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  • 301. Grim, Katarina
    et al.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Svedberg, Petra
    Schön, Ulla-Karin
    Development- and usability testing of a web-based decision support for users and health professionals in psychiatric services2017In: Psychiatric rehabilitation journal, ISSN 1095-158X, E-ISSN 1559-3126, Vol. 40, no 3, p. 293-302Article in journal (Refereed)
    Abstract [en]

    Objective: Shared decision making (SMD) related to treatment and rehabilitation is considered a central component in recovery-oriented practice. Although decision aids are regarded as an essential component for successfully implementing SDM, these aids are often lacking within psychiatric services. The aim of this study was to use a participatory design to facilitate the development of a user-generated, web-based decision aid for individuals receiving psychiatric services. The results of this effort as well as the lessons learned during the development and usability processes are reported. Method: The participatory design included 4 iterative cycles of development. Various qualitative methods for data collection were used with potential end users participating as informants in focus group and individual interviews and as usability and pilot testers. Results: Interviewing and testing identified usability problems that then led to refinements and making the subsequent prototypes increasingly user-friendly and relevant. In each phase of the process, feedback from potential end-users provided guidance in developing the formation of the web-based decision aid that strengthens the position of users by integrating access to information regarding alternative supports, interactivity between staff and users, and user preferences as a continual focus in the tool. Conclusions and Implications for Practice: This web-based decision aid has the potential to strengthen service users’ experience of self-efficacy and control as well as provide staff access to user knowledge and preferences. Studies employing participatory models focusing on usability have potential to significantly contribute to the development and implementation of tools that reflect user perspectives.

  • 302. Grooten, W. J.
    et al.
    Conradsson, D.
    Äng, Björn
    Franzen, E.
    Is active sitting as active as we think?2013In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 56, no 8, p. 1304-14Article in journal (Refereed)
  • 303. Grooten, W. J.
    et al.
    Äng, Björn
    Reliability of measurements of wrist extension force obtained with a Nicholas Manual Muscle Tester (NMMT)2010In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 26, no 4, p. 281-7Article in journal (Refereed)
  • 304. Grooten, Wilhelmus Johannes Andreas
    et al.
    Tseli, Elena
    Äng, Björn
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska institutet; Uppsala universitet.
    Boersma, Katja
    Stålnacke, Britt-Marie
    Gerdle, Björn
    Enthoven, Paul
    Elaborating on the assessment of the risk of bias in prognostic studies in pain rehabilitation using QUIPS-aspects of interrater agreement2019In: Diagnostic and Prognostic Research, ISSN 2397-7523, Vol. 3, article id 5Article in journal (Refereed)
    Abstract [en]

    Background: Many studies have been performed to identify important prognostic factors for outcomes after rehabilitation of patients with chronic pain, and there is a need to synthesize them through systematic review. In this process, it is important to assess the study quality and risk of bias. The "Quality In Prognosis Studies" (QUIPS) tool has been developed for this purpose and consists of several prompting items categorized into six domains, and each domain is judged on a three-grade scale (low, moderate or high risk of bias). The aim of the present study was to determine the interrater agreement of the risk of bias assessment in prognostic studies of patients with chronic pain using QUIPS and to elaborate on the use of this instrument.

    Methods: We performed a systematic review and a meta-analysis of prognostic factors for long-term outcomes after multidisciplinary rehabilitation in patients with chronic pain. Two researchers rated the risk of bias in 43 published papers in two rounds (15 and 28 papers, respectively). The interrater agreement and Cohen's quadratic weighted kappa coefficient (κ) and 95% confidence interval (95%CI) were calculated in all domains and separately for the first and second rounds.

    Results: The raters agreed in 61% of the domains (157 out of 258), with similar interrater agreement in the first (59%, 53/90) and second rounds (62%, 104/168). The overall weighted kappa coefficient (kappa for all domains and all papers) was weak: κ = 0.475 (95%CI = 0.358-0.601). A "minimal agreement" between the raters was found in the first round, κ = 0.323 (95%CI = 0.129-0.517), but increased to "weak agreement" in the second round, κ = 0.536 (95%CI = 0.390-0.682).

    Conclusion: Despite a relatively low interrater agreement, QUIPS proved to be a useful tool in assessing the risk of bias when performing a meta-analysis of prognostic studies in pain rehabilitation, since it demands of raters to discuss and investigate important aspects of study quality. Some items were particularly hard to differentiate in-between, and a learning phase was required to increase the interrater agreement. This paper highlights several aspects of the tool that should be kept in mind when rating the risk of bias in prognostic studies, and provides some suggestions on common pitfalls to avoid during this process.

    Trial registration: PROSPERO CRD42016025339; registered 05 February 2016.

  • 305.
    Grossi, Giorgio
    et al.
    National Institute for Psychosocial Factors and Health, Stockholm.
    Perski, Aleksander
    National Institute for Psychosocial Factors and Health, Stockholm.
    Ekstedt, Mirjam
    National Institute for Psychosocial Factors and Health, Stockholm.
    Johansson, Thorbjörn
    National Institute for Psychosocial Factors and Health, Stockholm.
    Lindström, Morie
    Uppsala University.
    Holm, Karin
    Uppsala University.
    The morning salivary cortisol response in burnout.2005In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 59, no 2, p. 103-111Article in journal (Refereed)
    Abstract [en]

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

  • 306.
    Grunér, Sofia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Östberg, Per
    Institutionen för Klinisk vetenskap, Intervention och Teknik (CLINTEC), Karolinska Institutet.
    Hedenius, Martina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi. Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    The Compensatory Effect of Text-to-Speech Technology on Reading Comprehension and Reading Rate in Swedish Schoolchildren With Reading Disability: The Moderating Effect of Inattention and Hyperactivity Symptoms Differs by Grade Groups2018In: Journal of Special Education Technology, ISSN 0162-6434, Vol. 33, no 2, p. 98-110Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was (i) to investigate if the compensatory effect of text-to-speech (TTS) technology on reading comprehension and reading rate in schoolchildren with reading disability is influenced by problems with inattention and hyperactivity and (ii) to examine whether a potentially moderating effect of such symptoms differ between grade groups. Participants (N = 49) were randomized into one of the two experimental conditions: Group A listened to a text with TTS, and Group B read the text themselves. The conditions were then switched. Inattention and hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire (SDQ). Statistical analyses were performed both on the whole group and within-grade groups (Grades 3–5 and 6–9). Using TTS technology had a positive effect on reading rate for both grade groups, and this effect was not influenced by attention-deficit/hyperactivity disorder (ADHD) symptoms. As for reading comprehension, the two groups differed both with respect to the amount of improvement seen in the TTS condition and with respect to the moderating effect of ADHD symptoms. Reading with TTS improved reading comprehension significantly in the younger group, whereas no effect on reading comprehension was found in the older group. A higher score on the SDQ ADHD Scale was associated with less improvement in reading comprehension in the younger group and with greater improvement in reading comprehension in the older group. The results indicate that symptoms of inattention and hyperactivity, as well as the child’s grade level, are factors that should be taken into account when planning and introducing TTS technology.

  • 307.
    Gryth, Dan
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Rådestad, Monica
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Nilsson, Heléne
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology. Linköping University, Department of Clinical and Experimental Medicine, Surgery. Linköping University, Faculty of Health Sciences.
    Nerf, Ola
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Svensson, Leif
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Castrén, Maaret
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm Prehospital Centre, Stockholm, Sweden.
    Rüter, Anders
    Östergötlands Läns Landsting, Center for Disaster Medicine and Traumatology.
    Evaluation of medical command and control using performance indicators in a full-scale, major aircraft accident exercise.2010In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 25, no 2, p. 118-123Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 308.
    Gröndal, Hedvig
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Sociology.
    Signs of bacteria: Enacting Sore Throat2015Conference paper (Refereed)
    Abstract [en]

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

  • 309.
    Gudmundsson, Cecilia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    "Anknytningsteori har ju funnits sen Hedenhös": Anknytning som psykoterapeutiskt fenomen2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

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

  • 310.
    Gunnarsson, Ingemar
    Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences. Linnaeus University Centre for Concurrences in Colonial and Postcolonial Stuides.
    Biografin som historisk genre och metod2015In: Livsberättelser, kultur & hälsa / [ed] Motzi Eklöf, Margareta Petersson, Växjö: Linnaeus University Press, 2015, 1, p. 75-79Chapter in book (Other academic)
  • 311.
    Gunnarsson, Ingemar
    Linnaeus University, Faculty of Arts and Humanities, Department of Cultural Sciences. Linnaeus University, The University Library.
    Referenshantering med EndNote2017In: Vetenskaplig teori och metod: Från idé till examination inom omvårdnad / [ed] Maria Henricson, Lund: Studentlitteratur AB, 2017, 2, p. 439-458Chapter in book (Other academic)
  • 312.
    Gunnarsson, Lars-Gunnar
    et al.
    Örebro University, School of Medical Sciences.
    Bodin, Lennart
    Örebro University, Örebro University School of Business.
    Epidemiologiskt undersökta samband mellan Alzheimers sjukdom och faktorer i arbetsmiljön2015Report (Refereed)
    Abstract [en]

    Epidemiological evidence on associations between work environment and Alzheimers disease

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

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

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

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

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

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

  • 313.
    Gunnarsson Payne, Jenny
    Södertörn University, School of Historical and Contemporary Studies, Ethnology. Södertörn University, Centre for Baltic and East European Studies (CBEES).
    Mattering Kinship: Inheritance, biology and egg donation, between genetics and epigenetics2016In: Critical Kinship Studies / [ed] Charlotte Krolokke, Lene Myong, Stine W. Adrian, Tine Tjornhoj-Thomsen, London: Rowman & Littlefield Publishers, 2016, 1, p. 33-47Chapter in book (Other academic)
  • 314.
    Gunnarsson, Stina
    et al.
    Linkoping Univ, Dept Rehabil Med, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Alehagen, Siw
    Linkoping Univ, Dept Med & Hlth Sci, Div Nursing Sci, Linkoping, Sweden.
    Lemming, Dag
    Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Ertzgaard, Per
    Linkoping Univ, Dept Rehabil Med, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Berntsson, Shala Ghaderi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Samuelsson, Kersti
    Linkoping Univ, Dept Rehabil Med, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Experiences from intrathecal baclofen treatment based on medical records and patient- and proxy-reported outcome: a multicentre study2019In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 9, p. 1037-1043Article in journal (Refereed)
    Abstract [en]

    Purpose:

    To investigate patient satisfaction with intrathecal baclofen treatment, complications from the treatment, and the impact of general expectations on treatment outcome in relation to satisfaction.

    Methods:

    A multicentre study with cross-sectional design. Data were collected through questionnaires and patient records. Patients were recruited from six outpatient intrathecal baclofen clinics in Sweden. Eighty-three patients who had been treated with intrathecal baclofen for 1-4 years were included. For patients unable to communicate, data were collected through a proxy. The Patient Global Impression of Change was used to measure patients' general satisfaction with change from intrathecal baclofen treatment. The Life Orientation Test - revised, was used to measure general expectations/optimism.

    Results:

    General satisfaction with intrathecal baclofen treatment was high; 51/77 patients reported "much improved" or "very much improved." There was no relationship between the two main outcomes (general satisfaction and general expectations/optimism) (r(s) = 0.12, p = 0.382). The two groups; those who could and those who could not communicate, did differ regarding personal characteristics and should be evaluated as such.

    Conclusions:

    Most patients/proxies reported a high level of satisfaction with intrathecal baclofen treatment. The reported satisfaction with intrathecal baclofen treatment was not dependent on general expectations.

  • 315.
    Gustafsson, Berit M.
    et al.
    Linköping University, Center for Social and Affective Neuroscience (CSAN). Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Högland Hospital, Sweden; Jönköping University, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Proczkowska, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Hospital Jönköping, Sweden.
    The Strengths and Difficulties Questionnaire (SDQ) for preschool childrena Swedish validation2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 8, p. 567-574Article in journal (Refereed)
    Abstract [en]

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

  • 316.
    Gustafsson, E.
    et al.
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Litström, Emma
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Drott, Jenny
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Reliability testing of oxaliplatin-associated neurotoxicity questionnaire (OANQ), a pilot study2016In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 24, no 2, p. 747-754Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

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

    METHODS:

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

    RESULTS:

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

    CONCLUSIONS:

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

  • 317.
    Gustafsson, Gabriel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Uppsala University.
    Alpha-Synuclein Oligomers: Cellular Mechanisms and Aspects of Antibody Treatment2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

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

  • 318.
    Gustafsson, Ingrid
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Olandersson, Carin
    Centralsjukhuset Kristianstad.
    Kliniska examinationer på KTC2015In: Kliniska examinationer: Handbok för sjuksköterskestudenter på grund- och avancerad nivå / [ed] Sofia Almerud Österberg och Carina Elmqvist, Lund: Studentlitteratur AB, 2015, p. 77-108Chapter in book (Other academic)
  • 319.
    Gustafsson, Sofia
    et al.
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    Jeanette, Backholm
    Halmstad University, School of Business and Engineering (SET), Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine.
    PÅVERKAR ÅLDER, KÖN OCH TRÄNINGSMÄNGD FMS?: En tvärsnittsstudie mellan Functional movement screen samt sf-36v2 Health survey2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

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

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

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

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

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

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

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

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

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

  • 320.
    Gustafsson, Åsa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kadmium och preeklampsi - finns det något samband? En litteraturstudie2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Cadmium (Cd) is a metallic element with well-known negative health effects that we are exposed to in our environment, largely through diet. Preeclampsia annually affects 3-7% of all pregnant women and is one of the most common causes of morbidity and mortality for the mother and a major cause of prematurity and fetal growth retardation.

    Purpose: The purpose of the study was to investigate whether there is any correlation between Cd and preeclampsia and, if so, what the connection may be.

    Method: This study is a literature review based on scientific articles summarized.

    Results: All seven articles show a correlation between Cd and preeclampsia. In experimental models on pregnant rats exposed to Cd, rats develop characteristics of preeclampsia including high blood pressure. In humans, significant association between preeclampsia and higher Cd levels are observed in blood, serum and amniotic fluid.

    Conclusion: The articles show that there is a correlation between Cd and preeclampsia, although it cannot be established that it is a direct causal link without further research.

  • 321.
    Haake, Kim
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dahlgren, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Föda utan rädsla: En utvärdering av förlossningsförberedelse i grupp2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

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

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

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

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

  • 322.
    Hagel, Sofia
    et al.
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Petersson, Ingemar F
    Department of Clinical Sciences in Lund, Section of Rheumatology & Orthopaedics, Lund University & Skane University Hospital, Lund, Sweden.
    Meesters, Jorit J L
    Department of Rheumatology, Department of Physical Therapy, Leiden University Medical Center, Leiden, Netherlands & National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Klokkerud, Mari
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Aanerud, Gerd J
    National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway .
    Stovgaard, Inger H
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Hørslev-Petersen, Kim
    King Christian Xth Hospital for Rheumatic Diseases, University of Southern Denmark, Gråsten, Denmark.
    Strömbeck, Britta
    Department of Clinical Sciences in Lund, Orthopaedics, Lund University, Lund, Sweden.
    Vliet Vlieland, Thea P M
    Department of Orthopaedics, Leiden University Medical Center, Leiden, Netherlands .
    Bremander, Ann
    Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS). Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden & School of Business and Engineering, Department of Exercise Physiology, Biomechanics and Health, Spenshult, Halmstad, Sweden.
    Which patients improve the most after arthritis rehabilitation? A study of predictors in patients with inflamatory arthritis in northern Europe, the STAR-ETIC collaboration2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 3, p. 250-257Article in journal (Refereed)
    Abstract [en]

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

    DESIGN: Multicentre prospective observational study in 4 European countries.

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

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

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

  • 323.
    Hagell, Peter
    et al.
    Kristianstad University.
    Broman, Jan-Erik
    Uppsala University.
    Hellström, Amanda
    Blekinge Institute of Technology.
    Fagerström, Cecilia
    Blekinge Institute of Technology.
    Willman, Ania
    Malmö University.
    Westergren, Albert
    Kristianstad University.
    Measurement properties of the Minimal Insomnia Symptom Scale (MISS) as an insomnia screening tool among adults and the elderly2015In: The 6th International Conference on Probabilistic Models for Measurement in Education: Psychology, Social Science and Health, 12 - 14 January 2015, University of Cape Town, 2015Conference paper (Refereed)
    Abstract [en]

    Background: The Minimal Insomnia Symptom Scale (MISS) has been suggested as a brief 3-item screening tool for detecting insomnia. Each item has an ordered 5-category (0-4) response scale and the instrument yields a total score between 0-12 (higher scores = more insomnia). Available MISS evaluations have been based on classical test theory (CTT) approaches. Different cut-offs for identifying insomnia have been suggested for adults (aged 20-64) and elderly (aged 65+). For adults, a cut-off of ≥6 has been suggested, while a cut-off of ≥7 has been suggested for the elderly, as determined from applications of the Youden index.

    Aim: To test the measurement properties of the MISS using the Rasch measurement model, with special emphasis on Differential Item Functioning (DIF) by age, and to explore implications for the two suggested cut-off scores.

    Design: Cross-sectional MISS data from adult (n=1075) and elderly (n=548) populations were analysed by the unrestricted polytomous Rasch measurement model using the RUMM2030 software program. To avoid an inflated type I error rate, sample size was algebraically adjusted to 500 in the calculation of P-values while leaving all other aspects of data (e.g., locations, fit residuals) unaltered.

    Results: Mean person location was -1.095 (SD, 1.28), i.e. items tend to represent more severe levels of insomnia than that experienced by the sample. However, for the purpose of screening this may be considered acceptable. There were no statistically significant deviations from model expectations, with a non-significant overall item-trait interaction (χ2 = 26.94, P=0.173). Reliability (PSI) was 0.59 suggesting that the MISS can separate approximately two statistically distinct groups of people (1.92 strata). The highest Information Function (IF) was found at -0.2 logits. There were no disordered response category thresholds. There was uniform DIF by age for all three items, which disappeared following adjustment (split by age group) for the most pronounced DIF, suggesting that DIF was artificial for two items. Examination of raw scores-to-location estimates between the two age groups revealed differences at the lower and higher ends of the scale. The raw score cut-off of ≥6 was associated with a smaller logit difference between age groups than the ≥7 cut-off (0.09 vs. 0.23). That is, at a raw score of 6 the two age groups were comparable regarding their logit location estimates. This raw score (representing a logit value of -0.03 for the pooled sample) was also the one closest to the location of the highest IF (i.e., -0.2 logits).

    Summary and implications: This study provides general support for the measurement properties of the MISS. However, caution should be exercised in comparing MISS scores between age groups, but applying a ≥6 raw score cut-off appears to allow for valid comparisons between adults and elderly regarding the presence of insomnia. Nevertheless, additional studies are needed to determine the clinically optimal cut-score for identification of insomnia. 

  • 324.
    Hagerman, Heidi
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Skytt, Bernice
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wadensten, Barbro
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Högberg, Hans
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Engström, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    A longitudinal study of working life among first-line managers in the care of older adults2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 32, p. 7-13Article in journal (Refereed)
    Abstract [en]

    Aim

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

    Methods

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

    Results

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

    Conclusion

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

  • 325.
    Hagman, Karl
    et al.
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    Barboutis, Christos
    Natural History Museum of Crete, University of Crete, Iraklion, Greece.
    Ehrenborg, Christian
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    Fransson, Thord
    Swedish Museum of Natural History, Department of.
    Jaenson, Thomas G. T.
    Department of Systematic Biology, Medical Entomology Unit, Uppsala University.
    Lindgren, Per-Eric
    Department of Clinical and Experimental Medicine, Microbiology, Linköping University.
    Lundkvist, Åke
    Department of Medical Microbiology and Biochemistry, Uppsala University and Swedish Institute for Communicable Diseases and Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet.
    Nyström, Fredrik
    Department of Clinical and Experimental Medicine, Microbiology, Linköping University.
    Waldenström, Jonas
    Center for Ecology and Evolution, Microbial Model Systems, Linneaus University.
    Salaneck, Erik
    Section for Infectious Diseases, Department of Medical Science, Uppsala University.
    On the potential roles of ticks and migrating birds in the ecology of West Nile virus.2014In: Infection Ecology and Epidemiology, ISSN 2000-8686, Vol. 4Article in journal (Refereed)
  • 326.
    Hagström, Anneli Silvén
    et al.
    Univ Gavle, Fac Hlth & Occupat Studies, Dept Social Work & Psychol, Gavle, Sweden;Stockholm Univ, Dept Social Work, Stockholm, Sweden.
    Toft, Teolinda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    "TOGETHER WE ARE UNBEATABLE": young sisters' narration of a sibling's cancer in personal blogs on the internet2019In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, no 1, article id 1586625Article in journal (Refereed)
    Abstract [en]

    Purpose: Siblings of children and young people diagnosed with cancer are commonly reluctant to talk about their experiences due to the circumstances of the illness situation. This article aims to bring voice to experience and inform practice by investigating what and how three young sisters narrate about their illness experiences in personal blogs on the Internet.

    Methods: A narrative methodology for the analysis of life storytelling was applied primarily to investigate the sister's coping strategies and support needs.

    Results: The results show how the sisters constructed their own space for narration, with the main aims of expressing their feelings about the illness and seeking social support. The telling of their experiences along with encouraging comments from a supportive audience enabled a change in position from feeling neglected and silenced to being a recognized agent and caring sister. In addition, through their narrative coping the sisters went from powerless to powerful in their position in relation to cancer.

    Conclusion: The results highlight the need for siblings to be able to narrate experience in a supportive context, where the processing of their relationship with the ill sister/brother should be understood as an important element of their coping with cancer and death.

  • 327.
    Hagström, Katja
    et al.
    Department of Environmental Science, Örebro University, Örebro,Sweden.
    Axelsson, Sara
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Arvidsson, Helena
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Lundholm, Cecilia
    Örebro University Hospital, Department of Occupational and Environmental Medicine, Örebro, Sweden.
    Eriksson, Kåre
    University Hospital of Umeå, Department of Occupational and Environmental Medicine, Umeå, Sweden.
    Exposure to Wood Dust, Resin Acids, and Volatile Organic Compounds During Production of Wood Pellets2008In: Journal of Occupational and Environmental Hygiene, ISSN 1545-9624, E-ISSN 1545-9632, Vol. 5, p. 296-304Article in journal (Refereed)
    Abstract [en]

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

  • 328.
    Halilovic, Amra
    et al.
    Landstinget i Dalarna.
    Terner, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation.
    Standardized headings as a foundation for semantic interoperability in EHR2016In: MATEC Web of Conferences / [ed] N. Mastorakis, V. Mladenov and A. Bulucea, 2016, Vol. 76, article id 04001Conference paper (Refereed)
    Abstract [en]

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

  • 329.
    Halilovic, Amra
    et al.
    Landstinget Dalarna.
    Terner, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    The Extent of Shared Headings in Electronic Health Records in Swedish County Councils and Regions2018In: Journal of Medical Imaging and Health Informatics, ISSN 2156-7018, E-ISSN 2156-7026, Vol. 8, no 3, p. 532-536Article in journal (Refereed)
    Abstract [en]

    The need to exchange health-related information contained in electronic health records across county councils and regions in Sweden has become necessary due to the new Swedish Patient Act. This act allows patients to choose health care both in their own county council or region as well as in county councils or regions other than their own. Exchange of health-related information demands interoperability and especially semantic interoperability. In Sweden headings are traditionally employed for structure the data in the health records. If the headings are shared and standardised they can enable the sharing of health-related information across county councils and regions. However, each county council and region has their own terminology of headings. The aim is to study to what extent headings are shared and to what extent the shared headings are standardised across county councils and regions in Sweden. The spelling of 32,228 headings from three county councils and regions was analysed to see to what extent they were spelled exactly the same and to what extent those headings spelled exactly the same corresponded to concepts in the Swedish Common Information Structure. In total 130 headings were spelled exactly the same across three county councils and regions. More than half of the headings spelled exactly the same corresponded to concepts in the Swedish Common Information Structure. The results showed that the three county councils and regions in total shared 2% of the studied headings. Of the shared headings more than half were standardised. Professional groups have long experience of employing headings and therefore we recommend headings as a tool for implementing a National Language for Specific Purposes as Swedish National Board of Health and Welfare's standard. This will enable health-related information to be available wherever the patient is located across county councils and regions.

  • 330.
    Hallberg, Anneli
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    SOS 112– vad har inträffat?: En studie av framgångs- och riskfaktorer i nöd-samtalet utifrån ett förbättringsarbete för att öka säkerställandet av vitala parametrar genom reflektion.2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    The purpose of the underlying improvement work was to increase the proportion of calls in which vital parameters are secured, and the case is given correct prioritization through regular interception and reflection. The purpose of the study was to identify success and risk factors from the perspective of the emergency call-taker on the emergency call with a focus on securing vital parameters, correct prioritization and the context of the emergency call.

     

    In the improvement work, 12 emergency call-takers were asked, within a period of four months, to individually reflected on the contents in calls and write down reflections. This was contributing to an increase in secured vital parameters and correct prioritization. A content analysis of the reflections demonstrated that it was a success factor to be professional and limitations in the call methodology was a risk factor. When the set process for the call was followed it was a success factor and a risk factor when it was not followed.

     

    The conclusion is that regular interception and reflection increase securing vital parameters and correct prioritization in emergency calls and that it is a success factor to follow the set process for the call, but that technical support for the purpose is missing.

  • 331.
    Hallvig, David
    et al.
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction. Chalmers Tekniska Högskola.
    Anund, Anna
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Fors, Carina
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Kecklund, Göran
    Stockholms Universitet.
    Karlsson, Johan G.
    Autoliv Development AB.
    Wande, Mattias
    Chalmers Tekniska Högskola.
    Åkerstedt, Torbjörn
    Stockholms Univeristet, Karolinska institutet.
    Sleepy driving on the real road and in the simulator: A comparison2013In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 50, p. 44-50Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 332.
    Halvorsen, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sharma, Hari Shanker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Neural injury after use of vasopressin and adrenaline during porcine cardiopulmonary resuscitation2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 1, p. 11-19Article in journal (Refereed)
    Abstract [en]

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

  • 333.
    Hanson, Anton
    et al.
    Linnaeus University, Faculty of Engineering and Technology, Kalmar Maritime Academy.
    Horck, Emma
    Linnaeus University, Faculty of Engineering and Technology, Kalmar Maritime Academy.
    Arbetsskador som drabbar marin maskinpersonal: En kartläggning av skaderiskerna för marin maskinpersonal ombord på svenska fartyg, samt en jämförelse av skaderisken med liknande arbeten iland2013Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

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

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

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

  • 334.
    Hanson, Claudia
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Waiswa, Peter
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Marchant, Tanya
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Marx, Michael
    Evaplan GmbH the University of Heidelberg, Germany.
    Manzi, Fatuma
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Mbaruku, Godfrey
    Ifakara Health Institute, Dar-es-Salaam, Tanzania.
    Rowe, Alex
    Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
    Tomson, Göran
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Schellenberg, Joanna
    Department of Disease Control, London School of Hygiene and Tropical Medicine, United Kingdom.
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.2014In: Implementation science : IS, ISSN 1748-5908, Vol. 9, article id 41Article in journal (Refereed)
    Abstract [en]

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

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

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

    TRIAL REGISTRATION: PACTR201311000681314.

  • 335.
    Hartleb, Hanna
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Törnqvist, Patrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
      Gör terapeuten det hon tror hon gör och spelar det någon roll?: En explorativ validitetsstudie om sambanden mellan självrapporterad och observatörsskattad följsamhet till IPT som metod och dess betydelse för terapins utfall.  2012Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

     

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

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

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

  • 337.
    Haynes, John E.
    et al.
    School of Education, University of New England, Armidale NSW, Australia.
    Miller, Judith A.
    School of Education, University of New England, Armidale NSW, Australia.
    Varea, Valeria
    School of Education, University of New England, Armidale NSW, Australia.
    Preservice generalist teachers enlightened approach to teaching Physical Education through Teacher Biography2016In: Australian Journal of Teacher Education, ISSN 1835-517X, Vol. 41, no 3, p. 21-38Article in journal (Refereed)
    Abstract [en]

    This paper describes a new learning experience, which was introduced following an examination of the literature regarding preservice primary school teachers' (PPST) notions of their past experience in Physical Education (PE) (Elliott 2013). PPSTs were given the opportunity to recognise, reflect, interrogate and reframe a critical incident from their schooling in PE or Sport. This exercise was designed to enlighten students about their own schooling and the potential impact this event may have on pre-conceived ideas and opinions about teaching PE. Students (N=214) enrolled in off and on campus mode, of a preservice teacher education program in a university located in regional NSW, were asked to provide information about, and to analyse, an incident, either positive or negative that occurred in PE or Sport during their primary or secondary school years. In addition, students were encouraged to reframe the incident and to seek out alternative actions that could have influenced the outcome. The aim was to encourage reflection about how preconceived notions pertaining to PE might be dealt within their present position as a preservice teacher. The PPSTs scripts were analysed using the Leximancer text mining software (Smith, 2000). Findings from the analysis provided themes and concepts, which suggest a similarity for both, off and on campus, males and females. However, there are some subtle differences between the cohorts that may be due to age or experience.

  • 338. Hedman, Leif
    et al.
    Fahlstedt, Madelen
    KTH, School of Technology and Health (STH), Medical Engineering, Neuronic Engineering.
    Schlickum, Marcus
    Möller, Hans
    von Holst, Hans
    KTH, School of Technology and Health (STH), Medical Engineering, Neuronic Engineering.
    Felländer-Tsai, Li
    A pilot evaluation of an educational program that offers visualizations of cervical spine injuries: medical students' self-efficacy increases by training2014In: Informatics for Health and Social Care, ISSN 1753-8157, E-ISSN 1753-8165, Vol. 39, no 1, p. 33-46Article in journal (Refereed)
    Abstract [en]

    In this pilot study, a new method for visualization through imaging and simulation (VIS-Ed) for teaching diagnosis and treatment of cervical spine trauma was formatively evaluated. The aims were to examine if medical students' self-efficacy would change by training using VIS-Ed, and if so these changes were related to how they evaluated the session, and the user interface (UI) of this program. Using a one-group, pre-post course test design 43 Swedish medical students (4th year, 17 males, 26 females) practiced in groups of three participants. Overall the practice and the UI were considered as positive experiences. They judged VIS-Ed as a good interactive scenario-based educational tool. All students' self-efficacy increased significantly by training (p<0.001). Spearman's rank correlation tests revealed that increased self-efficacy was only associated with: how the session was compared to as expected (p<0.007). Students' self-efficacy increased significantly by training, but replication studies should determine if this training effect is gender-related.

  • 339. Heijne, A.
    et al.
    Äng, Björn
    Werner, S.
    Predictive factors for 12-month outcome after anterior cruciate ligament reconstruction2009In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 19, no 6, p. 842-9Article in journal (Refereed)
  • 340. Heldal, Ilona
    et al.
    Backlund, Per
    Johannesson, Mikael
    Lebram, Mikael
    Lundberg, Lars
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Connecting the links: Narratives, simulations and serious games in prehospital training.2017In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 235, p. 343-347Article in journal (Refereed)
    Abstract [en]

    Due to rapid and substantial changes in the health sector, collaboration and supporting technologies get more into focus. Changes in education and training are also required. Simulations and serious games (SSG) are often advocated as promising technologies supporting training of many and in the same manner, or increasing the skills necessary to deal with new, dangerous, complex or unexpected situations. The aim of this paper is to illustrate and discuss resources needed for planning and performing collaborative contextual training scenarios. Based on a practical study involving prehospital nurses and different simulator technologies the often-recurring activity chains in prehospital training were trained. This paper exemplifies the benefit of using narratives and SSGs for contextual training contributing to higher user experiences. The benefits of using simulation technologies aligned by processes can be easier defined by narratives from practitioners. While processes help to define more efficient and effective training, narratives and SSGs are beneficial to design scenarios with clues for higher user experiences. By discussing illustrative examples, the paper contributes to better understanding of how to plan simulation-technology rich training scenarios.

  • 341.
    Helgesson, Gert
    et al.
    Karolinska Institutet, Sweden.
    Lindblad, Anna
    Karolinska Institutet, Sweden.
    Thulesius, Hans
    Lund university, Sweden;Region Kronoberg, Sweden.
    Lynöe, Niels
    Karolinska Institutet, Sweden.
    Reasoning about physician-assisted suicide: analysis of comments by physicians and the Swedish general public2009In: Clinical Ethics, ISSN 1477-7509, E-ISSN 1758-101X, Vol. 4, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Two questionnaires directed to Swedish physicians and a sample of the Swedish population investigated attitudes towards physician-assisted suicide (PAS). The aim of the present work was to analyse qualitative data from these questionnaires in order to explore how respondents reason about PAS. Data were analysed in two steps. First, we categorized different kinds of responses and identified pro and con arguments. Second, we identified general conclusions from the responses. The data reflect the differences in attitudes towards PAS among the public and physicians, with the former mainly in favour of PAS and the latter mainly against. There was, however, considerable agreement about what requirements must be met before PAS could be considered ethical. Many arguments against PAS concerned the professional role of physicians, which indicates that it may not be assisted suicide as such that many PAS opponents disagree with, but rather that it is handled by physicians in the regular health-care system.

  • 342.
    Helldahl, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Mattsson, Carola
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Negativa effekter av psykoterapi2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med studien var att undersöka blivande psykoterapeuters uppfattning av negativa effekter av den egenterapi som de genomgått inom ramen för utbildningen till legitimerade psykoterapeuter. Vilka negativa effekter av egenterapi rapporterar psykoterapeutstudenter och skiljer sig dessa från vad patienter som genomgått psykoterapi rapporterar? En frågeställning var också hur blivande psykoterapeuter ser på egenterapins funktion (terapeutisk funktion, modellfunktion, empatisk funktion eller övertygelsefunktion),

    En enkätundersökning genomfördes bland studenter på två olika psykoterapeutprogram under den avslutande terminen. Totalt kom 33 studenter att delta. Instrumentet som använts, “Negativa händelser och effekter av psykologisk behandling”, består av 60 påståenden som skattas utifrån upplevda biverkningar av psykoterapi (och vad som specifikt orsakats av egenterapin). Jämförelse gjordes med redan publicerade data kring patienters rapportering (Norström, 2015). I tillägg fick studenterna skatta egenterapins funktion på en fyrgradig skala. Resultatet visar att en relativt stor andel av psykoterapeutstudenterna rapporterade någon form av negativ effekt av egenterapin. Vanligast var att man upplevde att gamla obehagliga minnen väcktes till liv (36%), att man inte förstod sin terapeut (27%) och att man kände sig mer sorgsen (24%). Resultatet visar också att rapporterade negativa effekter av egenterapi var relativt likartad mellan gruppen studenter och patienter. Egenterapins terapeutiska funktion angavs ha mycket stor betydelse bland drygt hälften av studenterna. Störst andel av studenterna, drygt hälften, angav att den terapeutiska funktionen hade en mycket stor betydelse.

    Sammantaget pekar studien på behovet av att uppmärksamma de negativa effekterna av psykoterapi, samtidigt som fortsatt forskning inom detta komplexa område är nödvändig.

  • 343.
    Hellgren, Susanne
    Mälardalen University, School of Health, Care and Social Welfare.
    Vikten av det sociala stödet vid viktminskningskirurgi2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Antalet vuxna som lever med fetma har enligt WHO fördubblats sedan 1980. Kirurgiskt ingrepp såsom gastric bypass är den metod som leder till hållbar viktminskning. Syftet med studien var att undersöka hur patienter som genomgått viktminskningskirurgi kan uppleva stödet före, under och efter operation. Studien har en narrativ fenomenologisk ansats, berättelserna har analyserats genom meningskoncentrering, strukturering och tolkning. Studien innefattar berättelser från fem informanter som valdes genom handplockat urval. Resultatet visar att de flesta informanter upplever ett fint stöd från omgivningen under processen. Missnöjet riktar sig mot sjukvården och det först efter operationen. Informanterna upplever sig som ensamma och saknar sjukvårdens förståelse. Den bristfälliga uppföljningen genererar i svårigheter för patienterna att med tiden följa de kostrekommendationer som angavs. En samtalskontakt som stöd för hållbar viktminskning och för undvikande av bristsjukdomar är att rekommendera.

  • 344.
    Hellström Muhli, Ulla
    et al.
    University of Skövde, School of Life Sciences.
    Delbene, Roxana
    The ethical dimension of presence in elderly care talk-encounter2012In: Discursive, ethical, and psychological dimensions of Presence in Health Care Communication – implications for professional education / [ed] J.C. Gonçalves, Niteroi: Editora da Universidade Federal Fluminense , 2012Chapter in book (Refereed)
  • 345.
    Hemmingsson, Helena
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Björk Olafsdottir, Linda
    University of Iceland, Iceland.
    Thora Egilson, Snaefridur
    University of Iceland, Iceland.
    Agreements and disagreements between children and their parents in health-related assessments2017In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 11, p. 1059-1072Article, review/survey (Refereed)
    Abstract [en]

    Purpose: To systematically review research concerning parent-child agreement in health-related assessments to reveal overall agreement, directions of agreement, and the factors that affect agreement in ratings. Method: The Uni-Search and five additional databases were searched. Childrens health issues were grouped into psychosocial issues including autism and ADHD, and physical and performance issues including pain. Measures used for comparison were those addressing (a) psychosocial functioning, (b) physical and performance functioning, and (c) health-related quality of life. Results: Totally, 39 studies met the inclusion criteria, comprising 44 analyses in all since four studies contained more than one analyses. Moderate child-parent agreement was demonstrated in 23 analyses and poor agreement in 20 analyses. Several analyses found more agreement on observable/external than on non-observable/internal domains. Overall, parents considered their children had more difficulties than did the children themselves, although there were indications that for children with physical performance issues, parents may underreport their childrens difficulties in emotional functioning and pain. There were no consistencies in differences between childrens and parents ratings on levels of agreement with respect to the childrens health issue, age or gender. Conclusions: Discrepancies between child and parent reports seem to reflect their different perspectives and not merely inaccuracy or bias. IMPLICATIONS FOR REHABILITATION In general, parents consider their children to have more difficulties - or more extensive difficulties than the children themselves think they have. The perspectives of the child and his or her parents should be sought whenever possible since both constitute important information concerning the childs health and well-being. Children with physical and performance issues reported more difficulties than their parents concerning the childrens emotional functioning and pain. Clinicians should prioritize obtaining childrens views on subjective aspects such as emotional issues as well as on pain.

  • 346. Henderson, Audrey J.
    et al.
    Lasselin, Julie
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden; Institute of Medical Psychology and Behavioral Immunobiology, Germany.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Olsson, Mats J.
    Powis, Simon J.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Perrett, David I.
    Skin colour changes during experimentally-induced sickness2017In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 60, p. 312-318Article in journal (Refereed)
    Abstract [en]

    Skin colour may be an important cue to detect sickness in humans but how skin colour changes with acute sickness is currently unknown. To determine possible colour changes, 22 healthy Caucasian participants were injected twice, once with lipopolysaccharide (LPS, at a dose of 2ng/kg body weight) and once with placebo (saline), in a randomised cross-over design study. Skin colour across 3 arm and 3 face locations was recorded spectrophotometrically over a period of 8h in terms of lightness (L(∗)), redness (a(∗)) and yellowness (b(∗)) in a manner that is consistent with human colour perception. In addition, carotenoid status was assessed as we predicted that a decrease it skin yellowness would reflect a drop in skin carotenoids. We found an early change in skin colouration 1-3h post LPS injection with facial skin becoming lighter and less red whilst arm skin become darker but also less red and less yellow. The LPS injection also caused a drop in plasma carotenoids from 3h onwards. However, the timing of the carotenoid changes was not consistent with the skin colour changes suggesting that other mechanisms, such as a reduction of blood perfusion, oxygenation or composition. This is the first experimental study characterising skin colour associated with acute illness, and shows that changes occur early in the development of the sickness response. Colour changes may serve as a cue to health, prompting actions from others in terms of care-giving or disease avoidance. Specific mechanisms underlying these colour changes require further investigation.

  • 347.
    Henderson, Ewa
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Patienters upplevelser av KBTbehandling i grupp vid en Hälsocentral: att hantera tankar genom att vara här och nu - om psykologisk flexibilitet2013Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Abstract

    Idag är det ca 30 % av befolkningen som upplever någon form av psykisk ohälsa, många

    söker vård via primärvården där de hänvisas till Hälsocentraler som erbjuder KBT behandling

    för psykisk ohälsa. De flesta söker för diagnoser som depression och ångesttillstånd. Eftersom

    det kan vara långa köer för individuell terapi erbjuds KBT behandling i grupp som ett

    alternativ till enskild terapi.

    Denna studie är en utvärdering av en KBT behandling i grupp inom Primärvården vid en

    Hälsocentral i norra Sverige. Sex deltagare har intervjuats efter avslutad gruppbehandling.

    Materialet i studien har genomgått en kvalitativ innehållsanalys. Teman som framkom i

    studien är psykologisk flexibilitet, perspektivtagande, smågruppsprocesser,

    beteendeförändringar och tilltro till den egna förmågan.

    Resultatet visar på att samtliga deltagare är positiva till den behandling i gruppform som de

    erbjudits. De hade dock önskat fler gruppträffar. Samtliga gav uttryck för att de via metoder

    och tekniker som mindfulness, kognitiv defusion och perspektivtagande bättre kunde hantera

    sin tillvaro. De upplevde förbättrad psykisk hälsa och beskrev förändrade beteenden som lett

    till insikter om och tilltro till den egna förmågan. Deltagarna uttryckte att de på egen hand

    ville använda sig av de nya färdigheterna och implementera dem i sina vardagliga liv. Ingen

    av deltagarna i studien upplevde sig vara i behov av någon ny eller fortsatt behandling efter

    KBT gruppens avslutning.

  • 348.
    Hengen, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Kommunikativa utmaningar och strategier vid utskrivningssamtal mellan läkare och patienter med afasi2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Utskrivningssamtalet är den sista kontakten mellan läkare och patient innan patienten åker hem ifrån avdelningen. Syftet med den föreliggande studien är att undersöka ifall det förligger kommunikativa utmaningar i ett utskrivningssamtal mellan en läkare och en patient med afasi.  Den konkreta frågeställningen för studien var hur de potentiella problem som uppkom i samtalet hanterades och vilket utrymme som skapades för patientens deltagande i samtalet samt hur samtalsdeltagarna använde sig av icke-verbal kommunikation för att uppnå förståelse. Den valda metoden för att undersöka detta var Conversation Analysis, CA.

    I studien deltog två läkare, två patienter med afasi, samt två närstående till patienterna. Patienterna som deltog hade mild till måttlig afasi, svenska som modersmål och var 50 år och 70 år gamla. Läkarna som deltog hade varit anställda på avdelningen och arbetat med patienter med afasi i 2.5 år respektive 3.5 år och hade svenska som andraspråk.

    Resultatet av analysen var en identifiering av kommunikativa handlingar som ledde till sekvenser i samtalet som deltagarna orienterade mot som problematiska. Dessa var bland annat när läkaren inte följde upp på patientens förfrågan för mer information eller patient-initierade ämnen och inte redde ut missförstånd som uppkom. I resultatet identifierades även sekvenser där samtalsdeltagarna använde sin kommunikativa kompetens för att hantera kommunikativa utmaningar, samt sekvenser där samtalsdeltagarna använde sig av icke-verbal kommunikation för att underlätta den gemensamma förståelsen. Resultatet stämde överens med tidigare forskning om hur patienter med afasi och vårdpersonal organiserar interaktion i samtal.

  • 349.
    Hengen, Johanna
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Speech language pathology, Audiology and Otorhinolaryngology. Linköping University, Faculty of Medicine and Health Sciences.
    Peterson, Malin
    Specialpedagogiskt Centre, Sweden.
    McAllister, Anita
    Karolinska Institute, Sweden; Karolinska University Hospital, Sweden.
    Patient characteristics and intervention effect as measured by Voice Handicap Index2017In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 42, no 2, p. 93-98Article in journal (Refereed)
    Abstract [en]

    Objective: To analyze patients with a confirmed voice disorder in order to identify patterns regarding age, gender, and occupation compared to the general public. To explore effects of voice therapy according to the Voice Handicap Index (VHI) score pre- and post-therapy in relation to the number of sessions, age, and gender. Design: Prospective cohort study. Materials and methods: This study was conducted as a collaborative project between Linkoping University and hospitals in the south-east health care region in Sweden. Six voice clinics participated by asking their patients voluntarily to complete the Swedish version of the VHI at the beginning and end of therapy. Results and conclusions: The two most prevalent diagnoses were dysphonia (43%) and phonasthenia (25%). Among the working population, the three most common occupational fields were education, health care, and child-care. The majority of the patients were women (74.3%), and the mean age of all patients was 55 years. A significant improvement in VHI scores was found after therapy, with an average decrease of 19 median points in total score and a substantial effect size (0.55). The number of sessions did not significantly correlate with the mean VHI score difference but had a weak correlation to the start and end scores. Increasing age correlated with a higher median VHI score both at the start and end of therapy but did not affect the average decrease between the two measurements.

  • 350.
    Henoch, Ingela
    et al.
    Göteborgs universitet.
    Lövgren, Malin
    Högskolan Dalarna.
    The influence of symptom clusters and the most distressing concerns regarding quality of life among patients with inoperable lung cancer.2014In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 18, no 3, p. 236-241Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To explore the influence of symptom clusters and the most distressing concerns on global rating of quality of life (QoL) among patients with inoperable lung cancer (LC) over a three-month period following diagnosis.

    METHODS: Data were derived from a longitudinal study dealing with the symptom experiences of 400 patients with LC at three time points: close to diagnosis and one and three months later. The symptom clusters were derived from a QoL questionnaire using factor analysis, which resulted in three clusters: the Respiratory cluster, the Pain cluster and the Mood cluster. The most distressing concerns were derived from responses to a free listing question ('What is most distressing at present') and were categorised under three dimensions: Bodily distress, Life situation with LC and Iatrogenic distress. Cross-sectional, multivariate regression analyses with QoL as a dependent variable were used to determine predictors (symptom clusters and most distressing concerns) at the three time points.

    RESULTS: All three symptom clusters predicted QoL at each time point. Close to diagnosis, none of the dimensions of most distressing concerns predicted QoL, while the dimension Bodily distress was a significant predictor of QoL after one month. The Life situation with LC dimension was a significant predictor of QoL three months after diagnosis.

    CONCLUSIONS: Symptom clusters are important to LC patients' QoL and need to be acknowledged by healthcare professionals. The present study shows the importance of patients' descriptions of key concerns, which vary from diagnosis onwards, and urges healthcare professionals to be vigilant to such changes.

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