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  • 201.
    Forsberg, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    One hundred years of railway disasters and recent trends2011In: Prehospital and disaster medicine, ISSN 1049-023X, Vol. 26, no 5, 367-373 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Globally, railway transport is increasing steadily. Despite the adoption of diverse safety systems, major railway incidents continue to occur. Higher speeds and increased passenger traffic are factors that influence the risk of mass-casualty incidents and make railway crashes a reality that merits extensive planning and training.

    METHODS: Data on railway disasters were obtained from the Centre for Research on the Epidemiology of Disasters (CRED), which maintains the Emergency Events Database (EM-DAT). This descriptive study consists of 529 railway disasters (≥10 killed and/or ≥100 non- fatally injured) from 1910 through 2009.

    RESULTS: The number of railway disasters, people killed, and non-fatally injured, has increased throughout the last hundred years-particularly during the last four decades (1970-2009), when 88% of all disasters occurred. In the mid-20th century, a shift occurred, resulting in more people being non-fatally injured than fatally injured. During 1970-2009, 74% of all railway disasters occurred in Asia, Africa, and South and Central America, combined. The remaining 26% occurred in Europe, North America, and Oceania, combined. Since 1980, railway disasters have increased, especially in Asia and Africa, while Europe has had a decrease in railway disasters. The number killed per disaster (1970-2009) was highest in Africa (n = 55), followed by South and Central America (n = 47), and Asia (n = 44). The rate was lowest in North America (n = 10) and Europe (n = 29). On average, the number of non-fatal injuries per disaster was two to three times the number of fatalities, however, in the African countries (except South Africa) the relation was closer to 1:1, which correlates to the relation found in more developed countries during the mid-20th century. The total losses (non-fatally and fatally injured) per disaster has shown a slight decreasing trend.

    CONCLUSIONS: Despite extensive crash avoidance and injury reduction safety systems, railway crashes occur on all continents, indicating that this type of incident must be accounted for in disaster planning and training. Better developed safety, crashworthiness, and rescue resources in North America and Europe may be factors explaining why the number of crashes and losses has stabilized and why the average number of people killed per disaster is lowest on these continents.

  • 202.
    Forsberg, Rebecca
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Iglesias Vazquez, Jose Antonio
    A Case Study of the High-speed Train Crash Outside Santiago de Compostela, Galicia, Spain2016In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 31, no 2, 163-168 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: The worldwide use of rail transport has increased, and the train speeds are escalating. Concurrently, the number of train disasters has been amplified globally. Consequently, railway safety has become an important issue for the future. High-velocity crashes increase the risk for injuries and mortality; nevertheless, there are relatively few studies on high-speed train crashes and the influencing factors on travelers' injuries occurring in the crash phase. The aim of this study was to investigate the fatal and non-fatal injuries and the main interacting factors that contributed to the injury process in the crash phase of the 2013 high-velocity train crash that occurred at Angrois, outside Santiago de Compostela, Spain. Methods: Hospital records (n = 157) of all the injured who were admitted to the six hospitals in the region were reviewed and compiled by descriptive statistics. The instant fatalities (n = 63) were collected on site. Influencing crash factors were observed on the crash site, by carriage inspections, and by reviewing official reports concerning the approximated train speed. Results: The main interacting factors that contributed in the injury process in the crash phase were, among other things, the train speed, the design of the concrete structure of the curve, the robustness of the carriage exterior, and the interior environment of the carriages. Of the 222 people on board (218 passengers and four crew), 99% (n = 220) were fatally or non-fatally injured in the crash. Thirty-three percent (n = 72) suffered fatal injuries, of which 88% (n = 63) died at the crash site and 13% (n = 9) at the hospital. Twenty-one percent (n = 32) of those admitted to hospital suffered multi-trauma (ie, extensive, severe, and/or critical injuries). The head, face, and neck sustained 42% (n = 123) of the injuries followed by the trunk (chest, abdomen, and pelvis; n = 92; 32%). Fractures were the most frequent (n = 200; 69%) injury. Conclusion: A mass-casualty incident with an extensive amount of fatal, severe, and critical injuries is most probable with a high-velocity train; this presents prehospital challenges. This finding draws attention to the importance of more robust carriage exteriors and injury minimizing designs of both railway carriages and the surrounding environment to reduce injuries and fatalities in future high-speed crashes.

  • 203.
    Fridh, Isabell
    et al.
    Högskolan i Borås, Göteborgs universitet.
    Kenne Sarenmalm, Elisabeth
    Ersta Sköndal University College, Palliative Research Centre, PRC. Skaraborgs sjukhus.
    Falk, Kristin
    Göteborgs universitet.
    Henoch, Ingela
    Göteborgs universitet.
    Öhlen, Joakim
    Ersta Sköndal University College, Palliative Research Centre, PRC. Göteborgs universitet.
    Ozanne, Anneli
    Göteborgs universitet.
    Jakobsson Ung, Eva
    Göteborgs universitet.
    Extensive human suffering: a point prevalence survey of patients' most distressing concerns during inpatient care2015In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 29, 444-453 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To explore patients' most distressing concerns during a hospital stay.

    BACKGROUND: The characteristics of hospitalised patients have changed. Care is provided at a higher age, lengths of stay have fallen and the nursing workload is increasing. It is presumed that hospitalised patients are more seriously ill and have more palliative needs than previously. Studies show that inpatients suffer from more distress than similar outpatients although there is a lack of overall knowledge about inpatients' distress and major concerns, regardless of age, diagnosis or care setting.

    METHODS: This study was part of a point prevalence survey (PPS) concerning symptom prevalence. Of the 710 patients who participated in the PPS, 678 (95%) answered an open-ended question in a questionnaire: What is your main concern or what is most distressing or troublesome for you at present? Using a life-world approach, the text was analysed qualitatively and patients' concerns were interpreted in two main dimensions, an intersubjective dimension and a temporal dimension.

    FINDINGS: The patients reported extensive suffering due to illness, symptoms and failing health. Patients were concerned about family members, existential issues and the future. Three aspects of the patients' most distressing concerns were interpreted: The suffering self, The suffering person in close relations and The suffering person in a threatening world.

    CONCLUSION: Hospitalised patients are affected by severe illness, distressing symptoms and existential quandaries, revealing extensive human suffering in the midst of the demanding activities that take place during an ordinary day in a hospital. To support patients and alleviate suffering, hospital staff need to be more sensitive to patients' most distressing concerns. This presupposes a hospital environment in which the value system supports caring and comforting behaviour.

  • 204.
    Fröberg, Andreas
    et al.
    Göteborgs Universitet.
    Raustorp, Anders
    Göteborgs Universitet.
    Metoder för att minska vuxnas stillasittande2017In: Fysioterapi, ISSN 1653-5804, no 2, 28-34 p.Article, review/survey (Other academic)
    Abstract [sv]

    I takt med den växande kunskapen om stillasittandets potentiella negativa hälsokonsekvenser har flera studier publicerats där forskare utvärderat effekten av interventioner som syftar till att minska stillasittande. Denna artikel sammanfattar forskningsläget kring detta och ger exempel på de metoder som har använts och utvärderats. Resultatet visar att metoder som innebär rekonstruktion av miljö som bland annat höj- och sänkbara arbetsbord och självregleringstekniker som monitorering med stegräkning har varit framgångsrika metoder för att minska stillasittande. Även metoder där problemlösning och tillhandahållande av information ingått har visat sig användbara. Förslag ges på hur fysioterapeuter kan gå till väga vid målformulering samt -utvärdering av insatser för att minska vuxnas stillasittande.

  • 205.
    Fröberg, Andreas
    et al.
    University of Gothenburg.
    Raustorp, Anders
    University of Gothenburg.
    Så påverkas hälsan av vårt stillasittande: En kunskapsöversikt ur ett livsloppsperspektiv2017In: Fysioterapi, ISSN 1653-5804, no 1, 26-31 p.Article, review/survey (Other academic)
  • 206.
    Fyhr, Sofia
    et al.
    Ersta Sköndal University College, Department of Health Care Sciences.
    Yosifpour, Galawish
    Ersta Sköndal University College, Department of Health Care Sciences.
    Vårdpersonalens attityder gentemot äldre patienters sexualitet: En litteraturöversikt2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Sexuality is important for all individuals, then it is a part of the humans physical and mental needs. For older people regardless of sexual orientation (hetero– bi- gay) sexuality is important for the experience of a healthy life. Research shows that many of the older people just lack of love and a physical close contact. Patient ́s sexual expressions in the form of verbal and sexual acts sometimes creates anxiety among the care staff because of their lack of knowledge in this area. This is a problem too as it is the nursing staff tasked with helping to pay the society ́s negative image this topic with a positive image.

    Aim: To highlight professional healthcarer ́s attitudes of older patient́s sexuality.

    Methods: This project is a literature review where twelve scientific articles reviewed. The databases was CINAHL Plus With Full Text, Nursing and Allied Health Source, MEDLINE With Full Text and PubMed. The keywords was staff, nurse, nursing student, attitude, perceptions, experiences, barriers, perspektives, knowledge, older people, older adults, aged residential care, care, sexuality, sexual health.

    Results: Sexual health is a complicated subject for professionals to deal with, discussions about sexual health issues have low priority and routines are not established for this. This result also revealed that health professionals are aware of older people ́s sexual needs but that they lack the skills to handle with its expression. Other influencing factors include age, gender, religion and origin.

    Method – discussion: There are both strength and weaknesses with the selected method. For all involved articles the weaknesses can be that they were written in English, which may lead to misinterpretation when this is not the author ́s native language. What can be both a strength and weakness is that the articles include various participating countries.

    Result – discussion: In the result it was concluded that older peoples sexuality is not a priority in health care and a major influencing factor in this may be that health professionals lack the specialist training include older people and sexuality. The healthcare environment is in most cases not suitable for the elderly to express their sexuality.

  • 207.
    Fältström, Anne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.
    Hägglund, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Kvist, Joanna
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Functional Performance Among Active Female Soccer Players After Unilateral Primary Anterior Cruciate Ligament Reconstruction Compared With Knee-Healthy Controls2017In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 45, no 2, 377-385 p.Article in journal (Refereed)
    Abstract [en]

    Background: Good functional performance with limb symmetry is believed to be important to minimize the risk of injury after a return to pivoting and contact sports after anterior cruciate ligament reconstruction (ACLR).

    Purpose: This study aimed to investigate any side-to-side limb differences in functional performance and movement asymmetries in female soccer players with a primary unilateral anterior cruciate ligament (ACL)–reconstructed knee and to compare these players with knee-healthy controls from the same soccer teams.

    Study Design: Cross-sectional study; Level of evidence, 3.

    Methods: This study included 77 active female soccer players at a median of 18 months after ACLR (interquartile range [IQR], 14.5 months; range, 7-39 months) and 77 knee-healthy female soccer players. The mean age was 20.1 ± 2.3 years for players with an ACL-reconstructed knee and 19.5 ± 2.2 years for controls. We used a battery of tests to assess postural control (Star Excursion Balance Test) and hop performance (1-legged hop for distance, 5-jump test, and side hop). Movement asymmetries in the lower limbs and trunk were assessed with the drop vertical jump and the tuck jump using 2-dimensional analyses.

    Results: The reconstructed and uninvolved limbs did not differ in any of the tests. In the 5-jump test, players with an ACL-reconstructed knee performed worse than controls (mean 8.75 ± 1.05 m vs 9.09 ± 0.89 m; P = .034). On the drop vertical jump test, the ACL-reconstructed limb had significantly less knee valgus motion in the frontal plane (median 0.028 m [IQR, 0.049 m] vs 0.045 m [IQR, 0.043 m]; P = .004) and a lower probability of a high knee abduction moment (pKAM) (median 69.2% [IQR, 44.4%] vs 79.8% [IQR, 44.8%]; P = .043) compared with the control players’ matched limb (for leg dominance). Results showed that 9% to 49% of players in both groups performed outside recommended guidelines on the different tests. Only 14 players with an ACL-reconstructed knee (18%) and 15 controls (19%) had results that met the recommended guidelines for all 5 tests (P = .837).

    Conclusion: The reconstructed and uninvolved limbs did not differ, and players with an ACL-reconstructed knee and controls differed only minimally on the functional performance tests, indicating similar function. It is worth noting that many players with an ACL-reconstructed knee and controls had movement asymmetries and a high pKAM pattern, which have previously been associated with an increased risk for both primary and secondary ACL injury in female athletes.

  • 208. Färdig, Rickard
    et al.
    Lewander, Tommy
    Melin, Lennart
    Folke, Fredrik
    Fredriksson, Anders
    A randomized controlled trial of the illness management and recovery program for persons with schizophrenia.2011In: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 62, no 6, 606-12 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to evaluate the effects of the illness management and recovery (IMR) program on symptoms and psychosocial functioning of individuals with schizophrenia or schizoaffective disorder in an outpatient setting in Sweden.

    METHODS: A total of 41 persons with schizophrenia or schizoaffective disorder who were receiving treatment at six psychiatric outpatient rehabilitation centers were randomly assigned to either an IMR group for nine months or to treatment as usual (control condition). Assessments were conducted at baseline, posttreatment (nine months), and follow-up (21 months) and included self-reports and ratings by clinicians (both blind and nonblind to treatment assignment) of illness management, psychiatric symptoms, recovery, coping, quality of life, hospitalization, insight, and suicidal ideation.

    RESULTS: As measured by self-report and ratings of nonblinded clinicians, IMR program participants demonstrated significantly greater improvement in illness management than participants in the control condition. Ratings of psychiatric symptoms by blinded clinicians using the Psychosis Evaluation Tool for Common Use by Caregivers and self-reported ratings of psychosocial functioning on the Ways of Coping Questionnaire also showed better outcomes than for participants in treatment as usual. A statistically significant decrease in suicidal ideation between baseline and follow-up was found for IMR program participants.

    CONCLUSIONS: The study supports previous findings and suggests that the IMR program is effective in improving the ability of individuals with schizophrenia to better manage their illness.

  • 209.
    Gagner, Sandra
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Jägerstedt, Mika
    Halmstad University, School of Social and Health Sciences (HOS).
    Betydelsefull närhet och nödvändig distans: Sjuksköterskans professionella förhållningssätt inom palliativ vård2010Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Palliative care is an approach which has the main emphasis on the patient’s quality of life. It is characterized by a holistic view towards the patient’s physical, psychological, social and existential need. The nurse can work with palliative care in many different contexts, and to various degrees. Nonetheless, the nurse who conducts palliative care will always have a relation building function, and the relation between the nurse and the patient will have large impact of the patient’s perceived well-being. A nurse’s professional approach to palliative care is generally thought of as her taking on a compassionate role against her patients. The purpose of this paper was to describe the nurse’s experience of establishing and keeping a professional approach to her patients in palliative care. The study was conducted as a scientific literature review with a systematic gathering and scrutinizing of data. In total, eleven qualitative scientific articles were included in the review. Three main conclusions could be drawn. First, the nurses experienced that the relations within palliative care were characterized by closeness and emotional engagement. The close relationship between the nurse and her patients was regarded as being positive, although it constituted a risk of emotional overload. Second, it was found to be necessary for the nurse to maintain a professional distance to the patient to be able to separate work from private life. Third, many nurses identified a challenge of striking an appropriate balance between closeness and distance in order to be able to be personal without being private.

  • 210.
    Gardsten, Cecilia
    et al.
    Högskolan Kristianstad, Sweden.
    Blomqvist, Kerstin
    Högskolan Kristianstad, Sweden.
    Mörtberg, Christina
    Linnaeus University, Faculty of Technology, Department of Informatics. Linneus University.
    Ethical considerations in Participatory Action Research (PAR)2014In: Nordic Conference in Nursing Research: methods and networks for the future, 10-12 June, 2014, Odense, 2014Conference paper (Other academic)
  • 211.
    Gelhaus, Petra
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Psychiatry and Habilitation.
    The desired moral attitude of the physician: (I) Empathy2012In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 2, 103-113 p.Article in journal (Refereed)
    Abstract [en]

    In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired underlying attitude of physicians. In this article, one of them—empathy—is presented in an interpretation that is meant to depicture (together with the two additional concepts compassion and care) this attitude. Therefore empathy in the clinical context is defined as the adequate understanding of the inner processes of the patient concerning his health-related problems. Adequacy is scrutinized on behalf of the emotional and subjective involvement of he physician, and on the necessary dependence on medical—moral—goals. In the present interpretation, empathy alone is no guarantee of the right moral attitude, but a necessary instrumental skill in order to perceive and treat a patient as an individual person. The concepts of compassion and care that will be discussed in two forthcoming articles are necessary parts to describe the desired moral attitude of the physician more completely.

  • 212.
    Gelhaus, Petra
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Psychiatry and Habilitation.
    The desired moral attitude of the physician: (II) Compassion2012In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 15, no 4, 397-410 p.Article in journal (Refereed)
    Abstract [en]

    Professional medical ethics demands of health care professionals in addition to specific duties and rules of conduct that they embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired implied attitude of physicians. In a sequel of three articles, a set of three of these concepts is presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In this article, the emotional and virtuous core of the desired professional attitude—compassion—is elaborated. Compassion is distinguished from sympathy, empathy and pity. Several problems of compassion as a spontaneous, warm emotion for being a professional virtue are discussed: especially questions of over-demand, of justice and of concerns because of a possible threat to the patient’s dignity and autonomy. An interpretation of compassion as processed and learned professional attitude, that founds dignity on the general idea of man as a sentient being and on solidarity, not on his independence and capacities, is developed. It is meant to rule out the possible side effects and to make compassion as a professional attitude and as professional virtue attractive, teachable and acquirable. In order to reach the adequate warmth and closeness for the particular physician-patient-relation, professional compassion has to be combined with the capacity of empathy. If appropriate, the combination of both empathy and compassion as “empathic compassion” can demand a much warmer attitude towards the patient than each of the elements alone, or the simple addition of them can provide. The concept of “care” that will be discussed in a forthcoming article of this sequel is a missing necessary part to describe the active potential of the desired moral attitude of the physician more completely. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.

  • 213.
    Gelhaus, Petra
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Psychiatry and Habilitation.
    The desired moral attitude of the physicians: (III) Care2013In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 16, no 2, 125-139 p.Article in journal (Refereed)
    Abstract [en]

    In professional medical ethics, the physician traditionally is obliged to fulfil specific duties as well as to embody a responsible and trustworthy personality. In the public discussion, different concepts are suggested to describe the desired moral attitude of physicians. In a series of three articles, three of the discussed concepts are presented in an interpretation that is meant to characterise the morally emotional part of this attitude: “empathy”, “compassion” and “care”. In the first article of the series, “empathy” has been developed as a mainly cognitive and morally neutral capacity of understanding. In the second article, the emotional and virtuous core of the desired professional attitude—compassion—has been presented. Compassion as a professional attitude has been distinguished from a spontaneous feeling of compassion, and has been related to a general idea of man as vulnerable and solidary being. Thus, the dignity of the patient is safeguarded in spite of the asymmetry of compassion. In this article, the third concept of the triad—“care”—is presented. Care is conceived as an attitude as well as an activity which can be directed to different objects: if it is directed to another sentient being, it is regarded as intrinsically morally valuable; implying (1) the acceptance of being addressed, (2) a benevolent inclination to help and to foster, and (3) activity to realize this. There are different forms of benevolence that can underlie caring. With regard to the professional physician’s ethos, the attitude of empathic compassion as developed in the two previous articles is proposed to be the adequate underlying attitude of care which demands the right balance between closeness and professionalism and the right form of attention to the person of the patient. ‘Empathic compassionate care’ does not, however, describe the whole of the desired attitude of a physician, but focuses on the morally-emotive aspects. In order to get also the cognitive and practical aspects of biomedicine into the picture, ‘empathic compassionate care’ has to be combined with an attitude of responsibility that is more directed to decision-making and outcome than a caring attitude alone can be. The reconstruction of the desired professional attitude in terms of “empathic compassionate care” and “responsibility” is certainly not the only possible description, but it is a detailed proposal in order to give an impulse for the discussion about the inner tacit values and the meaning of medicine and clinical healthcare professions.

  • 214.
    Georgsson, Mattias
    Blekinge Institute of Technology, Faculty of Computing, Department of Creative Technologies.
    Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics2016In: JAMIA Journal of the American Medical Informatics Association, ISSN 1067-5027, E-ISSN 1527-974X, Vol. 23, no 1, 5-11 p.Article in journal (Refereed)
    Abstract [en]

    Objective Mobile health (mHealth) systems are becoming more common for chronic disease management, but usability studies are still needed on patients' perspectives and mHealth interaction performance. This deficiency is addressed by our quantitative usability study of a mHealth diabetes system evaluating patients' task performance, satisfaction, and the relationship of these measures to user characteristics. Materials and Methods We used metrics in the International Organization for Standardization (ISO) 9241-11 standard. After standardized training, 10 patients performed representative tasks and were assessed on individual task success, errors, efficiency (time on task), satisfaction (System Usability Scale [SUS]) and user characteristics. Results Tasks of exporting and correcting values proved the most difficult, had the most errors, the lowest task success rates, and consumed the longest times on task. The average SUS satisfaction score was 80.5, indicating good but not excellent system usability. Data trends showed males were more successful in task completion, and younger participants had higher performance scores. Educational level did not influence performance, but a more recent diabetes diagnosis did. Patients with more experience in information technology (IT) also had higher performance rates. Discussion Difficult task performance indicated areas for redesign. Our methods can assist others in identifying areas in need of improvement. Data about user background and IT skills also showed how user characteristics influence performance and can provide future considerations for targeted mHealth designs. Conclusion Using the ISO 9241-11 usability standard, the SUS instrument for satisfaction and measuring user characteristics provided objective measures of patients' experienced usability. These could serve as an exemplar for standardized, quantitative methods for usability studies on mHealth systems.

  • 215. Gerdle, Björn
    et al.
    Stålnacke, Britt-Marie
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Rudling, Karin
    Jansen, Gunilla Brodda
    Fischer, Marcelo Rivano
    Do not compare apples and pears in the evaluation of the rehabilitation guarantee.2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 47, 2111-2 p.Article in journal (Refereed)
  • 216.
    Germundsson, Per
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The Swedish Institute for Disability Research.
    Danermark, Berth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. The Swedish Institute for Disability Research.
    Vocational rehabilitation, interagency collaboration and social representations2012In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 42, no 4, 507-517 p.Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study is to describe and analyse two important dimensions of vocational rehabilitation for disadvantaged groups and persons with disabilities: interagency collaboration and social representations.

    Participants: Four focus group discussions were conducted. The participants were 20 officials of various agencies who had taken part in collaboration projects in vocational rehabilitation.

    Methods: Qualitative content analysis was used for the analysis. The material was categorised and central themes identified.

    Results: Three themes emerged: 'Collaboration Process', 'Other Agencies' and 'Object for Collaboration'. The results indicate that interagency collaboration is very important in vocational rehabilitation, but that there are a number of obstacles to smooth collaboration. The professionals of the different agencies shared social representations to a great extent. Working with people with psychiatric disorders is especially challenging, and conflicts tended to arise between the projects and the home organisations.

    Conclusions: Recognition of others' knowledge and respectfulness toward other professions facilitated vocational rehabilitation and the interagency collaboration process. The agencies' lack of flexibility increased the risk of conflicts as attempts were made to integrate the new working methods developed within the projects into the ordinary activities of the agencies.

  • 217.
    Giardina, Rebecca
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Familjeterapins roll vid ångest-behandling av barn och ungdomar: - en systematisk litteraturöversikt2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Antalet barn och unga som drabbas av psykisk ohälsa fortsätter att öka i Sverige. Detta ställer höga krav på att vården kan erbjuda effektiv hjälp för de lidande samt ständigt utvärdera om insatserna är bra eller behöver utvecklas. Ångestsyndrom hos barn och unga är ett tillstånd som innebär ett signifikant lidande för den drabbade och den unges familj. I Socialstyrelsens allmänna riktlinjer från 2010, rekommenderas i första hand kognitiv beteendeterapi för dessa barn och ungdomar. Då alla barnpsykiatriska tillstånd uppkommer och utvecklas i ett familjesammanhang (oavsett genes), fanns en önskan om att ta reda på vilken aktuell forskning som finns gällande familjeterapeutiska interventioner vid behandling av barn och unga med ångestsyndrom. 

    Metod/Resultat: 

    Som metod användes systematisk litteratursökning på kliniska studier de senaste 10 åren där familjeterapeutiska interventioner använts vid ångestbehandling av barn och unga. Resultaten visade på två huvudfynd; dels att det finns få kliniska studier gällande familjeterapeutiska interventioner vid ångesttillstånd hos barn och unga samt att de studier som gjorts visade på god effekt vid tillägg av familjeterapeutiska interventioner och då i synnerhet när insatserna var mer omfattande. 

    Slutsatser

    De slutsatser som dras av studien är dels att mer forskning kring familjeterapi och ångestsyndrom hos barn och unga behövs, att familjeterapeutiska interventioner ger lovande resultat samt att forskningen inom kognitiv beteendeterapi banat

  • 218.
    Gjessing, Kristian
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Torgé, Cristina Joy
    Linköping University, Department of Social and Welfare Studies, NISAL - National Institute for the Study of Ageing and Later Life. Linköping University, Faculty of Arts and Sciences.
    Hammar, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Dahlberg, Johanna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, no 7, 341-347 p.Article in journal (Refereed)
    Abstract [en]

    Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

    Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

    Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

    Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

  • 219.
    Gjessing, Kristian
    et al.
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Torgé, Cristina Joy
    Linköpings universitet, NISAL - Nationella institutet för forskning om äldre och åldrande.
    Hammar, Mats
    Linköpings universitet, Avdelningen för kliniska vetenskaper.
    Dahlberg, Johanna
    Linköpings universitet, Avdelningen för mikrobiologi och molekylär medicin.
    Faresjö, Tomas
    Linköpings universitet, Avdelningen för samhällsmedicin.
    Improvement of quality and safety in health care as a new interprofessional learning module – evaluation from students2014In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, no 7, 341-347 p.Article in journal (Refereed)
    Abstract [en]

    Background: Interprofessional teamwork is in many ways a norm in modern health care, and needs to be taught during professional education.

    Description: This study is an evaluation of a newly introduced and mandatory learning module where students from different health profession programs used Improvement of Quality and Safety as a way to develop interprofessional competence in a real-life setting. The intention of this learning module was to integrate interprofessional teamwork within the students' basic education, and to give students a basic knowledge about Improvement of Quality and Safety. This report focuses on evaluations from the participating students (n=222), mainly medical and nursing students.

    Materials and methods: To evaluate this new learning module, a questionnaire was developed and analyzed using a mixed methods design, integrating both qualitative and quantitative methods. The evaluation addressed learning concepts, learning objectives, and interprofessional and professional development.

    Results and conclusion: A majority of students responded positively to the learning module as a whole, but many were negative towards specific parts of the learning module and its implementation. Medical students and male students were less positive towards this learning module. Improvements and alterations were suggested. 

  • 220. Gladh, K.
    et al.
    Lo Martire, R.
    Äng, Björn
    Lindholm, P.
    Nilsson, J.
    Westman, A.
    Decelerations of parachute opening shock in skydivers2017In: Aerospace Medicine and Human Performance, ISSN 2375-6314, Vol. 88, no 2, 121-127 p.Article in journal (Refereed)
  • 221. Gladh, K.
    et al.
    Äng, Björn
    Lindholm, P.
    Nilsson, J.
    Westman, A.
    Decelerations and muscle responses during parachute opening shock2013In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 84, no 11, 1205-10 p.Article in journal (Refereed)
  • 222.
    Grahn Vera Gajardo, Jannette
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. 6406282787.
    ”Man vill ha bekräftelse på att allt rullar åt rätt håll” - En intervjustudie om föräldrars upplevelse av 3-års teambesöket på BVC i Värmland2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Föräldrarnas levnadsvanor kan vara avgörande för hur barnets framtida levnadsvanor kommer att se ut och är därför väsentliga ur ett folkhälsoperspektiv.

     

    Syftet med denna studie var att undersöka de värmländska föräldrarnas upplevelse av 3-års teambesök på barnavårdscentralerna (BVC) i Värmland. Teambesöket, där både barnhälsovårdsläkare och barnhälsovårdssjuksköterska träffar föräldrarna tillsammans har som syfte att prata om levnadsvanor med alla föräldrar ur ett hälsofrämjande perspektiv som innebär att utgå från faktorer som bidrar till att främja och bevara hälsan.

     

     

    För att svara på syftet användes kvalitativ induktiv metod. Urvalet, tio föräldrar, var strategiskt och kompletterades med ett bekvämlighetsurval. Datainsamlingen skedde genom intervjuer som spelades in, transkriberades och analyserades med kvalitativ innehållsanalys metod. Resultatet från denna studie visar att upplevelsen av 3-års teambesöket på BVC i Värmland skiljer sig åt avseende personalens bemötande. Faktorer som avgjorde upplevelse av ”det goda mötet” berodde inte endast på BVC-personalens tidsbrist utan upplevelsen påverkades också av förhållningssättet, innefattande struktur och arbetssätt på teambesöket. Det var viktigt för en positiv upplevelse att känna att alla blev delaktiga i ett samtal som inte är utpekande och som kan ge möjlighet till reflektion samt bekräftelse på att man som förälder gör rätt.  Det är dessa aspekter som leder till att föräldrarna känner sig stärkta i sitt föräldraskap. Föräldrarna upplevde levnadsvanefrågor som viktiga likaså uppföljningen av BVC samt att tilliten till BVC:s arbete med att övervaka och följa upp barns hälsa var stark.

     

    Mot bakgrund av studiens resultat föreslås åtgärder för att förbättra struktur, samarbete och roller på teambesöket på BVC i Värmland.

  • 223.
    Grenklo, Tove Bylund
    et al.
    Karolinska Institutet, Stockholm Sjukhem Foundation.
    Kreicbergs, Ulrika C
    Karolinska Institutet, Sophiahemmet.
    Valdimarsdóttir, Unnur A
    Karolinska Institutet, University of Iceland, Reykjavík, Iceland, Harvard School of Public Health, Boston, USA.
    Nyberg, Tommy
    Karolinska Institutet.
    Steineck, Gunnar
    Karolinska Institutet, Göteborgs universitet.
    Fürst, Carl Johan
    Karolinska Institutet, Stockholm Sjukhem Foundation, Lunds universitet.
    Communication and trust in the care provided to a dying parent: A nationwide study of cancer-bereaved youths.2013In: Journal of Clinical Oncology, ISSN 0732-183X, E-ISSN 1527-7755, Vol. 31, no 23, 2886-2894 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess children's trust in the care provided to a dying parent during the final week of life in relation to end-of-life medical information about disease, treatment, and death.

    METHODS: This nationwide population-based survey included 622 (73%) of 851 youths who, 6 to 9 years earlier, at age 13 to 16 years, lost a parent to cancer. We asked about the children's reception of end-of-life professional information and trust in the care provided. We also asked about depression and several potential risk factors of distrust in the care provided.

    RESULTS: A majority (82%) reported moderate/very much trust in the care provided. Compared with children who received end-of-life medical information before their loss, the risk of distrust in the care provided was higher in those who received no information (risk ratio [RR], 2.5; 95% CI, 1.5 to 4.1), in those who only received information afterward (RR, 3.2; 95% CI, 1.7 to 5.9), and in those who did not know or remember if end-of-life medical information was provided (RR, 1.7; 95% CI, 1.1 to 2.5). Those reporting distrust in the care provided had an RR of 2.3 (95% CI, 1.5 to 3.5) for depression. Furthermore, the risk of distrust in the care provided was higher among children reporting poor efforts to cure (RR, 5.1; 95% CI, 3.6 to 7.3), and/or a poor relationship with the surviving parent (RR, 2.9; 95% CI, 2.0 to 4.1).

    CONCLUSION: Our study suggests that children's trust in the care provided to a dying parent was highest when they received end-of-life medical information before their loss.

  • 224.
    Grill, Lisa
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Jönsson, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Hur skapar terapeuten ett samtalsklimat där patienten kan förmedla sitt dilemma med öppenhet och tillit?2015Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Som kliniker värderar vi energin i det terapeutiska samtalet. Studien syftar till att undersöka vad

    som möjliggör för patienter att sätta ord på livets mångfald, tillkortakommanden och existentiella

    dilemman i ett psykoterapeutiskt sammanhang. Kvalitativ metod tillämpades. En initierad

    kollega intervjuade en av författarna i hens roll som terapeut tillsammans med tre patienter och

    deras anhöriga vid olika tillfällen. Patienterna hade diagnoserna psykos, GAD (=generaliserad

    ångest) och depression och är knutna till öppenpsykiatrin. Intervjun genomfördes enligt

    samforskningsmetoden och filmades. Författarna har tittat spontant på de filmade intervjuerna

    och skrivit ned direkta reflektioner. Därefter särskådades materialet metodiskt för att identifiera

    samband och upprepningar. Analys av inspelningarna bekräftar vikten av terapeutens personliga

    egenskaper: Att kunna inge trygghet, och inspiration, att ha förmåga till inkännande, samt tilltro

    till patientens kapacitet under och utanför samtalen. Våra slutsatser stämmer väl med tidigare

    publicerade forskningsresultat.

  • 225. Grooten, W. J.
    et al.
    Conradsson, D.
    Äng, Björn
    Franzen, E.
    Is active sitting as active as we think?2013In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 56, no 8, 1304-14 p.Article in journal (Refereed)
  • 226. Grooten, W. J.
    et al.
    Äng, Björn
    Reliability of measurements of wrist extension force obtained with a Nicholas Manual Muscle Tester (NMMT)2010In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 26, no 4, 281-7 p.Article in journal (Refereed)
  • 227.
    Grossi, Giorgio
    et al.
    Psykologiska Institutionen, Stockholms universitet.
    Perski, Aleksander
    Psykologiska Institutionen, Stockholms universitet.
    Ekstedt, Mirjam
    Karolinska Institutet.
    Johansson, Thorbjörn
    Lindström, Morie
    Holm, Karin
    The morning salivary cortisol response in burnout.2005In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 59, no 2, 103-11 p.Article in journal (Refereed)
    Abstract [en]

    The results of the present study indicate a dysregulation in hypothalamic-pituitary-adrenocortical axis (HPA axis) activity, characterised by elevated morning salivary cortisol levels, among female burnout patients. Among males, increased cortisol levels were observed among participants with moderate levels of burnout, but not among patients or healthy controls.

  • 228.
    Gryth, Dan
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Rådestad, Monica
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Nilsson, Heléne
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Nerf, Ola
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Svensson, Leif
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Rüter, Anders
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology.
    Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise.2010In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 25, no 2, 118-123 p.Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Large, functional, disaster exercises are expensive to plan and execute, and often are difficult to evaluate objectively. Command and control in disaster medicine organizations can benefit from objective results from disaster exercises to identify areas that must be improved.

    OBJECTIVE: The objective of this pilot study was to examine if it is possible to use performance indicators for documentation and evaluation of medical command and control in a full-scale major incident exercise at two levels: (1) local level (scene of the incident and hospital); and (2) strategic level of command and control. Staff procedure skills also were evaluated.

    METHODS: Trained observers were placed in each of the three command and control locations. These observers recorded and scored the performance of command and control using templates of performance indicators. The observers scored the level of performance by awarding 2, 1, or 0 points according to the template and evaluated content and timing of decisions. Results from 11 performance indicators were recorded at each template and scores greater than 11 were considered as acceptable.

    RESULTS: Prehospital command and control had the lowest score. This also was expressed by problems at the scene of the incident. The scores in management and staff skills were at the strategic level 15 and 17, respectively; and at the hospital level, 17 and 21, respectively.

    CONCLUSIONS: It is possible to use performance indicators in a full-scale, major incident exercise for evaluation of medical command and control. The results could be used to compare similar exercises and evaluate real incidents in the future.

  • 229.
    Gröndal, Hedvig
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Signs of bacteria: Enacting Sore Throat2015Conference paper (Refereed)
    Abstract [en]

    In this paper I analyse the diagnostic process in relation to bacterial sore throat and how this disease comes into being, or how it is enacted, at two Swedish health centres. The empirical data analysed consist of interviews with nurses and general practioners as well as observations at the health centres. The concept of enactment implies that disease is relationally constituted in and through relations between human and non-human actors. In the paper the relations between health care personnel, bodies, symptoms, instruments, bacteria and other actors are investigated, and I discuss how different enactments of bacterial sore throat come to being depending on how these relations are organized. When doing this the clinical gaze - the diagnosing gaze that interpret signs of an underlying pathology on the patients body – is explored and in relation to the empirical material this gaze is investigated, that is, how it is employed and how it is established in relation to a number of human and non-human actors. 

  • 230.
    Gudmundsson, Cecilia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    "Anknytningsteori har ju funnits sen Hedenhös": Anknytning som psykoterapeutiskt fenomen2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Detta är en kvalitativ studie vars syfte är att undersöka anknytingsfenomenet. Frågorna berör hur terapeuter ser på anknytningsfenomenet, vilken betydelse de tillskriver fenomenet och hur det tar sig uttryck i det konkreta terapiarbetet med barn och ungdomar. För att få svar på frågorna genomfördes en intervjustudie. Fem yrkesverksamma barn- och ungdomsterapeuter, tre kvinnor och två män, alla med mångårig erfarenhet av att arbeta med terapier med barn och ungdomar intervjuades. Intervjuerna spelades in, transkriberades, lästes noggrant och analyserades därefter i två steg. I första steget markerades de för studien relevanta citaten och sammanställdes i huvudteman utifrån frågeordning och respondent. Detta följdes av en sammanfattande kommentar. I andra steget togs nyckelbegrepp ut och grupperades.  Resultaten visar bland annat hur mångfacetterat fenomenet blir genom terapeutens subjektiva upplevelse och därigenom deras olika sätt att beskriva fenomenet. Resultaten visar vidare att terapeuter tillskriver fenomenet stor betydelse och beaktar detta medvetet i sitt praktiska arbete.

  • 231.
    Gunnarsson, Ingemar
    Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences. Linnaeus University Centre for Concurrences in Colonial and Postcolonial Stuides.
    Biografin som historisk genre och metod2015In: Livsberättelser, kultur & hälsa / [ed] Motzi Eklöf, Margareta Petersson, Växjö: Linnaeus University Press, 2015, 1, 75-79 p.Chapter in book (Other academic)
  • 232.
    Gunnarsson, Ingemar
    Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences. Linnaeus University, The University Library.
    Referenshantering med EndNote2017In: Vetenskaplig teori och metod: Från idé till examination inom omvårdnad / [ed] Maria Henricson, Lund: Studentlitteratur, 2017, 2, 439-458 p.Chapter in book (Other academic)
  • 233.
    Gunnarsson, Lars-Gunnar
    et al.
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business.
    Epidemiologiskt undersökta samband mellan Alzheimers sjukdom och faktorer i arbetsmiljön2015Report (Refereed)
    Abstract [en]

    Epidemiological evidence on associations between work environment and Alzheimers disease

    Lars-Gunnar Gunnarsson, assistant professor at School of Medicine, Örebro University, Sweden and

    Lennart Bodin, professor emeritus, Department of Statistics, Örebro University, Sweden and senior researcher at Institute of Environmental Medicine, Karolinska Institute, Sweden.

    In this systematic literature review we identified 50 original publications on associations between work and Alzheimer’s disease. GRADE guidelines were used to secure high scientific quality and reliable guidelines were applied to classify the papers. Thirty-one papers fulfilled high quality standards while 19 were methodologically deficient and thus were excluded from our meta-analyses.

    Twenty-seven studies concerned exposure to electromagnetic fields and two published meta-analyses indicated a weighted relative risk (RR) reaching 2.0. Our meta-analysis was only based on twelve high quality publications and the weighted relative risk included statistically over chemicals was evaluated in seven studies and the weighted RR was 1.55 (95% confidence interval 1.19-2.02). Only some few publications concerned pesticides and other chemicals and the weighted RR indicated increased risk.

    Higher education and work complexity were evaluated in eleven publications and our meta-analysis show a reduced the risk for Alzheimer’s disease. The weighted RR was 0.47 (95% confidence interval 0.35-0.63). Both factors were independently and additively protective.

    There are indications of an association between ALS and exposure to heavy muscle work especially in combination with muscle trauma, i.e. professional football players are reported to have an elevated risk. More studies are needed with more precise measures on these exposures.

  • 234.
    Gunnarsson Payne, Jenny
    Södertörn University, School of Historical and Contemporary Studies, Ethnology. Södertörn University, Centre for Baltic and East European Studies (CBEES).
    Mattering Kinship: Inheritance, biology and egg donation, between genetics and epigenetics2016In: Critical Kinship Studies / [ed] Charlotte Krolokke, Lene Myong, Stine W. Adrian, Tine Tjornhoj-Thomsen, London: Rowman & Littlefield Publishers, 2016, 1, 33-47 p.Chapter in book (Other academic)
  • 235.
    Gustafsson, Berit M.
    et al.
    Linköping University, Center for Social and Affective Neuroscience (CSAN). Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Högland Hospital, Sweden; Jönköping University, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Proczkowska, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Hospital Jönköping, Sweden.
    The Strengths and Difficulties Questionnaire (SDQ) for preschool childrena Swedish validation2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 8, 567-574 p.Article in journal (Refereed)
    Abstract [en]

    Background: In Sweden, 80-90% of children aged 1-5 years attend preschool, and that environment is well suited to identify behaviours that may be signs of mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is a well-known short and structured instrument measuring child behaviours that indicate mental health problems well suited for preschool use.Aim: To investigate whether SDQ is a reliable and valid instrument for identifying behavioural problems in children aged 1-3 years and 4-5 years in a Swedish population, as rated by preschool teachers.Methods: Preschools situated in different sized municipalities in Sweden participated. The preschool teacher rated each individual child. Concurrent validity was tested using the Child-Teacher Report Form (C-TRF) and Child Engagement Questionnaire (CEQ). Exploratory factor analysis was conducted for age groups, 1-3 years and 4-5 years.Results: The preschool teachers considered most of the SDQ items relevant and possible to rate. For the children aged 1-3 years, the subscales Hyperactivity (Cronbach alpha=0.84, split half=0.73) and Conduct (Cronbach alpha=0.76, split half=0.80) were considered to be valid. For the age group 4-5 years, the whole original SDQ scale, 4-factor solution was used and showed reasonable validity (Cronbach alpha=0.83, split half=0.87).Conclusion: SDQ can be used in a preschool setting by preschool teachers as a valid instrument for identifying externalizing behavioural problems (hyperactivity and conduct problems) in young children.Clinical implications: SDQ could be used to identify preschool children at high-risk for mental health problems later in life.

  • 236.
    Gustafsson, E.
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Litström, Emma
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Drott, Jenny
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 2, 747-754 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    The purpose of this study was to test the reliability of the Swedish version of the Oxaliplatin-Associated Neurotoxicity Questionnaire (OANQ) administrated throughout a self-reported mobile phone-based system, a pilot study.

    METHODS:

    Twenty-three patients from two university hospitals and two regional hospitals who had been treated with oxaliplatin were included through purposive sampling between autumn 2013 to autumn 2014. A test-retest was performed through a mobile phone-based system, with a recall period of 1 h to determine the reliability of the questionnaire.

    RESULTS:

    Internal consistency was strong for the three domains of the scale (α > 0.840). The statistical analyses for the test-retest indicated that the OANQ was stable. Intraclass correlation (ICC) for symptom items and effect on daily activities items showed an overall excellent reproducibility at 69 and 83 %, respectively. The weighted kappa for symptom items and daily activities items showed an overall almost perfect agreement at 59 and 52 %, respectively. A paired samples t test did not reveal any significant differences between the two measures.

    CONCLUSIONS:

    The OANQ was tested and considered a reliable assessment for capturing the oxaliplatin-induced peripheral neurotoxicity (OIPN) in patients receiving oxaliplatin. However, further reliability testing of the OANQ is needed.

  • 237.
    Gustafsson, Gabriel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University.
    Alpha-Synuclein Oligomers: Cellular Mechanisms and Aspects of Antibody Treatment2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In Parkinson’s disease (PD) and dementia with Lewy bodies (DLB), aggregated α-synuclein deposit inside cells within the brain. Smaller soluble α-synuclein aggregates, oligomers, are present both intra- and extracellularly. The α-synuclein oligomers are known to be particularly harmful, although the underlying neurotoxic mechanisms are not fully understood. The aim of this thesis was to investigate the pathogenic roles of α-synuclein oligomers and the possibility to target such species with antibody treatment.

    Passive immunotherapy with α-synuclein antibodies can lead to reduced pathology and ameliorated symptoms in transgenic mice. However, it remains unknown whether the antibodies are taken up by cells or whether they act extracellularly. In Paper I, we assessed cellular internalization of various α-synuclein monoclonal antibodies. The oligomer selective mAb47 displayed the highest uptake, which was promoted by the extracellular presence of α-synuclein.

    Alpha-synuclein aggregates can be found in both neurons and glial cells, but the pathogenic role of glial deposits has only been sparsely investigated. In Paper II, co-cultures of neurons and glia were exposed to α-synuclein oligomers. The astrocytes in the cultures rapidly accumulated oligomers, which were only partially degraded by lysosomes. The sustained intracellular α-synuclein deposits were associated with mitochondrial stress reactions in the astrocytes. 

    In Paper III, we sought to explore whether the astrocytic pathology induced by α-synuclein oligomers could be ameliorated by antibody treatment. Pre-incubation of oligomers with mAb47 promoted α-synuclein clearance, reduced astrocytic accumulation and rescued cells from mitochondrial stress. We could demonstrate that binding of the antibody to its antigen in the extracellular space was crucial for these effects to occur.

    The progressive pathology in PD is believed to be driven by cell-to-cell spreading of α-synuclein aggregates, potentially via exosomes and other extracellular vesicles (EVs). In Paper IV, we found that either fusing α-synuclein to a non-physiological protein tag or introducing the PD-causing A53T mutation directed α-synuclein towards EV secretion. Also, EV-associated α-synuclein was particularly prone to induce toxicity in recipient cells.

    In conclusion, this thesis sheds new light on the cellular dysfunction related to α-synuclein pathology and on how the underlying pathogenic processes may be targeted by antibody treatment.  

  • 238.
    Gustafsson, Sofia
    et al.
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Jeanette, Backholm
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    PÅVERKAR ÅLDER, KÖN OCH TRÄNINGSMÄNGD FMS?: En tvärsnittsstudie mellan Functional movement screen samt sf-36v2 Health survey2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Regelbunden fysisk aktivitet motverkar en rad fysiska och mentala sjukdomar. Hälsovinster av fysisk aktivitet är bland annat en högre funktionell muskulär- och kardiovaskulär kapacitet samt en högre livskvalitet. Stillasittande och inaktivitet kan leda till övervikt, kardiovaskulära sjukdomar, cancer, psykosociala problem och metaboliska sjukdomar.

    Mellan män och kvinnor finns fysiologiska skillnader som visar sig i kroppsstorlek och muskelmassa. Detta ger generellt sett kvinnor mer flexibel fysik medan män är fysiskt starkare.

    WHOs rekommendationer om daglig fysisk aktivitet är 150 min/vecka av moderat aerobisk träning eller 75 min mer ansträngande aerobisk träning. Styrketräning som involverar större muskelgrupper rekommenderas i åldrarna 18-64.  

    Till hjälp att undersöka hypotesen har två oberoende test används. En skriftlig enkät, SF-36v2 Health Survey, samt ett fysiskt test, Functional Movement Screen.

    I denna studie undersöks huruvida det finns ett samband mellan en ökad träningsmängd och ett högre FMS-resultat samt om en högre ålder ger lägre FMS-resultat, oavsett kön. Vi tror oss även se ett samband mellan högre FMS-poäng och ett högre uppskattat mentalt och fysiskt mående.

    Testpersonerna (N:30) som deltog i studien var arbetande eller studerande män (N:15) och kvinnor (N:15) i åldrarna 20-65år.

    FMS-resultaten visade ingen signifikant skillnad mellan kön eller stigande ålder. Däremot ser vi signifikanta skillnader mellan könen vid specifika styrke- eller rörlighetstester i FMS. Kvinnorna visar tydligt via resultaten att de generellt har en mer flexibel fysik medan männen är starkare.

    Som slutsats av denna studie kan vi konstatera att FMS som testmetod är könsneutralt och kan användas på blandade populationer. Detta ger testmetoden en bred användbarhet på just en blandad population.

    Fler studier krävs för att få fram normerande poängsättning om FMS skall användas på medelmotionären. 

  • 239.
    Haake, Kim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dahlgren, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Föda utan rädsla: En utvärdering av förlossningsförberedelse i grupp2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: En förlossningsupplevelse har beskrivits som en central upplevelse i en kvinnas liv och något som hon och hennes partner bar med sig.

    Syftet: var att undersöka blivande föräldrars oro, rädsla, trygghet, tillit till sin egen förmåga och kroppsförståelse inför en förlossning, innan och efter genomgången Föda utan rädsla kurs samt om det fanns skillnader relaterat till sociodemografiska variabler. Metod: Studiens design var experimentell och utformades som en före- och eftermätning med huvudsakligen kvantitativ ansats. Ett semistrukturerat frågeformulär användes och 42 blivande föräldrar deltog i studien.

    Huvudresultat: Deltagarna kände större trygghet, mer tillit till den egna förmågan, större förståelse för vad som hände i kroppen samt mindre oro inför en förlossning, efter kursen. Den största oron inför förlossningen var kontrollförlust, oro för komplikationer, bristande vård och stöd samt distraktion. Deltagare med barn upplevde en lägre trygghet, mer oro och ökad rädsla inför förlossningen än de deltagare som inte hade barn. Efter kursen planerade deltagarna i större utsträckning, att använda sig av massage, andning och avslappning samt Föda utan rädsla metoden under förlossningen. Fler deltagare beskrev att samarbete och Föda utan rädsla metoden var de främsta verktygen som de tänkt använda. Fler deltagare ansåg att intimitet, humor, tystnad, lugn och avslappning samt musik tillhörde en förlossning, efter kursen. Deltagarna beskrev även en ökad känsla av förberedelse efter genomgången kurs.

    Slutsats: Föda utan rädsla kursen kan medföra ett bättre samarbete mellan paret och barnmorskan. Det kan även ge föräldrarna större möjligheter till olika val då de har mer kunskap om de alternativ som finns. Materialet i studien var dock relativt litet vilket innebär att inga säkra slutsatser gentemot populationen kunde dras. 

  • 240.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Meesters, Jorit J L
    Department of Rheumatology, Department of Physical Therapy, Leiden University Medical Center, Leiden, Netherlands & National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Klokkerud, Mari
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Aanerud, Gerd J
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Stovgaard, Inger H
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Hørslev-Petersen, Kim
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Strömbeck, Britta
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University, Lund, Sweden.
    Vliet Vlieland, Thea P M
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands .
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & School of Business and Engineering, Department of Exercise Physiology, Biomechanics and Health, Spenshult, Halmstad, Sweden.
    Which patients improve the most after arthritis rehabilitation? A study of predictors in patients with inflamatory arthritis in northern Europe, the STAR-ETIC collaboration2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 3, 250-257 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investigated.

    DESIGN: Multicentre prospective observational study in 4 European countries.

    METHODS: HRQoL was measured with the European Quality 5 Dimensions (EQ-5D) and the Short Form 36 Health Survey (SF-36) in 731 patients who underwent multidisciplinary rehabilitation. Potential predictors were physical functioning (Health Assessment Questionnaire (HAQ)), self-efficacy (Arthritis Self Efficacy Scale (ASES)), psychological health (Hopkins Symptom Check List (HSCL-25)), pain/fatigue (numeric rating scales (NRS)), age, sex, diagnosis, comorbidity, education, clinical setting and change of medication during rehabilitation. Analysis of covariance (ANCOVA) was used to assess for potential predictors and interactions. The minimal important differences for HRQoL were analysed.

    RESULTS: Reporting worse function (b 0.05, p = 0.01), less psychological well-being (b 0.09, p = 0.000), and experiencing more pain (b 0.03, p = 0.000) or fatigue (b 0.02, p = 0.000) at admission predicted improved HRQoL. Change in medication during rehabilitation (b 0.08, p = 0.013) was associated with greater improvement in HRQoL. These EQ-5D findings were supported by SF-36 findings. Positive minimal important differences were noted in 46% (EQ-5D) and 23-47% (SF-36 subscales) of the patients.

    CONCLUSION: Patients with more severe symptoms experienced the largest gain in HRQoL post-intervention. The results of this study are of value for selecting the right patients for rheumatological team rehabilitation. © 2014 The Authors

  • 241.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högberg, Hans
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A longitudinal study of working life among first-line managers in the care of older adults2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, 7-13 p.Article in journal (Refereed)
    Abstract [en]

    Aim

    To study whether the number of subordinates plays a role in first-line managers’ and subordinates’ ratings of empowerment, stress symptoms, and leadership–management performance. The aim was also to study relationships between managers’ empowerment and stress symptoms and leadership–management performance.

    Methods

    A longitudinal and correlational design was used. All first-line managers (n = 98) and their subordinates (n = 2085) working in the care of older adults in five municipalities were approached.

    Results

    With fewer (≤ 30) subordinates per manager, there were higher ratings of structural empowerment among managers and subordinates and lower stress symptoms among subordinates, than with ≥ 31 subordinates. Furthermore, structural empowerment was related to the managers’ stress symptoms and leadership–management performance, mediated through psychological empowerment. Moreover, structural empowerment can control/adjust for large numbers of subordinates in relation to stress symptoms.

    Conclusion

    The higher FLMs rated their access to empowerment, the lower stress symptoms and higher leadership–management performance they rated over time.

  • 242.
    Hagman, Karl
    et al.
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    Barboutis, Christos
    Natural History Museum of Crete, University of Crete, Iraklion, Greece.
    Ehrenborg, Christian
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    Fransson, Thord
    Swedish Museum of Natural History, Department of.
    Jaenson, Thomas G. T.
    Department of Systematic Biology, Medical Entomology Unit, Uppsala University.
    Lindgren, Per-Eric
    Department of Clinical and Experimental Medicine, Microbiology, Linköping University.
    Lundkvist, Åke
    Department of Medical Microbiology and Biochemistry, Uppsala University and Swedish Institute for Communicable Diseases and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet.
    Nyström, Fredrik
    Department of Clinical and Experimental Medicine, Microbiology, Linköping University.
    Waldenström, Jonas
    Center for Ecology and Evolution, Microbial Model Systems, Linneaus University.
    Salaneck, Erik
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    On the potential roles of ticks and migrating birds in the ecology of West Nile virus.2014In: Infection Ecology and Epidemiology, ISSN 2000-8686, Vol. 4Article in journal (Refereed)
  • 243.
    Hagström, Katja
    et al.
    Department of Environmental Science, Örebro University, Örebro,Sweden.
    Axelsson, Sara
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Arvidsson, Helena
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Lundholm, Cecilia
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Eriksson, Kåre
    University Hospital of Umeå, Department of Occupational and Environmental Medicine, Umeå, Sweden.
    Exposure to Wood Dust, Resin Acids, and Volatile Organic Compounds During Production of Wood Pellets2008In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 5, 296-304 p.Article in journal (Refereed)
    Abstract [en]

    The main aim of this study was to investigate exposure to airborne substances that are potentially harmful to health during the production of wood pellets, including wood dust, monoterpenes, and resin acids, and as an indicator of diesel exhaust nitrogen dioxide. In addition, area measurements were taken to assess background exposure levels of these substances, volatile organic compounds (VOCs), and carbon monoxide. Measurements were taken at four wood pellet production plants from May 2004 to April 2005. Forty-four workers participated in the study, and a total of 68 personal measurements were taken to determine personal exposure to wood dust (inhalable and total dust), resin acids, monoterpenes, and nitrogen dioxide. In addition, 42 measurements of nitrogen dioxide and 71 measurements of total dust, resin acids, monoterpenes, VOCs, and carbon monoxide were taken to quantify their indoor area concentrations. Personal exposure levels to wood dust were high, and a third of the measured levels of inhalable dust exceeded the Swedish occupational exposure limit (OEL) of 2 mg/m 3 . Parallel measurements of inhalable and total dust indicated that the former were, on average, 3.2 times higher than the latter. The data indicate that workers at the plants are exposed to significant amounts of the resin acid 7-oxodehydroabietic acid in the air, an observation that has not been recorded previously at wood processing and handling plants. The study also found evidence of exposure to dehydroabietic acid, and exposure levels for resin acids approached 74% of the British OEL for colophony, set at 50 μg/m 3 . Personal exposure levels to monoterpenes and nitrogen dioxide were low. Area sampling measurements indicated that aldehydes and terpenes were the most abundant VOCs, suggesting that measuring personal exposure to aldehydes might be of interest. Carbon monoxide levels were under the detection limit in all area measurements. High wood dust exposure levels are likely to have implications for worker health; therefore, it is important to reduce exposure to wood dust in this industry.

  • 244.
    Halilovic, Amra
    et al.
    Landstinget i Dalarna.
    Terner, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Standardized headings as a foundation for semantic interoperability in EHR2016In: MATEC Web of Conferences / [ed] N. Mastorakis, V. Mladenov and A. Bulucea, 2016, Vol. 76, 04001Conference paper (Refereed)
    Abstract [en]

    The new Swedish Patient Act, which allows patients to choose health care in county councils other than their own, creates the need to be able to share health-related information contained in electronic health records [EHRs) across county councils. This demands interoperability in terms of structured and standardized data. Headings in EHR could also be a part of structured and standardized data. The aim was to study to what extent terminology is shared and standardized across county councils in Sweden. Headings from three county councils were analyzed to see to what extent they were shared and to what extent they corresponded to concepts in SNOMED CT and the National Board of Health and Welfare’s term dictionary [NBHW’s TD). In total 41% of the headings were shared across two or three county councils. A third of the shared headings corresponded to concepts in SNOMED CT. Further, an eighth of the shared headings corresponded to concepts in NBHW’s TD. The results showed that the extent of shared and standardized terminology in terms of headings across the studied three county councils were negligible.

  • 245.
    Hallvig, David
    et al.
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction. Chalmers Tekniska Högskola.
    Anund, Anna
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Fors, Carina
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Kecklund, Göran
    Stockholms Universitet.
    Karlsson, Johan G.
    Autoliv Development AB.
    Wande, Mattias
    Chalmers Tekniska Högskola.
    Åkerstedt, Torbjörn
    Stockholms Univeristet, Karolinska institutet.
    Sleepy driving on the real road and in the simulator: A comparison2013In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 50, 44-50 p.Article in journal (Refereed)
    Abstract [en]

    This study compared real driving with driving in a high fidelity, moving base, driving simulator with respect to driving performance, sleep related physiology (using electroencephalography and electrooculography) and subjective sleepiness during night and day driving for 10 participants.

    Sleepiness has been identified as one of the most important factors contributing to road crashes. However, almost all work on the detailed changes in behavior and physiology leading up to sleep related crashes has been carried out in driving simulators. It is not clear, however, to what extent simulator results can be generalized to real driving.

    The real road was emulated in the simulator. The results show that the simulator was associated with higher levels of subjective and physiological sleepiness than real driving. However, both for real and simulated driving, the response to night driving appears to be rather similar for subjective sleepiness and sleep physiology. Lateral variability was more responsive to night driving in the simulator, while real driving at night involved a movement to the left in the lane and a reduction of speed, both of which effects were absent in the simulator. It was concluded that the relative validity of simulators is acceptable for many variables, but that in absolute terms simulators cause higher sleepiness levels than real driving. Thus, generalizations from simulators to real driving must be made with great caution.

  • 246.
    Halvorsen, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 1, 11-19 p.Article in journal (Refereed)
    Abstract [en]

    Background. Our aim was to investigate cerebral and cardiac tissue injury subsequent to use of vasopressin and adrenaline in combination compared with vasopressin alone during cardiopulmonary resuscitation (CPR). Methods. In a randomized, prospective, laboratory animal study 28 anesthetized piglets were subject to a 12-min untreated cardiac arrest and subsequent CPR. After 1 min of CPR, 10 of the piglets received 0.4 U/kg of arg(8)-vasopressin (V group), and 10 piglets received 0.4 U/kg of arg(8)-vasopressin, 1 min later followed by 20 mu g/kg body weight of adrenaline, and another 1 min later continuous administration (10 mu g/kg/min) of adrenaline (VA group). After 8 min of CPR, the piglets were defibrillated and monitored for another 3 h. Then they were killed and the brain immediately removed pending histological analysis. Results. During CPR, the VA group had higher mean blood pressure and cerebral cortical blood flow (CCBF) but similar coronary perfusion pressure. After restoration of spontaneous circulation there was no difference in the pressure variables, but CCBF tended to be (36% +/- 16%) higher in the V group. Neuronal injury and signs of a disrupted blood-brain barrier (BBB) were greater, 20% +/- 4% and 21% +/- 4%, respectively, in the VA group. In a background study of repeated single doses of adrenaline every third minute after 5 min arrest but otherwise the same protocol, histological measurements showed even worse neural injury and disruption of the BBB. Conclusion. Combined use of vasopressin and adrenaline caused greater signs of cerebral and cardiac injury than use of vasopressin alone during experimental cardiopulmonary resuscitation.

  • 247.
    Hanson, Anton
    et al.
    Linnaeus University, Faculty of Engineering and Technology, Kalmar Maritime Academy.
    Horck, Emma
    Linnaeus University, Faculty of Engineering and Technology, Kalmar Maritime Academy.
    Arbetsskador som drabbar marin maskinpersonal: En kartläggning av skaderiskerna för marin maskinpersonal ombord på svenska fartyg, samt en jämförelse av skaderisken med liknande arbeten iland2013Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The aim with this thesis is to identify the risks of injury while working as marine engine staff and compare the risk of injury to employees who have similar jobs ashore. The thesis also includes identifying the types of work injuries, which leads to the most serious consequences for the employee in relation to how frequent the accident is.

    The thesis studied literature in which the Swedish Work Environment Authority's work injury reports are the base material, where a total of 198 injuries were treated and categorized. The Swedish Transport Agency’s statistics for employees at sea were compared with the Swedish Work Environment Authority’s and the Swedish Central Bureau of Statistics’ statistics for employees ashore.

    The result of the thesis show that work related accidents categorized as "Carry" and "Slip/Trip/Fall" and work related diseases categorized as "Heavy lifting/Working positions" are the injuries leading to the most serious consequences in relation to how frequent the accident is. When comparing the risk of injury with similar professions ashore, marine engine staff is the second worst. The profession most similar to marine engine staff has four times less risk of injury.

  • 248.
    Hanson, Claudia
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Waiswa, Peter
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Marchant, Tanya
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Marx, Michael
    Evaplan GmbH the University of Heidelberg, Germany.
    Manzi, Fatuma
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Mbaruku, Godfrey
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Rowe, Alex
    Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
    Tomson, Göran
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Schellenberg, Joanna
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.2014In: Implementation science : IS, ISSN 1748-5908, Vol. 9, 41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda.

    METHODS: In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys.

    DISCUSSION: EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings.

    TRIAL REGISTRATION: PACTR201311000681314.

  • 249.
    Hartleb, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Törnqvist, Patrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
      Gör terapeuten det hon tror hon gör och spelar det någon roll?: En explorativ validitetsstudie om sambanden mellan självrapporterad och observatörsskattad följsamhet till IPT som metod och dess betydelse för terapins utfall.  2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

     

    Denna studie har syftat till att mäta följsamhet till terapimetoden Interpersonell psykoterapi, undersöka sambanden mellan självrapporterad och observatörsskattad följsamhet samt utforska om terapeutens följsamhet påverkar behandlingsresultatet. Inga signifikanta samband mellan den självrapporterade och observatörsskattade följsamheten hos terapeuterna kunde konstateras. På de observatörsskattade variablerna fanns det en signifikant skillnad mellan terapeuterna, där en terapeut var mer följsam än de övriga två. Detta visade sig dock inte ha någon signifikant betydelse för behandlingsresultatet. Patienterna uppnådde en betydande symtomreduktion efter behandlingen utifrån deras självskattningar på MADRS-S och PHQ-9, men några samband med terapeuternas nivå av följsamhet kunde inte statistiskt beläggas. Författarna menar att det låga undersökningsmaterialet och bristen på ett enhetligt skattningsinstrument för den subjektiva och objektiva mätningen ger anledning att inte övertolka resultaten. En utvidgning av följsamhet som begrepp förespråkas, där följsamhet inte bara definieras av terapeutens beteende utan även av patientens beteende och samspelet mellan terapeut och patient. Vikten av fortsatta studier med denna definition som utgångspunkt poängteras.

  • 250. Hastbacka, Johanna
    et al.
    Fredén, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Hult, Maarit
    Bergquist, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
    Wilkman, Erika
    Vuola, Jyrki
    Sorsa, Timo
    Tervahartiala, Taina
    Huss, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Matrix Metalloproteinases-8 and-9 and Tissue Inhibitor of Metalloproteinase-1 in Burn Patients. A Prospective Observational Study2015In: PLoS ONE, ISSN 1932-6203, Vol. 10, no 5, e0125918Article in journal (Refereed)
    Abstract [en]

    Introduction Matrix metalloproteinases (MMPs) -8 and -9 are released from neutrophils in acute inflammation and may contribute to permeability changes in burn injury. In retrospective studies on sepsis, levels of MMP-8, MMP-9, and tissue inhibitor of metalloproteinase-1 (TIMP-1) differed from those of healthy controls, and TIMP-1 showed an association with outcome. Our objective was to investigate the relationship between these proteins and disease severity and outcome in burn patients. Methods In this prospective, observational, two-center study, we collected plasma samples from admission to day 21 post-burn, and burn blister fluid samples on admission. We compared MMP-8, -9, and TIMP-1 levels between TBSA<20% (N = 19) and TBSA>20% (N = 30) injured patients and healthy controls, and between 90-day survivors and non-survivors. MMP-8, -9, and TIMP-1 levels at 24-48 hours from injury, their maximal levels, and their time-adjusted means were compared between groups. Correlations with clinical parameters and the extent of burn were analyzed. MMP-8, -9, and TIMP-1 levels in burn blister fluids were also studied. Results Plasma MMP-8 and -9 were higher in patients than in healthy controls (P<0.001 and P = 0.016), but only MMP-8 differed between the TBSA<20% and TBSA>20% groups. MMP-8 and -9 were not associated with clinical severity or outcome measures. TIMP-1 differed significantly between patients and controls (P<0.001) and between TBSA<20% and TBSA>20% groups (P<0.002). TIMP-1 was associated with 90-day mortality and correlated with the extent of injury and clinical measures of disease severity. TIMP-1 may serve as a new biomarker in outcome prognostication of burn patients.

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