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  • 151.
    Crossland, Michael D.
    et al.
    Anglia Ruskin University, UK ; Moorfields Eye Hospital NHS Foundation Trust, UK.
    Silva, Rui S.
    University of Minho, Portugal.
    Macedo, António Filipe
    University of Minho, Portugal.
    Smartphone, tablet computer and e-reader use by people with vision impairment2014In: Ophthalmic & physiological optics, ISSN 0275-5408, E-ISSN 1475-1313, Vol. 34, no 5, p. 552-557Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    Consumer electronic devices such as smartphones, tablet computers, and e-book readers have become far more widely used in recent years. Many of these devices contain accessibility features such as large print and speech. Anecdotal experience suggests people with vision impairment frequently make use of these systems. Here we survey people with self-identified vision impairment to determine their use of this equipment.

    METHOD:

    An internet-based survey was advertised to people with vision impairment by word of mouth, social media, and online. Respondents were asked demographic information, what devices they owned, what they used these devices for, and what accessibility features they used.

    RESULTS:

    One hundred and thirty-two complete responses were received. Twenty-six percent of the sample reported that they had no vision and the remainder reported they had low vision. One hundred and seven people (81%) reported using a smartphone. Those with no vision were as likely to use a smartphone or tablet as those with low vision. Speech was found useful by 59% of smartphone users. Fifty-one percent of smartphone owners used the camera and screen as a magnifier. Forty-eight percent of the sample used a tablet computer, and 17% used an e-book reader. The most frequently cited reason for not using these devices included cost and lack of interest.

    CONCLUSIONS:

    Smartphones, tablet computers, and e-book readers can be used by people with vision impairment. Speech is used by people with low vision as well as those with no vision. Many of our (self-selected) group used their smartphone camera and screen as a magnifier, and others used the camera flash as a spotlight.

  • 152.
    Cruice, Madeline
    et al.
    Division of Language and Communication Science, School of Health Sciences, City University London, London, United Kingdom.
    Blom Johansson, Monica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Isaksen, Jytte
    Department of Language and Communication, University of Southern Denmark, Odense, Denmark.
    Horton, Simon
    School of Health Sciences, University of East Anglia, Norwich, United Kingdom.
    Reporting Interventions in Communication Partner Training: A Critical Review and Narrative Synthesis of the Literature2018In: Aphasiology, ISSN 0268-7038, E-ISSN 1464-5041, Vol. 32, no 10, p. 1135-1166Article in journal (Refereed)
    Abstract [en]

    Background: Communication partner training (CPT) is an umbrella term for a complex behavioural intervention for communications partners (CPs) of people with aphasia (PWA) and possibly PWA themselves, with many interacting components, deployed in flexible ways. Recent systematic reviews (Simmons-Mackie, Raymer, Armstrong, Holland, & Cherney, 2010; Simmons-Mackie, Raymer, & Cherney, 2016) have highlighted the effectiveness of CPT in addressing the skills of conversation partners and the communicative participation of people with aphasia but have suggested that CPT has been variably delivered, with no clear picture of what the essential elements of CPT are and how CPT is expected to achieve its results through hypothesised mechanisms of change (Coster, 2013).

    Aim: This paper aims broadly to consider specification of CPT and describes how CPT has been conducted overall and in relation to treatment recipients. Recommendations for CPT and areas for future research are considered.

    Methods & Procedures: A critical review and narrative synthesis was carried out through: (i) the systematic application of the 12-item TIDieR checklist (Hoffmann et al., 2014) to the 56 studies appraised in the Simmons-Mackie et al. (2010, 2016)) reviews, providing a quantitative overview of the completeness of CPT intervention reporting; and (ii) a qualitative synthesis of the reviewed CPT literature according to TIDieR items.

    Outcomes & Results: Half of the TIDieR checklist items were reported by 71% or more of the studies, and the rest of the items were reported by 0–63% of studies. TIDieR items relating to the treatment (goal, rationale or theory of essential elements, materials and procedures) and provision (provider, mode, timing, dose) were more frequently reported; however, the level of detail provided was often inadequate or incomplete. The interventions were insufficiently specified to enable replication for most of the studies considered. The most infrequently reported items were: name, location, intervention tailoring and modification, and planned and actual intervention adherence/fidelity.

    Conclusion: For a better understanding of an intervention, it is necessary to identify and describe potentially central elements and perhaps especially in complex interventions as CPT, where it is likely also more difficult. Whilst the reviewed CPT studies are on average reporting on slightly more than half of the TIDieR items, they are overall insufficiently detailed. Some items appear easier to report on, whereas other items have not been attended to, are too complex in nature to give a full report on, or simply have not been relevant for the individual study to include.

  • 153.
    Dahlqvist-Edberg, Ulla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Ek, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    Purification of a Ca2+-activated protease from rat erythrocytes and its possible effect on pyruvate kinase in vivo1981In: Biochimica et Biophysica Acta-Enzymology, ISSN 0005-2744, Vol. 660, no 1, p. 96-101Article in journal (Refereed)
    Abstract [en]

    A Ca2+-activated protease with [32P]phosphopyruvate kinase as substrate was purified to about 50% from rat erythrocytes. The purification involved chromatography on Sepharose/Sephadex gels, DEAE-cellulose and (NH4)2SO4 precipitation. The protease required 3.3 mM Ca2+ for full activity. When pyruvate kinase (ATP: pyruvate 2-O-phosphotransferase, EC 2.7.1.40) was purified from erythrocytes incubated with [32P]phosphate it contained 0.5 mol [32P]phosphate/mol enzyme subunit. When 3.3 mM Ca2+ were added at hemolysis this incorporation decreased. The possible importance of this Ca2+-activated protease for the regulation of pyruvate kinase in erythrocytes is discussed.

  • 154.
    Dalal, Koustuv
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lee, Ming-Shinn
    National Dong Hwa University, Hualien, Taiwan.
    Ussatayeva, Gainel
    Kazakhstan School of Public Health, Almaty, Kazakhstan.
    Gifford, Mervyn
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Female genital mutilation: a multi-country study2015In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 4, p. 161-167Article in journal (Refereed)
  • 155.
    Danermark, Berth
    Örebro University, Department of Health Sciences.
    Att (åter)erövra samtalet: en bok om hörselskada och kommunikation2005 (ed. 1)Book (Other academic)
  • 156.
    Danermark, Berth
    et al.
    Örebro University, School of Health and Medical Sciences.
    Coniavitis Gellerstedt, Lotta
    Att höra till: om hörselskadades psykosociala arbetsmiljö2003 (ed. 1)Book (Other academic)
  • 157.
    Danielsson, Ulla
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Betydelse av stöd från familj/vänner vid olika typer av psykoterapeutisk behandling av depression2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Depression är en av de vanligaste orsakerna till ohälsa hos befolkningen världen över, med en livstidsprevalens på 15% för män och upp till 25% bland kvinnor. Det är en allvarlig och smärtsam sjukdom som orsakar mycket lidande både för den sjuke, för familjen och viktiga andra närstående. Genom att få förståelse för att en depression inte enbart drabbar den som är sjuk, finns förmodligen stora vinster att göra. Behandlingstiden kan troligen förkortas och leda till ett mer varaktigt behandlingsresultat om relationen till familj och nätverk undersöks närmare, samt att dessa involveras i behandlingen. Det är inte vanligt att familje/parterapi erbjuds inom vuxenpsykiatrin, utan huvuddelen av behandling vid depression sker individuellt. 

    Syfte/frågeställning: Syftet med denna studie har varit att undersöka om socialt stöd från familj respektive vänner har betydelse för utfall av olika typer av depressionsbehandling (IPT/KBT). 

    Studien har fokuserat på följande frågeställningar: 

    1. Finns det samband mellan upplevt stöd och avbruten behandling? 

    2. Finns det skillnad i hur man upplever det sociala stödet före och efter genomförd behandling inom respektive metod? 

    3. Påverkar upplevelsen av det sociala stödet behandlingsresultatet? 

    4. Är det skillnad i upplevelse av stöd utifrån behandlingsmetod? 

    Metod: Studien bygger på data från en randomiserad behandlingsstudie vid depression där två olika psykoterapeutiska behandlingsmetoder jämförts; IPT och KBT. Totalt omfattar studien 35 IPT-behandlingar och 28 KBT-behandlingar. 

    Resultat: De som upplevde ett gott stöd från familj förbättrades i högre grad i sin depression. Det syns ingen större skillnad i behandlingsutfall utifrån metod. Man kan se en tendens i att ett sämre upplevt socialt stöd ökar risken för att behandlingen avbryts i förtid. 

    Slutsats: Studien ger stöd för att involvera partner/familj i depressionsbehandling.

  • 158.
    Dannapfel, Petra
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Törnvall, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Wressle, Ewa
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Education to Increase Skills in Research Methods among Clinicians in Health Care2017In: Journal of Health & Medical Informatics, ISSN 2157-7420, Vol. 8, no 4Article in journal (Refereed)
    Abstract [en]

    Introduction

    The aim of this study was to evaluate participants’ and managers’ experience of the design and content of an education programme. The Knowledge to Action (KTA) framework was applied to identify the steps of knowledge creation and action in the education programme.

    Methods

    Data were collected from 18 participants representing two groups: participants in the intervention and supervisors and managers. Two focus groups took place: two with participants in the intervention (4 and 3 in each) and one with eleven managers.

    Results

    All steps in the KTA framework were identified and discussed from several aspects. The importance of selecting projects that were relevant and added value in their clinics was mentioned by all participants. The participants also mentioned that after the education, they had further understanding and increased skills in how to be active and perform continuous improvement projects. The step in the KTA process regarding how to adapt knowledge to local context was not discussed explicitly by the participants or managers.

    Discussion

    Education in research methods and performing improvement projects to develop the clinic creates a more positive attitude to working with continuous improvement. The participant’s self-esteem and knowledge increased regarding how to work with improvements. It is important to have the manager’s support to perform a project. Emphasis was on knowledge inquiry and synthesis and presenting the results with or without possible solutions. The participants and managers talked about barriers and knowledge use more generally and at an organizational level. This means that the participants did not gain the last bit of nowledge needed to put the action into practice. This implies that the problem regarding lack of implementation skills in health care might remain.

  • 159.
    Davidsson, Magnus
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Herpes Simplex Typ1: Ofarlig infektion eller åkomma som ger komplikationer2012Student paper other, 5 credits / 7,5 HE creditsStudent thesis
  • 160. Davoody, Nadia
    et al.
    Koch, Sabine
    Krakau, Ingvar
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet.
    Supporting Self-care and Collaboration in Stroke Care through Information andCommunication Technology2012In: Quality of Life through Quality of Information, 2012Conference paper (Other academic)
  • 161. Davoody, Nadia
    et al.
    Woldemariam, Yamrotsow
    Hägglund, Maria
    Health Informatics Centre, Karolinska Institutet.
    Stroke patients’ post-discharge information needs and actual information provision2014Conference paper (Other academic)
  • 162. de Alwis, M. P.
    et al.
    Lo Martire, R.
    Äng, Björn
    Garme, K.
    Development and validation of a web-based questionnaire for surveying the health and working conditions of high-performance marine craft populations2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 6, p. e011681-Article in journal (Refereed)
  • 163.
    Diderholm, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Perinatal energy metabolism with reference to IUGR & SGA: Studies in pregnant women & newborn infants2009In: Indian Journal of Medical Research (IJMR), ISSN 0971-5916, Vol. 130, no 5, p. 612-617Article, review/survey (Refereed)
    Abstract [en]

    Glucose is the most important fetal energy substrate. During the third trimester increased maternal glucose production and insulin resistance improves fetal glucose availability. Maternal malnutrition, chronic disease and/or placental dysfunction can disturb glucose delivery, resulting in intrauterine growth restriction (IUGR) and an infant born small for gestational age (SGA). Hypoglycaemia is a problem frequently occurring in infants born SGA; they are also at long-term risk of developing insulin resistance. In the studies presented, energy substrate production was investigated using stable isotope dilution technique, in normal pregnancies and pregnancies complicated by intrauterine growth restriction (IUGR). In addition energy substrate production in infants born SGA was studied on their first day of life. We found that late pregnancy was associated with an almost twofold increase in rate of lipolysis. This provides substrates for maternal energy metabolism, sparing glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late gestation, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Data on insulin and IGFBP-1 in the SGA infants indicate that insulin sensitivity is increased peripherally but reduced in the liver.

  • 164.
    Digas, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Om man vandrar i andras skor kan man förstå var de klämmer: Therapeutic Assessment with Children (TA-C) i kombination med familjeterapi -         ett alternativ till dagens barnpsykiatriska utredningar?2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [ar]

    Therapeutic Assessment with Children (TA-C) är en utrednings- och behandlingsmetod som på ett uttalat och strukturerat sätt tar med familjen och barnet under hela utredningen för att fånga underliggande strukturer som bidrar till beteenden. Utredning och behandling flätas in i varandra. Denna kombination väckte mitt intresse till att närmare undersöka denna relativt nya metod genom att inom ramen av detta arbete, utreda en familj som jag hade haft en fungerande kontakt med.

     

    Utvärderingen med föräldrarna visade att de främst uppskattade möjlighet att få vara med under alla delar av utredningen. Testsituationerna blev synliga då föräldrarna tillsammans med familjeterapeut observerade barnet och psykologen bakom en enväggsspegel och kopplade det som hände i testrummet till vardagssituationer. Föräldrarna var kollaboratörer, observatörer och tolkare av de psykologiska testen tillsammans med utredarna. Detta sätt att utreda bidrog till ny förståelse och ökad nyfikenhet hos familjen. Föräldrarna som de själva beskrev det ”växte långsamt in i processen” och utvecklade en berättelse om sitt barn som var mer överensstämmande och användbar för att skapa mer positiva och framgångsrika sätt att interagera med barnet. Utifrån mina tidigare erfarenheter av att använda utredningsmetoden TA-C i kombination med familjeterapi och denna utredning så anser jag att det finns många anledningar till att involvera föräldrarna i utredningarna.

     

    Vår hypotes utifrån studiet är att metoden skulle kunna tillämpas i familjer med social problematik där flera instanser är inkopplade och då man inte kommer vidare i behandlingsarbetet. Det krävs då erfarna terapeuter som dels har en familjeterapeutisk utbildning och dels att psykolog har fördjupad utbildning i TA-C metoden. Det finns många frågor som behöver undersökas närmare och vi rekommenderar varmt fortsatt forskning i utredningsmetoden.

     

  • 165.
    Dinic, Jelena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Riehl, Astrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Adler, Jeremy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Parmryd, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    The T cell receptor resides in ordered plasma membrane nanodomains that aggregate upon patching of the receptor2015In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 5, article id 10082Article in journal (Refereed)
    Abstract [en]

    Two related models for T cell signalling initiation suggest either that T cell receptor (TCR) engagement leads to its recruitment to ordered membrane domains, often referred to as lipid rafts, where signalling molecules are enriched or that ordered TCR-containing membrane nanodomains coalesce upon TCR engagement. That ordered domains form upon TCR engagement, as they do upon lipid raft marker patching, has not been considered. The target of this study was to differentiate between those three options. Plasma membrane order was followed in live T cells at 37 °C using laurdan to report on lipid packing. Patching of the TCR that elicits a signalling response resulted in aggregation, not formation, of ordered plasma membrane domains in both Jurkat and primary T cells. The TCR colocalised with actin filaments at the plasma membrane in unstimulated Jurkat T cells, consistent with it being localised to ordered membrane domains. The colocalisation was most prominent in cells in G1 phase when the cells are ready to commit to proliferation. At other cell cycle phases the TCR was mainly found at perinuclear membranes. Our study suggests that the TCR resides in ordered plasma membrane domains that are linked to actin filaments and aggregate upon TCR engagement.

  • 166.
    Divanoglou, Anestis
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Central Queensland University, School of Human Health and Social Sciences, Physiotherapy Program, North Rockhampton, Australia; Alli Opsi, Not-for-profit Organization, Thessaloniki, Greece.
    Georgiou, M.
    Perceived effectiveness and mechanisms of community peer-based programmes for Spinal Cord Injuries- a systematic review of qualitative findings2017In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 55, no 3, p. 225-234Article, review/survey (Refereed)
    Abstract [en]

    Study design: Systematic review and meta-synthesis of qualitative findings.

    Objectives: To establish the perceived effectiveness and mechanisms of community peer-based programmes based on narratives of consumers with spinal cord injury (SCI).

    Methods: Scopus, Academic Search Complete, CINAHL, Health Source, Medline, PsycARTICLES, PsychINFO, SPORTSDiscus and ProQuest were searched for articles published in English between January 1990 and December 2015. Qualitative studies referring to community peer-based interventions were included if most cases had a SCI. The results section of included studies was extracted and entered in NVivo. Data were inductively coded and analysed according to the three phases of Thematic Synthesis.

    Results: The search yielded 1402 unique records, out of which 126 were scrutinised in full. Four studies were appraised based on eight criteria and were finally included in the analysis. Three analytical themes emerged: (1) a unique learning environment created by the right mixture of learning resources, learning processes and a can-do attitude; (2) peer mentors—a unique learning resource with high level of relatedness that eases and empowers participants; and (3) an intervention that responds to important unmet needs and unrealised potential.

    Conclusions: Community peer-based programmes for people with SCI provide individualised training in important life areas, using a variety of learning resources and a plethora of learning processes. The high level of perceived effectiveness suggests that this type of intervention is an important tool of health systems post discharge from initial rehabilitation. Community organisations should be supported with evaluating their programmes through quality research.

  • 167.
    Domeij, Erica
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Eriksson, Malin
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Buller ur barns perspektiv: en kartläggning av hur barn upplever ljud- och kommunikationsmiljö på förskola2013Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Studies have shown that high levels of background noise are damaging on voice, hearing andlanguage learning skills but also affects other cognitive skills. High sound pressure can lead to ahyperfunctional and faulty voice use. This can cause chronic voice disorders. The voice organs inchildren may be particularly vulnerable since they are not yet fully developed. The noise level ishigh in many preschools and therefore both children and teachers are at risk for developing voicedisorders and hearing impairment.The study consists of sound pressure level measurements and focus group interviews of 16 fiveyear-old children in two different preschools. The purpose was to find out how five-year-oldchildren experience noise and communication in preschools and relate their opinions to themeasured sound pressure levels. The study is included in a bigger Nordic project.The result showed that the children seem to have some knowledge of the effects of noise onhearing but not at all of the effects on voice. The statements reflect that they seem to have someknowledge about negative effects of noise on communication. The children also express that theyprefer lower levels of background noise rather than high. The children expressed that they hadexperiences of occasionally having difficulties to communicate in their preschool due to highbackground noise. These statements are supported by the high levels of background noisemeasured in the study. Three themes and six categories were identified from the interviews, theywere: Own Experiences (Physical, Emotional), Environmental Factors (Spatial, Noise) andStrategies (Voice, Hearing).Sound pressure levels were measured in all rooms with and without the children and teacher’sattendance. With children and teachers present noise levels were ranging from 60 to 93 dB(A).The noise levels were frequently over 70 dB(A) and the highest noise value was 93 dB(A) in the playing room when free play occurred.

  • 168.
    Domkin, Dmitry
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Zetterlund, Christina
    Örebro County Council, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Örebro County Council, Örebro, Sweden; Örebro University, Örebro, Sweden.
    Effect of reduced visual acuity on precision of two-dimensional tracing movements2016In: Journal of Optometry, ISSN 1888-4296, Vol. 9, no 2, p. 93-101Article in journal (Refereed)
    Abstract [en]

    Purpose

    We intended to assess consequences of reduced visual acuity for performance in a natural simple motor task (tracing) using objective kinematic performance measures. Specifically, we intended to elucidate the kind of relationship between the task performance and best corrected binocular visual acuity and to determine the threshold of visual acuity when task performance starts to deteriorate.

    Methods

    Ninety-five individuals with different best corrected visual acuity participated in the study (age 49 ± 12 years, mean ± SD, 27 men and 68 women). The participants manually traced maze-like visual patterns of different spatial complexity presented on the screen of a portable notebook computer using Clinical Kinematic Assessment Tool software. Tracing error was computed as performance measure in each trial with a spatial pattern matching technique – rigid point set registration method.

    Results

    The segmented linear regression analysis showed that the relation between visual acuity and tracing errors was best described with a regression function having a break point between two data segments. Tracing performance was unaffected by values of visual acuity below 0.2 on logMAR scale, but when logMAR values increased above this critical limit (i.e. when visual acuity is further reduced), tracing errors linearly increased. The rate of the increase of the tracing error correlated with the complexity of visual stimulus shape.

    Conclusion

    Testing of fine motor functions with objective kinematic measures during visuomotor tasks may help differentiating between actual effects of reduced visual acuity on eye–hand coordination in individuals with similar levels of impairment of visual acuity.

  • 169.
    Doohan, Isabelle
    et al.
    Umeå University.
    Björnstig, Ulf
    Umeå University.
    Östlund, Ulrika
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University.
    Saveman, Britt-Inger
    Umeå University.
    Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 165-174Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery.

    METHODS: The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis.

    RESULTS: Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four "core cases" of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash.

    CONCLUSION: The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery. Doohan I , Björnstig U , Östlund U , Saveman BI . Exploring injury panorama, consequences, and recovery among bus crash survivors: a mixed-methods research study. Prehosp Disaster Med. 2017;32(2):165-174.

  • 170.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Östtlund, Ulrika
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 165-174Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. Methods The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Results Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four core cases of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. Conclusion The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

  • 171.
    Doohan, Isabelle Marie
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Gyllencreutz, Lina
    Umeå University, Faculty of Medicine, Department of Nursing. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Affiliated to Arctic Research Centre, Umeå University, Umeå, Sweden.
    Survivors' experiences of consequences and recovery five years after a major bus crash2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 3, p. 1179-1187Article in journal (Refereed)
    Abstract [en]

    Rationale: There is a lack of long-term follow-up studies focused on injured and uninjured survivors’ experiences of the recovery process after major traffic crashes.

    Aim/objective: To explore survivors’ experiences of long-term physical and psychological consequences and recovery five years after a major bus crash.

    Methodological design and justification: A qualitative design was used to explore experiences in a 5-year follow-up study.

    Research methods: Participants were 54 survivors of a bus crash with 56 survivors and six fatalities. Telephone interviews were analyzed with qualitative content analysis.

    Results: The theme overarching the categories is “visible and existential marks in everyday life” and it represents the range of the crash’s influence in the survivors’ lives. The first category, “health consequences in daily life,” has four subcategories covering quick recovery, suffering in daily life, distress in traffic situations, and long-term pain. Described reasons for quick recovery among survivors were previous crisis experiences, traveling alone, being uninjured, and not being exposed to traumatic impressions. For the other survivors, being reminded of the crash caused disturbing reactions, such as sweating, anxiety, and flashbacks. Survivors avoided going by bus if they could. A group of the injured survivors were still suffering from limiting and painful injuries. The second category, “oneself and social connection,” has three subcategories that include self-awareness, impact on relationships, and connectedness. Survivors developed a stronger bond to their significant other or separated from their partner within the first couple of years. Friendships and a sense of connectedness among survivors were sources of long-lasting comfort and support.

    Conclusion: There is a need for more information about disruptive long-lasting consequences, such as travel anxiety, and available treatments. Initially, health-promoting connectedness can be facilitated by treating survivors as a group of people who belong together, from the day of the crash and throughout the recovery process. 

  • 172.
    Doorn, Jan van
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy. Umeå University, Faculty of Arts, Department of language studies.
    Influence of speech task and utterance length on the measurement of pitch variability in the speech of Parkinson's disease patients after deep brain stimulation2013Conference paper (Other academic)
    Abstract [en]

    Parkinson’s disease (PD) affects patients voice characteristics, reducing pitch variability compared to normal controls (1,2). Previous reports have shown an increase in pitch variability due to deep brain stimulation (DBS) of the Subthalamic nucleus (STN) (3). For patients stimulated in caudal zona incerta (cZi), the results indicate no effect on pitch variability in a read speech task{Karlsson:2012jr}.

    The present study aimed at investigating the effects of speech task (spontaneous or read speech) and the lenght of the utterance on overall measures of pitch variability observed in DBS-treated patients. Ten patients treated with STN-DBS and ten patients treated with cZi-DBS were included in this prospective study.

    Utterances produced sponatenously and produced during readings of a standard passage were compared in terms of treatment effects in pitch variability due to STN-DBS and cZi-DBS (Stim OFF and Stim ON recordings made 1,5 hour apart, all in Med ON) 6 and 12 months after operation. The results indicate that pitch variability is affected differently by STN-DBS and cZi-DBS depending on speech task and utterance length. In short utterances (<10 words), an increase in pitch variability is observed for both treatment groups and both speech tasks. For longer utterances, however, a more diverse effect of treatment and speech task is observed. The results therefore suggest that spech task and characteristics of thate utterance should be carefully considered when drawing conclusions on the overall effect of DBS on pitch variability.

    1. Jiménez-Jiménez FJ, Gamboa J, Nieto A, Guerrero J, Ortí-Pareja M, Molina JA, et al. Acoustic voice analysis in untreated patients with Parkinson's disease. Parkinsonism Relat. Disord. 1997 Apr;3(2):111–6. 

    2. Holmes RJ, Oates JM, Phyland DJ, Hughes AJ. Voice characteristics in the progression of Parkinson’s disease. International Journal of Language & Communication Disorders. 2000;35(3):407–18. 

    3. Dromey C, Kumar R, Lang AE, Lozano AM. An investigation of the effects of subthalamic nucleus stimulation on acoustic measures of voice. Mov. Disord. 2000;15(6):1132–8.

  • 173.
    Dragsten, Mirjam
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Salmonsson, Ingela
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Vårdpersonalens kunskapsläge i hjärtlungräddning samt följsamhet till det svenska hjärtlungräddningsregistret på ett länssjukhus i Mellansverige: En kvantitativ tvärsnittsstudie2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Objective: To identify the healthcare professional´s knowledge and training frequency of cardiopulmony resuscitation in a county hospital in central Sweden, and compliance of the Swedish Register of cardiopulmony resuscitation.

    Method: Survey with quantitative approach consisting of 177 respondents, as well as a retrospective observational study.

    Main results: Individuals answered correctly to all knowledge questions, but as a group, there were deficiencies in the knowledge of cardiopulmonary resuscitation. When comparing healthcare professional´s knowledge it was demonstrated that in four of the seven knowledge questions it was a significant difference in knowledge between the health professionals who have more regular training than those with fewer. Those who had more regular education had more right answers. A significant difference was also detected depending on when they had their latest CPR training, where those who have had their education more recently also had more right answers. Compliance of healthcare professional´s to register patients treated for cardiac arrest in hospital at the Swedish CPR registry, can be summarized by the deficiencies in reporting. Conclusion: It is important to create conditions for frequent training to health professionals to increase the knowledge and preparedness in CPR, which can also be seen as a quality assurance work. An improvement is necessary in order to improve compliance to registration.

  • 174.
    Draycott, T.
    et al.
    Spire Bristol Hospital, England.
    van der Nelson, H.
    Spire Bristol Hospital, England.
    Montouchet, C.
    Covance Inc, England.
    Ruff, L.
    Covance Inc, England.
    Andersson, F.
    Linköping University. Ferring Pharmaceut AS, Denmark.
    Reduction in resource use with the misoprostol vaginal insert vs the dinoprostone vaginal insert for labour induction: a model-based analysis from a United Kingdom healthcare perspective2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, no 1, p. 49-Article in journal (Refereed)
    Abstract [en]

    Background: In view of the increasing pressure on the UKs maternity units, new methods of labour induction are required to alleviate the burden on the National Health Service, while maintaining the quality of care for women during delivery. A model was developed to evaluate the resource use associated with misoprostol vaginal inserts (MVIs) and dinoprostone vaginal inserts (DVIs) for the induction of labour at term. Methods: The one-year Markov model estimated clinical outcomes in a hypothetical cohort of 1397 pregnant women (parous and nulliparous) induced with either MVI or DVI at Southmead Hospital, Bristol, UK. Efficacy and safety data were based on published and unpublished results from a phase III, double-blind, multicentre, randomised controlled trial. Resource use was modelled using data from labour induction during antenatal admission to patient discharge from Southmead Hospital. The models sensitivity to key parameters was explored in deterministic multi-way and scenario-based analyses. Results: Over one year, the model results indicated MVI use could lead to a reduction of 10,201 h (28.9 %) in the time to vaginal delivery, and an increase of 121 % and 52 % in the proportion of women achieving vaginal delivery at 12 and 24 h, respectively, compared with DVI use. Inducing women with the MVI could lead to a 25.2 % reduction in the number of midwife shifts spent managing labour induction and 451 fewer hospital bed days. These resource utilisation reductions may equate to a potential 27.4 % increase in birthing capacity at Southmead Hospital, when using the MVI instead of the DVI. Conclusions: Resource use, in addition to clinical considerations, should be considered when making decisions about labour induction methods. Our model analysis suggests the MVI is an effective method for labour induction, and could lead to a considerable reduction in resource use compared with the DVI, thereby alleviating the increasing burden of labour induction in UK hospitals.

  • 175.
    Dubois, Mathieu
    et al.
    NeuroSpin, I2BM, CEA.
    Hadj-Selem, Fouad
    NeuroSpin, I2BM, CEA.
    Löfstedt, Tommy
    NeuroSpin, I2BM, CEA.
    Perrot, Matthieu
    Centre d'Acquisition et de Traitement des Images (CATI).
    Fischer, Clara
    Centre d'Acquisition et de Traitement des Images (CATI).
    Frouin, Vincent
    NeuroSpin, I2BM, CEA.
    Duchesnay, Edouard
    NeuroSpin, I2BM, CEA.
    Predictive support recovery with TV-Elastic Net penalty and logistic regression: An application to structural MRI2014Conference paper (Refereed)
    Abstract [en]

    The use of machine-learning in neuroimaging offers new perspectives in early diagnosis and prognosis of brain diseases. Although such multivariate methods can capture complex relationships in the data, traditional approaches provide irregular (l12 penalty) or scattered (l1 penalty) predictive pattern with a very limited relevance. A penalty like Total Variation (TV) that exploits the natural 3D structure of the images can increase the spatial coherence of the weight map. However, TV penalization leads to non-smooth optimization problems that are hard to minimize. We propose an optimization framework that minimizes any combination of l1, l2, and TV penalties while preserving the exact l1 penalty. This algorithm uses Nesterov's smoothing technique to approximate the TV penalty with a smooth function such that the loss and the penalties are minimized with an exact accelerated proximal gradient algorithm. We propose an original continuation algorithm that uses successively smaller values of the smoothing parameter to reach a prescribed precision while achieving the best possible convergence rate. This algorithm can be used with other losses or penalties. The algorithm is applied on a classification problem on the ADNI dataset. We observe that the TV penalty does not necessarily improve the prediction but provides a major breakthrough in terms of support recovery of the predictive brain regions.

  • 176.
    Dunberger, Gail
    et al.
    Karolinska institutet.
    Thulin, Helena
    Karolinska institutet.
    Waldenström, Ann-Charlotte
    Göteborgs universitet.
    Lind, Helena
    Karolinska institutet.
    Henningsohn, Lars
    Karolinska institutet.
    Åvall-Lundqvist, Elisabeth
    Karolinska institutet.
    Steineck, Gunnar
    Karolinska institutet, Göteborgs universitet.
    Kreicbergs, Ulrika
    Karolinska institutet, Sophiahemmet.
    Cancer survivors' perception of participation in a long-term follow-up study.2013In: Journal of Medical Ethics, ISSN 0306-6800, E-ISSN 1473-4257, Vol. 39, no 1, p. 41-45Article in journal (Refereed)
    Abstract [en]

    Every year medical researchers make contact with a large number of cancer survivors with the aim of evaluating cancer treatment. For this reason we decided to investigate how Swedish cancer survivors perceived their participation in research studies focusing on the long-term consequences of being a survivor of gynaecological or urinary bladder cancer. Data were collected by means of two study-specific postal questionnaires, both consisting of questions covering physical symptoms, well-being and the experience of being a cancer survivor. Both questionnaires also included questions evaluating the participants' experience of being research subjects. The questionnaires were developed in close co-operation with cancer survivors. The study population consisted of 1068 cancer survivors. Of these, 95% (n=1003) reported that they thought the study was valuable and 54% (n=559) that they had been positively affected by participating. Four per cent (n=39) expressed that they had been negatively affected by their participation in the study. The vast majority of the cancer survivors thought that participating in their particular study was valuable.

  • 177.
    Dussel, Veronica
    et al.
    USA.
    Kreicbergs, Ulrika
    Karolinska institutet. Dana-Farber Cancer Institute, Boston, USA..
    Hilden, Joanne M
    USA.
    Watterson, Jan
    USA.
    Moore, Caron
    USA.
    Turner, Brian G
    USA.
    Weeks, Jane C
    USA.
    Wolfe, Joanne
    USA.
    Looking beyond where children die: Determinants and effects of planning a child's location of death.2009In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 37, no 1, p. 33-43Article in journal (Refereed)
    Abstract [en]

    While dying at home may be the choice of many, where people die may be less important than argued. We examined factors associated with parental planning of a child's location of death (LOD) and its effects on patterns of care and parent's experience. In a cross-sectional study of 140 parents who lost a child to cancer at one of two tertiary-level U.S. pediatric hospitals, 88 (63%) planned the child's LOD and 97% accomplished their plan. After adjusting for disease and family characteristics, families whose primary oncologist clearly explained treatment options during the child's end of life and who had home care involved were more likely to plan LOD. Planning LOD was associated with more home deaths (72% vs. 8% among those who did not plan, P<0.001) and fewer hospital admissions (54% vs. 98%, P<0.001). Parents who planned were more likely to feel very prepared for the child's end of life (33% vs. 12%, P=0.007) and very comfortable with LOD (84% vs. 40%, P<0.001), and less likely to have preferred a different LOD (2% vs. 46%, P<0.001). Among the 73 nonhome deaths, planning was associated with more deaths occurring in the ward than in the intensive care unit or other hospital (92% vs. 33%, P<0.001), and fewer children being intubated (21% vs. 48%, P=0.029). Comprehensive physician communication and home care involvement increase the likelihood of planning a child's LOD. Opportunity to plan LOD is associated with outcomes consistent with high-quality palliative care, even among nonhome deaths, and thus may represent a more relevant outcome than actual LOD.

  • 178.
    Edebol, Hanna
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Global Assessment of Attention Deficit Hyperactivity Disorder: Examining Objective Measures of Hyperactivity, Impulsivity and Inattention in Adults2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis is to examine objective laboratory measures of Attention Deficit Hyperactivity Disorder (ADHD) in adult persons and to develop measures for diagnosis and treatment using a psychometric instrument called the Quantified Behavior Test Plus. The instrument objectively quantifies cardinal symptom manifestations in adult ADHD using motion tracking devices and continuous performance testing. Paper I-IV suggest that ADHD predisposes adult persons to perform poorer on continuous performance tasks and to have higher levels of motor activity while performing these tasks as compared to other clinical as well as non-clinical groups. Performance by adults with ADHD is normalized following stimulant treatment which implicates therapeutic effects and measures of response to treatment and remission for ADHD is suggested.

    Paper I concludes that the psychometric instrument needs to be calibrated with regard to adult ADHD and emphasizes the importance of a composite measure for the disorder. Paper II generates two new measures, the Weighed Core Symptom scale (WCS) - a composite measure of adult ADHD ranging from 0 to 100, and Prediction of ADHD (PADHD) - a categorical variable of the diagnostic status with good predictive power. A majority of participants with ADHD has low points on WCS (indicating high levels of symptoms) and a majority of non-ADHD normative participants has high points on WCS (indicating low levels of symptoms). Paper III examines WCS and PADHD among complex clinical groups with shared symptoms vis-à-vis ADHD. Here, findings from Paper II are replicated since participants with ADHD present the highest level of global symptoms, followed by participants with bipolar II disorder and borderline personality disorder, participant with diconfirmed ADHD and finally, non-clinical participants has the lowest level of global symptoms. In Paper IV, the measures are proposed as indications of response to treatment and remission after titration with stimulant treatment and WCS indicates response to small changes in dose level.

    The major findings of the present thesis may be summarized as the construction of two new objective measures for ADHD in adult persons with practical implications for diagnosis and treatment. Hyperactivity is the most specific marker of ADHD in both men and women, followed by the cognitive markers of inattention and impulsivity. The composite measure, WCS, quantifies the global amount of ADHD symptoms and provides the most sensitive measure for the disorder. PADHD and WCS may not replace a thorough neuropsychiatric assessment and further studies promoting diagnostic subtype stratification is suggested. Future studies may want to consider these measures in outcome-based investigations of treatment efficacy as well as in the study of neuropsychological endophenotypes. Practical implications include clinical strategies to enhance objectivity during assessment as well as optimizing beneficial effects of treatment and attaining remission.

     

     

  • 179.
    Edelbring, Samuel
    et al.
    Örebro University, School of Health Sciences. Linköping University, Linköping, Sweden.
    Allvin, Renée
    Örebro University Hospital, Örebro, Sweden.
    Karlsson, Katarina
    Linköping University, Linköping, Sweden.
    Hjelmqvist, Hans
    Örebro University, School of Medical Sciences. Örebro University Hospital, Örebro, Sweden.
    Hjelm, Carina
    Linköping University, Linköping, Sweden.
    Brandt, Jonathan
    Capio Specialistvård Motala, Motala, Sweden.
    Tamás, Éva
    Linköping University, Linköping, Sweden.
    Interprofessionell simulering är engagerande och relevant: Utbildningsstrategi som tränar samverkan över yrkesgränser, visar enkätstudie [Interprofessional simulation: an engaging and relevant technique for teamwork practice]2019In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116, article id FHWLArticle in journal (Refereed)
    Abstract [en]

    Stakeholders in healthcare and education find interprofessional teamwork to be crucial for today’s complex healthcare. Consequently, the students need to prepare for future collaboration with other professions. Interprofessional simulation (IPS) is a technique in which several professions can engage together in clinical scenarios. Using a survey we studied the perceived relevance of two IPS settings in which last-year medical and nursing students participated in acute care scenarios. The findings showed that students perceive IPS as being highly relevant and that students from the other profession contributed to their learning. IPS holds promise as a pedagogical tool towards future interprofessional competence. However, pedagogical improvements can be made, and the professional perspectives can be better balanced. Furthermore, in order to equip students with broader interprofessional competence, scenarios should include several professions and a variety of clinical contexts.

  • 180.
    Edelbring, Samuel
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Dastmalchi, Maryam
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Lundberg, Ingrid E.
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Dahlgren, Lars-Ove
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Experiencing virtual patients in clinical learning: a phenomenological study2011In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 16, no 3, p. 331-345Article in journal (Refereed)
    Abstract [en]

    Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

  • 181.
    Edelbring, Samuel
    et al.
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Dastmalchi, Maryam
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Hult, Håkan
    Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden.
    Lundberg, Ingrid E.
    Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.
    Dahlgren, Lars-Ove
    Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden.
    Experiencing virtual patients in clinical learning: a phenomenological study2011In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 16, no 3, p. 331-345Article in journal (Refereed)
    Abstract [en]

    Computerised virtual patients (VPs) are increasingly being used in medical education. With more use of this technology, there is a need to increase the knowledge of students experiences with VPs. The aim of the study was to elicit the nature of virtual patients in a clinical setting, taking the students experience as a point of departure. Thirty-one students used VPs as a mandatory part of an early clinical rotation in rheumatology. Using the qualitative approach of phenomenology, we interviewed these students and then analysed data regarding their experiences of VPs as a learning activity. The result shows that students perceived VP activities in relation to actual patients, the clinical context and other learning activities. The VPs represented typical clinical cases which encouraged clinical reasoning and allowed for decision making. The students experienced the activities as integrating biomedical knowledge and clinical experience, providing structure that prepared for the unstructured clinical environment and patient encounters under unstressful conditions. However, the VPs were experienced as lacking the emotional interactivity and complexity of actual patients. Theoretical frameworks of clinical reasoning and experiential learning are suggested as foundations for further educational integration of VPs in the clinical environment. VP activities during clinical rotations provide experiences of clinical reality and allow students to solve problems actively. These features are dependent on VP technology but are also contingent on the surrounding environment.

  • 182.
    Edfast, Erica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Lundström Sundin, Maria
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    ”Det ger ju en närhet tycker jag att man öppnar sig”: Pars upplevelse av Emotional Focused Couple Therapy2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syfte: Studien syftade till att undersöka hur par som fullföljt parterapin Emotionally Focused

    Couple Therapy (EFT) hos certifierade EFT-terapeuter i Sverige, upplevt parterapin. Två

    frågeställningar belystes; vilken upplevelse paren har av förändring i relationen samt vad

    paren upplevde som verksamt i EFT-behandlingen. Metod: Åtta individuella telefon

    intervjuer genomfördes och analyserades med kvalitativ innehållsanalys. Resultat: Analysen

    utmynnade i två teman Den egna förändringen samt Terapin och terapeutens agerande, med

    tre subteman vardera. Konklusion: Det visade sig att deltagarnas upplevelser av förändring

    och vad som upplevdes som verksamt stämmer överens med vad som framkommit i tidigare

    internationell forskning. Alliansens betydelse diskuteras, samt arbete med parsexualitet inom

    ramen för EFT. Sammantaget tyder studien på att EFT även är tillämpbar på svenska

    förhållanden.

  • 183.
    Edholm, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Theory of Mind: Kan Kicki och Katten var ett instrument att använda för bedömning av yngre barn?2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Studien beskriver aktuell forskning kring hur yngre barn tänker om andra människors tankar och känslor utifrån olika teoretiska perspektiv. Vidare provas ett test som så tidigt som möjligt under barns utveckling möjligen kan belysa förskolebarns förmåga att sätta sig in i någon annans tankar, perspektiv. Inom autismforskningen har begreppet theory of mind använts för att belysa den kognitiva förmåga som krävs för att en person ska kunna sätta sig in i någon annans tankar. Från flera håll har begreppet ifrågasatts eftersom det krävs flera kognitiva komponenter såsom minne och verbal förmåga för att lösa denna typ av uppgifter. Följande studie har genomförts för att undersöka ett test som så renodlat som möjligt försöker belysa förmågan att förstå hur någon annan tänker. Elva barn som utretts för autismspektrumfrågeställning och fått diagnosen autism har fått genomföra testet ”Kicki och Katten” och jämförts med tio typiskt utvecklade barn matchade på mental ålder. Resultatet visar att det inte finns någon skillnad mellan barnen med autism och de typiskt utvecklade barnen och att barn med en mental ålder under fyra år, i båda grupperna, inte klarar av testet Kicki och Katten. Testet Kicki och Katten fungerar inte för att bedöma theory of mind hos yngre barn än fyra år.

     

  • 184.
    Edorsdotter, Anna-Lena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Titta, det rör sig!: Pupillen avslöjar känslighet för biologisk rörlese hos 10-månader gamla barn2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Föreliggande arbete är en experimentell studie som genomfördes vid Spädbarnslabbet, Uppsala Universitet. Undersökningsgruppen bestod av 10-månader gamla barn (n=33) och deras föräldrar. På en dataskärm fick barnen titta på stimuli i form av ljuspunktsanimering av mänsklig rörelse. Barnens titt-tid och pupilldilation registrerades. Det finns i tidigare forskningsresultat belägg för att normalutvecklade barn har en känslighet för biologisk rörelse men detta är inte tidigare studerat med hjälp av pupillometri. I studien ingick också att föräldrarna till barnen i undersökningsgruppen fyllde i ett självskattningsformulär för symtom inom autismspektrum. Syftet med studien var att undersöka om små barns känslighet för biologisk rörelse går att mäta med pupillometri samt att kartlägga om individuella skillnader i känslighet för biologisk rörelse var relaterat till graden av symtom inom autismspektrum hos föräldrarna. Hypoteserna som testades var dels att barnen i undersökningsgruppen var känsliga för biologisk rörelse och att detta skulle visa sig i termer av pupilldilation dels att det skulle finnas ett negativt samband mellan föräldrars självskattning av symtom inom autismspektrum och deras barns känslighet för biologisk rörelse. Resultaten visade att barngruppen som helhet var känslig för biologisk rörelse och att pupillometri var ett användbart mätinstrument för att mäta detta. Resultaten visade inte något samband mellan barnens känslighet för biologisk rörelse och föräldrarnas självskattade symtom inom autismspektrumområdet. Vi fann däremot ett oväntat negativt samband mellan barnens känslighet för biologisk rörelse och familjens socioekonomiska status.

     

    Slutsatsen av denna studie är att pupillometri är en användbar datainsamlingsmetod för att studera små barns känslighet för biologisk rörelse. Något negativt samband mellan barnens känslighet för biologisk rörelse och föräldrarnas symtom inom autismspektrum framkom inte denna studie.

     

     

     

  • 185. Edvardsson, Berit
    et al.
    Ahlgren, Christina
    Weinehall, Lars
    Stenberg, Berndt
    Patient experiences of developing Sick Building Syndrome (SBS) symptoms and related encounters – a qualitative studyManuscript (preprint) (Other academic)
    Abstract [en]

    Objective:

    This study aimed to describe the experiences and encounters of a group of people with Sick Building Syndrome (SBS) as their symptoms emerged.

    Design, methods and subjects:

    A semi-structured interview was performed with 10 informants with symptoms of SBS. Five of them were previously diagnosed and had participated in an earlier follow-up study. The remaining five had had SBS symptoms for a shorter period. The interviews were analysed using qualitative content analysis. To ensure trustworthiness triangulation was used. 

    Results:

    The analysis resulted in a main theme: Conflicting Interpretations of SBS Symptoms, and three subthemes: Gradual Understanding of SBS Symptoms, Experience of Rejection and Experience of Confirmation. The main theme and the sub-themes together represent a process where the informants’ experiences of belief and support, lack of support and disbelief and limited understanding occurs when they are perceiving symptoms, looking for explanations, understanding  the connection between symptoms and being  in a poor indoor environment  and while managing their SBS symptoms.

    The symptoms, when they first appear, often appear similar to that of flu. When the informants realise the connection between the symptoms and the building some of them decide that “Okay, enough is enough, there’s nothing wrong with me, it’s the building”. Many of the informants act to  change the way they manage the situation as a result of increased symptoms. During this whole process the informants/patients perceived a lack of confirmation and support from e.g. employers, primary health care and occupational health care centres. The informants were confirmed by colleagues acting for a better indoor environment.

    Conclusion:

    The symptoms of SBS are diffuse and difficult to recognise for all involved. The experiences of those who have dealt with this issue are in line with knowledge relating to other diseases not recognised as legitimate. It is important for healthcare personnel to be aware of the possible connection between symptoms and the indoor environment. For employers and facility managers, knowledge of their obligations in terms of the working environment is important. The importance of confirmation in encounters has to be underlined.

     

  • 186.
    Edvardsson, Bo
    Örebro University, School of Law, Psychology and Social Work.
    "Mina hypoteser om Stern tycks vara riktiga!"1986In: Personal, människor & arbete, ISSN 0348-5242, no 2, p. 36-36Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    En uppföljande debattartikel efter replikerna på mitt debattinlägg i nr 9, 1985

  • 187.
    Edvinsson, Joakim
    et al.
    Qulturum, Center for Development, Jönköping County Council, Jönköping, Sweden.
    Rahm, Magnus
    Qulturum, Center for Development, Jönköping County Council, Jönköping, Sweden.
    Trinks, Anna
    Qulturum, Center for Development, Jönköping County Council, Jönköping, Sweden.
    Höglund, Pär J.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Senior alert: A quality registry to support a standardized, structured, and systematic preventive care process for older adults2015In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 24, no 2, p. 96-101Article in journal (Refereed)
    Abstract [en]

    The average life expectancy and the proportion of the elderly in the Western countries are increasing. The care processes used for the elderly are known to differ between the care providers in Sweden. Accordingly, the need to develop a system to support the processes in order to attain a standardized, structured, and systematic approach to improve preventive care processes for the elderly has been called for. The County Council of Jönköping developed a national Web-based quality registry, Senior Alert, with a focus on the following areas: falls, pressure ulcers, malnutrition, and oral health. The patients are evaluated using validated risk assessment instruments, and the care is planned, executed, evaluated. The registry supports the users to work with preventive care systematically and in a standardized way and provides feedback to the care providers on their preventive care processes. The registry helps the caregivers fulfill the preventive care according to the best available clinical knowledge and practice. The registry also provides the government and health care politicians with data for setting aims for elderly care. The registry is used in 90% of the municipalities and county councils throughout the country. The total number of risk assessments completed from 2009 to 2014 exceeded 1 000 000.

  • 188.
    Edwards, Ian
    et al.
    University of South Australia.
    Wickford, Jenny
    Göteborgs universitet.
    Ahmed Adel, Aziz
    Physical Therapy Institute Kabul.
    Thoren, Judy
    International Assistance Mission.
    Living a moral professional life amidst uncertainty: Ethics for an Afghan physical therapy curriculum2011In: Advances in Physiotherapy, ISSN 1403-8196, E-ISSN 1651-1948, Vol. 13, no 1, p. 26-33Article in journal (Refereed)
  • 189.
    Eilegård, Alexandra
    et al.
    Karolinska institutet.
    Kreicbergs, Ulrika
    Karolinska institutet.
    Risk of parental dissolution of partnership following the loss of a child to cancer: A population-based long-term follow-up.2010In: Archives of Pediatrics & Adolescent Medicine, ISSN 1072-4710, E-ISSN 1538-3628, Vol. 164, no 1, p. 100-101Article in journal (Refereed)
  • 190.
    Eilegård, Alexandra
    et al.
    Karolinska institutet, Sophiahemmet högskola.
    Steineck, Gunnar
    Göteborgs universitet, Karolinska institutet.
    Nyberg, Tommy
    Göteborgs universitet, Karolinska institutet.
    Kreicbergs, Ulrika
    Karolinska institutet, Sophiahemmet högskola, Göteborgs universitet.
    Bereaved siblings' perception of participating in research: A nationwide study2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 2, p. 411-416Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The objective of the present study is to examine bereaved siblings' perception of research participation.

    METHODS: A Swedish nationwide study on avoidable and modifiable health care-related factors in paediatric oncology among bereaved siblings who lost a brother or sister to cancer between the years 2000 and 2007 was conducted. Data are presented as proportions, and the differences between groups were statistically tested at the 5% significant level using Fisher's exact test.

    RESULTS: Out of 240 eligible siblings, 174 responded (73 %). None of the siblings (0/168) thought their participation would affect them negatively in the long term. However, 13% (21/168) stated it was a negative experience to fill out the questionnaire, whereas 84% (142/169) found it to be a positive experience. Women were more likely to report their participation as positive in a long-term perspective compared with men (p = 0.018).

    CONCLUSIONS: None of the bereaved siblings in this Swedish nationwide study anticipated any long-term negative effect from their research participation. A majority reported it as positive to revisit their needs and experiences throughout their brother or sister's illness and death 2-9 years following the loss. We believe that the stepwise approach used in this study contributed to the high acceptance.

  • 191.
    Eilegård, Alexandra
    et al.
    Karolinska institutet, Sophiahemmet.
    Steineck, Gunnar
    Göteborgs universitet, Karolinska institutet.
    Nyberg, Tommy
    Karolinska institutet.
    Kreicbergs, Ulrika
    Karolinska institutet, Sophiahemmet.
    Psychological health in siblings who lost a brother or sister to cancer 2 to 9 years earlier.2013In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 22, no 3, p. 683-691Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The objective of this study was to assess long-term psychological distress in siblings who lost a brother or sister to cancer 2 to 9 years earlier, as compared with a control group of non-bereaved siblings from the general population.

    METHODS: During 2009, we conducted a nationwide follow-up study in Sweden by using an anonymous study-specific questionnaire. Siblings who had lost a brother or sister to cancer between the years 2000 and 2007 and also a control group of non-bereaved siblings from the general population were invited to participate. The Hospital Anxiety and Depression Scale (HADS) was used to measure psychological distress, and to test for differences in the ordinal outcome responses between the groups, we used Wilcoxon-Mann-Whitney rank-sum test.

    RESULTS: Among the bereaved siblings, 174/240 (73%) participated and 219/293 (75%) among the non-bereaved. Self-assessed low self-esteem (p = 0.002), difficulties falling asleep (p = 0.005), and low level of personal maturity (p = 0.007) at follow-up were more prevalent among bereaved siblings. However, anxiety (p = 0.298) and depression (p = 0.946), according to HADS, were similar.

    CONCLUSION: Bereaved siblings are at increased risk of low self-esteem, low level of personal maturity and difficulties falling asleep as compared with non-bereaved peers. Yet, the bereaved were not more likely to report anxiety or depression.

  • 192.
    Eilegård Wallin, Alexandra
    et al.
    Karolinska Institutet, Högskolan Dalarna.
    Steineck, Gunnar
    Göteborgs universitet, Karolinska institutet.
    Nyberg, Tommy
    Karolinska Institutet.
    Kreicbergs, Ulrika
    Ersta Sköndal University College, Department of Health Care Sciences, Palliative Research Centre, PRC. Karolinska Institutet.
    Insufficient communication and anxiety in cancer-bereaved siblings: A nationwide long-term follow-up.2016In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 14, no 5, p. 488-494Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to examine siblings' long-term psychological health in relation to their perception of communication with their family, friends, and healthcare professionals during a brother or sister's last month of life.

    METHOD: A nationwide questionnaire study was conducted during 2009 in Sweden of individuals who had lost a brother or sister to cancer within the previous two to nine years. Of the 240 siblings contacted, 174 (73%), participated. The Hospital Anxiety and Depression Scale (HADS) was employed to assess psychological health (anxiety). The data are presented as proportions (%) and relative risks (RR) with a 95% confidence interval (CI 95%).

    RESULTS: Siblings who were not satisfied with the amount they talked about their feelings with others during their brother or sister's last month of life were more likely to report anxiety (15/58, 26%) than those who were satisfied (13/115, 11%; RR = 2.3(1.2-4.5)). The same was true for those who had been unable to talk to their family after bereavement (RR = 2.5(1.3-4.8)). Avoiding healthcare professionals for fear of being in their way increased siblings' risk of reporting anxiety at follow-up (RR = 2.2(1.1-4.6)), especially avoidance in the hospital setting (RR = 6.7(2.5-18.2)). No such differences were seen when the ill brother or sister was cared for at home.

    SIGNIFICANCE OF RESULTS: Long-term anxiety in bereaved siblings might be due to insufficient communication. Avoiding healthcare professionals, especially when the brother or sister is cared for at the hospital, may also increase the risk of anxiety.

  • 193.
    Eilertsen, Mary-Elizabeth Bradley
    et al.
    Sør-Trøndelag University College, Trondheim, Norway .
    Eilegård, Alexandra
    Karolinska Institutet.
    Steineck, Gunnar
    Karolinska Institutet, Göteborgs universitet .
    Nyberg, Tommy
    Karolinska Institutet.
    Kreicbergs, Ulrika
    Karolinska Institutet, Sophiahemmet.
    Impact of social support on bereaved siblings' anxiety: a nationwide follow-up.2013In: Journal of Pediatric Oncology Nursing, ISSN 1043-4542, E-ISSN 1532-8457, Vol. 30, no 6, p. 301-310Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess adolescent and young adult siblings' perception of social support prior to and following the loss of their brother or sister to cancer, 2 to 9 years earlier, and their anxiety at follow-up.

    METHOD: In 2009, 174 (73%) bereaved siblings (12-25 years) participated in a nationwide, long-term follow-up study in Sweden using an anonymous study-specific questionnaire. The Hospital Anxiety and Depression Scale was used to measure self-assessed anxiety.

    RESULTS: Siblings had a higher risk of anxiety if they perceived their need for social support was unsatisfied during their brother or sisters' last month before death, relative risk (RR) = 3.6 (95% confidence interval [CI] = 1.8-7.3); time after death, RR = 2.9 (95% CI = 1.5-5.6); and at follow-up, RR = 3.8 (95% CI = 2.0-7.2). Furthermore, a higher risk for anxiety was shown for siblings if they did not perceive that their parents and neighbors cared for them after their brother or sisters' death, RR = 2.7 (95% CI = 1.3-5.5), RR = 5.4 (95% CI = 1.3-21.9), respectively.

    CONCLUSION: Bereaved siblings had a greater probability to report self-assessed anxiety if they perceived that their need for social support was not satisfied prior to and following death. Information from both nurses and other health care professionals to families about the impact of social support may contribute to lessen the siblings' risk of anxiety.

  • 194.
    Ejelöv, Marina
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Bergström, Margareta
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Mattsson, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    “Many obstacles along the way”: follow-up of rehabilitation plans after multimodal pain rehabilitation2016In: European Journal of Physiotherapy, ISSN 2167-9169, E-ISSN 2167-9177, Vol. 18, no 1, p. 18-26Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore the content of rehabilitation plans after multimodal rehabilitation (MMR) for chronic pain patients, focusing on occupation-oriented measures. A secondary aim was to study how the individual rehabilitation plans had been carried out and implemented during 1 year after MMR. A multiple methods approach with quantitative and qualitative data was used. The quantitative part was descriptive and examined whether the rehabilitation plans were carried out, the number of recommendations in each plan and the type of measures suggested. The qualitative part constituted a content analysis of interviews. Vocational rehabilitation was the second most common recommendation for the whole group. The analysis of the interviews resulted in seven categories divided into two main categories: impeding factors and facilitating factors for rehabilitation. The compliance of professionals and external parties with the patients’ rehabilitation plans, and the patients’ positive experience of their change in behaviour, contributed to the completion of the rehabilitation plans. In conclusion, lack of follow-up from the professionals and negative bodily signals inhibited the completion of rehabilitation. Flexibility on the part of professionals and external actors regarding patients’ rehabilitation plans as well as their own positive experiences of striving for change facilitated rehabilitation.

  • 195.
    Ek, Johan
    Växjö University, Faculty of Mathematics/Science/Technology, School of Technology and Design.
    Att höra eller icke höra2007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    This exam work on a bachelor-degree will result in a re-design (re-production?) of Peltor ear defender, called PTL, which is a semi-active ear defender, pro ”hearing” of the surrounding. To raise the sales of the product, which has a unique and well-structured function, the new function of the defender has to be communicated.

    Through studies of semantic, different shapes and forms developed which communicated the unique function for consumer, user and surrounding. Aspects of ergonomics were linked together with human symbolic signs to create a semantic unit between product and user.

    Apart from the semantic studies, solutions concerning functional aspects of the hearing protectors were studied.

    The result is a new design the model PTL with a stronger visual design communicating the new function of the hearing protector.

  • 196.
    Ekelund, Lovisa
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Erhardsdotter, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Speech and Language Pathology. Linköping University, Faculty of Health Sciences.
    Kommunikation vid demenssjukdom: En studie av samtalsstrategier och positionering i samtal mellan personer med demenssjukdom och vårdpersonal.2013Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Dementia may cause impairment of linguistic abilities, affecting both production and comprehension, which in turn affects communication (Mahendra & Hopper, 2012: Perkins, Whithworth & Lesser, 1998). The aim of the present study was to investigate and describe the communication strategies in everyday conversations between people with dementia and their interlocutors, and to describe the identified interaction phenomena based on a participatory perspective.

    The study was conducted at a home for people with dementia. Three people with known dementia and two health professionals participated in the study. Everyday interactions were filmed, and then transcribed and analyzed according conversation analytic principles. The transcribed data was also analyzed with ideas from positioning theory.

    The present study highlights the presence of trouble sources in communication between the person with dementia and carers and how these are handled by the participants in terms of strategies, competence and positioning. The study shows that all participants use communicative strategies when trouble sources occurs, but also that trouble sources in the conversation sometimes are ignored. How trouble sources are handled affects how participants acknowledge themselves and each other competence and how they position themselves and each other in the conversation. The study also demonstrates that Conversation Analysis can be an important tool to map strenghts and break downs in communication between people with dementia and key interlocutors. That knowledge could then form the basis for designing individual adaptations and strategies to facilitate communication. 

  • 197.
    Eklund, Elisabeth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Qvist, Johanna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Sandström, Lena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Viklund, Fanny
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Doorn, Jan van
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Karlsson, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy. Umeå University, Faculty of Arts, Department of language studies.
    Perceived articulatory precision in patients with Parkinson’s disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta2015In: Clinical Linguistics & Phonetics, ISSN 0269-9206, E-ISSN 1464-5076, Vol. 29, no 2, p. 150-166Article in journal (Refereed)
    Abstract [en]

    The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson’s disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and ten with cZi-DBS. The recordings were made preoperatively and 12 months postoperatively with stimulator on and off (on medication). Blinded, randomized, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess 1) overall articulatory quality ratings, 2) frequency of occurrence of misarticulation patterns, and 3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realizations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group. 

  • 198.
    Eklöf, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Hallén, Yvonne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
      Familjebaserad Korttidsterapi: Beskrivning av en behandlingsmodell och terapeuternas reflektioner2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Uppsatsen inleds med en beskrivning av Familjebaserad korttidsterapi såsom den bedrivs vid Barn- och ungdomspsykiatrimottagningarna i Falun resp Sundsvall/Härnösand, där författarna själva är verksamma. Modellen innehåller en särskild struktur med urvalsprocess utifrån särskilda kriterier och 1-2 samtal som är två timmar inkl paus. Ett salutogent synsätt genomsyrar denna familjeterapeutiska modell, där det också ingår reflektioner för terapeuter och med familj. Ramarna och de olika momenten i behandlingen syftar till att starta och optimera en förändringsprocess som familjerna själva kan arbeta vidare med.

     

    Studien syftar till att få en fördjupad beskrivning av modellen samt närmare undersöka hur de verksamma terapeuterna i Falun och Sundsvall/Härnösand tänker att de påverkas av att arbeta med denna modell och vad de tänker att de själva bidrar med som är verksamt. Som metod valdes en form av semistrukturerad intervju, s k fokusgruppintervju. Terapeuternas reflektioner utifrån intervjuerna, redovisas dels i processbeskrivande form, dels i tematiska summeringar och citat.

     

    Resultatet visar på att terapeuterna i båda grupperna beskriver att de i denna modell tycker sig vara på en högre medveten prestationsnivå och att de upplever mer kraftfullhet och positiva känslor än när de arbetar med annat behandlingsarbete. De beskriver att både den begränsade tiden, samt övriga ramar, förhållningssätt och metoder samverkar och påverkar den egna upplevelsen och att det de gör upplevs verksamt. Särskilt intressanta reflektioner framkommer kring betydelsen av arbetsteamet, som finns med i och under det direkta familjearbetet, samt de ”reflekterande teamen” som metod. 

  • 199.
    Ekman, Marine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Familjebehandling på väg tillbaka?: En intervjustudie om behandlingspersonals syn på familjeterapi inom barn och ungdomspsykiatrin2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Uppsatsens syfte var att via intervjuer med behandlingspersonal vid en barnpsykiatrisk klinik undersöka deras syn på behov av att erbjuda familjebehandling/familjeterapeutiska insatser samt hur man, om behov föreligger, ska gå tillväga för att stärka familjeperspektivet utifrån förändrad prioritering. Det visade sig att alla respondenter, både nya och mer erfarna, såg ett tydligt behov av att behandla hela familjer då barnet är en del av detta sammanhang och inte själva kan bära ansvar för förändring. Respondenterna såg både ett behov av familjekompetens hos alla behandlare, men även behov av familjeterapi för mer komplexa ärenden. Tre betydelsefulla åtgärder kunde identifieras för att förstärka familjeperspektivet. Dels framkom ett behov av utbildningsinsatser. En basutbildning för alla på kliniken i familjebehandling med syfte att förstärka och behålla kompetens, men framförallt för att skapa en gemensam grundsyn hos medarbetarna. Man ansåg det också som betydelsefullt och lärorikt att få arbeta tillsammans med erfarna behandlare. Även familjeterapeuterna behöver fortbildas, dels i nya evidensbaserade metoder men också handledarutbildas beroende på hur uppdraget till gruppen kommer att formuleras av ledningen. Specialistgrupp för att möjliggöra metodarbete är den andra åtgärden. Kompetens finns i metod hos klinikens medarbetare men praktiseras inte till fullo. De metoder som används systematiskt inom kliniken, är de som har stöd av specialistgrupp. Rätt använd kompetens ses också som betydelsefullt. Dels utifrån att det bidrar till att behålla och utveckla spetskompetens, men det skapar också ökad respekt för ledningen hos medarbetarna och ger arbetstillfredsställelse om klinikens resurser används på ett effektivt sätt.

     

  • 200.
    Ekman, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical and Physiological Chemistry.
    Eriksson, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical and Physiological Chemistry.
    The in vitro modification of phosphorylated pyruvate kinase by a Ca2+-activated protease from rat liver1980In: Acta Chemica Scandinavica, ISSN 0904-213X, E-ISSN 1902-3103, Vol. 34, no 6, p. 419-422Article in journal (Refereed)
    Abstract [en]

    A Ca/+-activated protease from rat liver cell sap was prepared. It was shown to act on rat liver pyruvate kinase that had been phosphorylated by the catalytic subunit of cyclic AMP-dependent protein kinase, the activity being optimum at neutral pH. The modified pyruvate kinase had the same Vmax as the phosphoenzyme but showed a lower affinity for the substrate phosphoenolpyruvate. The possibility that this proteolytic attack is the step that initiates further degradation in the cell is discussed.

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