The kidney in different stages of the cardiovascular continuum

Patients with chronic kidney disease are at higher risk of developing cardiovascular disease. The complex, interaction between the kidney and the cardiovascular system is incompletely understood, particularly at the early stages of the cardiovascular continuum. The overall aim of this thesis was to clarify novel aspects of the interplay between the kidney and the cardiovascular system at different stages of the cardiovascular continuum; from risk factors such as insulin resistance, inflammation and oxidative stress, via sub-clinical cardiovascular damage such as endothelial dysfunction and left ventricular dysfunction, to overt cardiovascular death. This thesis is based on two community-based cohorts of elderly, Uppsala Longitudinal Study of Adult Men (ULSAM) and Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS). The first study, show that higher insulin sensitivity, measured with euglycemic-hyperinsulinemic clamp technique was associated to improve estimated glomerular filtration rate (eGFR) in participants with normal fasting plasma glucose, normal glucose tolerance and normal eGFR. In longitudinal analyses, higher insulin sensitivity at baseline was associated with lower risk of impaired renal function during follow-up. In the second study, eGFR was inversely associated with different inflammatory markers (C-reactive protein, interleukin-6, serum amyloid A) and positively associated with a marker of oxidative stress (urinary F2-isoprostanes). In line with this, the urinary albumin/creatinine ratio was positively associated with these inflammatory markers, and negatively associated with oxidative stress. In study three, higher eGFR was associated with better endothelial function as assessed by the invasive forearm model. Further, in study four, higher eGFR was significantly associated with higher left ventricular systolic function (ejection fraction). The 5th study of the thesis shows that higher urinary albumin excretion rate (UAER) and lower eGFR was independently associated with an increased risk for cardiovascular mortality. Analyses of global model fit, discrimination, calibration, and reclassification suggest that UAER and eGFR add relevant prognostic information beyond established cardiovascular risk factors in participants without prevalent cardiovascular disease. Conclusion: this thesis show that the interaction between the kidney and the cardiovascular system plays an important role in the development of cardiovascular disease and that this interplay begins at an early asymptomatic stage of the disease process.

School leaders as agents of change : a case study on how two head teachers are trying to implement the learning study method in their school

This paper seeks to describe and discuss the impact of inspections of schools in Sweden. It outlines the political context, based on New Public Management (NPM) theory, according to what role the Schools Inspectorate is supposed to play in order to govern and control. Attention is also devoted, referring an on-going case study, to how inspections influence head teachers and their leadership in their everyday work.   Reports from the Schools inspectorate are public. This forces both politicians and head teachers to take measures. In this case, the head teachers perceived that the inspection reports confirmed what they already knew, but it also gave them an alibi and a tool to push their teachers to take part in everyday school development work. During the first year after the inspection the head teachers mainly strived to adjust formal deficiencies in local steering documents. However, some of the deviations reported from the Schools inspectorate are regarding pedagogical problems that are complicated and difficult to handle. As interventions in many cases will show up much later the results are, for example as increased goal fulfilment, in this case, still an open question. Nevertheless, it seems obvious that the Schools Inspectorate must be seen as a result of the governing philosophy that denotes New Public Management NPM).

One rapidly growing market of Sweden: organic food : A qualitative study portraying some consumers’ decision to purchase organic food

In recent years there has been a significantly rising trend amongst consumers for health and environmental issues, which has resulted in greater attention for and sales of organic food. Organic food production strives to use natural resources, such as land, energy and water in a sustainable way and the products does not contain artificial fertilizers or chemical pesticides. However, organic food products are also often more expensive and less available in comparison to conventional food products. Despite this, interest for and sales of organic food products have increased around the globe, and in Sweden particularly, the increase in sales has grown largely from an international perspective. This thesis is of qualitative character and is focused on studying some consumers from the Swedish market of organic food. The purpose of this thesis is to contribute with a better understanding on the buying decision process regarding organic food purchase. To achieve this, the authors have studied some consumers that purchase organic food and have searched for patterns that could be identified in the decision process. The consumer buying decision process model has been used for portrayal of the chosen consumers’ decision to purchase organic food products. Interviews with six Swedish consumers were conducted, whereas each respondent continuously purchase organic food products. Results show that the purchase of organic food products begins with discovering an unsatisfied need state, which the consumers of this study desired to change with the purchase of organic food products. This study show how six consumers reason when passing through the stages of the buying decision process, in order to satisfy their desired need state. The authors found that the respondents feel satisfied with purchasing organic food products, which lead them in to continuously buying these products. Altogether, the findings contribute with knowledge that can come to be helpful when wanting to understand more about the consumer decision to purchase organic food.