Coming theses from other universities
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Improving Oral Health Assisted by Smart Powered Toothbrushes and Exploring Their Role in Innovative Health Technology
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:bth-26839
Maintaining good oral health is critical to healthy aging, as cognitive decline often accelerates the deterioration of oral health. Conversely, poor oral health can exacerbate cognitive decline. The thesis examines if introducing a powered toothbrush could prevent the deterioration of oral health in older individuals with mild cognitive impairment (MCI) and maintain a good quality of life. Another aim was to evaluate the actual use and the possibility of using the powered toothbrush as a carrier for other health sensors. From an interdisciplinary perspective, it examines technology's direct and indirect impact on oral health, which aligns with the World Health Organization's definition of applied health technology. Maintaining oral health is critical in a growing aging population and with the increased incidence of MCI. The thesis includes four sub-studies. A pilot study was conducted on healthy adults, where core body temperature was assessed with a sensor attached to the toothbrush. For study I-III, two hundred and thirteen participants who met specific criteria such as age, memory problems, and cognitive levels were initially recruited. Oral health data with medical, cognitive, and quality of life assessments were collected over two years, with visits scheduled every six months. Ethical considerations followed the Declaration of Helsinki, which emphasized informed consent, participant autonomy, and dignity protection, which are particularly important for vulnerable populations such as individuals with MCI. This thesis shows that it is possible to maintain and improve oral health measured by Plaque Index (PI), Bleeding on Probing (BOP), and Periodontal Pocket depth 4mm or deeper (PPD≥4 mm) in a group of older individuals with MCI for at least 24 months. The results underline the potential of smart toothbrushes as tools for improved oral health and as carriers of sensors for health monitoring.
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Benign hysterectomy and salpingectomy : outcomes and complications according to Swedish health and quality registers and women’s perspectives
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-228778
Background
Opportunistic salpingectomy at the time of hysterectomy, i.e., removing presumed healthy fallopian tubes when removing the uterus, is suggested to reduce the risk of ovarian cancer. However, the impact of opportunistic salpingectomy on complications and ovarian function is insufficiently studied. Furthermore, the perspectives of women with no increased risk of ovarian cancer facing the choice to undergo opportunistic salpingectomy at hysterectomy have not been previously explored. There is consensus that surgical complications are important to register, both for quality control and research. Nevertheless, internationally there is no agreement on when, how, and even what to register, which reduces the comparability. This thesis aimed to compare complication rates and menopausal symptoms after opportunistic salpingectomy, as well as to explore women’s views on hysterectomy and salpingectomy before surgery. Furthermore, it aimed to validate complication registration after uterine and adnexal surgery in the Swedish National Quality Register of Gynecological Surgery (GynOp).
Methods
A retrospective cohort study with data from GynOp (Paper I), explored the uptake of opportunistic salpingectomy in Sweden 1998-2016. Hysterectomy with bilateral salpingectomy vs hysterectomy only, performed 2013-2016, was compared regarding complications and menopausal symptoms one year after surgery. Paper II is a qualitative study, with focus group discussions including women waiting for hysterectomy in different parts of Sweden. The participants’ experiences and perceptions of health, healthcare, and potential outcomes of hysterectomy with or without salpingectomy were explored. For Paper III, a cross-sectional study based on a survey sent to Swedish gynecologists was conducted. Fictional cases describing various postoperative courses were used to explore interrater reliability in assessing complications according to the methods in GynOp. Finally, a cohort study including surgeries of the uterus and/or adnexa with benign indications 2017-2020 was conducted. Complications registered in GynOp, the National Patient Register, Prescribed Drug Register, and Cause of Death Register were compared (Paper IV).
Results
The uptake of bilateral salpingectomy at the time of hysterectomy increased from 1.9% in 2012 to 37.8% in 2016. Comparing hysterectomy with bilateral salpingectomy vs hysterectomy only, salpingectomy was associated with an increased risk of menopausal symptoms one year after surgery (adjusted relative risk (aRR) 1.35, 95% confidence interval (CI) 1.07-1.71)). A slight increase in mean length of hospital stay (0.1 day, 95% CI 0.01-0.17) was seen, as well as an increased risk of minor complications in unadjusted analysis (relative risk (RR) 1.36, 95% CI 1.05-1.77). The latter was, however, not significant after adjusting for potential confounders (aRR 1.29, 95% CI 0.92-1.82) (Paper I). Women waiting for hysterectomy expressed that healthcare personnel held differing perspectives from the women, both regarding the surgery and the health problems being the cause of surgery. They also perceived a dependency on the advice and opinion of the physician for the choice of surgical procedure and possibly having opportunistic salpingectomy (Paper II). Swedish gynecologists demonstrated high interrater reliability in assessing whether a complication had occurred (agreement >80% in 85% of cases (17/20)), and in using the Clavien-Dindo classification, (agreement >90% in 80% of cases (16/20)) in our survey. Cases with lower agreement rates were bordering between minor complications and normal postoperative course (Paper III). From 2017 to 2020, 32,537 surgeries of the uterus and/or adnexa were registered in GynOp (Paper IV). Higher rates of complications from discharge to three months were found in GynOp compared with the Patient Register (13.7% vs 6.9%). The coverage of all complications was 79.1% in GynOp and 46.1% in the Patient Register when linking the two registers. Of the included individuals, 12.7% had a prescription of antibiotics ≤30 days after surgery, indicating a postoperative infection.
Conclusions
This thesis suggests that bilateral salpingectomy at the time of hysterectomy affects ovarian function and might increase the risk of minor complications, concerns which must be properly addressed in the consultation before surgery as well as in future research. Research on surgical interventions require reliable tools for evaluating complications. In finding a higher rate of complications captured in GynOp compared with the health registers, and a high interrater reliability among Swedish gynecologists, the registration of complications in GynOp are validated. However, continued work is required with definitions of what is normal in recovery after any specific surgery, for reliable capture of complications and to provide adequate information before surgery. Shared decision-making based on high quality scientific evidence of risks and benefits is important in all interventions, especially in prophylactic surgery, e.g., opportunistic salpingectomy.
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”Det är liksom en stor grej som händer just nu i våra liv” : Psykisk hälsa och stigma bland ungdomar
Link: http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-535659
Adolescents’ mental health is a current public health issue. However, research, on adolescents’ views on different aspects of mental health, and the prevalence of mental well-being, mental illness and related stigma, among adolescents is limited in Sweden. The overall aim of this thesis was to explore perceptions and status of mental health and stigma related to mental health problems among adolescents in a Swedish context.
Study I and II were based on qualitative interviews with 32 adolescents on the Swedish island Gotland. Study I indicated that the adolescents had a complex understanding of various mental health concepts but labelled mental well-being as ‘feeling good’ and mental illness as ‘feeling bad’. In Study II, the adolescents described mental health problems as common due to current living conditions, e.g. stress related to school performance and social media and an increased openness about mental health problems. Stigmatisation of people with mental health problems was perceived as problematic, caused by lack of experience and knowledge, but also as related to rumour spreading and stereotypical gender norms.
Study III and IV were based on the Life and Health Youth survey, conducted in secondary schools located on Gotland. In study III, the results according to the dual-factor model of mental health showed that most adolescents had vulnerable mental health status (47.5%), while 36.2% had complete mental health. A smaller proportion had troubled (13,9%) or symptomatic but content (2,5%) mental health status. Associations were observed between mental health status and gender, grades, truancy, stress level, resilience, and subjective social status in school.
In study IV, the factor structure and internal consistency was acceptable for the modified Attitudes About Mental Illness and its Treatment scale, but the adolescents perceived it as difficult to answer. Further, negative attitudes towards people with mental health problems were present, and more common among boys and foreign-born adolescents.
The findings of this thesis suggests the two-factor model of mental health and the three-part description of stigma, including stereotypes, prejudice and discrimination, to be applicable among adolescents. Further, the findings suggest a need for promotion of mental well-being and prevention of mental health problems such as interventions to reduce school-related stress, increase resilience and promote societal knowledge about mental health, stigma and gender stereotypes among adolescents. The findings also motivate support to adolescents with low mental wellbeing and minor mental health problems as well as to adolescents who have friends with mental health problems.