Patient experiences and the influence on health literacy and self-care using mHealth to manage symptoms during radiotherapy for prostate cancer

Introduction: Prostate cancer is a diagnosis that can affect the men’s quality of life both due to the symptoms related to the disease and the treatment the men receive. Treatment with radiotherapy for prostate cancer in Sweden takes place at outpatient clinics, where the patient visits daily for radiotherapy and then returns home. Most of the time the patient is experiencing the symptoms and side-effects at home without health-care professionals easily accessible. To facilitate personcentered care and improve clinical management when hospital care is moving to outpatient care, the app (Interaktor) for smartphones and tablets was developed. Using patient-reported outcomes (PRO), the app was intended to identify symptoms early, assess them in real time, and provide symptom-management support during radiotherapy for prostate cancer. Aims: The overall objective of the intervention described in this thesis, was to facilitate symptom management for patients with prostate cancer assisted with an interactive app during radiotherapy treatment. Methods: The two studies included in this thesis come from one trial. A descriptive investigation evaluated the intervention group’s use and perception of the using the app, and a quasi-experimental investigation compared those using the app with a historical control group not using the app to evaluate the effect on health literacy and self-care agency. The patients (n=130) were recruited consecutively from two university hospitals in Sweden between April 2012 and October 2013. The intervention group (n=66) had access to the app during 5-7 weeks of radiotherapy and three additional weeks. The intervention group’s use of the app was logged. Health literacy was measured using the Swedish Functional Health Literacy Scale (FHL) and the Swedish Communicative and Critical Health Literacy Scale (CCHL), and the Appraisal of Self-care Agency scale, version A (patient’s assessment) (ASA-A) for self-care agency. Transcribed notes from phone or face-to-face interviews about participants’ experiences of using and reporting in the app were analyzed. Results: In the intervention group using the app, adherence to daily reports was 87% (Md 92%, 16-100%), and generated 3,536 reports. All listed symptoms were used, where the most common being: urinary urgency, fatigue, hot flushes, and difficulties in urinating. A total of 1,566 alerts were generated, with 1/3 being severe (red alert). The app was reported in the interviews as easy to use, the reporting became routine; to report facilitated reflection over symptoms, the symptoms were relevant although some found that nuancing severity was hard. Using the app was reported as providing a sense of security. Substantial portions of the participants showed inadequate FHL and CCHL at baseline for both groups. CCHL changed significantly for the intervention group from baseline to three months after ended treatment (p = 0.050). Functional health literacy and self-care agency did not reveal any statistically significant differences over time for either group. Conclusions: The conclusions to draw from this thesis are that an mHealth intervention, the app Interaktor, served as a supportive tool for the patients to assess and manage symptoms during the radiotherapy for prostate cancer. The intervention provided the patients with a sense of safety, increased awareness of own well-being and a significant improvement in communicative and critical health literacy was found. The portions of inadequate levels of health literacy reported leave substantial groups of patients more vulnerable in assessing and managing symptoms when treated with radiotherapy for prostate cancer. Although health literacy levels include notable portions of patients in this study that have inadequate levels of both functional and communicative and critical health literacy, the adherence of using the app was high

Hur AI-verktyget ChatGPT klarar en hemtentamen i palliativ vård

Dataprogrammet ChatGPT är en bott som utför automatiska uppgifter. Denna chattbott skapade rubriker under hösten på grund av dess förmåga att med artificiell intelligens (AI) skapa svar på riktade frågor och texter utifrån ett beskrivet syfte. I slutet av december 2022 lades 16 frågor från en hemtentamen i palliativ vård vid sjuksköterskeprogrammet in i AI-botten för att få dem besvarade och testa bottens förmåga att besvara frågorna korrekt. Vi ville även testa om man kunde se någon skillnad på svaren i rättningsmallen och på studenternas svar och på de svar som genererats från AI-botten. En bedömning av bottens svar visade på att den hade klarat examinationen. Somliga svar var mycket bra och resonerande till sin natur, något gav reducerade poäng pga. bristande innehåll och ett par svar felaktiga. Ett svar stack ut då det var på engelska. Svaren hade ibland smärre grammatiska fel, men var främst betydligt längre och bättre strukturerade än studerandes. Möjligheten att upptäcka försök till vilseledande i examination hade varit liten. Det finns skillnad i svarens diskurs, där svaren från botten har en mer amerikansk stil i sin formulering.  ENGLSIH ABSTRACT How the AI tool ChatGPT passes a home exam in palliative care The ChatGPT computer program is a bot that performs automatic tasks. This chatbot made headlines during the fall due to its ability to use Artificial Intelligence (AI) to create answers to targeted questions and texts based on a described purpose. At the end of December 2022, 16 questions from a home exam in palliative care at the nursing program were put into the AI bot to get them answered and test its ability to answer the questions correctly but also an assessment of whether the answers could be detected. An evaluation of the bot’s answers showed it had passed the examination. Some answers were excellent and reasoned, some gave reduced points due to lack of content, and some were incorrect. One answer stood out as it was in English. The answers sometimes had minor grammatical errors but were significantly more prolonged and better structured than the students’ answers. The possibility of detecting attempts at deception in the examination had been limited. There is a difference in discourse in the answers, with the answers from the bot having a more American style

Vertical redistribution of principle water masses on the Northeast Greenland Shelf

The Northeast Greenland shelf (NEGS) is a recipient of Polar Water (PW) from the Arctic Ocean, Greenland Ice Sheet melt, and Atlantic Water (AW). Here, we compile hydrographical measurements to quantify long-term changes in fjords and coastal waters. We find a profound change in the vertical distribution of water masses, with AW shoaling >60 m and PW thinning >50 m since early 2000’s. The properties of these waters have also changed. AW is now 1 °C warmer and the salinity of surface waters and PW are 1.8 and 0.68 lower, respectively. The AW changes have substantially weakened stratification south of ~74°N, indicating increased accessibility of heat and potentially nutrients associated with AW. The Atlantification earlier reported for the eastern Fram Strait and Barents Sea region has also propagated to the NEGS. The increased presence of AW, is an important driver for regional change leading to a likely shift in ecosystem structure and function

Reviews and syntheses : Greenhouse gas exchange data from drained organic forest soils - a review of current approaches and recommendations for future research

Drained organic forest soils in boreal and temperate climate zones are believed to be significant sources of the greenhouse gases (GHGs) carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O), but the annual fluxes are still highly uncertain. Drained organic soils exemplify systems where many studies are still carried out with relatively small resources, several methodologies and manually operated systems, which further involve different options for the detailed design of the measurement and data analysis protocols for deriving the annual flux. It would be beneficial to set certain guidelines for how to measure and report the data, so that data from individual studies could also be used in synthesis work based on data collation and modelling. Such synthesis work is necessary for deciphering general patterns and trends related to, e.g., site types, climate, and management, and the development of corresponding emission factors, i.e. estimates of the net annual soil GHG emission and removal, which can be used in GHG inventories. Development of specific emission factors also sets prerequisites for the background or environmental data to be reported in individual studies. We argue that wide applicability greatly increases the value of individual studies. An overall objective of this paper is to support future monitoring campaigns in obtaining high-value data. We analysed peer-reviewed publications presenting CO2, CH4 and N2O flux data for drained organic forest soils in boreal and temperate climate zones, focusing on data that have been used, or have the potential to be used, for estimating net annual soil GHG emissions and removals. We evaluated the methods used in data collection and identified major gaps in background or environmental data. Based on these, we formulated recommendations for future research.Peer reviewe

An international clinical study of ability and disability in ADHD using the WHO-ICF framework

This is the fourth and final study designed to develop International Classification of Functioning, Disability and Health (ICF, and children and youth version, ICF-CY) core sets for attention-deficit hyperactivity disorder (ADHD). To investigate aspects of functioning and environment of individuals with ADHD as documented by the ICF-CY in clinical practice settings. An international cross-sectional multi-centre study was applied, involving nine units from eight countries: Denmark, Germany, India, Italy, Portugal, Saudi Arabia, Sweden and Taiwan. Clinicians and clinical researchers rated the functioning level of 112 children, adolescents and adults with ADHD using the extended ICF-CY checklist version 2.1a. The ratings were based on a variety of information sources, such as medical records, medical history, clinical observations, clinical questionnaires, psychometric tests and structured interviews with participants and family members. In total, 113 ICF-CY categories were identified, of which 50 were related to the activities and participation, 33 to environmental factors and 30 to body functions. The clinical study also yielded strengths related to ADHD, which included temperament and personality functions and recreation and leisure. The study findings endorse the complex nature of ADHD, as evidenced by the many functional and contextual domains impacted in ADHD. ICF-CY based tools can serve as foundation for capturing various functional profiles and environmental facilitators and barriers. The international nature of the ICF-CY makes it possible to develop user-friendly tools that can be applied globally and in multiple settings, ranging from clinical services and policy-making to education and research

Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes

OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p <0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.Peer reviewe

Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence

Intelligence is highly heritable(1) and a major determinant of human health and well-being(2). Recent genome-wide meta-analyses have identified 24 genomic loci linked to variation in intelligence3-7, but much about its genetic underpinnings remains to be discovered. Here, we present a large-scale genetic association study of intelligence (n = 269,867), identifying 205 associated genomic loci (190 new) and 1,016 genes (939 new) via positional mapping, expression quantitative trait locus (eQTL) mapping, chromatin interaction mapping, and gene-based association analysis. We find enrichment of genetic effects in conserved and coding regions and associations with 146 nonsynonymous exonic variants. Associated genes are strongly expressed in the brain, specifically in striatal medium spiny neurons and hippocampal pyramidal neurons. Gene set analyses implicate pathways related to nervous system development and synaptic structure. We confirm previous strong genetic correlations with multiple health-related outcomes, and Mendelian randomization analysis results suggest protective effects of intelligence for Alzheimer's disease and ADHD and bidirectional causation with pleiotropic effects for schizophrenia. These results are a major step forward in understanding the neurobiology of cognitive function as well as genetically related neurological and psychiatric disorders.Peer reviewe

Marine pollution and water quality monitoring in Myanmar – assessment and bridging of capacity needs

The Bay of Bengal Large Marine Ecosystem (BOBLME) project of the Food and Agricultural Organization of the United Nations (FAO) and the Norwegian Institute for Water Research (NIVA) agreed on a project for improving knowledge base and enhancing capacity to address marine pollution and water quality monitoring issues in Myanmar. More specifically, NIVA experts visited Myanmar and worked together with experts from University of Yangon, Department of Chemistry, to describe the most important needs for capacity building. Significant capacity needs were identified and a plan for following up this is presented.The Bay of Bengal Large Marine Ecosystem (BOBLME) project of the Food and Agricultural Organization of the United Nations (FAO