based on C-peptide (HOMA2-Cpep). Dysglycemia was diagnosed based on the 2-h postload glucose value obtained from the OGTT. Information on study participants was obtained by standardized interviews. The optimal thresholds of the three HOMA indexes for dysglycemia diagnosis were obtained by the maximum value of Youden’s J statistic on receiver operator characteristic curves. Their correlation with clinical parameters was assessed by Spearman coefficients

Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

Background: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. Methods: A total of 6187 patients (18–80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012–2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. Results: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35 %) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of 9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40%) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. Conclusions: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease

Patients with coronary artery disease and diabetes need improved management: a report from the EUROASPIRE IV survey: a registry from the EuroObservational Research Programme of the European Society of Cardiology

BACKGROUND: In order to influence every day clinical practice professional organisations issue management guidelines. Cross-sectional surveys are used to evaluate the implementation of such guidelines. The present survey investigated screening for glucose perturbations in people with coronary artery disease and compared patients with known and newly detected type 2 diabetes with those without diabetes in terms of their life-style and pharmacological risk factor management in relation to contemporary European guidelines. ----- METHODS: A total of 6187 patients (18-80 years) with coronary artery disease and known glycaemic status based on a self reported history of diabetes (previously known diabetes) or the results of an oral glucose tolerance test and HbA1c (no diabetes or newly diagnosed diabetes) were investigated in EUROASPIRE IV including patients in 24 European countries 2012-2013. The patients were interviewed and investigated in order to enable a comparison between their actual risk factor control with that recommended in current European management guidelines and the outcome in previously conducted surveys. ----- RESULTS: A total of 2846 (46%) patients had no diabetes, 1158 (19%) newly diagnosed diabetes and 2183 (35%) previously known diabetes. The combined use of all four cardioprotective drugs in these groups was 53, 55 and 60%, respectively. A blood pressure target of 9.0% (>75 mmol/mol). Of the patients with diabetes 69% reported on low physical activity. The proportion of patients participating in cardiac rehabilitation programmes was low (≈40 %) and only 27% of those with diabetes had attended diabetes schools. Compared with data from previous surveys the use of cardioprotective drugs had increased and more patients were achieving the risk factor treatment targets. ----- CONCLUSIONS: Despite advances in patient management there is further potential to improve both the detection and management of patients with diabetes and coronary artery disease