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  • 2601.
    Ternström, Sten
    KTH, Tidigare Institutioner, Talöverföring och musikakustik.
    Perceptual evaluations of voice scatter in unison choir sounds.1993Inngår i: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 7, nr 2, s. 129-135Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The preferences of experiences listerners for pitch and formant frequency dispersion in unison choir sounds were explored using synthesized stimuli. Two types of dispersion were investigated: (a) pitch scatter, which arises when voices in an ensemble exhibit small differences in mean fundamental frequency, and (b) spectral smear, defined as such dispersion of formants 3 to 5 as arises from differences in vocal tract length. Each stimulus represented a choir section of five bass, tenor, alto, or soprano voices, producing the vowel [u], [a], or [ae]. Subjects chose one dispersion level out of six available, selecting the "maximum tolerable" in a first run and the "preferred" in a second run. The listeners were very different in their tolerance for dispersion. Typical scatter choices were 14 cent standard deviation for "tolerable" and 0 or 5 cent for "preferred." The smear choices were less consistent; the standard deviations were 12 and 7%, respectively. In all modes of assessment, the largest dispersion was chosen for the vowel [u] on a bass tone. There was a vowel effect on the smear choices. The effects of voice category were not significant.

  • 2602.
    Tervo, Taru
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Nordström, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Neovius, Martin
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Constant adaptation of bone to current physical activity level in men: a 12-year longitudinal study2008Inngår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 93, nr 12, s. 4873-4879Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    CONTEXT: A high peak bone mineral density (BMD; grams per square centimeter) could reduce the risk of osteoporosis related fractures later in life. OBJECTIVE: This 12-yr longitudinal study investigated whether a high BMD from previous high physical activity is maintained with reduced activity later in life. DESIGN: This was a longitudinal study. PARTICIPANTS: Three groups were investigated with a mean age of 17 yr at baseline; 51 athletes who stopped their active careers during follow-up (former athletes), 16 who were active throughout follow-up (active athletes), and 25 controls. Main Outcome Measures: BMD of the femoral neck, total body, and lumbar spine were examined five times during the 12-yr follow-up period. RESULTS: After adjustment for age, weight, and height, the former athletes were found to have higher BMD at all sites at every follow-up visit except the last one, when compared with controls (P < 0.05). The active athletes were found to have significantly higher BMD at all measured locations when compared with controls throughout the entire study (P < 0.05). From the first to the final follow-up visit, the former athletes were found to have lost more femoral neck BMD than both the active athletes (mean difference, 0.12 g/cm(2); P = 0.003) and controls (mean difference 0.08 g/cm(2); P = 0.02). CONCLUSION: This study suggests that BMD constantly adapts to the present physical activity levels in young men. Thus, increased BMD due to previous high physical activity may not prevent osteoporosis in later years.

  • 2603.
    Tham, Wilhelm
    et al.
    Örebro universitet, Institutionen för restaurang- och måltidskunskap.
    Lopez-Valladares, Gloria
    Örebro universitet, Institutionen för restaurang- och måltidskunskap.
    Helmersson, S.
    Österlund, A.
    Danielsson-Tham, Marie-Louise
    Örebro universitet, Institutionen för restaurang- och måltidskunskap.
    More than one variant of Listeria monocytogenes isolated from each of two human cases of invasive listeriosis2007Inngår i: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 135, nr 5, s. 854-856Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Two variants of Listeria monocytogenes were isolated from blood cultures from each of two patients with listeriosis. Each variant displayed a two-band difference in DNA profile from the other by pulsed-field gel electrophoresis. Although this difference in profile is insufficient to distinguish clearly between the variants, the possibility of co-infection with different strains of L. monocytogenes needs to be considered. We suggest that more than one colony should be selected for molecular typing to aid interpretation during investigation of the sources and routes of Listeria infection.

  • 2604.
    Thammaiah, Spoorthi
    et al.
    Lamar University, TX 77710 USA; Audiol India, India.
    Manchaiah, Vinaya
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Lamar University, TX 77710 USA; Audiol India, India.
    Easwar, Vijayalakshmi
    Audiol India, India; University of Western Ontario, Canada.
    Krishna, Rajalakshmi
    Audiol India, India; University of Mysore, India.
    McPherson, Bradley
    University of Hong Kong, Peoples R China.
    Psychometric properties of the hearing handicap questionnaire: a Kannada (South-Indian) translation2017Inngår i: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 56, nr 3, s. 194-201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the psychometric properties of the Hearing Handicap Questionnaire (HHQ) in Kannada (a South-Indian language) among adults with hearing loss. Design: The study involved a cross-sectional survey design. Participants provided demographic details and completed the Kannada and English (original) version of the HHQ questionnaire. To evaluate test-retest reliability, approximate to 50% of the participants completed the Kannada version for the second time after 15 days. Study sample: The sample comprised 103 adults with hearing loss recruited from local audiology clinics. Results: Exploratory factor analysis indicated a one-factor structure, which explained 71% of the variance in Kannada-HHQ scores. The internal consistency measured with Cronbachs alpha was 0.96. The test-retest reliability correlations of the Kannada version with the English and with the same Kannada version re-administered after 15 days were 0.96 and 0.91, respectively. Convergent validity of the scale was confirmed by significant correlations with the Participation Scale and the Assessment of Quality of Life scales. Discriminant validity was found to be low as all the Kannada-HHQ questions were highly correlated with each other (ramp;gt;0.60). No floor and ceiling effects were identified. Conclusions: The psychometric properties of the Kannada-HHQ scale are considered to be adequate for clinical or research use.

  • 2605.
    Theorell, Töres
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Psykosociala faktorer – vad är det?2012Inngår i: Psykosocial miljö och stress / [ed] Töres Theorell, Lund: Studentlitteratur , 2012, 2, s. 15-75Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2606.
    Theorell, Töres
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Kreutz, Gunther
    Epidemiological studies of the relationship between musical experiences and public health2012Inngår i: Music, Health & Wellbeing / [ed] MacDonald, R, Kreutz, G and Mitchell, L, Oxford: Oxford University Press, 2012, s. 424-435Kapittel i bok, del av antologi (Fagfellevurdert)
  • 2607.
    Theorell, Töres
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Osika, Walter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Leineweber, Constanze
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Magnusson Hanson, Linda L.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Bojner Horwitz, Eva
    Westerlund, Hugo
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Stressforskningsinstitutet.
    Is cultural activity at work related to mental health in employees?2013Inngår i: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 86, nr 3, s. 281-288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To examine relationships between work-based cultural activities and mental employee health in working Swedes.

    Hypothesis: A positive relationship between frequent cultural activity at work and good employee health was expected.

    Research design: Random sample of working Swedish men and women in three waves, 2006, 2008 and 2010, on average 60 % participation rate.

    Methods: A postal questionnaire with questions about cultural activities organised for employees and about emotional exhaustion (Maslach) and depressive symptoms (short form of SCL). Employee assessments of "non-listening manager" and work environment ("psychological demands" and "decision latitude") as well as socioeconomic variables were covariates. Cross-sectional analyses for each study year as well as prospective analyses for 2006-2008 and 2008-2010 were performed.

    Main outcome and results: Lower frequency of cultural activities at work during the period of high unemployment. The effects of relationships with emotional exhaustion were more significant than those with depressive symptoms. The associations were attenuated when adjustments were made for manager function (does your manager listen?) and demand/control. Associations were more pronounced during the period with low unemployment and high cultural activity at work (2008). In a prospective analysis, cultural activity at work in 2008 had an independent statistically significant "protective" effect on emotional exhaustion in 2010. No corresponding such association was found between 2006 and 2008.

    Conclusions: Cultural activities at work vary according to business cycle and have a statistical association with mental employee health, particularly with emotional exhaustion.

    Implications for future research: There are particularly pronounced statistical protective effects of frequent cultural activity at work on likelihood of emotional exhaustion among employees.

  • 2608.
    Thiblin, Ingemar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Fugelstad, Anna
    Felaktiga slutsatser om narkotikadödsfall2016Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikkel-id EC63Artikkel i tidsskrift (Annet vitenskapelig)
  • 2609.
    Thiblin, Ingemar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Michard, Jean-Francois
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Rättsmedicin i teori och praktik: En guide för läkare och jurister2014 (oppl. 1)Bok (Fagfellevurdert)
    Abstract [sv]

    Rättsmedicin är en medicinsk vetenskap, men samtidigt väsentligt skild från den terapeutiskt inriktade kliniska medicinen. Syftet med rättsmedicin är sakkunnigverksamhet på vetenskaplig grund till gagn för rättsväsendet och rättssäkerheten. Rättsmedicin i teori och praktik belyser dessa skillnader i förhållningssätt och förmedlar principiella frågor och kunskaper på ett lättillgängligt sätt. Boken ger även praktisk handledning i att skriva rättsintyg och att göra skadetolkningar och bedömningar.

    I första delen av boken beskrivs läkarens roll i förhållande till rättsväsendet samtidigt som de vetenskapliga begreppen och tankemodellerna reds ut och kopplas till den kliniska verkligheten. Vanliga fallgropar och missräkningar förmedlas också. Den andra delen av boken är en handbok i hur man skriver rättsintyg och utlåtanden samt hur man bedömer och tolkar skador. Boken är rikligt försedd med fallbeskrivningar som på ett pedagogiskt sätt applicerar teorierna i praktiken.

    Målgruppen är främst blivande och praktiserande läkare och jurister. Även naturvetenskapligt orienterade experter som avger utlåtanden till rätten, till exempel kriminaltekniker, och de som i sin profession kommer i kontakt med rättsmedicinska bedömningar, till exempel socialtjänsten, har nytta av boken, liksom politiska beslutsfattare och personer med intresse för rättssäkerhetsfrågor.

  • 2610. Thid, Micael
    et al.
    Eriksson, Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Retsmedicinske systemer i de nordiske lande2004Inngår i: Retsmedicin: nordisk laerebog / [ed] Jørgen L. Thomsen, Köpenhavn: Foreningen af danske Laegestuderendes forlag aktieselskab , 2004, 1, s. 425-436Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 2611. Thid, Micael
    et al.
    Eriksson, Anders
    Umeå universitet, Medicinsk fakultet, Samhällsmedicin och rehabilitering, Rättsmedicin.
    Rättsmedicinska system i de nordiska länderna2006Inngår i: Rättsmedicin / [ed] Thomsen J, Liber , 2006, s. 403-414Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2612.
    Thomas, Ilias
    et al.
    Högskolan Dalarna, Akademin Industri och samhälle, Mikrodataanalys.
    Alam, Moudud
    Högskolan Dalarna, Akademin Industri och samhälle, Statistik.
    Bergquist, Filip
    Johansson, Dongni
    Memedi, Mevludin
    Nyholm, Dag
    Westin, Jerker
    Högskolan Dalarna, Akademin Industri och samhälle, Datateknik.
    Sensor-based algorithmic dosing suggestions for oral administration of levodopa/carbidopa microtablets for Parkinson's disease: a first experience2019Inngår i: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 266, nr 3, s. 651-658Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Dosing schedules for oral levodopa in advanced stages of Parkinson's disease (PD) require careful tailoring to fit the needs of each patient. This study proposes a dosing algorithm for oral administration of levodopa and evaluates its integration into a sensor-based dosing system (SBDS).

    MATERIALS AND METHODS: In collaboration with two movement disorder experts a knowledge-driven, simulation based algorithm was designed and integrated into a SBDS. The SBDS uses data from wearable sensors to fit individual patient models, which are then used as input to the dosing algorithm. To access the feasibility of using the SBDS in clinical practice its performance was evaluated during a clinical experiment where dosing optimization of oral levodopa was explored. The supervising neurologist made dosing adjustments based on data from the Parkinson's KinetiGraph™ (PKG) that the patients wore for a week in a free living setting. The dosing suggestions of the SBDS were compared with the PKG-guided adjustments.

    RESULTS: The SBDS maintenance and morning dosing suggestions had a Pearson's correlation of 0.80 and 0.95 (with mean relative errors of 21% and 12.5%), to the PKG-guided dosing adjustments. Paired t test indicated no statistical differences between the algorithmic suggestions and the clinician's adjustments.

    CONCLUSION: This study shows that it is possible to use algorithmic sensor-based dosing adjustments to optimize treatment with oral medication for PD patients.

  • 2613.
    Thor, Johan
    et al.
    Högskolan i Jönköping.
    Lundgren, Charlotte
    Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för språk och kultur. Linköpings universitet, Institutionen för kultur och kommunikation, Avdelningen för svenska och litteratur. Linköpings universitet, Filosofiska fakulteten.
    Batalden, Paul
    The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire, USA.
    Andersson Gäre, Boel
    Landstinget i Jönköpings län.
    Henriks, Göran
    Landstinget i Jönköpings län.
    Sjödahl, Rune
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Gabrielsson Järhult, Felicia
    Högskolan i Jönköping, Institutionen för gerontologi.
    Collaborative improvement of cancer care in southeastern Sweden – striving for better patient and population health, better care, and better professional development2012Inngår i: Sustainably improving health care: creatively linking care outcomes, system performance and professional development / [ed] Batalden, Paul and Foster, Tina, London: Radcliffe Publishing, 2012Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2614.
    Thorsell Cederberg, Jenny
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Acceptance for persons suffering from pain: Evaluation of acceptance-based interventions for adults with chronic pain and children with cancer experiencing acute pain2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    It is increasingly clear that pain and emotions are closely interconnected. Pain does not only cause psychological distress, but psychological distress also amplifies pain through neurological mechanisms. Treatment of both chronic and acute pain would benefit from acknowledging the psychological mechanisms of pain neurophysiology. Psychological acceptance predicts increased pain tolerance and decreased pain intensity and discomfort in experimentally induced pain and improved physical and psychosocial functioning for persons with chronic pain.

    The overall aim of this thesis was to evaluate acceptance-based interventions for persons suffering from pain.

    In Study I the effect of a manualised ACT-based self-help intervention for adults with chronic pain was evaluated in an RCT (n=90). The results showed improvements in satisfaction with life, physical functioning and pain intensity for the ACT group. Both the ACT and the control group improved regarding depression and anxiety. In Study II the mediating effect of acceptance for treatment change was evaluated, using data from Study I (n=64). The results showed indirect effects of treatment via acceptance for physical functioning but not for satisfaction with life. In Studies III and IV, instruments to measure psychological flexibility in relation to pain were developed for children with cancer, and their parents respectively, using factor analysis. The results showed that a two-factor solution for the child scale (n=61) and a three-factor solution for the parent scale (n=243), best represented the data. In Study V, an acceptance-based intervention was preliminarily evaluated in a single-subject study (n=5) for children reporting pain during cancer treatment. The intervention consisted of an approximately 15-minute long pain exposure exercise. All participants reported reduced discomfort of pain, and three of the participants reported reduced pain intensity.

    The results suggest that a manualised ACT-based self-help intervention is a valuable addition to the treatment repertoire for persons with chronic pain and that acceptance may mediate the effect of treatment on physical functioning. Furthermore, instruments to measure acceptance in the context of acute pain in children with cancer are now available, although further validation is needed. Lastly, the results indicate that an acceptance-based intervention may help children undergoing cancer treatment to cope with pain.

  • 2615.
    Thorslund, Birgitta
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT. Linköpings universitet.
    Effects of hearing loss on traffic safety and mobility2014Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of this PhD thesis was to investigate traffic safety and mobility for individuals with hearing loss (HL). Three studies were conducted: 1. a questionnaire survey aimed to evaluate differences in choice of transportation that might be related to HL, 2. a driving simulator study that looked into compensatory strategies and evaluated the efficiency of a tactile signal to alert the driver, and 3. a field study to evaluate these effects in real traffic and to evaluate a navigation system with a supportive tactile signal. The effects of HL discovered in this thesis add to the knowledge and understanding of the influence of HL on traffic safety and mobility. Differences found consistently point to a generally more cautious behavior. Compensatory and coping strategies associated with HL are bound to driving complexity and appear when complexity increases. These strategies include driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities. Evaluation of a tactile signal showed that by adding a tactile modality, some driver assistance systems can also be made accessible to drivers with HL. At the same time, the systems might be more effective for all users, since the driver can be more focused on the road. Based on the results in this thesis, drivers with HL cannot be considered an increased traffic safety risk, and there should be no need for adjustments of the requirements of hearing for a license to drive a car.

  • 2616.
    Thorslund, Birgitta
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV).
    Effects of hearing loss on traffic safety and mobility2014Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The aim of this PhD thesis was to investigate traffic safety and mobility for individuals with hearing loss (HL). Three studies were conducted: 1. a questionnaire survey aimed to evaluate differences in choice of transportation that might be related to HL, 2. a driving simulator study that looked into compensatory strategies and evaluated the efficiency of a tactile signal to alert the driver, and 3. a field study to evaluate these effects in real traffic and to evaluate a navigation system with a supportive tactile signal. The effects of HL discovered in this thesis add to the knowledge and understanding of the influence of HL on traffic safety and mobility. Differences found consistently point to a generally more cautious behavior. Compensatory and coping strategies associated with HL are bound to driving complexity and appear when complexity increases. These strategies include driving at lower speeds, using a more comprehensive visual search behavior and being less engaged in distracting activities. Evaluation of a tactile signal showed that by adding a tactile modality, some driver assistance systems can also be made accessible to drivers with HL. At the same time, the systems might be more effective for all users, since the driver can be more focused on the road. Based on the results in this thesis, drivers with HL cannot be considered an increased traffic safety risk, and there should be no need for adjustments of the requirements of hearing for a license to drive a car.

  • 2617.
    Thorslund, Birgitta
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    The effect of hearing loss on driving performance and experience of navigation system2013Inngår i: Abstract book: Second International Conference onCognitive Hearing Sciencefor Communication, 2013, s. 34-Konferansepaper (Annet vitenskapelig)
    Abstract [en]

    A field study was conducted to evaluate the use of an additional tactile signal in a navigation system and to examine the effect of hearing loss on driving behavior. 32 participants took part in the study, whereof 16 with normal hearing and 16 with moderate hearing loss.

    The participants performed two preprogrammed navigation tasks. In one they received only visual information from the navigation system and in the other there was an additional vibration in the seat to guide the driver in the right direction. Both routes included two levels of driver workload. The order of which the systems were tested as well as the order of workload level was balanced over the participants.

    Pretest included hearing screening of normal hearing participants, verbal ability test and KIPS test battery for cognitive performance. During the run an on-road protocol was used to evaluate driving performance. A VBOX was used to measure speed and record the route with a video camera. SMI glasses were used for eye tracking, which means the field of view was recorded with a marker showing where the driver is looking. Predefined targets will be analyzed, e.g. the mirrors and the speedometer. A questionnaire including questions about the experience of the two navigation systems was given to the drivers afterwards.

    Analysis continues but preliminary results indicate that hearing loss is associated with lower speed, higher satisfaction with the additional tactile signal and more glances in the rear view mirror. 

  • 2618.
    Thorslund, Birgitta
    et al.
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Institutet för handikappvetenskap (IHV). Linköpings universitet, Filosofiska fakulteten.
    Ahlström, Christer
    VTI, Swedish National Road and Transport Research Institute, Linköping, Sweden.
    Peters, Björn
    VTI, Swedish National Road and Transport Research Institute, Linköping, Sweden.
    Eriksson, Olle
    VTI, Swedish National Road and Transport Research Institute, Linköping, Sweden .
    Lidestam, Björn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Lyxell, Björn
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Handikappvetenskap. Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutet för handikappvetenskap (IHV). Östergötlands Läns Landsting, Sinnescentrum, Öron- näsa- och halskliniken US.
    Cognitive workload and visual behavior in elderly drivers with hearing loss2014Inngår i: European Transport Research Review, ISSN 1867-0717, E-ISSN 1866-8887, Vol. 6, nr 4, s. 377-385Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose

    To examine eye tracking data and compare visual behavior in individuals with normal hearing (NH) and with moderate hearing loss (HL) during two types of driving conditions: normal driving and driving while performing a secondary task.

    Methods

    24 participants with HL and 24 with NH were exposed to normal driving and to driving with a secondary task (observation and recall of 4 visually displayed letters). Eye movement behavior was assessed during normal driving by the following performance indicators: number of glances away from the road; mean duration of glances away from the road; maximum duration of glances away from the road; and percentage of time looking at the road. During driving with the secondary task, eye movement data were assessed in terms of number of glances to the secondary task display, mean duration of glances to the secondary task display, and maximum duration of glances to the secondary task display. The secondary task performance was assessed as well, counting the number of correct letters, the number of skipped letters, and the number of correct letters ignoring order.

    Results

    While driving with the secondary task, drivers with HL looked twice as often in the rear-view mirror than during normal driving and twice as often as drivers with NH regardless of condition. During secondary task, the HL group looked away from the road more frequently but for shorter durations than the NH group. Drivers with HL had fewer correct letters and more skipped letters than drivers with NH.

    Conclusions

    Differences in visual behavior between drivers with NH and with HL are bound to the driving condition. Driving with a secondary task, drivers with HL spend as much time looking away from the road as drivers with NH, however with more frequent and shorter glances away. Secondary task performance is lower for the HL group, suggesting this group is less willing to perform this task. The results also indicate that drivers with HL use fewer but more focused glances away than drivers with NH, they also perform a visual scan of the surrounding traffic environment before looking away towards the secondary task display.

  • 2619.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Holmqvist, Kenneth
    Lunds Universitet.
    Black, Alexander
    Queensland University of Technology, School of Optometry.
    The effect of hearing loss on eye movements when driving and an evaluation of tactile support for navigation2013Inngår i: Book of Abstracts of the 17th European Conference on Eye Movements, 11-16 August 2013, in Lund, Sweden / [ed] Kenneth Holmqvist, Fiona Mulvey & Roger Johansson (Red), 2013, s. 34-Konferansepaper (Fagfellevurdert)
    Abstract [en]

    A field study was conducted to evaluate the use of an additional tactile signal in a navigation system and to examine the effect of hearing loss on eye movements. 32 participants took part in the study, whereof 16 with normal hearing and 16 with moderate hearing loss.

    The participants performed two preprogrammed navigation tasks. In one they received only visual information from the navigation system and in the other there was an additional vibration in the seat to guide the driver in the right direction. The order of which the systems were tested was balanced over the participants.

    SMI glasses were used for eye tracking, and the field of view was recorded with a marker showing where the driver is looking. Predefined targets were analyzed, e.g. the mirrors, the speedometer and the navigation display. A questionnaire including questions about the experience of the two navigation systems was given to the drivers afterwards.

    Results revealed that hearing loss is associated with lower speed, higher satisfaction with the additional tactile signal and more glances in the rear view mirror. Additionally, tactile support lead to less gaze data on the navigation display, regardless of hearing status.

     

  • 2620.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Peters, Björn
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Herbert, Nicholas
    University of Leeds, Institute for Transport Studies.
    Holmqvist, Kenneth
    Lunds Universitet.
    Lidestam, Björn
    Linköpings Universitet.
    Black, Alexander
    Queensland University of Technology, School of Optometry.
    Lyxell, Björn
    Linköpings Universitet.
    Hearing loss and a supportive tactile signal in a navigation system: Effects on driving behavior and eye movements2013Inngår i: Journal of Eye Movement Research, ISSN 1995-8692, Vol. 6, nr 5, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    An on-road study was conducted to evaluate a complementary tactile navigation signal on driving behaviour and eye movements for drivers with hearing loss (HL) compared to drivers with normal hearing (NH). 32 participants (16 HL and 16 NH) performed two preprogrammed navigation tasks. In one, participants received only visual information, while the other also included a vibration in the seat to guide them in the correct direction. SMI glasses were used for eye tracking, recording the point of gaze within the scene. Analysis was performed on predefined regions. A questionnaire examined participant's experience of the navigation systems. Hearing loss was associated with lower speed, higher satisfaction with the tactile signal and more glances in the rear view mirror. Additionally, tactile support led to less time spent viewing the navigation display. 

  • 2621.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Peters, Björn
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Lidestam, Björn
    Linköping University.
    Lyxell, Björn
    Linköping University.
    Cognitive workload and driving behavior in persons with hearing loss2013Inngår i: Transportation Research Part F: Traffic Psychology and Behaviour, ISSN 1369-8478, E-ISSN 1873-5517, Vol. 21, s. 113-121Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To compare the effect of cognitive workload in individuals with and without hearing loss, respectively, in driving situations with varying degree of complexity.

    Methods: 24 participants with moderate hearing loss (HL) and 24 with normal hearing (NH) experienced three different driving conditions: Baseline driving; Critical events with a need to act fast; and a Parked car event with the possibility to adapt the workload to the situation. Additionally, a Secondary task (observation and recalling of 4 visually displayed letters) was present during the drive, with two levels of difficulty in terms of load on the phonological loop. A tactile signal, presented by means of a vibration in the seat, was used to announce the Secondary task and thereby simultaneously evaluated in terms of effectiveness when calling for driver attention. Objective driver behavior measures (M and SD of driving speed, M and SD of lateral position, time to line crossing) were accompanied by subjective ratings during and after the test drive.

    Results: HL had no effect on driving behavior at Baseline driving, where no events occurred. Both during Secondary task and at the Parked car event HL was associated with decreased mean driving speed compared to baseline driving. The effect of HL on the Secondary task performance, both at Baseline driving and at the lower Difficulty Level at Critical events, was more skipped letters and fewer correctly recalled letters. At Critical events, task difficulty affected participants with HL more. Participants were generally positive to use vibrations in the seat as a means for announcing the Secondary task.

    Conclusions: Differences in terms of driving behavior and task performance related to HL appear when the driving complexity exceeds Baseline driving either in the driving task, Secondary task or a combination of both. This leads to a more cautious driving behavior with a decreased mean driving speed and less focus on the Secondary task, which could be a way of compensating for the increasing driving complexity. Seat vibration was found to be a feasible way to alert drivers with or without HL.

  • 2622.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Peters, Björn
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Lyxell, Björn
    Linköping University.
    Lidestam, Björn
    Linköping University.
    The influence of hearing loss on transport safety and mobility2013Inngår i: European Transport Research Review, ISSN 1867-0717, E-ISSN 1866-8887, Vol. 5, nr 3, s. 117-127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To examine how road users with different degree of hearing loss experience safety and mobility in transport situations, compared to road users with normal hearing.

    Methods: A questionnaire study was conducted with participants recruited from the local branch of The Swedish hard of hearing society. A normal hearing control group, matched on age, gender and geographical location, was selected from a commercial database. The response rate was 35% (n = 194) in the group with Hearing Loss (HL) and 42% (n = 125) in the group with Normal Hearing (NH). The individuals with hearing loss were grouped into four groups according to the degree of their hearing loss (mild, moderate, severe and profound).

    Results: Hearing loss affected some specific aspects regarding transport situations, while others remained unaffected. Individuals with hearing loss were not as likely to have a driving license, but for those who have, hearing loss had no effect on mileage per year. Loss of hearing had an effect on criteria for choosing mode of transportation, but in the aggregate, no difference between the groups could be shown in the distribution of how much each mode of transportation was used. With a few exceptions, hearing loss did not affect the ratings of importance of hearing for different transportation modes. Hearing loss affected most questions regarding hearing and driver abilities, while avoidance of specific traffic situations was not associated with hearing loss. Hearing loss had only minor effects on the factors causing inattention when driving, and on the interest in a warning system for driver inattention. The interest in a warning system for driver inattention was high regardless of hearing category.

    Conclusions: Hearing loss influences the prevalence of driving license and criteria for choosing mode of transportation, however has no effect on the distribution of how much each mode of transportation was used. In general, in this study, respondents with higher degree of hearing loss were less concerned about the effect of hearing loss, indicating that they might be using coping strategies. The interest in warning system for inattention and the attitude towards strengthening of auditory information in traffic situations is high regardless of hearing category. This suggests further research on coping strategies and on design of support systems accessible for drivers with hearing loss. 

  • 2623.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Strand, Niklas
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Samspel människa, fordon, transportsystem, MFT.
    Synförmågans mätbarhet och inverkan på säker bilkörning: en litteraturstudie2015Rapport (Annet vitenskapelig)
    Abstract [sv]

    I detta notat redovisas en litteraturstudie som ger en översikt över synförmågor som är viktiga för bilkörning. Forskarna konstaterar att de mest förekommande måtten på synskärpa inte är tillräckliga för att säkerställa säker bilkörning och att kognitiva tester kan komplettera bedömningen. Studien besvarar frågor om egenskaper i synen som är viktiga för säker bilkörning, vilka tester som finns och hur dessa används, samt vilken evidens som finns för olika tester. Totalt inkluderades 128 vetenskapliga publicering i litteraturöversikten. Flera olika ansatser till att mäta synförmågan i syfte att förbättra trafiksäkerheten har identifierats runt om i världen. En trend som setts är att traditionella syntester alltmer kompletterats med kognitiva tester. Resultaten ger en översyn av internationella krav på synförmågan som ställs för privata bilförare. Vidare presenteras resultat uppdelat utifrån olika synförmågor där dessa beskrivs tillsammans med en översikt av sjukdomar som kan påverka förmågan, vilka tester som finns och dess evidens, samt hur förmågan inverkar på säker bilkörning. Två tester lyftes fram utifrån starka stöd i litteraturen: (1) kontrastkänslighet och (2) Useful Field of View. Utifrån resultatet drogs slutsatsen att testning av synförmåga bör bestå av kompletterande tester, att de mest förekommande måtten på synskärpa inte är tillräckligt för att säkerställa säker bilkörning, samt att tester som inrymmer kognitiva aspekter kan komplettera bedömningen av synförmågan.

  • 2624.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Förare och fordon, FOF.
    Strand, Niklas
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Förare och fordon, FOF.
    Vision measurability and its impact on safe driving: a literature review2016Inngår i: Scandinavian Journal of Optometry and Visual Science, ISSN 1891-0882, E-ISSN 1891-0890, Vol. 9, nr 1, s. 1-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Knowledge of measurability of vision and its impact on safe driving have been proven to be important to secure a safe traffic system. Several different approaches to measuring visual function in order to improve road safety have been identified around the world. A trend seen in the literature is that traditional vision tests are increasingly supplemented by cognitive tests.

    The purpose of this study was to provide an overview of visual capabilities that are important for safe driving. The study answered questions about the visual capabilities that are essential for safe driving; which tests are available and how they are used; and existing evidence for these tests.

    The literature review was based on database searches of TRID, Web of Science and PubMed. In total 128 scientific publications were included in the overview. The results provided an overview of international standards of vision required for driving a car. Moreover, the results were structured according to the different visual capabilities and a corresponding account of the diseases that may affect these capabilities; available tests and corroborating evidence for the test; and the manner in which these capabilities are important for safe driving. Two tests were highlighted based on the review: contrast sensitivity, and Useful Field of View.

    It was also concluded that 1) testing of vision should consist of several complementary tests, 2) good visual acuity is not alone sufficient for safe driving, and 3) tests including cognitive aspects can complement vision testing and improve the assessment of safe driving.

  • 2625.
    Thorslund, Birgitta
    et al.
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Förare och fordon, FOF.
    Strand, Niklas
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Förare och fordon, FOF.
    Dukic Willstrand, Tania
    Statens väg- och transportforskningsinstitut, Trafik och trafikant,TRAF, Trafikanttillstånd, TIL.
    Attitudes among older drivers towards medical assessment at renewal of driving license in Sweden2017Inngår i: European Transport Research Review, ISSN 1867-0717, E-ISSN 1866-8887, Vol. 9, nr 2, artikkel-id 14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The aim was to examine attitudes among older adults in Sweden as regards a possible legislation for medical assessment at license renewal depending on their health status (vision and hearing) and gender.

    Methods: A questionnaire study measuring attitudes towards medical assessments at license renewal and an examination of vision, hearing, and cognitive abilities was conducted by the Swedish National Road and Transport Research Institute. 109 participants older than 60 years participated in the study (58 women, 51 men). They were categorized into four groups according to their health status: (1) without any visual or hearing impairment, (2) visual impairment, (3) hearing impairment, and (4) visual and hearing impairment. All data collection was performed in a driving assessment situation.

    Results: The answers showed positive attitudes towards recurring vision test (94% positive) and recurring medical assessments (93% positive). A majority wanted to include tests of visual acuity, contrast vision, and visual field. The most common choice was a starting point of 70 years and an interval of 2–3 years. Gender effects showing that woman were more positive towards some assessment and shorter time intervals between them was revealed. No significant effect of hearing or vision decline was found. Better results on cognitive tests was associated with positive attitudes towards medical testing.

    Conclusions: The participants were positive towards medical assessments at license renewal, indicating that there is an acceptance in the population for such legislation. Even short intervals such as every two or three years were accepted.

  • 2626.
    Thorslund, Mats
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Hälsa och ohälsa bland äldre2012Inngår i: Jämlik ålderdom?: i samtiden och framtiden / [ed] Lars Andersson, Peter Öberg, Malmö: Liber, 2012, s. 137-163Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 2627.
    Thorslund, Mats
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Wastesson, Jonas W.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Agahi, Neda
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Lagergren, Mårten
    Parker, Marti G.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    The rise and fall of women's advantage: a comparison of national trends in life expectancy at age 65 years2013Inngår i: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 10, nr 4, s. 271-277Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The female advantage in life expectancy (LE) is found worldwide, despite differences in living conditions, the status of women and other factors. However, this advantage has decreased in recent years in low-mortality countries. Few researchers have looked at the gender gap in LE in old age (age 65) in a longer historical perspective. Have women always had an advantage in LE at old age and do different countries share the same trends? Life expectancy data for 17 countries were assessed from Human Mortality Database from 1751 to 2007. Since most of the changes in LE taking place today are driven by reductions of old age mortality the gender difference in LE was calculated at age 65. Most low-mortality countries show the same historical trend, a rise and fall of women's advantage in LE at age 65. Three phases that all but two countries passed through were discerned. After a long phase with a female advantage in LE at 65 of <1 year, the gender gap increased significantly during the twentieth century. The increase occurred in all countries but at different time points. Some countries such as England and France had an early rise in female advantage (1900-1919), while it occurred 50 years later in Sweden, Norway and in the Netherlands. The rise was followed by a more simultaneous fall in female advantage in the studied countries towards the end of the century, with exceptions of Japan and Spain. The different timing regarding the increase of women's advantage indicates that country-specific factors may have driven the rise in female advantage, while factors shared by all countries may underlie the simultaneous fall. More comprehensive, multi-disciplinary study of the evolution of the gender gap in old age could provide new hypotheses concerning the determinants of gendered differences in mortality.

  • 2628.
    Thorvaldsson, Valgeir
    et al.
    University of Gothenburg, Gothenburg, Sweden.
    Karlsson, Peter
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). University of Gothenburg, Gothenburg, Sweden.
    Skoog, Johan
    University of Gothenburg, Gothenburg, Sweden.
    Skoog, Ingmar
    Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Johansson, Boo
    University of Gothenburg, Gothenburg, Sweden.
    Better Cognition in New Birth Cohorts of 70 Year Olds, But Greater Decline Thereafter2017Inngår i: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 72, nr 1, s. 16-24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives

    To evaluate birth cohort differences in level of cognition and rate of change in old age.

    Methods

    Data were drawn from three population-based Swedish samples including age-homogenous cohorts born 1901/02, 1906/07, and 1930, and measured on the same cognitive tests at ages 70, 75, and 79 as part of the Gerontological and Geriatric Populations Studies in Gothenburg (H70). We fitted growth curve models to the data using a Bayesian framework and derived estimates and inferences from the marginal posterior distributions.

    Results

    We found moderate to large birth cohort effects in level of performance on all cognitive outcomes. Later born cohorts, however, showed steeper linear rate of decline on reasoning, spatial ability, and perceptual- and motor-speed, but not on picture recognition memory and verbal ability.

    Discussion

    These findings provide strong evidence for substantial birth cohort effects in cognition in older ages and emphasize the importance of life long environmental factors in shaping cognitive aging trajectories. Inferences from cognitive testing, and standardization of test scores, in elderly populations must take into account the substantial birth cohort differences. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.

  • 2629. Thorvaldsson, Valgeir
    et al.
    Macdonald, Stuart W. S.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Fratiglioni, Laura
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Winblad, Bengt
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Kivipelto, Miia
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Laukka Jonsson, Erika
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Skoog, Ingmar
    Sacuiu, Simona
    Guo, Xinxin
    Östling, Svante
    Börjesson-Hanson, Anne
    Gustafson, Deborah
    Johansson, Boo
    Bäckman, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Onset and rate of cognitive change before dementia diagnosis: findings from two Swedish population-based longitudinal studies2011Inngår i: Journal of the International Neuropsychological Society, ISSN 1355-6177, E-ISSN 1469-7661, Vol. 17, nr 1, s. 154-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We used data from two population-based longitudinal studies to estimate time of onset and rate of accelerated decline across cognitive domains before dementia diagnosis. The H70 includes an age-homogeneous sample (127 cases and 255 non-cases) initially assessed at age 70 with 12 follow-ups over 30 years. The Kungsholmen Project (KP) includes an age-heterogeneous sample (279 cases and 562 non-cases), with an average age of 82 years at initial assessment, and 4 follow-ups spanning 13 years. We fit mixed linear models to the data and determined placement of change points by a profile likelihood method. Results demonstrated onset of accelerated decline for fluid (speed, memory) versus crystallized (verbal, clock reading) abilities occurring approximately 10 and 5 years before diagnosis, respectively. Although decline before change points was greater for fluid abilities, acceleration was more pronounced for crystallized abilities after the change points. This suggests that onset and rate of acceleration vary systematically along the fluid-crystallized ability continuum. There is early onset in fluid abilities, but these changes are difficult to detect due to substantial age-related decline. Onset occurred later and acceleration was greater in crystallized abilities, suggesting that those markers may provide more valid identification of cases in later stages of the prodromal phase.

  • 2630. Thuemmler, C.
    et al.
    Mival, O.
    Lim, A. K.
    Holanec, I.
    Fricker, Samuel
    Blekinge Tekniska Högskola, Fakulteten för datavetenskaper, Institutionen för programvaruteknik.
    A social-technological alignment matrix2015Inngår i: IEEE 16th International Conference on e-Health Networking, Applications and Services, Healthcom 2014, 2015, Vol. Article number 7001841, s. 200-205Konferansepaper (Fagfellevurdert)
    Abstract [en]

    This paper refers to the term ’implementation’ as the process of integrating a new technology into established workfows. Especially in health care this has proven to be a very critical phase and many large-scale projects have failed on this very last mile. Although strategies such as requirements engineering, co-designing and user interaction design have been proposed to reduce the risk of end-user rejection and subsequently project failur. There is still no tool to analyze, predict and quantify user acceptance and identify critical areas which might be addressed before the start of the implementation phase in order to reduce resistance and increase the effectiveness and effciency. © 2014 IEEE.

  • 2631.
    Thulesius, Hans
    Lund university, Sweden;Region Kronoberg, Sweden.
    Work incentives, chronic illnesses and how sickness certificates are written affect sickness absence.2019Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, nr 1, s. 1-2Artikkel i tidsskrift (Fagfellevurdert)
  • 2632.
    Thulesius, Hans
    et al.
    Lund University, Sweden;Region Kronoberg, Sweden.
    Scott, Helen
    Grounded Theory Online, Chichester, UK.
    Helgesson, Gert
    Karolinska Institutet, Sweden.
    Lynöe, Niels
    Karolinska Institutet, Sweden.
    De-tabooing dying control - a grounded theory study.2013Inngår i: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 12, s. 1-8, artikkel-id 13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Dying is inescapable yet remains a neglected issue in modern health care. The research question in this study was "what is going on in the field of dying today?" What emerged was to eventually present a grounded theory of control of dying focusing specifically on how people react in relation to issues about euthanasia and physician-assisted suicide (PAS).

    METHODS: Classic grounded theory was used to analyze interviews with 55 laypersons and health care professionals in North America and Europe, surveys on attitudes to PAS among physicians and the Swedish general public, and scientific literature, North American discussion forum websites, and news sites.

    RESULTS: Open awareness of the nature and timing of a patient's death became common in health care during the 1960s in the Western world. Open dying awareness contexts can be seen as the start of a weakening of a taboo towards controlled dying called de-tabooing. The growth of the hospice movement and palliative care, but also the legalization of euthanasia and PAS in the Benelux countries, and PAS in Montana, Oregon and Washington further represents de-tabooing dying control. An attitude positioning between the taboo of dying control and a growing taboo against questioning patient autonomy and self-determination called de-paternalizing is another aspect of de-tabooing. When confronted with a taboo, people first react emotionally based on "gut feelings" - emotional positioning. This is followed by reasoning and label wrestling using euphemisms and dysphemisms - reflective positioning. Rarely is de-tabooing unconditional but enabled by stipulated positioning as in soft laws (palliative care guidelines) and hard laws (euthanasia/PAS legislation). From a global perspective three shapes of dying control emerge. First, suboptimal palliative care in closed awareness contexts seen in Asian, Islamic and Latin cultures, called closed dying. Second, palliative care and sedation therapy, but not euthanasia or PAS, is seen in Europe and North America, called open dying with reversible medical control. Third, palliative care, sedation therapy, and PAS or euthanasia occurs together in the Benelux countries, Oregon, Washington and Montana, called open dying with irreversible medical control.

    CONCLUSIONS: De-tabooing dying control is an assumed secular process starting with open awareness contexts of dying half a century ago, and continuing with the growth of the palliative care movement and later euthanasia and PAS legislation.

  • 2633. Thulin, Helena
    et al.
    Kreicbergs, Ulrika
    Karolinska institutet. Dana Farber Cancer Insitute, Bostron, USA..
    Onelöv, Erik
    Ahlstrand, Christer
    Carringer, Malcolm
    Holmäng, Sten
    Ljungberg, Börje
    Malmström, Per-Uno
    Robinsson, David
    Wijkström, Hans
    Wiklund, N Peter
    Steineck, Gunnar
    Henningsohn, Lars
    Defecation disturbances after cystectomy for urinary bladder cancer.2011Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 108, nr 2, s. 196--203Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: • To describe and compare long-term defecation disturbances in patients who had undergone a cystectomy due to urinary bladder cancer with non-continent urostomies, continent reservoirs and orthotopic neobladder urinary diversions.

    PATIENTS AND METHODS: • During their follow-up we attempted to contact all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. • During a qualitative phase we identified defecation disturbances as a distressful symptom and included this item in a study-specific questionnaire together with free-hand comments. The patients completed the questionnaire at home. • Outcome variables were dichotomized and the results are presented as relative risks with 95% confidence interval.

    RESULTS: • The questionnaire was returned from 452 (92%) of 491 identified patients. Up to 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). • A sense of decreased straining capacity was reported by 20% of the men and women with non-continent urostomy and 14% and 8% of those with continent reservoirs and orthotopic neobladders, respectively.

    CONCLUSIONS: • Of the cystectomized individuals 30% reported problems with the physiological emptying process of stool (bowel movement, sensory rectal function, awareness of need for defecation, motoric rectal and anal function, straining ability). • Those wanting to improve the situation for bladder cancer survivors may consider communicating before surgery the possibility of stool-emptying problems, and asking about them after surgery.

  • 2634.
    Thulin, Helena
    et al.
    Karolinska institutet.
    Kreicbergs, Ulrika
    Karolinska institutet, Dana Farber Cancer Institute, Boston, USA.
    Wijkström, Hans
    Steineck, Gunnar
    Henningsohn, Lars
    Sleep disturbances decrease self-assessed quality of life in individuals who have undergone cystectomy.2010Inngår i: Journal of Urology, ISSN 0022-5347, E-ISSN 1527-3792, Vol. 184, nr 1, s. 198-202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The best possible urinary diversion after cystectomy, if any, is yet to be defined to our knowledge. Therefore, we investigated nocturnal urinary disturbances and quality of life in individuals who have undergone cystectomy with urinary diversion for bladder cancer.

    MATERIALS AND METHODS: All patients 30 to 80 years old who had undergone cystectomy with urinary diversion at 7 urological centers in Sweden were included in the study. Sleep disturbances, nocturnal urinary leakage and urine evacuation frequency, as well as their effect on self-assessed quality of life variables were measured with a study specific questionnaire. We received the questionnaire from 452 (92%) of 491 identified individuals. Outcome variables were dichotomized and the results are presented as relative risks.

    RESULTS: Those individuals with an orthotopic neobladder had an increased risk of nocturnal urinary leakage and/or urine evacuation frequency compared to those with a noncontinent urostomy or cutaneous continent reservoir. Of the patients with an orthotopic neobladder 37% reported negative effects on nocturnal sleep compared to 22% and 14% of those with a noncontinent or continent urostomy, respectively. Of those patients reporting that the urinary diversion had a negative effect on nocturnal sleep 88% had a decreased quality of life vs 65% of those who stated that the urinary diversion had no or little influence on nocturnal sleep.

    CONCLUSIONS: Nocturnal urinary problems are of great concern for individuals with urinary diversion, especially those with an orthotopic neobladder. Regular disruption of sleep decreases quality of life.

  • 2635.
    Thulin, Helena
    et al.
    Karolinska Institutet.
    Steineck, Gunnar
    Karolinska Institutet, Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska Academy, Göteborg.
    Kreicbergs, Ulrika
    Karolinska institutet. Dana Farber Cancer Institute, Boston, USA..
    Onelöv, Erik
    Karolinska Institutet.
    Ahlstrand, Christer
    Division of Urology, Faculty of Health Sciences, University Hospital Linköping.
    Carringer, Malcolm
    Universitetssjukhuset Örebro.
    Holmäng, Sten
    Department of Urology, Sahlgrenska University Hospital, Göteborg.
    Ljungberg, Börje
    Norrlands University Hospital, Umeå.
    Malmström, Per-Uno
    Uppsala Universitet.
    Robinsson, David
    Department of Urology, Ryhov County Hospital, Jönköping.
    Wijkström, Hans
    Karolinska Institutet.
    Wiklund, N Peter
    Karolinska Institutet.
    Henningsohn, Lars
    Karolinska Institutet.
    Hygiene and urinary tract infections after cystectomy in 452 Swedish survivors of bladder cancer.2010Inngår i: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 105, nr 8, s. 1107-1117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections (UTIs) in patients treated by cystectomy for urinary bladder cancer.

    PATIENTS AND METHODS: We attempted to contact during their follow-up all men and women aged 30-80 years who had undergone cystectomy and urinary diversion at seven Swedish hospitals. During a qualitative phase we identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks (RR) with 95% confidence interval.

    RESULTS: We received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The RR for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a RR of 2.1 (1.4-3.2) for having a symptomatic UTI.

    CONCLUSIONS: We could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy with urinary diversion. Patients with diabetes mellitus have a greater risk of contracting a UTI.

  • 2636.
    Thun Westerberg, Helena
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Olika terapiers påverkan på riskfaktorena för hjärt-och kärlsjukdomar hos diabetespatienter2014Independent thesis Basic level (professional degree), 10 poäng / 15 hpOppgave
  • 2637.
    Thunander Sundbom, Lena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicin- och vårdvetenskap.
    Förskrivning och följsamhet av antidepressiva hade koppling till kön2017Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr 51-52Artikkel, omtale (Annet (populærvitenskap, debatt, mm))
    Abstract [sv]

    Avhandling. Kvinnor diagnostiseras med depression dubbelt så ofta som män och förskrivs antidepressiva betydligt oftare. Syftet med denna avhandling var att studera hur psykisk ohälsa och kön påverkar läkemedelsanvändning när det gäller följsamhet respektive förskrivning.

    Vi lät 16 000 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 48 procent) skatta depression genom formuläret HADS (Hospital anxiety and depression scale). Männen hade rapporterad depression i något högre utsträckning än kvinnorna. Dessa data kopplades sedan på individnivå till förskrivna antidepressiva via Läkemedelsregistret. En högre andel av männen än kvinnorna hade rapporterad depression utan att använda antidepressiva, vilket kan bero på att män inte söker vård vid psykisk ohälsa eller på att mäns psykiska besvär inte upptäcks då symtomen ofta avviker från vårdens diagnoskriterier.

    Kvinnorna däremot använde antidepressiva utan att ha rapporterad depression betydligt oftare än männen, vilket kan bero på tillfrisknande från depressionen eller på att kvinnor förskrivs antidepressiva redan vid mycket lindriga besvär. Vi lät även 7 985 slumpmässigt utvalda personer mellan 18 och 84 år (svarsfrekvens 61 procent) svara på frågor gällande följsamhet.

    Kvinnorna rapporterade betydligt oftare än männen att de avstod från att ta sina läkemedel på grund av läkemedelsbiverkningar, medan männen oftare än kvinnorna rapporterade att de ändrade doserna och glömde att ta sina läkemedel. Resultaten tyder på att kön bör beaktas i riktlinjer för diagnostik och behandling av depression och vid bristande följsamhet: även om studiedesignen i form av tvärsnittsstudier inte möjliggör fastställande av orsakssamband belyser denna avhandling könsskillnader, vilka bör beaktas såväl inom klinisk praxis som framtida studier.

  • 2638.
    Thunander Sundbom, Lena
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap. Uppsala universitet.
    The influence of gender and psychological distress on adherence to prescribed medication2014Licentiatavhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: The lack of adherence to drug therapy is a major problem; it can contribute to significant deterioration of disease and increased health-care costs. Improving medication adherence is a big challenge; there is no simple solution to the problem. It is thus essential to improve our knowledge of non-adherence (NA) and its causes.

    Aims: The aims of the thesis were to study the influence of gender and psychological distress on self-reported, intentional and unintentional non-adherent behaviour, and to investigate the reasons for NA.

    Methods: A population-based study that included a postal questionnaire was carried out in a cross-section of the general Swedish population (n=7,985, aged 18-84 years). The response rate was 61.1% (n=4,875) and current prescription drug use was reported by 2,802 participants. The questionnaire covered use of prescription drugs, NA to the drug regimens, reasons for NA, economic status, attitudes to drugs, and the presence of somatic or mental problems, and also included the Hospital Anxiety and Depression Scale questionnaire.

    Results: The results showed differences in various self-reported non-adherent behaviour patterns and reasons for NA between the genders. In most cases, these remained after controlling for confounders such as socioeconomic factors and attitudes to drugs that are known to differ between women and men. Associations were also found between symptoms of anxiety and/or depression and the presence of intentional or unintentional non-adherent behaviour (with a stronger average association for intentional NA), and between anxiety/depression and some of the reasons given for NA, e.g. adverse drug reactions (ADRs).

    Conclusions: Although it was not possible to confirm causal relationships, this thesis emphasises the effects of gender and psychological distress on NA. In summary, both gender and anxiety and/or depression influenced non-adherent behaviour and the reasons given for NA. For instance, ADRs seemed to influence the decision not to take the drug as prescribed, especially among women and participants under psychological distress. It is suggested that a deep understanding of the causes of NA and of the impact of gender and psychological distress on the outcomes would help those aiming to improve adherence to prescribed medication.

  • 2639.
    Thunander Sundbom, Lena
    et al.
    Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för hälso- och vårdvetenskap, Medicinvetenskap. Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Bingefors, Kerstin
    Department of Pharmacy, University of Uppsala, Uppsala, Sweden.
    Women and men report different behaviours in, and reasons for medication non-adherence : a nationwide Swedish survey [Hombres y mujeres comunican diferentes comportamientos y razones para el incumplimiento de la medicación: Encuesta nacional Sueca]2012Inngår i: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 10, nr 4, s. 207-221Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: The aim of the present study was to analyse gender differences in self-reported non-adherence (NA) to prescribed medication in the Swedish general population. We aimed to study unintentional and intentional NA as well as the reasons given for NA.

    Methods: A questionnaire was mailed to a cross-sectional, random, national sample of people aged 18-84 years in Sweden (n=7985). The response rate was 61.1% (n=4875). The questionnaire covered use of prescription drugs, NA behaviour and reasons for NA.

    Results: Use of prescription drugs was reported by 59.5% (n=2802) of the participants, and 66.4% (n=1860) of these participants did not adhere to the prescribed regimen. No overall gender differences in reporting NA were found. However, when analysing the various types of NA behaviour and the reasons for NA, different gender patterns emerged. Men were more likely to report forgetting [OR 0.77 (95% CI 0.65:0.92)], changing the dosage [OR 0.64 (95% CI 0.52:0.79)] and that they had recovered [14.3%, (OR 0.71 (95% CI 0.56:0.90)] as a reason. In contrast, more women than men reported filling the prescription but not taking the drug [OR 1.25 (95% CI 1.02:1.54)] and reported the development of adverse drug reactions (ADRs) [OR 1.89 (95% CI 1.37:2.59)] as a reason more commonly. The gender differences remained, in most cases, after controlling for confounders such as age, socioeconomic factors, medical problems and attitudes toward drugs.

    Conclusions: Women and men have different patterns of NA behaviour and different reasons for NA. Therefore, if adherence is to be improved, a wide knowledge of all the reasons for NA is required, along with an understanding of the impact of gender on the outcomes.

  • 2640. Thuresson, M.
    et al.
    Äng, Björn
    Linder, J.
    Harms-Ringdahl, K.
    Intra-rater reliability of electromyographic recordings and subjective evaluation of neck muscle fatigue among helicopter pilots2005Inngår i: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 15, nr 3, s. 323-31Artikkel i tidsskrift (Fagfellevurdert)
  • 2641. Thuresson, M.
    et al.
    Äng, Björn
    Linder, J.
    Harms-Ringdahl, K.
    Mechanical load and EMG activity in the neck induced by different head-worn equipment and neck postures2005Inngår i: Journal of Industrial Economics, ISSN 0022-1821, E-ISSN 1467-6451, Vol. 35, nr 1, s. 13-18Artikkel i tidsskrift (Fagfellevurdert)
  • 2642. Thuresson, M.
    et al.
    Äng, Björn
    Linder, J.
    Harms-Ringdahl, K.
    Neck muscle activity in helicopter pilots: effect of position and helmet-mounted equipment2003Inngår i: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 74, nr 5, s. 527-32Artikkel i tidsskrift (Fagfellevurdert)
  • 2643.
    Thurgren, Caroline
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Catch And Run "On LINE": grovmotoriskt test2013Independent thesis Advanced level (degree of Master (One Year)), 10 poäng / 15 hpOppgave
    Abstract [sv]

    Sammanfattning

    Syfte och frågeställningar

    Peabody Developmental Motor Scale 2 (PDMS-2) är ett motoriskt test för barn upp till sex års ålder. Syftet med denna studie var att undersöka genomförbarheten hos Catch And Run On LINE (On Line), ett nytt grovmotoriskt test för förskolebarn, samt att utvärdera överensstämmelsen (concurrent validity) mellan On Line och den grovmotoriska delen av PDMS-2. Frågeställningarna som ställdes var hur den totala poängen överensstämmer mellan On Line och PDMS-2 och hur lång tid det tog att sammanställa resultatet av de två olika grovmotoriska bedömningarna.

    Metod

    On Line utformades som en kortare variant av PDMS-2. Alla barn (n=26) som remitterades till sjukgymnastiken på Sachsska barn- och ungdomssjukhuset för en grovmotorisk bedömning och som besökte författaren där under 4 månader erbjöds delta i studien om de hade börjat gå, men inte hade fyllt 6 år. Barnet bedömdes vid ett tillfälle. Summan av poäng på deltesten räknades ut för båda bedömningsinstrumenten. Den administrativa tiden jämfördes mellan de olika testerna. Korrelation mellan PDMS-2 och On Line samt för de två olika grupperna, yngre (1-2år) och äldre (3-5år) barn beräknades med Spearmans rho. ROC analys användes för att ta fram gränsvärden för respektive grupp, utifrån vilka sensitiviteten och specificiteten testades.

    Resultat

    On Line tog signifikant kortare tid att administrera jämfört med PDMS-2 (9,4 ± 2,4 kontra 28,1±6,4 minuter). Korrelationen mellan On Line och PDMS-2 var väldigt god både för gruppen som helhet (rho=0,969) och när de yngre barnen (rho=0,841) respektive de äldre barnen (rho=0,970) betraktades var för sig. Två av deltesterna studerades närmare. ”Boll” visade god korrelation mot ”Object Manipulation” (rho=0,935) sett till hela gruppen. Även den yngre gruppen (rho=0,934) respektive den äldre gruppen (rho=0,900) visade god korrelation var för sig. Balansdelarna mellan On Line och PDMS-2 visade också god korrelation för alla (rho=0,939) och för de äldre (rho=0,851), men däremot sämre korrelation för de yngre (rho=0,573). ROC analys föreslog ett gränsvärde för de yngre barnen på 19,5 på totalpoäng på det nya testet, vilket resulterade i en sensitivitet på 0,75 och en specificitet på 0,88. För de äldre barnen blev gränsvärdet 48,5, sensitiviteten 0,75 och specificiteten 0,80.

    Slutsats

    On Line går fortare att administrera och uppvisar en god korrelation med PDMS-2, vilket indikerar att det kan bli ett lämpligt bedömningsinstrument för att se vilka förskolebarn som har grovmotoriska svårigheter. Mer normativ data behövs innan testet kan tillämpas i kliniken.

  • 2644.
    Thylen, Ingela
    et al.
    Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Wenemark, Marika
    Division of Community Medicine, Linköping University, Linköping, Sweden.
    Fluur, Christina
    Department of Cardiology, County Council of Östergötland, Linköping, Sweden.
    Strömberg, Anna
    Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Bolse, Kärstin
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Årestedt, Kristofer
    Division of Nursing Sciences, Linköping University, Linköping, Sweden.
    Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator2013Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, nr 2, s. 142-151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Due to extended indications and resynchronization therapy, many implantable cardioverter defibrillator (ICD) recipients will experience progressive co-morbid conditions and will be more likely to die of causes other than cardiac death. It is therefore important to elucidate the ICD patients' preferences when nearing end-of-life. Instead of avoiding the subject of end-of-life, a validated questionnaire may be helpful to explore patients' experiences and attitudes about end-of-life concerns and to assess knowledge of the function of the ICD in end-of-life. Validated instruments assessing patients' perspective concerning end-of-life issues are scarce.

    Aim: The purpose of this study was to develop and evaluate respondent satisfaction and measurement properties of the 'Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients' Questionnaire' (EOL-ICDQ).

    Methods: The instrument was tested for validity, respondent satisfaction, and for homogeneity and stability in the Swedish language. An English version of the EOL-ICDQ was validated, but has not yet been pilot tested.

    Results: The final instrument contained three domains, which were clustered into 39 items measuring: experiences (10 items), attitudes (18 items), and knowledge (11 items) of end-of-life concerns in ICD patients. In addition, the questionnaire also contained items on socio-demographic background (six items) and ICD-specific background (eight items). The validity and reliability properties were considered sufficient.

    Conclusions: The EOL-ICDQ has the potential to be used in clinical practice and future research. Further studies are needed using this instrument in an Anglo-Saxon context with a sample of English-speaking ICD recipients. © The European Society of Cardiology 2013.

  • 2645.
    Thysell, Elin
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Multivariate profiling of metabolites in human disease: Method evaluation and application to prostate cancer2012Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    There is an ever increasing need of new technologies for identification of molecular markers for early diagnosis of fatal diseases to allow efficient treatment. In addition, there is great value in finding patterns of metabolites, proteins or genes altered in relation to specific disease conditions to gain a deeper understanding of the underlying mechanisms of disease development. If successful, scientific achievements in this field could apart from early diagnosis lead to development of new drugs, treatments or preventions for many serious diseases.  Metabolites are low molecular weight compounds involved in the chemical reactions taking place in the cells of living organisms to uphold life, i.e. metabolism. The research field of metabolomics investigates the relationship between metabolite alterations and biochemical mechanisms, e.g. disease processes. To understand these associations hundreds of metabolites present in a sample are quantified using sensitive bioanalytical techniques. In this way a unique chemical fingerprint is obtained for each sample, providing an instant picture of the current state of the studied system. This fingerprint or picture can then be utilized for the discovery of biomarkers or biomarker patterns of biological and clinical relevance.

    In this thesis the focus is set on evaluation and application of strategies for studying metabolic alterations in human tissues associated with disease. A chemometric methodology for processing and modeling of gas chromatography-mass spectrometry (GC-MS) based metabolomics data, is designed for developing predictive systems for generation of representative data, validation and result verification, diagnosis and screening of large sample sets.

    The developed strategies were specifically applied for identification of metabolite markers and metabolic pathways associated with prostate cancer disease progression. The long-term goal was to detect new sensitive diagnostic/prognostic markers, which ultimately could be used to differentiate between indolent and aggressive tumors at diagnosis and thus aid in the development of personalized treatments. Our main finding so far is the detection of high levels of cholesterol in prostate cancer bone metastases. This in combination with previously presented results suggests cholesterol as a potentially interesting therapeutic target for advanced prostate cancer. Furthermore we detected metabolic alterations in plasma associated with metastasis development. These results were further explored in prospective samples attempting to verify some of the identified metabolites as potential prognostic markers.

  • 2646.
    Thysell, Elin
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Chorell, Elin
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Svensson, Michael B.
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Moritz, Thomas
    Jonsson, Pär
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Processing of mass spectrometry based metabolomics data for large scale screening studies and diagnosticsManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    In mass spectrometry based metabolomics predictive data processing and sample classification based on representative sample subsets makes it possible to screen large sample banks or data sets in an efficient fashion regarding both data quality and processing time. This is a requirement for making use of high sensitivity and complexity metabolite data and to turn the metabolomics field into a competitive omics platform for biological interpretation and diagnostics. Predictive metabolomics by means of hierarchical multivariate curve resolution (H-MCR) followed by orthogonal partial least squares discriminant analysis (OPLS-DA) was used for the processing and classification of gas chromatography/time of flight mass spectrometry (GC/TOFMS) data characterizing human blood serum samples collected in a study of strenuous physical exercise. The efficiency of the predictive processing as a high throughput tool for generating high quality data is clearly proven and stated as a main benefit of the method. Extensive model validation schemes by means of cross validation and external predictions verified the robustness of the extracted systematic patterns in the data. Comparisons regarding the extracted metabolite patterns between models emphasized the reliability of the methodology in a biological information context. Furthermore, the high predictive power concerning longitudinal predictions provided proof for the diagnostic potential of the methodology. Finally, the predictive metabolite pattern was interpreted physiologically as well as verified in the literature, highlighting the biological relevance of the diagnostic pattern. The suggested approach makes it feasible to screen large data or sample sets with retained data quality and interpretation and to do this in a high throughput fashion. The method could be of value for sample bank mining, metabolome-wide association studies, verification of marker patterns and development of diagnostic systems.

  • 2647.
    Thysell, Elin
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Pohjanen, Elin
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Lindberg, Johan
    Schuppe-Koistinen, Ina
    Moritz, Thomas
    Jonsson, Pär
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Reliable Profile Detection in Comparative Metabolomics2007Inngår i: Omics, ISSN 1536-2310, E-ISSN 1557-8100, Vol. 11, nr 2, s. 209-224Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A strategy for processing of metabolomic GC/MS data is presented. By considering the relationship between quantity and quality of detected profiles, representative data suitable for multiple sample comparisons and metabolite identification was generated. Design of experiments (DOE) and multivariate analysis was used to relate the changes in settings of the hierarchical multivariate curve resolution (H-MCR) method to quantitative and qualitative characteristics of the output data. These characteristics included number of resolved profiles, chromatographic quality in terms of reproducibility between analytical replicates, and spectral quality defined by purity and number of spectra containing structural information. The strategy was exemplified in two datasets: one containing 119 common metabolites, 18 of which were varied according to a DOE protocol; and one consisting of rat urine samples from control rats and rats exposed to a liver toxin. It was shown that the performance of the data processing could be optimized to produce metabolite data of high quality that allowed reliable sample comparisons and metabolite identification. This is a general approach applicable to any type of data processing where the important processing parameters are known and relevant output data characteristics can be defined. The results imply that this type of data quality optimization should be carried out as an integral step of data processing to ensure high quality data for further modeling and biological evaluation. Within metabolomics, this degree of optimization will be of high importance to generate models and extract biomarkers or biomarker patterns of biological or clinical relevance.

  • 2648.
    Thysell, Elin
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Stattin, Pär
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi.
    Moritz, Thomas
    Wikström, Pernilla
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Antti, Henrik
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Evaluation of metabolic alterations in patient plasma associated with disease aggressiveness in prostate cancerManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    GC-MS was used for the study of plasma metabolite profiles in prostate cancer patients. Multivariate analysis of the acquired data revealed metabolites and metabolite patterns associated with prostate cancer disease progression from benign disease to distant metastases. Moreover, by evaluation of plasma metabolite patterns before and after radical prostatectomy differences associated with biochemical relapse was detected. Specifically we found two unidentified plasma metabolites which showed decreased plasma levels with increased disease progression and, furthermore, increased plasma levels post compared to pre surgery in patients who later experienced biochemical relapse. We hypothesize that those metabolites are consumed by aggressive tumors more than by indolent tumors. Identification of those metabolites are hence crucial, and under-way, in order to enable biological interpretation of the results. We further hypothesized that any tumor-derived metabolite secreted into plasma would show increased concentrations with increased PCa risk. Notably we did not detect any such metabolite, but only a few metabolites which showed increased plasma concentrations in patients with metastases compared to patients with benign disease and low risk PCa. In addition, verification of metabolite markers for metastatic disease detected previously by us and others was made, and included decreased plasma levels of stearic acid and increased levels of pseudouridine with metastatic disease.

  • 2649.
    Thörne, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Läkare, lärande och interaktion i hälso-och sjukvårdspraktiker2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Bakgrund: Komplexiteten i hälso- och sjukvården blir kontinuerligt större, liksom möjligheterna till diagnostik och behandling. Samtidigt pressas hälso- och sjukvården av förändringar i demografier och sjukdomspanoraman, olika uttryck för globalisering och tillämpning av nya teknologier. Ett omfattande antal olika professioner förväntas genomföra och utveckla det dagliga arbetet med ännu mer involvering av patienter. Vi behöver mer kunskap om hur lärande sker och hur det underlättas och utvecklas i dagligt hälso- och sjukvårdsarbete för att kunna möta förändringar och utmaningar.

    Syfte: Avhandlingens övergripande syfte är att fördjupa kunskap och förståelse om pedagogiska processer och lärande i hälso- och sjukvårdspraktiker, med särskilt fokus på läkare.

    Metoder: Intervjustudier och fältstudie med interaktiv forskningsansats gav data med både bredd och djup från autentiskt hälso- och sjukvårdsarbete. I pågående hälso- och sjukvårdsarbete studerades läkare, vårdgivare i andra professioner, patienter, redskap som användes och praktikens rumsliga utformning. Data analyserades genom både kulturella och sociomateriella praktikteoretiska linser, vilket möjliggjorde att flera dimensioner av lärande och interaktion i hälso- och sjukvårdspraktiker kunde spåras.

    Fynd: I arbetet med patienter agerade läkare och andra professioner pedagogiskt med eller utan intentioner, i pedagogiska processer som bestod av att avläsa-färdrikta-lärstödja. Den pedagogiska dimensionen av arbetet var inte synliggjord eller diskuterad i relation till patientarbetet. Dynamiskt inbäddat i arbetet lärde och stöttade läkare också yngre läkares och andra vårdgivares lärande. Läkarnas mobilitet i olika vårdsammanhang, såväl som ansvarsfördelning och delande av olika perspektiv, hade betydelse för vilket lärande som uppstod. Genom att betrakta specifika vårdsammanhang som hälso- och sjukvårdspraktiker under utövning, framträdde vid studiet av en rondmodell både samskapande lärande ronder och operativa ronder med begränsat lärande. Det framträdde genom sättet som deltagande personer, rumsliga och materiella förhållande samspelade på, som ömsesidigt utbyte respektive separata individuella arbetsprocesser. Samspelet mellan hälso- och sjukvårdspraktikers arrangemang (praktikarkitekturer) och genomförande snarare begränsade än underlättade underläkares lärandepraktiker. Underläkarnas arbete hade inte kontinuitet, koherens eller progression för att bredden av kunnande i medicinsk praktiskt arbete skulle kunna utvecklas bra.

    Implikationer: Att förstå och synliggöra lärande i hälso- och sjukvårdens dagliga arbete genom att gemensamt prata om pedagogiska dimensioner i det arbete som pågår, kan utveckla lärande och lärstödjande ageranden. Samskapande lärande hälso- och sjukvårdspraktiker där alla deltagande gruppers behov och uppdrag medräknas, har implikationer på underläkares kompetensutveckling, studenters lärande, patienters involvering i sin vård och interprofessionellt och interdisciplinärt samarbete. Det ger också ledare möjlighet att knyta arbete med förbättringar av vårdens kvalitetet och säkerhet till dagligt vårdarbete.

  • 2650.
    Tiger Axelsson, Malin
    et al.
    Linnéuniversitetet, Fakultetsnämnden för hälsa, socialt arbete och beteendevetenskap, Institutionen för hälso- och vårdvetenskap, HV.
    Wångelid, Anna
    Linnéuniversitetet, Fakultetsnämnden för hälsa, socialt arbete och beteendevetenskap, Institutionen för hälso- och vårdvetenskap, HV.
    Sjuksköterskans erfarenheter av att kommunicera med patienter med afasi till följd av stroke: litteraturstudie2011Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
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