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  • 147401.
    Wigston, Christine
    et al.
    Curtin University, Australia.
    Falkmer, Marita
    Curtin University, Australia; Jonköping University, Sweden.
    Vaz, Sharmila
    Curtin University, Australia.
    Parsons, Richard
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Curtin University, Australia; La Trobe University, Australia.
    Participation in extracurricular activities for children with and without siblings with autism spectrum disorder2017Inngår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, nr 1, s. 25-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation. Methods: A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire. Results: Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD. Conclusion: While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.

  • 147402.
    Wigston, Christine
    et al.
    Curtin University, Perth, Western Australia, Australia.
    Falkmer, Marita
    Högskolan i Jönköping, Högskolan för lärande och kommunikation, HLK, CHILD. Curtin University, Perth, Western Australia, Australia.
    Vaz, Sharmila
    Curtin University, Perth, Western Australia, Australia.
    Parsons, Richard
    Curtin University, Perth, Western Australia, Australia.
    Falkmer, Torbjörn
    Högskolan i Jönköping, Hälsohögskolan, HHJ. CHILD. Curtin University, Perth, Western Australia, Australia.
    Participation in extracurricular activities for children with and without siblings with autism spectrum disorder2017Inngår i: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 20, nr 1, s. 25-39Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE:

    To compare the number, frequency, enjoyment and performance in extracurricular activities of siblings of children with autism spectrum disorders (ASD) to their typically developing (TD) peers, and to identify differences between actual and desired participation.

    METHODS:

    A case-control study with 30 siblings of children with ASD and 30 siblings of TD children was conducted using the Paediatric Interest Profiles and a questionnaire.

    RESULTS:

    Siblings of children with ASD participated in fewer extracurricular activities than those with TD siblings. ASD symptoms were significantly associated with the sibling participating in fewer extracurricular activities. Children with TD siblings had higher enjoyment scores in relaxation activities than children with siblings with ASD.

    CONCLUSION:

    While results were mainly positive, some differences indicated that having a sibling with ASD may impact participation in extracurricular activities. Assessments of participation barriers, as well as support to minimise participation restrictions among siblings of children with ASD are required.

  • 147403.
    Wigström, Lars
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Institutionen för medicin och vård. Linköpings universitet, Tekniska högskolan.
    Multidimensional magnetic resonance imaging: new methods for analysis of cardiovascular dynamics2003Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Cardiovascular flow and motion occur in three-dimensional (3D) space and vary dynamically over the cardiac cycle. The description of these complicated patterns using non-invasive imaging requires new tools for data acquisition, processing and visualization. In this thesis, a number of techniques are presented, all of which aim at improving the description of multidimensional cardiovascular flow and motion.

    For the study of cardiac motion, a new M-mode method was developed that uses time-resolved image data to retrospectively calculate an M-mode image along an arbitrary line. This reduces the dimensionality of the acquired image data to one dimension plus time, which facilitates the analysis of the motion of cardiac structures. In order to describe flow patterns within the heart and great vessels, phase contrast magnetic resonance imaging (MRI) can be used to accurately measure velocities. Existing techniques for the acquisition of phase contrast data were extended in order to acquire time-resolved 3D image data that contain information about all three velocity components in each voxel. A number of possible approaches for reducing the scan time required were applied. Reducing the scan time in MRI often results in images with a poor signal-to-noise ratio (SNR). Image processing techniques were therefore investigated that utilize adaptive filtering in order to reduce the noise level, while still preserving the details of small structures. Once multidimensional image data are acquired, there is an immediate need to visualize the data in a comprehensible way. Particle trace visualization of velocity vector data was applied in order to study flow patterns in the human heart. Using these methods, completely new insights into the patterns of blood flow within the left atrium were achieved. This and future applications are made possible by the powerful combination of massive multidimensional data sets and tools developed specifically for the complicated conditions of cardiovascular flow.

  • 147404.
    Wigström, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Ebbers, Tino
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Tekniska högskolan.
    Fyrenius, Anna
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Karlsson, Matts
    Linköpings universitet, Institutionen för medicinsk teknik. Linköpings universitet, Institutionen för konstruktions- och produktionsteknik. Linköpings universitet, Tekniska högskolan.
    Engvall, Jan
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Wranne, Bengt
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Bolger, Ann F.
    Division of Biomedical Science, University of California at Riverside, Riverside, California.
    Particle trace visualization of intracardiac flow using time-resolved 3D phase contrast MRI1999Inngår i: Magnetic Resonance in Medicine, ISSN 0740-3194, E-ISSN 1522-2594, Vol. 41, nr 4, s. 793-799Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The flow patterns in the human heart are complex and difficult to visualize using conventional two-dimensional (2D) modalities, whether they depict a single velocity component (Doppler echocardiography) or all three components in a few slices (2D phase contrast MRI). To avoid these shortcomings, a temporally resolved 3D phase contrast technique was used to derive data describing the intracardiac velocity fields in normal volunteers. The MRI data were corrected for phase shifts caused by eddy currents and concomitant gradient fields, with improvement in the accuracy of subsequent flow visualizations. Pathlines describing the blood pathways through the heart were generated from the temporally resolved velocity data, starting from user-specified locations and time frames. Flow trajectories were displayed as 3D particle traces, with simultaneous demonstration of morphologic 2D slices. This type of visualization is intuitive and interactive and may extend our understanding of dynamic and previously unrecognized patterns of intracardiac flow.

  • 147405.
    Wigström, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Ebbers, Tino
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Fyrenius, Anna
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi.
    Karlsson, Matts
    Linköpings universitet, Tekniska högskolan. Linköpings universitet, Institutionen för medicinsk teknik, Biomedicinsk modellering och simulering.
    Engvall, Jan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Wranne, Bengt
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Bolger, Ann F
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    The effects of maxwell terms on particle traces calculated from 3D cine phase contrast images1999Inngår i: Journal of Cardiovascular Magnetic Resonance,1999, 1999, s. 93-93Konferansepaper (Annet vitenskapelig)
  • 147406.
    Wigström, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Lindström, Lena
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöqvist, Lars
    Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Radiofysikavdelningen. Linköpings universitet, Hälsouniversitetet.
    Thuomas, K. Å.
    Linköpings universitet, Institutionen för medicin och vård, Radiologi. Linköpings universitet, Hälsouniversitetet.
    Wranne, Bengt
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    M-mode magnetic resonance imaging: a new modality for assessing cardiac function1995Inngår i: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 15, nr 4, s. 397-407Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Magnetic resonance imaging (MRI) studies of the heart have been used for some years, but there are few tools available to quantify cardiac motion. A method has been developed that creates an M-mode MRI image, analogous to the one used in echocardiography, to display motion along a line as a function of time. The M-mode image is created from MRI images acquired with an ordinary gradient echo cine sequence. In a cinematographic display of the images, a cursor line can be positioned in order to determine the orientation of the measurement. A resampling algorithm then calculates the appearance of the M-mode image along the cursor line. The MRI method has been compared to echocardiographic M-mode in a phantom study and by measuring mitral and tricuspid annulus motion in 20 normal subjects. The phantom study showed no significant differences between MRI and echocardiographic M-mode measurements (difference mm). The annulus motion exhibits a similar pattern using both methods and the measured amplitudes are in close agreement. M-mode MRI provides similar information to echocardiography, but the cursor line can be placed arbitrarily within the image plane and the method is thus not limited to certain acoustic windows. This makes M-mode MRI a promising technique for assessing cardiac motion.

  • 147407.
    Wigström, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Sjöqvist, Lars
    Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Radiofysikavdelningen. Linköpings universitet, Hälsouniversitetet.
    Wranne, Bengt
    Linköpings universitet, Institutionen för medicin och vård, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet.
    Temporally resolved 3D phase-contrast imaging1996Inngår i: Magnetic Resonance in Medicine, ISSN 0740-3194, E-ISSN 1522-2594, Vol. 36, nr 5, s. 800-803Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A conventional 3D phase contrast acquisition generates images with good spatial resolution, but often gives rise to artifacts due to pulsatile flow. 2D cine phase contrast, on the other hand, can register dynamic flow, but has a poor spatial resolution perpendicular to the imaging plane. A combination of both high spatial and temporal resolution may be advantageous in some cases, both in quantitative flow measurements and in MR angiography. The described 3D cine phase contrast pulse sequence creates a temporally resolved series of 3D data sets with velocity encoded data.

  • 147408.
    Wigårde, Emmy
    et al.
    Blekinge Tekniska Högskola, Sektionen för hälsa.
    Hansen, Michael
    Blekinge Tekniska Högskola, Sektionen för hälsa.
    Kvinnors upplevelser av att leva med fibromyalgi – En litteraturstudie2011Independent thesis Basic level (degree of Bachelor)Oppgave
    Abstract [en]

    Av de som drabbas av fibromyalgi är 80-85% kvinnor. Sjukdomen karakteriseras av diffus muskelsmärta, ömma beröringspunkter som också kallas för triggerpunkter, ledstelhet, ledvärk, trötthet och uttalade sömnproblem. I dagsläget finns det få kvalitativa studier gjorda om sjukdomen fibromyalgi. Av de som gjorts är det få studier som handlar om hur det vardagliga livet ter sig och upplevs av de som lever med fibromyalgi och hur de anpassar sig efter sin sjukdom. Studiens syfte var att belysa kvinnors upplevelser av att leva med fibromyalgi. Studien genomfördes som en litteraturstudie med kvalitativ metod och baserades på vetenskapligt granskade artiklar. Databaserna CINAHL och PubMed användes för artikelsökning. De funna artiklarna granskades sedan enligt ett protokoll för granskning av kvalitativa studier. Resultatet bygger på fyra olika teman ”Svårigheter att hantera vardagen”, ”Hur livet påverkas av sjukdomen”, ”Yttre relationers påverkan på livet” och ”Att hitta nya vägar”. Under dessa olika teman beskrevs kvinnors upplevelser av att leva med fibromyalgi. I resultatet framgick det att kvinnorna upplevde svårigheter att hantera sin vardag, att vara delaktiga i fysiska aktiviteter och bibehålla sociala relationer. Kvinnorna upplevde förändrade självbilder och att sjukdomen styrde deras liv, att de inte fick mycket förståelse från andra och att de ofta stötte på misstro men att ökad kunskap om den egna sjukdomen underlättade. Kvinnorna upplevde dock ökad samhörighet med sina närstående, det framkom också att kvinnorna upplevde känslor av hopp och en tro på att framtiden skulle bli bättre. Mer kvalitativ forskning behövs om upplevelser av att leva med denna sjukdom för att öka förståelsen för dessa personer och även för att vårdpersonal, arbetskollegor, vänner, närstående och familj ska få bättre förståelse för dessa personer.

  • 147409.
    Wihlborg, Annika
    Högskolan Kristianstad, Sektionen för hälsa och samhälle.
    Livet efter hjärtinfarkt.  En allmän litteraturstudie om kvinnors livssistuation.2012Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Årligen insjuknar cirka 13000 kvinnor i Sverige i hjärtinfarkt. Det är en av de vanligaste hjärt- och kärlsjukdomarna i Sverige. Det är en av de vanligaste hjärt- och kärlsjukdomarna i Sverige. Biologiska skillnader mellan kvinnor och män innebär att sjukdom och hälsa kan upplevas olika. Kvinnor har beskrivit insjuknandet i hjärtinfarkt som en overklig känsla och en skam över att bli sjuk. Kvinnan ställs inför psykiska och fysiska utmaningar där balans mellan livsmod och tappad livsgnista blir tydligare än tidigare. Syfte: Syftet var att beskriva kvinnors upplevelse av sin livssituation efter att ha insjuknat i hjärtinfarkt. Metod: En allmän litteraturstudie genomfördes.13 kvalitativa vetenskapliga original artiklar inkluderades. Resultat: Kvinnornas livssituation påverkades och förändrades av hjärtinfarkten. Nya tankar kring livet väcktes. Kvinnorna upplevde en osäkerhet inför framtiden, fysiska begränsningar på grund av trötthet och svaghet. Stöd och nära relationer var viktiga och stödjande i den nya livssituationen. Att komma till acceptans fick kvinnorna att våga se framåt. Diskussion: Som sjuksköterska är det betydelsefullt att känna till kvinnans förändrade livsvärld efter hjärtinfarkt för att kunna möta henne där hon är. Preventivt arbete med fokus på en personcentrerad omvårdnad där kvinnan känner sig sedd och bekräftad tas upp till diskussion.

  • 147410.
    Wihlborg, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Strokepatienters upplevelser av egenhälsa och stöd från sjukvården: en kvalitativ studie2017Independent thesis Advanced level (degree of Master (Two Years)), 20 poäng / 30 hpOppgave
  • 147411. Wihlborg, C.
    et al.
    List, T.
    Helkimo, M.
    Oester, A.
    Svensson, P.
    Leijon, Göran
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Neurologi. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Neurologiska kliniken.
    Pain characteristics, and sensory and clinical findings in patients with atypical odontalgia.2003Inngår i: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 82, s. 1767-Konferansepaper (Annet vitenskapelig)
  • 147412.
    Wihlborg, Elin
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Statsvetenskap. Linköpings universitet, Filosofiska fakulteten.
    Norstedt, Anna
    Linköpings universitet.
    New ways and actors when diplomacy goes digital: The e-Diplomacy Campaign “Midwives4All2017Inngår i: Proceedings of the 50th Hawaii International Conference on System Sciences, 2017, Waikoloa: University of Hawaii , 2017, s. 2438-2447Konferansepaper (Fagfellevurdert)
    Abstract [en]

    This article focuses on Midwives4All, an e-diplomacy campaign launched by the Swedish MFA in 2015. The campaign aims to spread knowledge about the benefits of midwives and evidence-based midwifery. Within the campaign, the Swedish MFA, and in particular its Communications Department (UD-KOM), combines e-diplomacy and networking and the campaign has become one key activity within the Swedish feminist foreign policy. It is organizing diplomacy in new ways that regards both choices of channels and the networking with inter- and nongovernmental organizations. The limited impacts of the campaign are seen as consequences of the peripheral status of the issue and the lack of systematic structures for e-diplomacy so far. In spite of this the case indicates that e-diplomacy has the potential to raise and empower both new actor groups and new issues on the diplomatic agenda.

  • 147413.
    Wihlborg, Helen
    et al.
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Wänman, Maria
    Högskolan Kristianstad, Sektionen för Hälsa och Samhälle.
    Vårdpersonalens upplevelser av omvårdnaden hos personer med demenssjukdom: en litteraturstudie2010Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Bakgrund: Demenssjukdomar blir allt vanligare och en stigande ålder ökar risken för att få denna sjukdom. Att få en demenssjukdom innebär att språket, tankeförmågan liksom de kognitiva och intellektuella funktionerna är nedsatta. Målet i omvårdnaden är att vårdtagaren skall ha ett gott liv trots sjukdom. Vårdpersonalen upplever att de behöver mer kunskap för att ge personer med demenssjukdom en god omvårdnad. Syfte: Syftet är att beskriva hur vårdpersonalen upplever omvårdnaden av personer med demenssjukdom. Metod: En litteraturöversikt som grundade sig på tolv kvalitativa och kvantitativa vetenskapliga artiklar som söktes fram via elektroniska databaser och som därefter granskades och analyserades. Resultat: Resultatet visade att kunskap och utbildning saknades, att det var svårt att kommunicera med vårdtagare med demenssjukdom samt att vårdpersonalen gav vårdtagarna lugnande läkemedel för att hinna med sitt arbete. Diskussion: Att ha kunskap och utbildning om demenssjukdomar och hur omvårdnaden påverkar vårdtagaren kan leda till att kommunikationen förbättras och en positiv atmosfär erhålls med mycket humor och skratt mellan vårdtagare och vårdpersonal. Dessutom kan vårdtagarnas läkemedelsintag av lugnande mediciner minskas. En slutsats av denna litteraturstudie är att utbildning och kunskap är en viktig del i omvårdnaden av personer med demenssjukdom och att arbetsgivaren bör tillhandahålla kontinuerlig utbildning till vårdpersonalen.

  • 147414. Wihlborg, Monne
    Pedagogical Awareness of Internationalisation in terms of Teaching and Learning in Higher Education.2005Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Wihlborg, M: At the 11th Earli (European Association for Research on learning and Instruction) Biennial Conference, Nicosia, Cyprus, August 23-27, 2005. Title: Pedagogical Awareness of Internationalisation in terms of Teaching and Learning in Higher Education. The Swedish nurse education as an 'investigation example'.

  • 147415. Wihlbäck, Anna-Carin
    et al.
    Nyberg, Sigrid
    Andersson, Agneta
    Bixo, Marie
    Bäckström, Torbjörn
    Sundström-Poromaa, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Allopregnanolone serum concentrations and neurosteroid sensitivity during withdrawal from postmenopausal hormone therapy2007Inngår i: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 23, nr 10, s. 590-596Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: We have previously compared the pharmacodynamic response to a neuroactive steroid, pregnanolone, before and during sequential treatment with estradiol-only (E2-only) and estradiol together with progesterone (E2 + P) in postmenopausal women. The aim of the present study was to evaluate the pharmacodynamic response to pregnanolone during withdrawal from E2-only treatment and during withdrawal from treatment with E2 + P. METHOD: Twenty-six postmenopausal women were administered hormone therapy (HT) in a randomized, double blinded, placebo-controlled, crossover study. The women received 2 mg oral estradiol continuously during two 28-day cycles and 800 mg vaginal progesterone or placebo sequentially for the last 14 days of each treatment cycle. The pharmacodynamic response to pregnanolone was assessed during the last week of the last treatment cycle and 48 h after termination of the last treatment cycle (withdrawal) by comparing the effects of intravenous pregnanolone (3alpha-hydroxy-5beta-pregnan-20-one) on saccadic eye movements. RESULTS: During E2-only withdrawal the pregnanolone sensitivity was reduced compared with E2-only treatment. Pregnanolone sensitivity remained unaltered between the combined E2 + P treatment regimen and the withdrawal from these steroids. CONCLUSION: The study indicates that withdrawal from E2-only treatment might change neurosteroid sensitivity, whereas the immediate withdrawal from E2 + P results in unchanged neurosteroid sensitivity.

  • 147416.
    Wihlbäck, Anna-Carin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Nyberg, Sigrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, Torbjörn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström-Poromaa, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Estradiol and the addition of progesterone increase the sensitivity to a neurosteroid in postmenopausal women2005Inngår i: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 30, nr 1, s. 38-50Artikkel i tidsskrift (Fagfellevurdert)
  • 147417.
    Wihlbäck, Anna-Carin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström Poromaa, Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bixo, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Allard, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mjörndal, Tom
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk farmakologi.
    Spigset, Olav
    Influence of menstrual cycle on platelet serotonin uptake site and serotonin2A receptor binding2004Inngår i: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 29, nr 6, s. 757-766Artikkel i tidsskrift (Fagfellevurdert)
  • 147418.
    Wihlbäck, Anna-Carin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström-Poromaa, I
    Allard, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mjörndal, T
    Spigset, O
    Bäckström, T
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Influence of postmenopausal hormone replacement therapy on platelet serotonin uptake site and 5-HT2A receptor binding2001Inngår i: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 98, nr 3, s. 450-457Artikkel i tidsskrift (Fagfellevurdert)
  • 147419.
    Wihlbäck, Anna-Carin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sundström-Poromaa, I
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Nyberg, S
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Bäckström, T
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Sensitivity to a neurosteroid is increased during the progestagen addition of postmenopausal hormone replacement therapy2001Inngår i: Neuroendocrinology, ISSN 0028-3835, E-ISSN 1423-0194, Vol. 73, s. 397-407Artikkel i tidsskrift (Fagfellevurdert)
  • 147420.
    Wihlman, Ulla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Lundborg, Cecilia Stålsby
    Axelsson, Runo
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Barriers of inter-organisational integration in vocational rehabilitation2008Inngår i: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 19, nr 8, s. 1-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: A project of vocational rehabilitation was studied in Sweden between 1999 and 2002. The project included four public organisations: the social insurance office, the local health services, the municipal social service and the office of the state employment service. The aim of this paper was to analyse perceived barriers in the development of inter-organisational integration. THEORY: Theories of inter-professional and inter-organisational integration, and theories on organisational change. METHODS: In total, 51 semi-structured interviews and 14 focus group discussions were performed with actors within the project between 1999 and 2002. A thematic approach was used for the analysis of the data. RESULTS: THREE DIFFERENT MAIN THEMES OF BARRIERS EMERGED FROM THE DATA: A Uncertainty, B Prioritising own organisation and C Lack of communication. The themes are interconnected in an intricate web and hence not mutually exclusive. CONCLUSIONS AND DISCUSSION: The barriers found are all related partly to organisational change in general and partly to the specific development of organisational integration. Prioritising of own organisation led to flaws in communication, which in turn led to a high degree of uncertainty within the project. This can be seen as a circular relationship, since uncertainty might increase focus on own organisation and lack of communication. A way to overcome these barriers would be to take the needs of the clients as a point of departure in the development of joint services and to also involve them in the development of inter-organisational integration.

  • 147421. Wihlman, Ulla
    et al.
    Stålsby Lundborg, Cecilia
    Holmström, Inger
    Örebro universitet, Hälsoakademin.
    Axelsson, Runo
    Organizing vocational rehabilitation through interorganizational integration: a case study in Sweden2011Inngår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, nr 3, s. E169-E185Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable. Copyright (C) 2010 John Wiley & Sons, Ltd.

  • 147422.
    Wihlman, Ulla
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Stålsby-Lundborg, Cecilia
    Karolinska Institutet, Stockholm, Sweden .
    Holmström, Inger
    Uppsala University, Uppsala, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration – a case study in Sweden2011Inngår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, nr 3, s. 169-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 147423.
    Wihlman, Ulla
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Stålsby-Lundborg, Cecilia
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Holmström, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Axelsson, Runo
    Nordic School of Public Health, Göteborg, Sweden.
    Organising vocational rehabilitation through interorganisational integration: a case study in Sweden2011Inngår i: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 26, nr 3, s. e169-e185Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study describes and analysis five years of experiences from organising an interorganisational project on vocational rehabilitation. A qualitative case study approach was used based on interviews, focus group discussions and documents. The aim was to analyse how and why the project was organised in the way it was in relation to theories of integration, organisational change and learning. The results show that the vocational rehabilitation project was initiated mainly for financial reasons. It was organised as a mechanistic system with the aim of producing different activities, where financial control and support from all the levels of the organisations involved was important. A new bureaucracy between the different authorities involved was built up, where the vertical (top-down) integration was more important than the horizontal. The result was scattered islands of interprofessional work in different teams, but without contacts between them. The project did not influence the processes or workflows of the organisations involved in the project, which would be important from a service-user perspective. It may therefore be questionnable to organise the development of interorganisational integration for vocational rehabilitation in a separate project organisation. Instead, interorganisational networks with focus on interconnections of processes and workflows may be more flexible and adaptable.

  • 147424.
    Wihlmark, Ulf
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Oftalmologi. Linköpings universitet, Hälsouniversitetet.
    The effects of reactive oxygen species and lipofuscin on the function and health of the retinal pigment epithelium1998Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Age-related macular degeneration (ARJVID) is a common cause of central vision loss in elderly people. Specific treatment is possible only for selected patients. A dysfunction of the retinal pigment epithelial (RPE) cells has been proposed to help explain the pathogenesis of ARMD. In the normal turnover of photoreceptor outer segments (POS), membranes rich in polyunsaturated fatty acids (PUPAs) are shed and phagocytised by the RPE. PUFAs are highly susceptible to free radical damage, causing peroxidation and subsequent formation of products with fluorescence similar to Schiff bases, a component of lipofuscin. With increasing age, lipofuscin accumulates in the RPE cells, and it has been suggested that lipofuscin could be detrimental to RPE function through free radical generation or interference with the autophagocytic capacity of cells having lipofuscin-loaded lysosomes.

    To study the effect of oxidative stress on lipofuscin accumulation, rabbit RPE cell cultures were kept at an ambient oxygen concentration of either 8 % or 40 %. To simulate the normal phagocytic function of RPE cells, bovine POS were added daily. The lipofuscin-specific autofluorescence was measured after 1, 2 and 3 weeks. RPE cells cultured under normobaric hyperoxic conditions (40 % oxygen) showed significantly higher levels of lipofuscin-like autofluorescence than those kept at nonnobaric and probably normooxic conditions (8 % oxygen) after 1, 2 as well as after 3 weeks. For both oxygen concentrations, the lipofuscin accumulation level was increased after 2 weeks of POS exposure and had increased even further after 3 weeks. The results suggest an involvement of oxidative mechanisms in the formation of lipofuscin from phagocytised POS by RPE cells.

    In the second study, bovine POS were photo-oxidised, and turned into a lipofuscin-like material, by irradiation with UV light. Transmission electron microscopy of irradiated POS showed loss of the normal stacks of the disk membranes with conversion into an amorphous osmiophilic, electron dense mass. The formation of thiobarbituric acid reactive substances (TEARS), estimated during the irradiation process, indicated lipid peroxidation. The later decline in TEARS indicates fragmentation of the peroxides and conjugation offonned aldehydes with proteins under the formation of more stable Schiff bases and their secondary reaction products, e.g. lipofuscin. Irradiated POS also showed a strong granular yellow auto-fluorescence. RPE cell cultures, kept at 21 % ambient oxygen, were fed daily for 3, 5 or 7 days with either UVperoxidised POS, native POS or culture medium only. RPE cells fed irradiated POS showed significantly higher levels of lipofuscin-specific autofluorescence compared to cells exposed tonativePOS after 3 days, 5 days and 7 days and to the non-exposed control cells. The lipofuscin content of ce11s exposed to irradiated POS increased significantly between days 3 and 7. Ultrastructural studies showed much more numerous and larger lipofuscin-like inclusions in RPE cells fed irradiated POS compared to cells exposed to native POS. In the control cells, lipofuscin-like granules were small and sparse. It appears that exposing RPE cells to previously peroxidised POS, thus artificially converted into lipofuscin-like material and obviously not digestible by the lysosomal enzymes, accelerates the fonnation of severely lipofuscin-loaded cells.

    A well-known physical property of lipofuscin is its yellowish autofluorescence when irradiated by blue light. Such energy transformation is known to induce photo-oxidative processes since oxygen present in the immediate surroundings would be activated into reactive oxygen metabolites. RPE cells are constantly exposed to visible light during the time the subject is awake. Consequently, in RPE cells exposed to light, the membranes of the lysosomes surrounding enclosed lipofuscin would be subjected to oxidative stress, which may result in damage, with leakage to the cytosol of lysosomal hydrolytic enzymes and ensuing cellular degeneration.

    To test this hypothesis, cultures of heavily lipofuscin-loaded RPE cells were blue-lightirradiated and compared to relevant controls. Following irradiation, lysosomal membrane stability was measured by vital staining with the lysosomotropic weak base, and metachromatic fluorochrome, acridine orange (AO). Quantifying red (high AO concentration within intact lysosomes with preserved proton gradient over their membranes) and green fluorescence (low AO concentration in nuclei, damaged lysosomes with decreased or lost proton gradients, and in the cytosol) allowed an estimation of the lysosomal membrane stability. Cellular viability was estimated with the delayed trypan blue dye exclusion test. Lipofuscin loaded blue-lightexposed RPE cells showed a considerably enhanced loss of both lysosomal stability and viability when compared to control cells. It is concluded that the accumulation of lipofuscin within secondary lysosomes of RPE sensitizes these cells to blue light by inducing photo oxidative alterations of their lysosomal membranes resulting in a presumed leakage of lysosomal contents to the cytosol with ensuing cellular degeneration of apoptotic type.,

    The aim of the last investigation was to study whether heavy loading with lipofuscin of RPE lysosomes would affect the further phagocytic ability of the cells.

    In the first section of the investigation, cultures of rabbit RPE cells were exposed daily to bovine UV-irradiated POS for 4 weeks, resulting in a pronounced lipofuscin accumulation of the cells. Fluorescent latex beads (labelled with a red fluorophore) were added to unloaded control cultures at 0 and 4 weeks after their establishment, and to lipofuscin loaded cells after 4 weeks of feeding with artificial lipofuscin. Cellular amounts of lipofuscin, and their phagocytotic activity, were quantified by static fluorometry measuring lipofuscin-specific and red bead-specific fluorescence, respectively. Unloaded, and thus almost lipofuscin-free, control cells exposed to latex beads showed numerous cytoplasmic particles emitting reddish fluorescence, while few particles were taken up by cells initially loaded with artificial, POSderived, lipofuscin. Measurement of the latex bead-specific fluorescence showed significantly higher levels in unloaded control cells than in lipofuscin-loaded ones.

    In the second part of the investigation, unloaded control cultures and lipofuscin-loaded cultures were exposed to native bovine Texas Red-X-labelled POS 4 weeks after the establishment of the cultures. Unloaded control cells showed a large number of cytoplasmic POS emitting reddish fluorescence, while fewer POS were fagocytosed by cells loaded with artificial lipofuscin. Measurement of the Texas Red-X-specific fluorescence, thus quantifying the fagocytic ability of the cells, showed significantly higher levels in control cells than in lipofuscin-loaded ones. Severe lipofuscin accumulation of RPE cells appears to result in a greatly decreased phagocytic capacity.

    The suggested mechanisms may be of relevance in the pathogenesis of ARMD.

  • 147425.
    Wiholm, Clairy
    Uppsala universitet, Medicinska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Advanced Knowledge Work and Stress-related Symptoms: Epidemiology and Clinical Intervention Studies2006Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Well educated knowledge workers are a growing group of the work force. Little research has been conducted on this group regarding possible work-related health symptoms, as well as interventions in order to reduce work-related stress. This thesis describes the current work-related symptoms and potential risk and salutogenic, i.e. protective factors, associated with these symptoms among software and system designers in a high tech company in Sweden. A stress management intervention program was launched in order to evaluate whether work-related stress might be a risk factors for these symptoms. It was also of interest to study the potential impact of stress management interventions on psychosocial work organizational factors.

    The thesis is based on cross sectional and longitudinal data. Paper I is focusing on risk factors for musculoskeletal symptoms and headaches, and their possible association with biological markers and self-reported physical and psychosocial work environmental factors. Paper II assessed the association between occupational psychosocial factors and psychosomatic symptoms i.e. mental fatigue, headache, restlessness, irritation, moodiness and difficulty concentrating. Paper III and IV evaluated the effects of a stress management program including three different stress reducing strategies, on musculoskeletal and skin symptoms as well as headaches, and on the perceived psychosocial work environment.

    The overall results indicate that psychosocial factors via stress sensitive hormones have an impact on employee health in a high technological work environment. Furthermore, stress management interventions, conducted as relaxation and mental training, had short-term favorable effects on some musculoskeletal and skin symptoms. It seems that competence and competence utilization among advanced knowledge workers are psychosocial work environmental factors that need to be take into consideration in future health preventive ventures.

  • 147426.
    Wiholm, Clairy
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Arnetz, Bengt B.
    Stress management and musculoskeletal disdsorders in knowledge workers: The possible mediating effects of stress hormones2006Inngår i: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 8, nr 1, s. 5-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Psychosocial stressors have been reported to be a risk factor for musculoskeletal symptoms (MSS) in modern offices. The exact mechanisms are not known but there are two theories. One concerns mentally induced muscle tension, and the other concerns impact on muscle fibers from stress hormones. To date, there have been only descriptive studies and short-term studies of the possible role of stress in the etiology of MSS symptoms. Furthermore, none have involved hormonal end-points and the use of a prospective and controlled design. The aims of this study were to (i) assess the possible impact on MSS (in neck and back/lower arm, respectively) from structured stress management programs, and (ii) determine the possible mediating role of stress hormones in linking stress and MSS symptoms. The subjects were telecommunications systems design engineers. Participants responded to a standardized questionnaire on MSS. Each subject also responded to a comprehensive questionnaire on psychosocial and physical work environments. Blood samples were collected as well, in order to measure possible changes in the psychobiological markers. Half of the subjects participated in one of three stress management programs (n=66), while the other half functioned as a reference group (n=50). Stress management significantly reduced lower-arm symptoms during the active training period of the study. There was an interaction between higher testosterone levels and stress management on the one hand and lower-arm symptoms on the other. No remaining effects on lower-arm symptoms were seen at the 5-month follow-up after the formal training was terminated. Results suggest that stress management might be beneficial for certain types of MSS in the short term, with active coaching from a group leader. There is support for theories suggesting that stress-sensitive hormones have a role in linking stress to MSS.

  • 147427. Wiholm, Clairy
    et al.
    Lowden, Arne
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Kuster, Niels
    Hillert, Lena
    Arnetz, Bengt B
    Akerstedt, Torbjörn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Moffat, Scott D
    Mobile phone exposure and spatial memory.2009Inngår i: Bioelectromagnetics, ISSN 1521-186X, Vol. 30, nr 1, s. 59-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Radiofrequency (RF) emission during mobile phone use has been suggested to impair cognitive functions, that is, working memory. This study investigated the effects of a 2 1/2 h RF exposure (884 MHz) on spatial memory and learning, using a double-blind repeated measures design. The exposure was designed to mimic that experienced during a real-life mobile phone conversation. The design maximized the exposure to the left hemisphere. The average exposure was peak spatial specific absorption rate (psSAR10g) of 1.4 W/kg. The primary outcome measure was a "virtual" spatial navigation task modeled after the commonly used and validated Morris Water Maze. The distance traveled on each trial and the amount of improvement across trials (i.e., learning) were used as dependent variables. The participants were daily mobile phone users, with and without symptoms attributed to regular mobile phone use. Results revealed a main effect of RF exposure and a significant RF exposure by group effect on distance traveled during the trials. The symptomatic group improved their performance during RF exposure while there was no such effect in the non-symptomatic group. Until this new finding is further investigated, we can only speculate about the cause.

  • 147428.
    Wiholm, Clairy
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Lowden, Arne
    Kuster, Niels
    Hillert, Lena
    Arnetz, Bengt B
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Åkerstedt, Torbjörn
    Moffat, Scott D
    Mobile phone exposure and spatial memory2009Inngår i: Bioelectromagnetics, ISSN 0197-8462, E-ISSN 1521-186X, Vol. 30, nr 1, s. 59-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Radiofrequency (RF) emission during mobile phone use has been suggested to impair cognitive functions, that is, working memory. This study investigated the effects of a 2 1/2 h RF exposure (884 MHz) on spatial memory and learning, using a double-blind repeated measures design. The exposure was designed to mimic that experienced during a real-life mobile phone conversation. The design maximized the exposure to the left hemisphere. The average exposure was peak spatial specific absorption rate (psSAR10g) of 1.4 W/kg. The primary outcome measure was a "virtual" spatial navigation task modeled after the commonly used and validated Morris Water Maze. The distance traveled on each trial and the amount of improvement across trials (i.e., learning) were used as dependent variables. The participants were daily mobile phone users, with and without symptoms attributed to regular mobile phone use. Results revealed a main effect of RF exposure and a significant RF exposure by group effect on distance traveled during the trials. The symptomatic group improved their performance during RF exposure while there was no such effect in the non-symptomatic group. Until this new finding is further investigated, we can only speculate about the cause.

  • 147429. Wiholm, Clairy
    et al.
    Richter, Hans O.
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Mathiassen, Svend Erik
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Toomingas, Allan
    Associations between eyestrain and neck-shoulder symptoms among call centre operators2007Inngår i: Scandinavian Journal of Work, Environment & Health, ISSN 0356-6528, nr Suppl. 3, s. 54-59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Few if any studies have investigated if eyestrain and shoulder-neck symptoms are correlated, although functional links could be expected on the basis of neurophysiological evidence. The present cross sectional study assessed correlations between self-reported eye strain and shoulder-neck symptoms among call centre workers, controlling for possible confounders for these ailments. A questionnaire concerning socioeconomic background, work conditions and symptoms was mailed to 1531 employees at 28 different call centers during the years 2001- 2003. Twenty-one percent of responding subjects (N = 1162) reported both eyestrain and neck shoulder symptoms, 46% reported neck/shoulder and 6 % eye symptoms. 46% were free from symptoms in these regions. A significant positive association was found between eyestrain and neck/shoulder symptoms. Significant covariates for shoulder-neck disorders were eyestrain (OR = 1.6 p = 0.007), gender (to be female) (OR 1.9, p < 0.001, irritation index (OR 1.2, p =0.03), and feeling stressed (OR 1.2, p = 0.001. In a multi-nominal regression analysis gender (female) (OR = 1.9, p = 0.002), feeling stressed (OR 1.3, p = 0.002), feelings of distress (OR = 1.7, p < 0.001), computer problems (OR 1.3, p = 0.002)) and social support (OR 0.6, p = 0.003) remained in the model for the eye/neck symptoms. The results from this study support an association between self-reported combined eyestrain and shoulder-neck symptoms. However no causal relations can be derived due to the cross-sectional design.

  • 147430.
    Wiiand, Tilda
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Lidholm, Anna
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Framgångsfaktorer på nationella idrottsutbildningar inom handboll: en kvalitativ studie av elevernas utvecklingsmiljö ur ett handbollslärarperspektiv2017Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Syfte och frågeställningar

    Syftet med denna uppsats är att undersöka vad handbollslärare som undervisar i specialidrott på nationella idrottsutbildningar (NIU) inom handboll anser om sin påverkan på elevernas utveckling. För att uppnå uppsatsens syfte har följande frågeställningar formulerats:

    • Hur beskriver handbollslärarna utvecklingsmiljön på Sveriges NIUhandbollsgymnasium?
    • På vilket sätt finns Henriksens omarbetade framgångsfaktorer representerade i elevernas utvecklingsmiljö?

    Metod

    Handbollslärarnas syn på elevernas utvecklingsmiljö undersöks med hjälp av en kvalitativ metod. Insamlingen av data sker i form av semistrukturerade intervjuer där målet är att komma mer på djupet kring ämnet för att få svar på uppsatsens frågeställningar. Intervjuerna genomfördes via telefon för att kunna nå handbollslärare över hela landet. Urvalsgruppen bestod av fem manliga handbollslärare som är anställda vid olika NIU- handbollsgymnasier i Sverige.

    Resultat

    Resultatet i uppsatsen visar en varierande utvecklingsmiljö. Elevantal, kommunikation mellan skola och klubb, avsaknad av förebilder är några av de bristfälliga områden som lärarna anser utvecklas. En stark idrottskultur har visats sig vara betydande för både skolan och kommunen gällande utvecklingsmiljön.

    Slutsatser

    Slutsatserna som kan dras av denna uppsats är att handbollslärare på NIUhandbollsgymnasium ser utvecklingsmiljön som framgångsrik, men de är överens om att det finns utvecklingsmöjligheter. De anser att framgångsfaktorerna förebilder och integrationsarbete med klubbtränare är bristfällig och bör prioriteras för att optimera elevernas utvecklingsmiljö.

  • 147431. Wiig, E H
    et al.
    Annas, P
    Basun, H
    Andreasen, N
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Zetterberg, H
    Blennow, K
    Minthon, L
    The stability of AQT processing speed, ADAS-Cog and MMSE during acetylcholinesterase inhibitor treatment in Alzheimer's disease2010Inngår i: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404, Vol. 121, nr 3, s. 186-193Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To explore the longitudinal stability of measures of cognition during treatment with acetylcholinesterase inhibitors (AchEI) in patients with Alzheimer's disease (AD). MATERIALS AND METHODS: Cognitive status was measured in a cohort of 60 patients at 6 months after initiation of treatment with AchEI (baseline) and after an additional 6 months of treatment (endpoint). A Quick Test of Cognitive Speed (AQT), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and MMSE were administered concurrently. RESULTS: Correlations (rho) between age and AQT processing speed were non-significant, but were significant for ADAS-Cog and Mini Mental State Examination (MMSE). AQT and ADAS-Cog means did not differ significantly between baseline and endpoint. There was a small, significant reduction in MMSE point scores. Measures of stability (Spearman's rho) were moderate-to-high for all tests. Means for subgroups did not differ as a function of medication type. CONCLUSIONS: AQT processing speed, ADAS-Cog, and MMSE measures proved stable during the second 6 months of treatment with AChEI.

  • 147432.
    Wiig, M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Handkirurgi.
    Olmarker, K.
    Hakansson, J.
    Ekstrom, L.
    Nilsson, E.
    Mahlapuu, M.
    A lactoferrin-derived peptide (PXL01) for the reduction of adhesion formation in flexor tendon surgery: an experimental study in rabbits2011Inngår i: Journal of Hand Surgery (European Volume), ISSN 1753-1934, Vol. 36E, nr 8, s. 656-662Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Injuries to flexor tendons can lead to loss of finger function after healing due to adhesion formation. The aim of this study was to assess the efficacy and safety of the new peptide, PXL01, in the prevention of peritendinous adhesions. The effect of a single intraoperative administration of PXL01 in sodium hyaluronate on mobility of the affected digit after surgery was assessed in a rabbit model by measuring total active motion, metatarsophalangeal-claw distance and resistance to bending the digits. Load-to-failure testing was done in the same specimens to assess tendon healing. The results demonstrated that a single application of PXL01 in sodium hyaluronate significantly improved mobility of the treated digits compared with the digits in which the same surgery was carried out but no treatment was provided. No negative effects on tendon healing were observed in connection with the treatment.

  • 147433.
    Wiig, Monica E.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Handkirurgi.
    Dahlin, Lars B.
    Friden, Jan
    Hagberg, Lars
    Larsen, Soren E.
    Wiklund, Kerstin
    Mahlapuu, Margit
    PXL01 in Sodium Hyaluronate for Improvement of Hand Recovery after Flexor Tendon Repair Surgery: Randomized Controlled Trial2014Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, nr 10, s. e110735-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Postoperative adhesions constitute a substantial clinical problem in hand surgery. Fexor tendon injury and repair result in adhesion formation around the tendon, which restricts the gliding function of the tendon, leading to decreased digit mobility and impaired hand recovery. This study evaluated the efficacy and safety of the peptide PXL01 in preventing adhesions, and correspondingly improving hand function, in flexor tendon repair surgery. Methods: This prospective, randomised, double-blind trial included 138 patients admitted for flexor tendon repair surgery. PXL01 in carrier sodium hyaluronate or placebo was administered around the repaired tendon. Efficacy was assessed by total active motion of the injured finger, tip-to-crease distance, sensory function, tenolysis rate and grip strength, and safety parameters were followed, for 12 months post-surgery. Results: The most pronounced difference between the treatment groups was observed at 6 months post-surgery. At this timepoint, the total active motion of the distal finger joint was improved in the PXL01 group (60 vs. 41 degrees for PXL01 vs. placebo group, p = 0.016 in PPAS). The proportion of patients with excellent/good digit mobility was higher in the PXL01 group (61% vs. 38%, p = 0.0499 in PPAS). Consistently, the PXL01 group presented improved tip-to-crease distance (5.0 vs. 15.5 mm for PXL01 vs. placebo group, p = 0.048 in PPAS). Sensory evaluation showed that more patients in the PXL01 group felt the thinnest monofilaments (FAS: 74% vs. 35%, p = 0.021; PPAS: 76% vs. 35%, p = 0.016). At 12 months post-surgery, more patients in the placebo group were considered to benefit from tenolysis (30% vs. 12%, p = 0.086 in PPAS). The treatment was safe, well tolerated, and did not increase the rate of tendon rupture. Conclusions: Treatment with PXL01 in sodium hyaluronate improves hand recovery after flexor tendon repair surgery. Further clinical trials are warranted to determine the most efficient dose and health economic benefits.

  • 147434.
    Wiig, Siri
    et al.
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Aase, Karina
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    von Plessen, Christian
    Department of Health Studies, University of Stavanger, N-4036 Stavanger, Norway.
    Burnett, Susan
    Imperial College, London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK.
    Nunes, Francisco
    ISCTE, Lisboa, Instituto Superior de Ciências do Trabalho e da Empresa (ISCTE), Av.ª das Forças Armadas, Lisbon 1649-026, Portugal.
    Weggelaar, Anne Marie
    Department of Health Policy and Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
    Andersson-Gäre, Boel
    Högskolan i Jönköping, Hälsohögskolan, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd.
    Calltorp, Johan
    Högskolan i Jönköping, Hälsohögskolan, The Jönköping Academy for Improvement of Health and Welfare.
    Fulop, Naomi
    Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
    Talking about quality: exploring how ‘quality’ is conceptualized in European hospitals and healthcare systems2014Inngår i: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, nr 478, s. 1-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study.

    METHODS:

    This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics).

    RESULTS:

    The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient-centered care, enough time to talk with patients). Conceptualization varied between micro systems depending on the type of services provided.

    CONCLUSION:

    The quality conceptualization differed across system levels (macro-meso-micro), among professional groups (nurses, doctors, managers), and between the studied micro systems in our ten sampled European hospitals. This entails a managerial alignment challenge translating macro level quality definitions into different local contexts.

  • 147435.
    Wiik, Benedicte P.
    et al.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Larstorp, Anne C.K.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Höieggen, Aud
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Kjeldsen, Sverre E.
    Department of Cardiology and Department of Nephrology, Oslo University Hospital, Norway.
    Hecht Olsen, Michael
    The Cardiovascular Research Unit, Cardiology Section, Department of Internal Medicine, Glostrup University Hospital, Glostrup, Denmark.
    Ibsen, Hans
    Division of Cardiology, Holbaek Hospital, Holbaek, Denmark.
    Lindholm, Lars H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Dahlöf, Björn
    Department of Medicine, Sahlgrenska University Hospital/östra, Göteborg, Sweden.
    Devereux, Richard B.
    Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
    Okin, Peter M.
    Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
    Wachtell, Kristian
    The Heart Center, Rigshospitalet, Copenhagen, Denmark.
    Serum uric acid is associated with new-onset diabetes in hypertensive patients with left ventricular hypertrophy: The LIFE study2010Inngår i: American Journal of Hypertension, ISSN 0895-7061, Vol. 23, nr 8, s. 845-851Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    It is unclear whether serum uric acid (SUA) is associated with development of new-onset diabetes (NOD) in patients with hypertension and left ventricular hypertrophy (LVH). The aim of the present investigation was to test the hypothesis that SUA predicts development of NOD in these patients.

    Methods

    In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, a double-masked, parallel-group design, 9,193 patients with hypertension and electrocardiographic LVH were randomized to losartan- or atenolol-based antihypertensive treatment and followed for a mean of 4.9 years. At baseline, 7,489 patients with available SUA measurements did not have diabetes mellitus and were thus at risk of its development during the study. We used Cox regression analyses to investigate whether SUA predicted development of NOD.

    Results

    NOD developed in 522 of 7,489 patients. The association between baseline SUA and development of NOD was significant (hazard ratio (HR) 1.29 per s.d. (1.3 mg/dl), 95% confidence interval (CI) 1.18–1.42, P < 0.001) after adjustment for treatment with losartan vs. atenolol, baseline serum glucose, urinary albumin/creatinine ratio, estimated glomerular filtration rate and Framingham risk score, time-varying systolic and diastolic blood pressure, and time-varying LVH by Cornell voltage-duration product and Sokolow–Lyon voltage. In parallel analyses, baseline quartiles of SUA were significantly associated with increasing NOD (HR 1.28, 95% CI 1.18–1.40, P < 0.001). Time-varying SUA was also associated with NOD (HR 1.10 per s.d. [1.3 mg/dl], 95% CI 1.02–1.19, P = 0.015).

    Conclusion

    Our analysis suggests that SUA is an independent risk marker for NOD in hypertensive patients with LVH.

  • 147436. Wiik, G. B.
    et al.
    Andreassen Devik, Siri
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Hellzen, Ove
    Don’t become a burden and don’t complain: a case study of older persons suffering from incurable cancer and living alone in rural areas2011Inngår i: Nursing Reports, ISSN 2039-439X, E-ISSN 2039-4403, Vol. 1, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The majority of older people wish to continue to live at home for as long as possible. As a consequence, the healthcare system, including cancer care, is located in urban areas and people living in rural areas must commute to gain access to the services offered. The aim of this study was to investigate how older people, who live on their own, experience living with incurable cancer and commuting for palliative care in rural Norway. A case study was designed and informants were recruited not because they were typical but because they were deemed to have the potential to contribute to knowledge about the phenomenon of being an older person who has been diagnosed with incurable cancer and lives alone in a rural area. Three major categories were identified: “Hovering between hope and fear, Stressful commuting to palliative care, and Being exhausted. The findings indicated that older people who have been stricken with incurable cancer and who live alone in rural areas have to walk the palliative path alone. A common feature of all the informants is that they do not speak out and they do not complain. Even though the trend in healthcare is towards centralized treatment, shorter and more effective stays in hospital, and policlinic (policlinic services are a place where healthcare services can be accessed without the need for an overnight stay in hospital, usually such clinics are located close to a hospital) treatment and care, not all older persons manage to take care of themselves. The findings suggest that nurses should pay more attention to these patients’ needs for care at different levels of the healthcare service.

  • 147437.
    Wiik, Lisa
    Mälardalens högskola, Institutionen för samhälls- och beteendevetenskap.
    Fysisk aktivitet i skolan: -till nytta eller nöje?2007Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Syftet med examensarbetet är att undersöka vad och på vilket sätt lärare använder sig av fysisk aktivitet som pedagogisk metod i den ordinarie undervisningen, vad barn lär sig av att utöva fysisk aktivitet i klassrummet samt om lärare känner till läroplanens mål. Studien grundar sig på kvalitativ metod och har genomförts med hjälp av tio enkäter med öppna frågor och en semistrukturerad intervju. Undersökningen har genomförts på tre olika skolor. Resultaten visar att det är viktigt för barns utveckling att det finns inslag av rörelse för dem varje skoldag. Genom att använda fysisk aktivitet får barnen bland annat en ökad självkänsla, ökad koncentration och koordination. Samtliga lärare använder sig i olika utsträckning av den fysiska aktiviteten i klassrummet, bl.a. rörelseramsor, sånglekar, RÖRIS (Friskis och svettis rörelseprogram) och rörelse i de olika ämnena, men alltför få känner till vad som står i läroplanen.

  • 147438.
    Wiik, Richard
    KTH, Skolan för teknik och hälsa (STH), Hälso- och systemvetenskap, Ergonomi.
    Stöd av kommunikation inom distansguidning av ERCP: Applicering av ett MTO-perspektiv tillsammans med ett tjänstedesignsverktyg2016Independent thesis Advanced level (degree of Master (One Year)), 40 poäng / 60 hpOppgave
    Abstract [sv]

    ERCP är ett komplicerat invärtes kirurgisk ingrepp som genomförs med hjälp av endoskopi. ERCP-avdelningen vid Karolinska Universitetssjukhuset tog tidigare ofta emot patienter från ERCP-avdelningen på Visby på grund av operationens förväntade svårighet. Nu har de istället sedan en tid tillbaka givit distansguidning under pågående operationen till ERCP i Visby. Distansguidningen skapar ett virtuellt team som ger nya mänskliga, tekniska och organisatoriska utmaningar.

    Syftet med denna studie var tvåfaldigt: det ena att fördjupa kunskapen i hur ett MTO-perspektiv tillsammans med ett tjänstedesignsverktyg kunde appliceras på det specifika fallet, det andra var att svara på hur utvalda faktorer som är kritiska för fysiskt åtskilda teams stöddes och hämmades i den valda fallstudien.

    En observation- och intervjustudie med hjälp av tjänstedesignsverktyget Blueprint utfördes med involverade personer för distansguidningen med efterföljande tematiskt analys av transkriberad data. Utfallet av analys belyser tekniska svårigheter och ett lärlingssystem mellan kirurgerna utanför distansguidningens av ERCP organisatoriska kontroll som är viktig för det virtuella teamets personliga relationer, tillit och kultur. En diskussion förs ur ett mänskligt, tekniskt och organisatoriskt perspektiv.

    Kombinationen av MTO och tjänstedesign fungerade för denna fallstudie och kan vara en kraftfull kombination. Dock anses studiens utförande kunna optimeras för att bättre integrera de två och utnyttja tjänstedesignsverktyget Blueprint ytterligare. Lärdomar i hur detta kan göras i framtida studier beskrivs.

  • 147439.
    Wiitavaara, Birgitta
    Umeå universitet, Medicinsk fakultet, Omvårdnad.
    Balancing intrusive illness: the experiences of people with musculoskeletal problems2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings.

    The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires.

  • 147440.
    Wiitavaara, Birgitta
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Balancing intrusive illness: the experiences of people with musculoskeletal problems2007Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The overall aim of the present thesis was to explore and describe the health experiences of men and women with musculoskeletal problems. The specific aims of the four papers were: (I) to explore the experience of illness and wellness among ambulance personnel with musculoskeletal symptoms; (II) to explore the experience of illness and wellness among female health care personnel with musculoskeletal symptoms; (III) to explore the experience of bodily illness among people with musculoskeletal problems in the neck-shoulder region, and; (IV) to investigate the symptoms described by people with non-specific neck-shoulder problems, to investigate the method of development of neck-shoulder questionnaires that assesses pain and other symptoms, to analyse the content and items of these questionnaires, and to compare the findings.

    The overall findings show that the occupationally active men and women with MSDs were “striving for balance” (I-II), that the disease course of chronic neck-shoulder disorders was characterised by “uncontrollable fluctuations” (III), and that most neck-shoulder questionnaires had a low correspondence to the variety of symptoms experienced during this course (IV). In the process of striving for balance (I-II), the informants’ health experiences were not a state of either wellness or illness, but of both, in varying degrees at different times. The balancing started when illness became too intrusive, and was a process of minimising the impact of illness by accepting and handling it, while attaining and maintaining wellness to feel well enough. When striving for balance, the interviewees kept on working to continue being nurtured at the same time as they made different efforts directed at minimising the impact of their illness. For both men and women, illness was characterised by disembodiment, vulnerability, and exhaustion. The illness experiences were counterbalanced by wellness, where some differences could be recognised between the men and the women. Study III further explored the experiences of bodily illness, focusing on people with chronic musculoskeletal disorders in the neck-shoulder region. The course of the disorder was described as characterised by uncontrollable fluctuations, and it usually developed from insidious symptoms to a state of constant discomfort. The participants experienced calmer periods during the course, but intermittent events of increasing illness were always lying in wait, with periodic moments of consuming intensity. In the interviews included in study IV a variety of symptoms were expressed, which indicated a bodily, mental, and emotional engagement, which included more general and more severe symptoms than are usually related to neck-shoulder disorders. Few of the questionnaires were developed using the experiences of the affected. Taken as a whole, did the questionnaires cover many of the symptoms of the interviewees, but each individual questionnaire only included a few. The fluctuations and nuances of symptoms were rarely considered. The correspondence between individual questionnaires and the experiences of those affected was most often low. This thesis reveals other aspects of health than just bodily experiences as important among occupationally active people with MSDs. It also provides a description of the disease course, and an indication of possibilities for improvement of neck-shoulder questionnaires

  • 147441.
    Wiitavaara, Birgitta
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Health as balance: illness and wellness among persons with musculoskeletal disorders2006Inngår i: 5th Global Conference Making Sense Of: Health, Illness and Disease, 2006Konferansepaper (Fagfellevurdert)
    Abstract [en]

    Musculoskeletal disorders is a condition mostly approached from an out-side perspective and with quantitative methodology. This paper presents health experiences of men with musculoskeletal problems, explored through narrative interviews and constant comparative analysis. As there is a need for further research concerning people with early musculoskeletal symptoms, we turned to persons still active in working life. Ten men working as ambulance personnel were interviewed about their health experiences.

    The analysis revealed a process of striving for balance between experiences of illness and wellness. The informants’ health experiences were not a state of either wellness or illness but both, in varying degrees at different times. The process of striving for balance started when the illness experience became too intrusive, and was a process of both minimising the impact of illness by accepting and handling it and attaining and maintaining enough wellness to strike a balance. The state of balance was the experience of feeling “well enough”.

    Illness was characterised by disembodiment, vulnerability, and exhaustion, as the illness experiences incorporated feelings of that the previously silent body made it self heard, of being vulnerable when suffering gets too close and of getting worn out. Those experiences were counterbalanced by wellness, which was nurtured by experiences of relatedness, usefulness, being some one, and by excitement, challenge, and freedom.

  • 147442.
    Wiitavaara, Birgitta
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, CBF. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Well but ill: Lay perspectives on health among people with musculoskeletal disorders.2012Konferansepaper (Fagfellevurdert)
    Abstract [en]

    This study departs from questions arisen in previous interview studies of health experiences with people with musculoskeletal disorders. During data collection about health experiences in this group a common comment to the question –“How do you experience your health”? was –“Well, but”…  This awoke our interest to further explore this topic. Thus the aim of present study was to investigate lay perspectives on health among people with musculoskeletal disorders. Semi-structured interviews were performed with 68 women and men with long term (>3 months) musculoskeletal disorders in neck, shoulder and/or low back. All informants were recruited as participants in previous studies on health experiences among people with MSDs (Wiitavaara et al., 2007a, b, 2008, 2009). The informants (39 women and 29 men), were 18-64 years old and most of them were occupationally active in a variety of different occupations. Analysis was performed using qualitative content analysis (Graneheim & Lundman, 2003). The lay perspective on health in this group of people with musculoskeletal problems was perceived as “Having resources and possibilities to lead the life one want”. This theme incorporated three main categories as the informants perceived health to include “A good enough physical and psychological functioning and balance”; “Freedom of action”; and “A positive state of emotion and an enriching social life”. The informants expressed a holistic view of health, encompassing physical, psychological, emotional, as well as social aspects, which can be interpreted from an action theoretical perspective (Nordenfelt, 2007).

  • 147443.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Nursing, Umeå University, Umeå, Sweden.
    Barnekow-Bergkvist, Margareta
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Brulin, Christine
    Department of Nursing, Umeå University, Umeå, Sweden.
    Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems.2007Inngår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 44, nr 8, s. 1379-1390Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration. OBJECTIVES: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms. DESIGN: A qualitative grounded theory approach guided the study in data collection and analysis. SETTINGS: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals. PARTICIPANTS: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages. METHODS: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons. RESULTS: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness. CONCLUSION: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.

  • 147444.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Bengs, Carita
    Sociologiska institutionen, Umeå universitet.
    Brulin, Christine
    Institutionen för omvårdnad, Umeå universitet.
    Lekmannaperspektiv på hälsa bland personer med muskuloskeletala besvär2015Inngår i: Best Practice : Smärta, Vol. 4, nr 10, s. 20-23Artikkel i tidsskrift (Annet vitenskapelig)
  • 147445.
    Wiitavaara, Birgitta
    et al.
    Akademin för hälsa och arbetsliv, Högskolan i Gävle.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lekmannaperspektiv på hälsa bland personer med muskuloskeletala besvär2015Inngår i: Best Practice: Smärta, nr 10, s. 20-23Artikkel i tidsskrift (Fagfellevurdert)
  • 147446.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle.
    Bengs, Carita
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Well, I'm healthy, but… - lay perspectives on health among people with musculoskeletal disorders2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 1, s. 71-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders.

    METHOD: Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis.

    RESULTS: These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want.

    CONCLUSIONS: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies. Implications for Rehabilitation Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.

  • 147447.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbets- och folkhälsovetenskap, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.
    Bengs, Carita
    Sociologiska institutionen, Umeå universitet.
    Brulin, Christine
    Institutionen för omvårdnad, Umeå universitet.
    Well, I'm healthy, but...: lay perspectives on health among people with musculoskeletal disorders2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 1, s. 71-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    urpose: The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders. Method: Semi-structured interviews were performed with 39 women and 30 men, (aged 22–63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis. Results: These people experienced health as “having resources and opportunities to lead the life one wants”. Three categories, “a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life”, illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on “being ill” and “being well” and what makes the difference. Five aspects influenced the dynamics of their health experiences: “body and soul, prognosis, character of symptoms, physical and social activity, and emotional state”. Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want. Conclusions: This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies.

  • 147448. Wiitavaara, Birgitta
    et al.
    Bjorklund, Martin
    Nilsson, Annika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    An initial factor analysis of prominent aspects of health experiences for women with neck-shoulder pain2012Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, nr 11, s. 934-942Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The prospect of adequate comparisons is essential to decide on the effectiveness of different treatments. As there is a lack of unity in choice of questionnaires and included measures concerning musculoskeletal disorders, further investigations based on international recommendations are of interest. The intention of present study was to initiate the development of a clinically useful short-form questionnaire. The aim was to select items that capture prominent health aspects for women with neck-shoulder pain and thereby reduce the number of items to a clinically more convenient amount, and to determine the underlying structure of included items.

    Method: Data were collected in a randomised controlled trial including women with non-specific neck-shoulder pain > 3 months (n = 117). Data collection included three core domains: pain intensity, physical and emotional functioning, and analysis was performed using Principal component analysis, and Varimax rotation.

    Results: The resulting 9-factor solution included interference, solicitous/distracting responses, mood and feelings about self and relations, pain intensity, punishing responses, personal growth, life control, sleep, and appetite (29 items).

    Conclusions: The results will contribute to the development of a reduced battery of questions representing core dimensions. Such questionnaire would lighten the assessment load in the clinic as well as in research.

  • 147449.
    Wiitavaara, Birgitta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Centre for Musculoskeletal Research, University of Gävle, S-801 76 Gävle, Sweden .
    Björklund, Martin
    Centre for Musculoskeletal Research, University of Gävle, Box 7629, S-907 12 Umeå, Sweden ; Alfta Research Foundation, Box 94, S-822 22 Alfta, Sweden.
    Brulin, Christine
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Djupsjöbacka, Mats
    Centre for Musculoskeletal Research, University of Gävle, Box 7629, S-907 12 Umeå, Sweden .
    How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from neck-shoulder disorders?: A content analysis of questionnaires and interviews2009Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, nr 30, s. 1-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants. METHODS: Content analysis of interviews with 40 people with non-specific neck-shoulder pain, and 10 questionnaires used to assess pain and other symptoms in neck-shoulder disorders. RESULTS: The interviews revealed a variety of symptoms indicating a bodily, mental/cognitive, and emotional engagement, and more general and severe symptoms than are usually considered in neck-shoulder questionnaires. Taking all questionnaires together many of the symptoms were considered, but most questionnaires only included a few of them. The informants were able to distinguish fluctuation of symptoms, and a variety of different qualities which were not usually considered in the questionnaires. Only two questionnaires had made use of the opinions of affected people in the development. CONCLUSION: Few of the questionnaires had made use of the experiences of affected people in the development. The correspondence between the symptoms expressed by those affected and the content of the questionnaires was low. A variety of symptoms were expressed by the interviewees, and the participants were also able to distinguish nuances and fluctuations of symptoms. The present study points to the importance of other aspects than just pain and physical functioning as clinical trial outcome measures related to neck-shoulder disorders. To develop a condition-specific questionnaire, it is important to decide on the specific symptoms for the condition. Using the experiences of those affected, in combination with relevant research and professional knowledge, can enhance the validity of the questionnaires.

  • 147450.
    Wiitavaara, Birgitta
    et al.
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Department of Nursing, Ume̊ University, Umeå, Sweden.
    Björklund, Martin
    Högskolan i Gävle, Centrum för belastningsskadeforskning. Alfta Research Foundation, Alfta, Sweden.
    Brulin, Christine
    Department of Nursing, Ume̊ University, Umeå, Sweden.
    Djupsjöbacka, Mats
    Högskolan i Gävle, Centrum för belastningsskadeforskning.
    How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from the disorders?: A content analysis of questionnaires and interviews2009Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 10, nr 1, artikkel-id 30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants. METHODS: Content analysis of interviews with 40 people with non-specific neck-shoulder pain, and 10 questionnaires used to assess pain and other symptoms in neck-shoulder disorders. RESULTS: The interviews revealed a variety of symptoms indicating a bodily, mental/cognitive, and emotional engagement, and more general and severe symptoms than are usually considered in neck-shoulder questionnaires. Taking all questionnaires together many of the symptoms were considered, but most questionnaires only included a few of them. The informants were able to distinguish fluctuation of symptoms, and a variety of different qualities which were not usually considered in the questionnaires. Only two questionnaires had made use of the opinions of affected people in the development. CONCLUSIONS: Few of the questionnaires had made use of the experiences of affected people in the development. The correspondence between the symptoms expressed by the affected and the content of the questionnaires was low. A variety of symptoms were expressed by the interviewees, and the participants were also able to distinguish nuances and fluctuations of symptoms. The present study points to the importance of other aspects than just pain and physical functioning as clinical trial outcome measures related to neck-shoulder disorders. To develop a condition-specific questionnaire, it is important to decide on the specific symptoms for the condition. Using the experiences of those affected, in combination with relevant research and professional knowledge, can enhance the validity of the questionnaires.

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