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Coming dissertations at MedFak

  • Cultural activities and health : Singer, patient, and healthcare staff perspectives. From feelings to biology Author: Christina Grape Viding Link: Publication date: 2021-11-23 13:39

    Objectives. The aim of this thesis was to explore and illuminate possible associations between various cultural activities and assessments of well-being, health, stress and emotions in a didactic setting and healthcare settings for singers, patients, and healthcare staff. 

    Material and methods. Paper I describes an empirical intervention study with repeated measures from a small cohort of singers, before, during and after a singing lesson. Physiological and endocrinological measures, as well as self-ratings were used. A two-way analysis of variance (ANOVA), as well as non-parametric tests were used. Paper II describes a randomised controlled trail for women with exhaustion symptoms participating in an intervention called the “culture palette”, consisting of six different cultural activities. Exhaustion, alexithymia, sense of coherence and self-rated health with standardised scales were assessed. A Linear Mixed Models were used. Paper III describes a study using a phenomenological hermeneutical method in analysing focus group interviews with women with burnout symptoms and cultural producers and separate interviews with health care managers to elucidate the experiences of participating in the culture palette. Paper IV describes a study with a phenomenological hermeneutical method analysing focus group interviews with healthcare staff members about their experiences of participating in self-chosen cultural activities.

    Results. The analysis of paper I showed increased wellbeing and joy in amateur singers. The professional singers showed better cardio-physiological fitness during singing. Both groups experienced more energy and relaxation after the singing lesson. The analysis of paper II showed decreased symptoms of exhaustion, alexithymia and increased self-rated health in the women after participation in the cultural activities. However, there was no significant differences between intervention and control groups regarding sense of coherence (SOC). Paper III describes the analysis of the interviews and shows three themes, where the culture palette impacted on the level of the body, group and indirectly on the managers and healthcare organisation. Paper IV describes the analysis of the interviews and shows three themes where cultural activities had a positive impact on the physical/psychological level, and enhanced work relations. Challenges in implementing cultural activities in the healthcare organisation were illuminated. 

    Conclusion. The cultural activities included in these studies show beneficial effects on health for individuals and groups, as well as for healthcare organisations. The multimodal components integrated in cultural activities exhibit possibilities of enhancing health, wellbeing and preventing and managing stress reactions. Cultural activities can enable the development of a more sustainable healthcare and eventually a more sustainable society. 

  • Influence of bone-associated and cardiovascular biomarkers on vascular events and mortality in relation to renal dysfunction Author: Ping-Hsun Wu Link: Publication date: 2021-11-23 12:12

    Biomarkers can help physicians identify subjects with an increased cardiovascular risk. Apart from the clinical factors, some biomarkers have been recognized as important predictors and risk factors for cardiovascular disease in renal disease. The applicability of biomarkers may be limited in patients with kidney disease due to the complex etiology of cardiovascular disease, which warrants separate evaluations, including established and novel biomarkers. The overall aim of the thesis was to investigate the association between bone-associated markers and cardiovascular proteins on death and vascular events in the elderly male population and patients with kidney disease.

    Study I included 3,014 participants in Swedish multicenter prospective Osteoporotic Fractures in Men (MrOS) cohort and investigated the associations between Klotho single-nucleotide polymorphism and mortality. Two potentially damaging single-nucleotide polymorphisms (rs9536314 and rs9527025) in the Klotho gene were not associated with mortality.

    Study II investigated the association between mineral bone markers and all-cause mortality / cardiovascular mortality. The composite evaluation of elevated fibroblast growth factor-23 levels, vitamin D deficiency, and renal impairment was associated with mortality.

    Study III evaluated the bone-associated proteins and mortality/composite vascular events in the 331 Demark hemodialysis patients. Osteoprotegerin, as one of the most promising bone-related proteins, was associated with composite vascular events independent of cytokine.

    Study IV investigated the association between 92 proteins measured by proximity extension assay and mortality/composite vascular events in hemodialysis patients. A higher level of Interleukin-8, T-cell immunoglobulin and mucin domain 1, C-C motif chemokine 20, and lower level of stem cell factor and galanin peptides were associated with poor outcomes.

    This thesis addressed the issue of bone-vascular axis and cardiovascular disease. We evaluated from gene levels to circulating protein levels and from the general population to patients with kidney disease. Based on our research findings, more evidence was linked between bone and vascular complications. We also identified several cardiovascular proteins considered potentially important predictors for cardiovascular disease in patients with renal failure, especially hemodialysis patients.

  • Surgical Outcomes in Sagittal Craniosynostosis Author: Jesper Unander-Scharin Link: Publication date: 2021-11-19 13:59

    The overarching aim of this thesis was to increase the understanding of patient and treatment related factors behind the variability in morphological outcomes seen in nonsyndromic sagittal craniosynostosis. There is a lack of knowledge regarding patient related predictors for the variability in outcomes, and consensus has yet to be reached regarding best practice with respect to surgical technique for the treatment of sagittal craniosynostosis. There is also a lack of objective outcome measures which further complicates evaluation and interpretation of outcomes. The studies included in this thesis analyze outcomes after early surgery for Nonsyndromic Sagittal Craniosynostosis (SC).

    Softwares for advanced image analysis were used to analyze cranial morphological changes from surgery and growth. Division of the total intracranial volume into three partial volumes (anterior, middle and posterior) was proposed as a means to further quantify the deformity seen in SC. The method detected differences that the conventionally used Cranial Index (CI) could not, adding further information when comparing data sets.

    Secondary Coronal Synostosis was evaluated. The finding was known to correlate to less growth of head circumference. We found that it further correlated with less growth of intracranial volume due to less growth in the posterior part of the skull. It also correlated to diffuse gyral impressions, a finding known to implicate raised intracranial pressure. Due to less growth in the anteroposterior plane, the patients who developed secondary coronal synostosis had a larger correction of scaphocephaly.

    Two cohorts having undergone H-Craniectomy for SC from Uppsala and Helsinki were studied. The Helsinki group had undergone an extended surgical version adding coronal suturectomies and posterior barrel staves with the aim to further correct the deformity. The Helsinki group were more scaphocephalic preoperatively, the cause of which is currently unexplained. The groups converged in CI postoperatively. Consequently, the Helsinki group, having undergone a more extended technique, had a larger correction. Further analysis implied that this was mainly due to the fact that a more severe preoperative deformity allows for a larger correction. Extending the H-Craniectomy technique could play a role in treating patients presenting with a more extreme deformity.

    Artificial Intelligences, in the form of neural networks, able to analyze total intracranial volume and segment separate cranial bones were established. The aim was to enable objective, efficient image analysis in order to manage large data sets in future multicenter studies.

    The H-Craniectomy technique used in Uppsala was compared to the Spring-assisted Surgery technique used in Gothenburg in a series of cases matched for sex and preoperative CI. The Spring-assisted Surgery group had a larger correction of CI and more shift of intracranial volume posteriorly without there being any difference in total intracranial volume. Taken together, this implies that Spring-assisted Surgery offers a greater correction of the scaphocephalic deformity compared to H-Craniectomy. Based on these results, the Uppsala Craniofacial Center subsequently altered their surgical protocol to Spring-assisted Surgery.