STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage (STATICH): Protocol for a randomised controlled trial

Background and aims: Many patients with prior intracerebral haemorrhage have indications for antithrombotic treatment with antiplatelet or anticoagulant drugs for prevention of ischaemic events, but it is uncertain whether such treatment is beneficial after intracerebral haemorrhage. STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage will assess (i) the effects of long-term antithrombotic treatment on the risk of recurrent intracerebral haemorrhage and occlusive vascular events after intracerebral haemorrhage and (ii) whether imaging findings, like cerebral microbleeds, modify these effects. Methods: STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is a multicentre, randomised controlled, open trial of starting versus avoiding antithrombotic treatment after non-traumatic intracerebral haemorrhage, in patients with an indication for antithrombotic treatment. Participants with vascular disease as an indication for antiplatelet treatment are randomly allocated to antiplatelet treatment or no antithrombotic treatment. Participants with atrial fibrillation as an indication for anticoagulant treatment are randomly allocated to anticoagulant treatment or no anticoagulant treatment. Cerebral CT or MRI is performed before randomisation. Duration of follow-up is at least two years. The primary outcome is recurrent intracerebral haemorrhage. Secondary outcomes include occlusive vascular events and death. Assessment of clinical outcomes is performed blinded to treatment allocation. Target recruitment is 500 participants. Trial status: Recruitment to STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is on-going. On 30 April 2020, 44 participants had been enrolled in 31 participating hospitals. An individual patient-data meta-analysis is planned with similar randomised trials

Interventions for reducing sedentary behaviour in people with stroke

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To determine whether interventions primarily intended to reduce time spent in sedentary behaviour after stroke reduce sedentary time, and whether they modify cardiovascular risk, and reduce the risk of death or secondary vascular events. We will also include interventions intended to reduce the length of prolonged uninterrupted periods of sedentary behaviour (i.e. interventions to fragment or interrupt). Primary objectives To determine whether interventions to reduce or interrupt sedentary time influence: mortality; recurrent cerebrovascular or cardiovascular events. Secondary objectives To determine whether interventions to reduce or interrupt sedentary time influence: amount of sedentary time; cardiometabolic risk profile (e.g. glucose tolerance, arterial function, blood cholesterol and blood pressure); adverse events (in addition to recurrent events, for example falls). Other objectives In addition, we will as a scoping exercise, describe the range of all outcome measures reported in all trials. By definition, any included study interventions will fall within the umbrella of physical activity.Therefore, it may be that multiple plausible benefits could emerge that are common to other energy-expending interventions

Meningen med metoden: Litteratursociologiska metoddiskussioner då och nu

The aim with the article is to trace the use of quantitative methods in literary studies in Sweden. Through the case of Karl Erik Rosengrens’ dissertation from 1968, the articles analyzes the discussions that the thesis generated during the 1960’s and 1970’s regarding questions on how to do literary studies, and how contemporary discussions about methods in sociology of literature can be said to be linked to a wider discussion about the discipline itself. &nbsp

Recurrent stroke : risk factors, predictors and prognosis

Background Many risk factors for stroke are well characterized and might, at least to some extent, be similar for first-ever stroke and for recurrent stroke events. However, previous studies have shown heterogeneous results on predictors and rates of stroke recurrence. Patients who survive spontaneous intracerebral hemorrhage (ICH) often have compelling indications for antithrombotic (AT) treatment (antiplatelet (AP) and/or anticoagulant (AC) treatment), but due to controversy of the decision to treat, a large proportion of these patients are untreated. In the absence of evidence from randomized controlled trials (RCTs), there is need for more high- quality observational data on the clinical impact of, and optimal timing of AT in ICH survivors. The aims of this thesis were to assess time trends in stroke recurrence, to determine the factors associated with an increased risk of stroke recurrence – including socioeconomic factors – and to determine to what extent ICH survivors with and without atrial fibrillation (AF) receive AT treatment and to determine the optimal timing (if any) of such treatment.  Methods The population-based Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) stroke incidence register was used to assess the epidemiology and predictors of stroke recurrence after ischemic stroke (IS) and ICH from 1995 to 2008 in northern Sweden. Riksstroke, the Swedish stroke register, linked with the National Patient Register and the Swedish Dispensed Drug Register, made it possible to identify survivors of first-ever ICH from 2005 to 2012 with and without concomitant AF to investigate to what extent these patients were prescribed AP and AC therapy. The optimal timing of initiating treatment following ICH in patients with AF 2005–2012 was described through separate cumulative incidence functions for severe thrombotic and hemorrhagic events and for the combined endpoint “vascular death or non-fatal stroke”. Riksstroke data on first-ever stroke patients from 2001 to 2012 was linked to the Longitudinal Integration Database for Health Insurance and Labour market studies to add information on education and income to investigate the relationship between socioeconomic status and risk of recurrence. Results Comparison between the cohorts of 1995–1998 and 2004–2008 showed declining risk of stroke recurrence (hazard ratio: 0.64, 95% confidence interval (CI): 0.52-0.78) in northern Sweden. Significant factors associated with an increased risk of stroke recurrence were age and diabetes. Following ICH, a majority (62%) of recurrent stroke events were ischemic.  The nationwide Riksstroke study confirmed the declining incidence, and it further concluded that low income, primary school as highest attained level of education, and living alone were associated with a higher risk of recurrence beyond the acute phase. The inverse effects of socioeconomic status on risk of recurrence did not differ between men and women and persisted over the study period. Of Swedish ICH-survivors with AF, 8.5% were prescribed AC and 36.6% AP treatment, within 6 months of ICH. In patients with AF, predictors of AC treatment were less severe ICH, younger age, previous anticoagulation, valvular disease and previous IS. High CHA2DS2-VASc scores did not seem to correlate with AC treatment. We observed both an increasing proportion of AC treatment at time of the initial ICH (8.1% in 2006 compared with 14.6% in 2012) and a secular trend of increasing AC use one year after discharge (8.3% in 2006 versus 17.2% in 2011) (p<0.001 assuming linear trends). In patients with high cardiovascular event risk, AC treatment was associated with a reduced risk of vascular death and non-fatal stroke with no significantly increased risk of severe hemorrhage. The benefit appeared to be greatest when treatment was started 7–8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within three years was 17.0% when AC treatment was initiated eight weeks after ICH and 28.6% without any antithrombotic treatment (95% CI for difference: 1.4% to 21.8%). For high-risk men, the corresponding risks were 14.3% vs. 23.6% (95% CI for difference: 0.4% to 18.2%). Conclusion Stroke recurrence is declining in Sweden, but it is still common among stroke survivors and has a severe impact on patient morbidity and mortality. Age, diabetes and low socioeconomic status are predictors of stroke recurrence. Regarding ICH survivors with concomitant AF, physicians face the clinical dilemma of balancing the risks of thrombosis and bleeding. In awaiting evidence from RCTs, our results show that AC treatment in ICH survivors with AF was initiated more frequently over the study period, which seems beneficial, particularly in high-risk patients. The optimal timing of anticoagulation following ICH in AF patients seems to be around 7–8 weeks following the hemorrhage

I hovedet på en læser: Et forsøg på at forstå lydbogslæseren

Reading has historically been framed both as a social and as an individual activity. During the last decade, the development of digital technologies has shed a new light on reading as a social practice, where readers can meet and share their reading experiences with others online. This article aims to chart the social traces that digital audiobook readers leave behind by analyzing reviews posted in the streaming service Storytel’s app and discussions between readers published in the Swedish Facebook-group “Talk about Audiobooks”. Drawing on theoretical insights from i.a. Elizabeth Long and Rita Felski, the article characterizes audiobook-users’ modes of reading and using literature

Poesi pågår : en studie av Poeter.se 2003-2016

This dissertation presents a study of Poeter.se, a Swedish web community for reading and writing poetry. The aim is to examine and analyze how a literary community online works, how the writers present themselves as authors and how conventions connected to poetry migrate into or are negotiated in the digital environment. The vast amount of material published on the website during the time-period 2003-2016 (2 million comments and about 860 000 poems) makes it imperative to raise questions about methodology and the dissertation highlights how a researcher dealing with digital material can combine methods.  The study is divided into six chapters in which I use different theoretical frameworks, such as the concept of digital paratexts, theories and discussions about the function of the author in a digital media landscape, and media-specific theories about how reading and writing can be approached when they occur online. The central research questions are: What characterizes the connection between genre-specific traits in poetry and the digital platform on which they are published? What kind of relations can be seen between the participants and their publication patterns, and the website? How do the members present their writing and their participation at the site

Att läsfrämja för öronen : Litteraturen, rösten och samtalet

I den här rapporten presenterar vi en studie om hur folkbibliotekarier i VästraGötaland använder sig av ljudet, rösten eller samtalet i sitt läsfrämjande arbete.Undersökningen består av intervjuer med folkbibliotekarier och bibliotekschefer.Studien gjordes 2022 av Julia Pennlert och Sirpa Bark vid Bibliotekshögskolanpå Högskolan i Borås.En del av de intervjuade personernas berättelser handlar om att förmedla taloch ljudböcker till enskilda läsare, men undersökningen visar att den största deleni främjandearbetet handlar om den sociala läsningen. För många av folkbiblioteketsmålgrupper finns det ett stort värde i att läsa tillsammans. Shared reading nämnssom ett exempel på en metod för högläsning som blivit populär och spridit sigöver hela världen på senare år.Syftet med rapporten är att skapa en fördjupad förståelse för hur folkbibliotekarbetar med förmedling av litteratur och läsfrämjande där ljudet, rösten ellersamtalet står i centrum. Syftet är också att lyfta fram hur förutsättningarna serut idag för folkbiblioteken i det arbetet och vilka resurser som krävs