Biomarkers of extracellular matrix metabolism (MMP-9 and TIMP-1) and risk of stroke, myocardial infarction and cause-specific mortality : cohort study

Objective: Turnover of the extracellular matrix in all solid organs is governed mainly by a balance between the degrading matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs). An altered extracellular matrix metabolism has been implicated in a variety of diseases. We investigated relations of serum levels of MMP-9 and TIMP-1 to mortality risk from an etiological perspective. Design: The prospective Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, followed from 1991–1995 for up to 18.1 years. A random population-based sample of 1,082 71-year-old men, no loss to follow-up. Endpoints were all-cause (n = 628), cardiovascular (n = 230), non-cardiovascular (n = 398) and cancer mortality (n = 178), and fatal or non-fatal myocardial infarction (n = 138) or stroke (n = 163). Results: Serum MMP-9 and TIMP-1 levels were associated with risk of all-cause mortality (Cox proportional hazard ratio [HR] per standard deviation 1.10, 95% confidence interval [CI] 1.03–1.19; and 1.11, 1.02–1.20; respectively). TIMP-1 levels were mainly related to risks of cardiovascular mortality and stroke (HR per standard deviation 1.22, 95% CI 1.09–1.37; and 1.18, 1.04–1.35; respectively). All relations except those of TIMP-1 to stroke risk were attenuated by adjustment for cardiovascular disease risk factors. Relations in a subsample without cardiovascular disease or cancer were similar to those in the total sample. Conclusion: In this community-based cohort of elderly men, serum MMP-9 and TIMP-1 levels were related to mortality risk. An altered extracellular matrix metabolism may be involved in several detrimental pathways, and circulating MMP-9 or TIMP-1 levels may be relevant markers thereof.

Muntlig framställning : att tolka och förstå kunskapskraven i nationellt prov SVA 1

Den här studien har haft som syfte att studera om kvalitetskraven i betygsskalan stämmer överens mellan nationellt prov i SVA1 och motsvarande kursplan svenska som andraspråk 1 (SVA1) samt på vilket sätt det nationella provet underlättar tolkningen av kunskapskraven i kursplanen för SVA1. Undersökningen begränsar sig till att omfatta enbart den muntliga delen, delprov A muntlig framställning. För att beskriva och analysera vilka kunskaper som anses vara eftersträvansvärda i muntlig framställning har en kvalitativ innehållsanalys genomförts som ger en grundmodell till den efterföljande kunskapsanalysen. Resultaten från studiens innehållsanalys visar fram en hur processen kring den muntliga framställningen utgår från den retoriska arbetsmodellen med ett gediget förberedande arbete som följs upp med anförande och avslutas med elevresponser. Resultatet från kunskapsanalysen visar hur eleverna behöver behärska en kombination av kunskapsformerna episteme, techné och fronesis för att uppfylla betygskraven på de högre nivåerna. Studiens slutsatser är att kvalitetskraven stämmer överens mellan det nationella provets bedömningsmatris och kursplanen i svenska som andraspråk 1 (SVA 1) vad gäller bedömningen av elevens språkliga kvaliteter. Dessutom går det att dra slutsatsen att de krav på anpassning till det retoriska sammanhanget också är krav som återfinns i kursplanen men beskrivs mer allmänt i ett språkutvecklande perspektiv vilket underlättar tolkningen av kunskapskraven i kursplanen. Studien visar hur eleven för att få det lägsta betyget (E) behöver kunskaper om en retorisk framställning och att eleven kan presentera ett förberett innehåll inför en publik.

Assessing the physical environment of older people’s residential care facilities: development of the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM)

Background There is emerging evidence that the physical environment is important for health, quality of life and care, but there is a lack of valid instruments to assess health care environments. The Sheffield Care Environment Assessment Matrix (SCEAM), developed in the United Kingdom, provides a comprehensive assessment of the physical environment of residential care facilities for older people. This paper reports on the translation and adaptation of SCEAM for use in Swedish residential care facilities for older people, including information on its validity and reliability. Methods SCEAM was translated into Swedish and back-translated into English, and assessed for its relevance by experts using content validity index (CVI) together with qualitative data. After modification, the validity assessments were repeated and followed by test-retest and inter-rater reliability tests in six units within a Swedish residential care facility that varied in terms of their environmental characteristics. Results Translation and back translation identified linguistic and semantic related issues. The results of the first content validity analysis showed that more than one third of the items had item-CVI (I-CVI) values less than the critical value of 0.78.  After modifying the instrument, the second content validation analysis resulted in I-CVI scores above 0.78, the suggested criteria for excellent content validity. Test-retest reliability showed high stability (96% and 95% for two independent raters respectively), and inter-rater reliability demonstrated high levels of agreement (95% and 94% on two separate rating occasions). Kappa values were very good for test-retest (κ= 0.903 and 0.869) and inter-rater reliability (κ= 0.851 and 0.832). Conclusions Adapting an instrument to a domestic context is a complex and time-consuming process, requiring an understanding of the culture where the instrument was developed and where it is to be used. A team, including the instrument’s developers, translators, and researchers is necessary to ensure a valid translation and adaption. This study showed preliminary validity and reliability evidence for the Swedish version (S-SCEAM) when used in a Swedish context. Further, we believe that the S-SCEAM has improved compared to the original instrument and suggest that it can be used as a foundation for future developments of the SCEAM model.