Yearbook (Central Research Institute for Physics of the Hungarian Academy of Sciences)

Background: Cardiovascular disease (CVD) has been the predominant cause of morbidity and mortality for many decades in Sweden. Preventive work in primary health care through individual approach and community-based programmes has shown some success. Still, we need better risk assessment tools and health strategies to lessen the burden of CVD in our population. Methods: This thesis is based on four studies that explore the cardiovascular risk factor pattern and its development to CVD morbidity and mortality in the middle-aged (40-59 years) population in Söderåkra, southern Sweden, 1989-2006. At a single physician consultation in 1989-1990 the participants provided information about lifestyle in a self-administered questionnaire, underwent a physical examination and received medical advice after a laboratory investigation. The laboratory tests consisted mainly of blood glucose, serum lipids and thyroid function tests. Blood samples were also frozen for later analyses. A telephone interview on self-reported lifestyle changes was conducted ten years later. In 2006, primary health care medical records were studied for incident diabetes and also for impaired glucose tolerance (IGT). Finally, national registers were studied for incident fatal or nonfatal cardiovascular disease until 2006. Cardiovascular risk assessments using three separate risk algorithms were applied on the population. Results: The participation rate was high with 90% attendance. The conclusion of this cross-sectional baseline analysis was that it is meaningful to check for a secondary cause of hyperlipidemia, hypothyroidism, in women with a cholesterol value above 7.0 mmol/L. After 10 years follow-up women reported significantly more lifestyle changes than men, odds ratio (OR) 1.56 (95% CI: 1.11- 2.18; p= 0.010). Men with a history of smoking or CVD at baseline and women with treated hypertension at baseline made successful lifestyle changes, OR 4.77 (95% CI: 2.18-10.5; p<0.001 and OR 1.84 (95% CI: 1.12-3.02; p= 0.016), respectively, than those without these characteristics. Until 2006, 38 participants had developed diabetes and four subjects IGT out of 664 participants, excluding 10 with diabetes at baseline. A low level of IGFBP-1 at baseline was associated with the development of type 2 diabetes/IGT, hazard ratio (HR) 3.54 (95% CI: 1.18-10.6, p=0.024). This was independent of abdominal obesity or inflammation (CRP). After excluding 16 participants with prevalent CVD at baseline, 71 first fatal or nonfatal CVD events in 689 men and women were registered. Several known risk factors and risk markers were applied on this population. Those that turned out to be significantly associated with development of incident CVD in univariate Cox´s regression proportional hazard analyses where used in three different risk assessment models: the consultation model, SCORE and the extensive model. A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner (GP), predicted cardiovascular events as accurately, HR 2.72; (CI 95% 2.18-3.39, p<0.001), as the established SCORE algorithm, HR 2.73; (CI 95% 2.10-3.55, p<0.001), which requires laboratory testing. Furthermore, adding laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk, HR 2.72; (CI 95% 2.19-3.37, p<0.001). The c-statistics for the consultation model (0.794; CI 95% 0.762-0.823) was not significantly different from SCORE (0.767; CI 95% 0.733-0.798, p=0.12) or the extended model (0.806; CI 95% 0.774-0.835, p=0.55). Conclusions: Our study showed that it is worth searching for hypothyroidism, in women with a cholesterol value above 7 mmol/L. The study identified female gender, previous CVD, hypertension and smoking as predictors of positive lifestyle change during follow-up. A low level of IGFBP-1 predicted future diabetes/IGT in this population as did increased waist and CRP. Finally, data on nonlaboratory risk factors obtained during one GP visit predicted future cardiovascular risk as accurately as SCORE or a laboratory-based risk algorithm

Screening för hjärtkärlrisk och diabetes i primärvården : Söderåkrastudien

Background: Cardiovascular disease (CVD) has been the predominant cause of morbidity and mortality for many decades in Sweden. Preventive work in primary health care through individual approach and community-based programmes has shown some success. Still, we need better risk assessment tools and health strategies to lessen the burden of CVD in our population. Methods: This thesis is based on four studies that explore the cardiovascular risk factor pattern and its development to CVD morbidity and mortality in the middle-aged (40-59 years) population in Söderåkra, southern Sweden, 1989-2006. At a single physician consultation in 1989-1990 the participants provided information about lifestyle in a self-administered questionnaire, underwent a physical examination and received medical advice after a laboratory investigation. The laboratory tests consisted mainly of blood glucose, serum lipids and thyroid function tests. Blood samples were also frozen for later analyses. A telephone interview on self-reported lifestyle changes was conducted ten years later. In 2006, primary health care medical records were studied for incident diabetes and also for impaired glucose tolerance (IGT). Finally, national registers were studied for incident fatal or nonfatal cardiovascular disease until 2006. Cardiovascular risk assessments using three separate risk algorithms were applied on the population. Results: The participation rate was high with 90% attendance. The conclusion of this cross-sectional baseline analysis was that it is meaningful to check for a secondary cause of hyperlipidemia, hypothyroidism, in women with a cholesterol value above 7.0 mmol/L. After 10 years follow-up women reported significantly more lifestyle changes than men, odds ratio (OR) 1.56 (95% CI: 1.11- 2.18; p= 0.010). Men with a history of smoking or CVD at baseline and women with treated hypertension at baseline made successful lifestyle changes, OR 4.77 (95% CI: 2.18-10.5; p<0.001 and OR 1.84 (95% CI: 1.12-3.02; p= 0.016), respectively, than those without these characteristics. Until 2006, 38 participants had developed diabetes and four subjects IGT out of 664 participants, excluding 10 with diabetes at baseline. A low level of IGFBP-1 at baseline was associated with the development of type 2 diabetes/IGT, hazard ratio (HR) 3.54 (95% CI: 1.18-10.6, p=0.024). This was independent of abdominal obesity or inflammation (CRP). After excluding 16 participants with prevalent CVD at baseline, 71 first fatal or nonfatal CVD events in 689 men and women were registered. Several known risk factors and risk markers were applied on this population. Those that turned out to be significantly associated with development of incident CVD in univariate Cox´s regression proportional hazard analyses where used in three different risk assessment models: the consultation model, SCORE and the extensive model. A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner (GP), predicted cardiovascular events as accurately, HR 2.72; (CI 95% 2.18-3.39, p<0.001), as the established SCORE algorithm, HR 2.73; (CI 95% 2.10-3.55, p<0.001), which requires laboratory testing. Furthermore, adding laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk, HR 2.72; (CI 95% 2.19-3.37, p<0.001). The c-statistics for the consultation model (0.794; CI 95% 0.762-0.823) was not significantly different from SCORE (0.767; CI 95% 0.733-0.798, p=0.12) or the extended model (0.806; CI 95% 0.774-0.835, p=0.55). Conclusions: Our study showed that it is worth searching for hypothyroidism, in women with a cholesterol value above 7 mmol/L. The study identified female gender, previous CVD, hypertension and smoking as predictors of positive lifestyle change during follow-up. A low level of IGFBP-1 predicted future diabetes/IGT in this population as did increased waist and CRP. Finally, data on nonlaboratory risk factors obtained during one GP visit predicted future cardiovascular risk as accurately as SCORE or a laboratory-based risk algorithm

“There’s something strange” : How to distinguish second language learners’ dyslexia

Att urskilja om en andraspråkselevs läs- och skrivsvårigheter är av tillfällig, andraspråksrelaterad natur eller ett tecken på en djupare problematik är svårt. Samtidigt är det av fundamental betydelse för att eleven i fråga ska få den undervisning som svarar mot aktuell utvecklingsnivå och behov. I föreliggande kvalitativa studie har pedagoger som ansvarar för språkundervisning i grundskolans högstadium och gymnasium intervjuats. Syftet med studien är att förstå pedagogers tankar kring faktorer som bidrar till att de uppmärksammar och urskiljer dyslexi hos tonåriga andraspråkselever, samt vad de anser vara viktigt för att skolorna ska kunna agera på ett adekvat sätt när funderingar kring dyslexi finns. Resultaten har analyserats utifrån teorin the Simple View of Reading och Aarons m.fl. (2008) vidareutveckling av denna teori. Pedagogerna i studien diskuterar läs- och skrivsvårigheter i allmänhet och dyslexi i synnerhet på ett sätt som visar att de har kunskap om vad som skiljer dyslexi från övriga läs- och skrivsvårigheter och förmåga att upptäcka vad som kan vara avvikande och problematiskt i en enskild elevs språkutveckling. Pedagogerna framhäver samarbete och elevens lärmiljö som viktiga faktorer för att skolan ska kunna agera på ett adekvat sätt kring andraspråkselever med eventuell dyslexi. Fasta modersmålslärare gagnar eleverna, eftersom dessa finns i verksamheten och är involverade i det dagliga arbetet. En önskan finns bland flera av informanterna att specialpedagoger och speciallärare kommer ut i klassrummen. Tillsammans med övriga pedagoger kan de observera, reflektera, föreslå och hjälpa till med extra anpassningar utifrån eleven i kontexten. Likaså uttrycks en önskan om en mindre hierarkisk organisation där pedagoger och skolledning har tillit och respekt för varandra och där fokus ligger på ett effektivt arbete med att stödja elevens utveckling. Genom en rutin att screena alla elevers läs- och skrivförmåga kan svårigheter upptäckas tidigare. Ett problem som fler av informanterna i studien tar upp är den långa väntan på utredning av extern aktör, vilket kan leda till att insatser för att stötta elevens utveckling försenas när skolorna saknar underlag för ändamålsenliga åtgärder. Därför är det önskvärt att skolan har egen kompetens att utreda läs- och skrivsvårigheter. Ett proaktivt ledarskap, där skolan är tydlig med vad den står för, har höga förväntningar på både elev och personal, struktur i undervisningen, regelbunden kunskaps- och färdighetskontroll och snabb respons är några exempel på framgångsrikt agerande, likaså att snabbt reagera när en elev inte utvecklar sina färdigheter och kunskaper som förväntat

Nationella prov i svenska skolår 5

Syftet med vår undersökning är att se om de nationella proven i svenska för skolår 5 uppfyller kraven från kriteriet godkänd. Vi vill även se om det finns en samsyn mellan lärarkategorier när det gäller tolkning, värdering och bedömning. Arbetet ger en översikt av tidigare forskning om betygssystemet, bedömningsteorier och nationella prov. Undersökningen genomfördes på en skola i tre steg; enkäter, två delprov att rätta samt intervjuer med standardiserade frågeområden. Undersökningen visar att det oftast är lärarens egna tolkningar och värderingar som styr själva bedömningen. Det råder ingen samsyn mellan lärare på olika stadier, trots att de nationella proven ska ge en rättvis och likvärdig bedömning i hela landet. Vår undersökning är liten och mycket begränsad. Den är på inget sätt heltäckande utan ger bara en bild av hur bedömningen av de nationella proven kan gå till på en skola

Dette nummers samlede debatindlæg

Ulla Højmark Jensen: "Samfundsvidenskabelig forskning - strategiplan 1998-2002"Birgit Petersson: "Sundhedsvidenskabelig forskning - strategiplan 1998-2002"Bente RosenBeck: "Berlin er nok et besøg værd

Teenagers' and young adults' sexual behaviour and its associations with exposure to violence, among visitors at a Youth Centre in Sweden

OBJECTIVES: This study aimed to investigate differences between teenagers and young adults in sexual behaviours and exposure to emotional, physical and/or sexual violence, and the associations between sexual behaviours and exposure to violence, among youths who visit a Youth Centre in Sweden. METHODS: A cross-sectional web survey was used among sexually experienced teenagers, aged 15-19, and young adults 20-24 years, wherein a total of 452 participated. Descriptive and bivariate analyses were used in the study. RESULTS: A majority had unprotected sex during the last year, namely 55.4 % of teenagers and 58.3 % of young adults. A higher proportion of teenagers reported having early sex debut, before 15 years age, compared with young adults (p = .003). A higher proportion of young adults reported having experienced a sexually transmitted infection (p = <.001). Nearly half of the teenagers (44.9 %) and the young adults (44.6 %) stated having been exposed to emotional, physical and/or sexual violence during their lifetime. Associations were found between all types of exposure to violence and having unprotected sex, using alcohol or drugs together with sex, and having had three or more different sex partners during last year. CONCLUSIONS: Regardless of age, there was a high proportion of youths, visiting a Youth Centre, having unprotected sex and who experienced exposure to violence. As these experiences may negatively affect youths' future sexual and reproductive health, healthcare professionals should identify youths in need or with early-in-life needs

A consultation-based method is equal to SCORE and an extensive laboratory-based method in predicting risk of future cardiovascular disease.

BACKGROUND: As cardiovascular disease (CVD) is one of the most common causes of mortality worldwide, much interest has been focused on reliable methods to predict cardiovascular risk. DESIGN: A cross-sectional, population-based screening study with 17-year follow-up in Southern Sweden. METHODS: We compared a non-laboratory, consultation-based risk assessment method comprising age, sex, present smoking, prevalent diabetes or hypertension at baseline, blood pressure (systolic >/=140 or diastolic >/=90), waist/height ratio and family history of CVD to Systemic COronary Risk Evaluation (SCORE) and a third model including several laboratory analyses, respectively, in predicting CVD risk. The study included clinical baseline data on 689 participants aged 40-59 years without CVD. Blood samples were analyzed for blood glucose, serum lipids, insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-1, C-reactive protein, asymmetric dimethyl arginine and symmetric dimethyl arginine. During 17 years, the incidence of total CVD (first event) and death was registered. RESULTS: A non-laboratory-based risk assessment model, including variables easily obtained during one consultation visit to a general practitioner, predicted cardiovascular events as accurately [hazard ratio (HR): 2.72; 95% confidence interval (CI): 2.18-3.39, P<0.001] as the established SCORE algorithm (HR: 2.73; 95% CI: 2.10-3.55, P<0.001), which requires laboratory testing. Furthermore, adding a combination of sophisticated laboratory measurements covering lipids, inflammation and endothelial dysfunction, did not confer any additional value to the prediction of CVD risk (HR: 2.72; 95% CI: 2.19-3.37, P<0.001). The c-statistics for the consultation model (0.794; 95% CI: 0.762-0.823) was not significantly different from SCORE (0.767; 95% CI: 0.733-0.798, P=0.12) or the extended model (0.806; 95% CI: 0.774-0.835, P=0.55). CONCLUSION: A risk algorithm based on non-laboratory data from a single primary care consultation predicted long-term cardiovascular risk as accurately as either SCORE or an elaborate laboratory-based method in a defined middle-aged population

Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care

Objective - To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care. Design - Cross-sectional survey of consecutive patients with treated hypertension in 1999. Setting - 17 primary care centres in Sweden. Subjects - 512 patients (mean age 67; SD 11 years). Main outcome measures - Antihypertensive treatment, cardiovascular risk factors. Results - Patients with high diastolic BP (greater than or equal to 100 mmHg) and systolic BP ( > 180 mmHg) values were few. The proportions with diastolic BP <90, BP <160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and &GE; 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smokers were 10%, 23% had diabetes, and many had overweight BMI =25 kg/m(2), 72%. Conclusion - Although two-thirds had diastolic BP <90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention

Predictors of successful, self-reported lifestyle changes in a defined middle-aged population: The Soderakra cardiovascular risk factor study, Sweden

Aims: It is well established that the main cause of the development of cardiovascular disease can be found in unhealthy lifestyle habits. In our study, we wanted to explore the long-term predictors of self-reported lifestyle changes in a middle-aged population after screening for cardiovascular risk factors 10 years earlier. Methods: We conducted a 10-year follow-up telephone interview on self-reported lifestyle changes in a rural population in south-eastern Sweden, after a cardiovascular screening programme. The population comprised 90% of all inhabitants (n=705) aged 40-59 years at baseline, and 90% of these (n=629) were reached for the telephone interview. Results: When multivariate logistic regression was used, a higher success rate for lifestyle changes was independently associated with female gender (odds ratio (OR)=1.56, 95% confidence interval (CI) 1.11-2.18). When stratified for gender, significant predictors for success in men were prevalent cardiovascular risk conditions (OR=4.77, 95% CI 2.18-10.5; p= 160 and/or >= 90 mmHg) measured at baseline (OR=1.84, 95% CI 1.12-3.02; p=0.016) was significantly associated with successful lifestyle changes. Smoking at baseline was also associated with significant success: OR=3.36 (95% CI: 2.05-5.51; p<0.001) and OR=1.81 (95% CI 1.11-2.95; p=0.017) for men and women, respectively. Conclusions: Female gender was associated with significant improvements in self-reported lifestyle changes. Furthermore, smoking, a medical history of diabetes, hypertension, angina pectoris or myocardial infarction at baseline predicted success in lifestyle change in this 10-year follow-up study

Sex differences in risk factor control of treated hypertensives: a national primary healthcare-based study in Sweden.

BACKGROUND: To evaluate potential sex differences, this study aimed to investigate blood pressure and lipid control and other risk factors for cardiovascular disease in treated hypertensive (tHT) patients from primary healthcare. DESIGN AND METHODS: This cross-sectional survey of tHT patients was carried out between 2002 and 2005 by 264 primary care physicians from Sweden who consecutively recruited 6537 tHT patients (48% men and 52% women) from medical records. RESULTS: tHT men more often reached the treatment goal for systolic/diastolic blood pressure, less than 140/90 mmHg, than tHT women (30 vs. 26%, P/=5.0 mmol/l than corresponding men (75 vs. 64% P<0.001). Men more often had diabetes (25 vs. 20% P<0.001), left ventricular hypertrophy (20 vs. 16% P<0.001), and microalbuminuria (24 vs. 16% P<0.001). Women were more often treated with diuretics (64 vs. 48%) and beta-receptor blockers (54 vs. 51%), and men more often treated with angiotensin-converting enzyme inhibitors (27 vs. 18%), calcium channel blockers (34 vs. 26%), and lipid-lowering drugs (34 vs. 29%). CONCLUSION: A need still exists for more intensified treatment of elevated blood pressure and hypercholesterolemia, especially in women. In hypertensives of both sexes, smoking and other risk factors also need to be addressed to reduce the risk of cardiovascular disease