Risk of recurrent stroke and death after first stroke in long-distance ski race participants

Background: Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation. Methods and results: From the participants of the Vasaloppet, the world's largest ski-race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first-time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person-years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers. Conclusions: This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

Distance teacher education – some experiences from Dalarna University, SwedenPaper presented at the 33rd Annual ATEE Conference Brussels, Belgium, 23rd – 27th August 2008

Distance teaching is now-a-days used in different shapes. However, it is something different from traditional campus organised education as it systematically uses Information Communication Technology (ICT) as a key element. When the distance teacher education started in Sweden many teacher educators doubted the wisdom of this. They expressed that the educational process to become a teacher would be deteriorated. For instance, they feared for high drop out rates and difficulties to examine in a proper way. The Swedish National Agency for Higher Education has recently edited a report that showed that this form of teacher education was well adapted to the labour market, but the possibilities for the teacher students to shape their education were relatively limited. However, we still know quite little about the effects of this way to educate teacher students. This paper explores the possibility of using distance teacher education.In a case study 20 students, who were the first to finish a complete a distance teacher education at Högskolan Dalarna, were asked in a questionnaire how they had apprehended their education. We also interviewed four of these students, as well as five teacher educators.One of our findings were that the distance teacher education reached new target groups, who not had been able to participate in university studies if it not had been offered in this form. Especially, this was valid for the middle-aged women, living a long distance away from a university, with social responsibilities for children or old parents. Other findings were that these students in general were target oriented and ambitious, wrote more than the campus students and developed that kind of skill better. Marratech, an ICT system for small groups, e-mail and chat were used for the communication. Marratech was considered to permit free and spontaneous communication, both of the teacher educators and the students. Initially the teacher educators were sceptical to distance teacher education, but afterwards they were surprised of how well it had worked. They declared that they had better and nearer contact with their students and more control over the students´ performance, but some parts of the teacher education were better suitable for campus education, for example, power of creating characters. Distance teacher education was considered time consuming and demanded much activity from the teacher educators as the students wanted rapid responses. This study indicates that distance teacher education works well for mature individuals with high motivation. However, it demands more time from the teacher educators, but it gives in general good results. Still, there are pedagogical challenges to overcome. Maybe we should reflect on a mix of distance teacher education and campus based teacher education, instead of separated ways of accomplishing teacher education?

'Moving On' and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Wind farm construction impacts reindeer migration and movement corridors

Over the last decade, we have seen a massive increase in the construction of wind farms in northern Fennoscandia. Wind farms comprising hundreds of wind turbines are being built, with little knowledge of the possible cumulative adverse effects on the habitat use and migration of semi-domesticated free-ranging reindeer. We assessed how reindeer responded to wind farm construction in an already fragmented landscape, with specific reference to the effects on use of movement corridors and reindeer habitat selection. We used GPS-data from reindeer during calving and post-calving in the MalAyen reindeer herding community in Sweden. We analysed data from the pre-development years compared to the construction years of two relatively small wind farms. During construction of the wind farms, use of original migration routes and movement corridors within 2 km of development declined by 76 %. This decline in use corresponded to an increase in activity of the reindeer measured by increased step lengths within 0-5 km. The step length was highest nearest the development and declining with distance, as animals moved towards migration corridors and turned around or were observed in holding patterns while not crossing. During construction, reindeer avoided the wind farms at both regional and landscape scale of selection. The combined construction activities associated with even a few wind turbines combined with power lines and roads in or close to central movement corridors caused a reduction in the use of such corridors and grazing habitat and increased the fragmentation of the reindeer calving ranges.