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  • 951.
    Werkander Harstäde, Carina
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Guilt and shame in end-of-life care: the next-of-kin's perspectives2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aim: The overall aim of the thesis was to explore and describe the concepts of guilt and shame and gain a greater understanding of the next-of-kin’s experiences of guilt and shame in end-of-life care.

    Methods: Study I was a qualitative secondary analysis of 47 interviews with next-of-kin searching for experiences of guilt and shame. In study II a semantic concept analysis of the two concepts guilt and shame was performed. In studies III and IV a hermeneutic approach inspired by Gadamer was used to analyze next-of-kin’s experiences of guilt (Study III), and shame (Study IV) in end-of-life care.

    Main findings: The concept of guilt focus on behaviour and the concept of shame on the influence on the self.  The situation of being next-of-kin in end-of-life care involves a commitment to make the remaining time for the loved one as good as possible. When, for some reason, the commitment cannot be accomplished there is a risk that the next-of-kin experience guilt such as not having done enough, not having been together during important events, not having talked enough to each other, or not having done the right things. Aspects such as not having fulfilled a commitment, omission, and being the cause of can be present in these experiences. The guilt experience has a focus on what the next-of-kin has, or has not done. The experiences of shame are also linked to a perception that the remaining time for the loved one should be as good as possible. Shame can occur when the next-of-kin is involved and actually causes harm to the loved one as well as in situations that are beyond their control. Shame that the next-of-kin experience can also emanate from being put in situations by other people. Feelings of inferiority and powerlessness, second order shame, and family conflicts that are brought into the open are experiences of shame found in the studies as well as ignominy, humiliation, and disgrace. The shame experience has a focus on the next-of-kin’s self.

    Conclusion: The situation of being next-of-kin in end-of-life care is complex and demanding, something that health professionals should be aware of. Acknowledgement of experiences of guilt and shame can help the next-of-kin in their adaptation to the end-of-life situation as a whole and maybe also give useful tools to support next-of-kin during bereavement.

  • 952.
    Werkander Harstäde, Carina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Blomberg, Karin
    Örebro University.
    Benzein, Eva
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Östlund, Ulrika
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Uppsala University;Region Gävleborg.
    Dignity-conserving care actions in palliative care: an integrative review of Swedish research2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 8-23Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has proposed that persons in need of palliative care often have a loss of functions and roles that affects social and existential self-image. Moreover, these individuals also commonly suffer from complex multisymptoms. This, together with the situation of facing an impending death, can lead to a loss of dignity. Therefore, supporting these persons’ dignity is a crucial challenge for professional nurses. The ‘Dignity Care Intervention’ addresses the multidimensionality of dignity by identifying patients’ dignity-related concerns and suggests care actions to address them. At the present, the Dignity Care Intervention is adapted for implementation in Swedish care settings. Because expressions of dignity are influenced by culture, and an overview of care actions in a Swedish context is lacking, this integrative review aimed to find suggestions from Swedish research literature on what kind of care actions can preserve dignity.

    Methods: An integrative literature review was conducted using the databases SwePub and SweMed+. Articles published from 2006 to 2015 and theses published from 2000 to 2015 were searched for using the terms ‘dignity’ and ‘palliative care’. Result sections of articles and theses were reviewed for dignity-conserving care actions synthesised by thematic analysis and categorised under themes and subthemes in Chochinov’s model of dignity.

    Results: Fifteen articles and 18 theses were included together providing suggestions of care actions in all themes and subthemes in the dignity model. Suggested care actions included listening, communication, information, symptom control, facilitating daily living and including patients in decision-making. Additionally, nurses’ perceptiveness towards the patients was a core approach.

    Conclusion: The review offers culturally relevant suggestions on how to address specific dignity-related concerns. The adapted Dignity Care Intervention will be a way for Swedish nurses to provide person-centred palliative care that will conserve patients’ dignity

  • 953.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Marsh, Gary
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Buchanich, Jeanine
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Esmen, Nurtan
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Svartengren, Magnus
    Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Mortality Among Hardmetal Production Workers: The Swedish Cohort2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e263-e274Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The mortality pattern was determined in a cohort of 16,999 white and blue-collar workers in the Swedish hardmetal industry, particularly for cobalt exposure and lung cancer.

    METHODS: The mortality follow-up analysis in the Swedish Mortality register covered the period from 1952 to 2012. The exposure measures were ever/never exposed, duration of exposure, cumulative, and mean cobalt concentrations.

    RESULTS: The mortality of all causes was significantly increased, highly associated with the short-term employed workers. A negative exposure-response was found for lung cancer and duration of exposure. An exposure-response was determined for cumulative and mean cobalt exposures analyzed by quartiles, but not for exposure classes. Internal comparison analysis using proportional hazard showed no exposure-response.

    CONCLUSIONS: The cohort lung cancer mortality showed no correlation to cobalt, nickel, or tungsten exposure.

  • 954.
    Westberg, Håkan
    et al.
    Örebro University, School of Science and Technology. Department of Occupational and Environmental Medicine, Örebro University, Örebro, Sweden.
    Bryngelsson, Ing-Liss
    Department of Occupational and Environmental Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Marsh, Gary
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Kennedy, Kathleen
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Buchanich, Jeanine
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Zimmerman, Sarah
    Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh PA, United States.
    Esmen, Nurtan
    Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago IL, United States.
    Svartengren, Magnus
    Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
    Mortality Among Hardmetal Production Workers: Swedish Measurement Data and Exposure Assessment2017In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 59, no 12, p. e327-e341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Mortality pattern was determined in a cohort of 16,999 white and blue-collar workers in the Swedish hardmetal industry. Exposure assessment for cobalt is presented.

    METHODS: A historical database (1970 to 2012) of personal and area measurements of cobalt, tungsten, and nickel in the Swedish hardmetal industry was created. Log linear and exponential modeling of cobalt concentrations based on time period, job, and site was performed, and cumulative and mean exposures were calculated.

    RESULTS: Some 37% of the personal cobalt measurements exceeded 0.02 mg/m, mostly for powder production, pressing, and shaping. The log linear regression showed statistical differences (P < 0.05) between sites, time periods, and jobs. Some 1.6% of the cobalt cumulative exposures for blue-collar workers exceeded 0.4 mg/m years.

    CONCLUSION: Low levels of cumulative and mean exposures were determined.

  • 955.
    Westermark, Gunilla T.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Faendrich, Marcus
    Westermark, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Molecular and Morphological Pathology.
    AA Amyloidosis: Pathogenesis and Targeted Therapy2015In: Annual Review Of Pathology: Mechanisms Of Disease, Vol 10, ANNUAL REVIEWS, 2015, Vol. 10, p. 321-344Chapter in book (Refereed)
    Abstract [en]

    The understanding of why and how proteins misfold and aggregate into amyloid fibrils has increased considerably during recent years. Central to amyloid formation is an increase in the frequency of the beta-sheet structure, leading to hydrogen bonding between misfolded monomers and creating a fibril that is comparably resistant to degradation. Generation of amyloid fibrils is nucleation dependent, and once formed, fibrils recruit and catalyze the conversion of native molecules. In AA amyloidosis, the expression of cytokines, particularly interleukin 6, leads to overproduction of serum amyloid A (SAA) by the liver. A chronically high plasma concentration of SAA results in the aggregation of amyloid into cross-beta-sheet fibrillar deposits by mechanisms not fully understood. Therefore, AA amyloidosis can be thought of as a consequence of long-standing inflammatory disease. This review summarizes current knowledge about AA amyloidosis. The systemic amyloidoses have been regarded as intractable conditions, but improvements in the understanding of fibril composition and pathogenesis over the past decade have led to the development of a number of different therapeutic approaches with promising results.

  • 956.
    Westermark, Gunilla T.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Oskarsson, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Andersson, Arne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Westermark, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Eighty years of research on islet amyloidosis in Uppsala2015In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 120, no 2, p. 117-123Article in journal (Refereed)
  • 957.
    Wickford, Jenny
    Mälardalen University, School of Health, Care and Social Welfare.
    Considerations for enhanced community based physiotherapy services in Afghanistan.2011In: Development efforts in Afghanistan: is there a will and a way?: The case of disability and vulnerability. / [ed] Jean-Francois Trani, Paris: L'Harmattan , 2011, p. 193-214Chapter in book (Other academic)
  • 958.
    Wickford, Jenny
    Göteborgs universitet.
    Physiotherapists in Afghanistan: Exploring, encouraging & experiencing professional development in the Afghan development context2010Doctoral thesis, comprehensive summary (Other academic)
  • 959.
    Wickford, Jenny
    et al.
    Göteborgs universitet.
    Edwards, Ian
    University of South Australia.
    Rosberg, Susanne
    Göteborgs universitet.
    A transformative perspective and learning and professional development of Afghan physiotherapists.2012In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 28, no 4, p. 269-282Article in journal (Refereed)
  • 960.
    Wickford, Jenny
    et al.
    Göteborgs universitet.
    Hultberg, John
    Göteborgs universitet.
    Rosberg, Susanne
    Göteborgs universitet.
    Physiotherapy in Afghanistan – needs and challenges for development.2008In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 30, no 4, p. 305-313Article in journal (Refereed)
  • 961.
    Wickford, Jenny
    et al.
    Göteborgs universitet.
    Rosberg, Susanne
    Göteborgs universitet.
    From Idealistic Helper to Enterprising Learner:  critical reflections on personal development through experiences from Afghanistan2012In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 28, no 4, p. 283-291Article in journal (Refereed)
  • 962.
    Wiesinger, Birgitta
    et al.
    Dept. of Odontology, Clinical Oral Physiology, Umeå University.
    Häggman-Henrikson, Birgitta
    Dept. of Odontology, Clinical Oral Physiology, Umeå University.
    Hellström, Fredrik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Wänman, Anders
    Dept. of Odontology, Clinical Oral Physiology, Umeå University.
    Experimental masseter muscle pain alters jaw-neck motor strategy2013In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 17, no 7, p. 995-1004Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    A functional integration between the jaw and neck regions has been demonstrated during normal jaw function. The effect of masseter muscle pain on this integrated motor behaviour in man is unknown. The aim of this study was to investigate the effect of induced masseter muscle pain on jaw-neck movements during a continuous jaw opening-closing task.

    METHODS:

    Sixteen healthy men performed continuous jaw opening-closing movements to a target position, defined as 75% of the maximum jaw opening. Each subject performed two trials without pain (controls) and two trials with masseter muscle pain, induced with hypertonic saline as a single injection. Simultaneous movements of the mandible and the head were registered with a wireless optoelectronic three-dimensional recording system. Differences in movement amplitudes between trials were analysed with Friedman's test and corrected Wilcoxon matched pairs test.

    RESULTS:

    The head movement amplitudes were significantly larger during masseter muscle pain trials compared with control. Jaw movement amplitudes did not differ significantly between any of the trials after corrected Wilcoxon tests. The ratio between head and jaw movement amplitudes was significantly larger during the first pain trial compared with control.

    CONCLUSIONS:

    Experimental masseter muscle pain in humans affected integrated jaw-neck movements by increasing the neck component during continuous jaw opening-closing tasks. The findings indicate that pain can alter the strategy for jaw-neck motor control, which further underlines the functional integration between the jaw and neck regions. This altered strategy may have consequences for development of musculoskeletal pain in the jaw and neck regions.

  • 963.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Rissén, Dag
    Region Gävleborg.
    Högberg, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Nilsson, Annika
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala universitet.
    Psychometric testing of a short form questionnaire for measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e025103Article in journal (Refereed)
    Abstract [en]

    Aim

    The aim of present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

    Methods

    Questionnaire data was collected in three different contexts, in primary care via eight different multimodal rehabilitation teams, in specialised care via two different specialist care centres. The sample consisted of 116 participants, male (n=29) and female (n=87) with non-specific musculoskeletal disorders.

    Data was analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the Principal Component Analysis in present study, and the results attained in a previous study with a similar aim and design.

    Results

    The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had an only partly comparable result, compared to previous study.

    Conclusion

    The results of present study did not prove the suggested short form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

  • 964.
    Wilczek-Rużyczka, Ewa
    et al.
    Uniwersytet Jagielloński, Collegium Medicum, Kraków, Polska.
    Basinska, Beata A.
    Gdansk University of Technology, Faculty of Management and Economics, Poland.
    Dåderman, Anna Maria
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies.
    Jak pogodzić życie zawodowe i prywatne? – stres zawodowy i zaangażowanie a konflikt praca - dom wśród pielęgniarek [How to balance professional involvement with private life? – job-related stress and professional responsibilities in the light of the conflict between job and private life in the nursing  profession].2012In: Conference "Patient-friendly medicine", Warsaw, 19-20.05.2012: XX Jubilee Conference of Psychosomatic Medicine, Section of the Polish Medicine Association / [ed] Szewczyk, Leszek, 2012, p. 2-Conference paper (Refereed)
    Abstract [pl]

    Wprowadzenie: Większość pielęgniarek to kobiety, które tradycyjnie często godzą profesjonalne obowiązki z życiem rodzinnym. Konflikt pomiędzy sferą prywatną i zawodową ma dwustronną naturę. Negatywny wpływ pracy na życie prywatne jest odnotowywany częściej niż relacja odwrotna (Greuters et al., 2003).

    Celem pracy była ocena konfliktu praca – dom i dom – praca na percepcję stresu zawodowego i zaangażowania w pracę. Wymagania zawodowe zdefiniowano jako przeciążenie pracą i konflikty interpersonalne (Spector & Jex, 1998). Zaangażowanie charakteryzowano jako wigor i poświęcenie (Schaufeli et al., 2002).

    Metody: Zastosowano następujące metody: Skala Konfliktu Interpersonalnego i Ilościowego Przeciążenia Pracą (Spector & Jex, 1998), Utrechtska Skala Zaangażowania w Pracę – wersja skrócona (Schaueli, Bakker, & Salanova, 2006), Skale Konflikt Praca – Rodzina i Rodzina Praca (Netemeyer, Boles, & McMurrian, 1996).

    W badaniu wzięło udział 98 pielęgniarek (średnia wieku 41 lat SD = 5,9) pracujące w zawodzie przeciętnie od 19 lat (zakres1,5 – 33). Większość byłą zamężna (85%), a ich partnerzy pracowali zawodowo (82%).

    Wyniki: Konflikt praca – rodzina był silniejszy niż konflikt rodzina – praca wśród badanych pielęgniarek. Negatywne oddziaływania pracy na życie prywatne, różnicuje percepcję stresu zawodowego (przeciążenie pracą i konflikty interpersonalne) i zaangażowania w pracę (wigor i poświęcenie).  Pielęgniarki, które odczuwały większy konflikt na linii dom – praca doświadczały większego konfliktu praca dom.

  • 965.
    Willberg, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Oidipus, Freud och det utsatta barnet2011Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna uppsats är att belysa och jämföra det utsatta barnets öde såsom det speglas i myten och dramat om Oidipus och i Freuds teori om oidipuskomplexet. Myten och senare Sofokles drama handlar om ett barn som av sina föräldrar sätts ut i skogen för att dö med genomborrade hälar, men blir funnet och räddat till livet. Som vuxen kommer Oidipus långt senare att ovetandes döda sin far och gifta sig med sin mor. Freud såg häri ett mönster som han menar går igen i varje pojkes psykosexuella utveckling – ett sexuellt begär i förhållande till modern och hatiska känslor i förhållande till fadern/rivalen. Freuds uppfattning har under senare år mött mycket kritik vilken refereras i uppsatsen. Oidipuskomplexet ersatte Freuds tidigare uppfattning att neuroserna orsakades av sexuella övergrepp – den s.k. förförelseteorin – och i uppsatsen diskuteras olika skäl till varför Freud övergav förförelseteorin. Bland annat diskuteras om Freuds familjebakgrund kan ha spelat in. Vidare redovisas den ursprungliga oidipusmyten, liksom Sofokles drama och det antika grekiska sammanhanget. Ett återkommande tema är omgivningens syn på det lilla barnet under antiken, på Freuds tid och i vår nutid. Författarens slutsatser är att Freud av flera olika skäl inte kunde behålla sin tidigare förståelse av det utsatte barnet och att oidipuskomplexets universalitet måste ifrågasättas.  Freud tycks förbise den utsatthet och totala hjälplöshet som varje barn föds till, och som inte minst är så påtaglig i berättelsen om Oidipus.

     

  • 966.
    Winroth, Ann Cristin
    Umeå University, Faculty of Arts, Culture and Media.
    Vardagligt och livsviktigt berättande om hälsa och bot2004In: Perspektiv på komplementärmedicin: medicinsk pluralism i mångvetenskaplig belysning / [ed] Motzi Eklöf, Lund: Studentlitteratur, 2004, p. 133-146Chapter in book (Other academic)
  • 967.
    Winroth, AnnCristin
    Umeå University, Faculty of Arts, Culture and Media.
    Hur tänker den alternativa patienten2004In: Människan och den medicinska mångfalden: 2003 års skandinaviska forskningskonferens om alternativ och komplementär medicin, Örebro: Örebro universitet , 2004Conference paper (Other academic)
  • 968.
    Wissel, Joerg
    et al.
    Vivantes Klinikum Spandau, Germany.
    Ganapathy, Vaidyanathan
    Sunovion Pharmaceut Inc, MA USA.
    Ward, Anthony B.
    Haywood Hospital, England.
    Borg, Jorgen
    Danderyd Hospital, Sweden.
    Ertzgaard, Per
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Herrmann, Christoph
    Asklepios Kliniken Schildautal, Germany.
    Häggstrom, Anders
    Örebro University Hospital, Sweden.
    Sakel, Mohamed
    East Kent University Hospital NHS, England.
    Ma, Julia
    Allergan Plc, CA 92612 USA.
    Dimitrova, Rozalina
    Allergan Plc, CA 92612 USA.
    Fulford-Smith, Antony
    Marlow Int, England.
    Gillard, Patrick
    Allergan Plc, CA 92612 USA.
    OnabotulinumtoxinA Improves Pain in Patients With Post-Stroke Spasticity: Findings From a Randomized, Double-Blind, Placebo-Controlled Trial2016In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 52, no 1, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Context. Patients with post-stroke spasticity (PSS) commonly experience pain in affected limbs, which may impact quality of life. Objectives. To assess onabotulinumtoxinA for pain in patients with PSS from the BOTOX (R) Economic Spasticity Trial, a multicenter, randomized, double-blind, placebo-controlled trial. Methods. Patients with PSS (N = 273) were randomized to 22- to 34-week double-blind treatment with onabotulinumtoxinA + standard care (SC) or placebo injection + SC and were eligible to receive open-label onabotulinumtoxinA up to 52 weeks. Assessments included change from baseline on the 11-point pain numeric rating scale, proportion of patients with baseline pain amp;gt;= 4 achieving amp;gt;= 30% and amp;gt;= 50% improvement in pain, and pain interference with work at Week 12, end of double-blind treatment, and Week 52. Results. At baseline, most patients (74.3%) experienced pain and 47.4% had pain amp;gt;= 4 (pain subgroup). Mean pain reduction from baseline at Week 12 was significantly greater with onabotulinumtoxinA + SC (-0.77, 95% CI -1.14 to -0.40) than placebo + SC (-0.13, 95% CI -0.51 to 0.24; P amp;lt; 0.05). Higher proportions of patients in the pain subgroup achieved amp;gt;= 30% and amp;gt;= 50% reductions in pain at Week 12 with onabotulinumtoxinA + SC (53.7% and 37.0%, respectively) compared with placebo (28.8% and 18.6%, respectively; P amp;lt; 0.05). Reductions in pain were sustained through Week 52. Compared with placebo + SC, onabotulinumtoxinA consistently reduced pain interference with work. Conclusion. This is the first randomized, placebo-controlled trial demonstrating statistically significant and clinically meaningful reductions in pain and pain interference with work with onabotulinumtoxinA in patients with PSS. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine. This is an open access article under the CC BY-NC-ND license.

  • 969.
    Wurm, Matilda
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Klein Strandberg, Ester
    Örebro University, School of Law, Psychology and Social Work.
    Lorenz, Caroline
    Private person.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Buhrman, Monica
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Holländare, Fredrik
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Internet delivered transdiagnostic treatment with telephone support for pain patients with emotional comorbidity: a replicated single case study2017In: Internet Interventions, ISSN 2214-7829, Vol. 10, p. 54-64Article in journal (Refereed)
    Abstract [en]

    In pain patients, comorbid emotional problems have been linked to negative outcomes, including suboptimaltreatment gains. Developing parsimonious and accessible treatment options is therefore important. The overarchingaim of this study was to test an internet delivered therapist guided transdiagnostic treatment withtelephone support. An adapted version of the Unified Protocol for Transdiagnostic Treatments of EmotionalDisorders was used as an intervention for pain patients with residual pain problems and comorbid emotionalproblems after having received a multimodal pain rehabilitation. The study used a replicated AB single caseexperimental design (N =5; 3 females). Outcome measures were depressive and general anxiety symptoms, painintensity, pain coping problems, and diagnostic status. Feasibility measures (completion and compliance) andpatient satisfaction were also assessed. Scores on Nonoverlap of All Pairs (NAP) indicate a decrease of anxiety forthree participants and a decrease of depression for four participants. Decreases were small and did not alwaysreach statistical significance. Also, Tau-U scores could only confirm a reliable trend for one participant. Two outof four patients who were diagnosed with psychiatric disorders before treatment did no longer fulfill diagnosticcriteria posttreatment. No improvements could be seen on pain problems. The treatment was feasible and patientsatisfaction was high. Hence, while an internet delivered transdiagnostic treatment with telephone support maybe a feasible and accepted secondary intervention for pain patients with comorbid emotional problems, theeffects are unclear. The gap between high patient satisfaction and small changes in symptomatology should beexplored further.

  • 970.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Reasons for declining extended information visit on prenatal screening among pregnant women and their partners2015In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1232-1237Article in journal (Refereed)
    Abstract [en]

    Objective: A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons

    Method: Eight qualitative interviews were analysed using Interpretive Description.

    Results: In the first theme “From an individual view”, the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, “From a societal view”, the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.

    Conclusion: The findings shows that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.

  • 971.
    Yang, Jiansong
    et al.
    Academic Unit of Molecular Pharmacology & Pharmacogenetics, Division of Clinical Sciences (South), University of Sheffield.
    Kjellsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Rostami-Hodjegan, Amin
    Academic Unit of Molecular Pharmacology & Pharmacogenetics, Division of Clinical Sciences (South), University of Sheffield.
    Tucker, Geoffrey T
    Academic Unit of Molecular Pharmacology & Pharmacogenetics, Division of Clinical Sciences (South), University of Sheffield.
    The effects of dose staggering on metabolic drug-drug interactions2003In: European Journal of Pharmaceutical Sciences, ISSN 0928-0987, E-ISSN 1879-0720, Vol. 20, no 2, p. 223-232Article in journal (Refereed)
    Abstract [en]

    PURPOSE

    To investigate the effect of dose staggering on metabolic drug-drug interactions (MDDI).

    METHODS

    Using Matlab, anatomical, physiological and biochemical data relating to human pharmacokinetics were integrated to create a representative virtual healthy subject relevant to in vivo studies. The effects of dose staggering on AUC and C(max) were investigated under various scenarios with respect to pharmacokinetic characteristics of the inhibitor and substrate drugs (e.g. hepatic extraction ratio). Specific cases were also simulated where MDDI had been studied experimentally for combinations of drugs (budesonide and ketoconazole; triazolam and itraconazole).

    RESULTS

    The decrease in the magnitude of the inhibitory effect of the 'perpetrator' drug (inhibitor) on the 'victim' drug (substrate) as a result of 'dose staggering' was greater when the 'perpetrator' was given after the 'victim'. There was reasonable agreement between the predicted extent of the interactions and the observed in vivo data (mean prediction errors of 25 and -14% for AUC and C(max) values, respectively (n=7)). The impact of dose staggering was minimal during continuous dosage of inhibitors with long elimination half-lives (e.g. itraconazole, >20 h).

    CONCLUSIONS

    Clinical trial simulations using physiological information may provide useful guidelines for optimal dose staggering when poly-pharmacy is inevitable.

  • 972. Yu, Feifan
    et al.
    Gudmundsdotter, Lindvi
    Akal, Anastassja
    Gunneriusson, Elin
    Frejd, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science.
    Nygren, Per-Ake
    An affibody-adalimumab hybrid blocks combined IL-6 and TNF-triggered serum amyloid A secretion in vivo2014In: MABS, ISSN 1942-0862, Vol. 6, no 6, p. 1598-1607Article in journal (Refereed)
    Abstract [en]

    In inflammatory disease conditions, the regulation of the cytokine system is impaired, leading to tissue damages. Here, we used protein engineering to develop biologicals suitable for blocking a combination of inflammation driving cytokines by a single construct. From a set of interleukin (IL)-6-binding affibody molecules selected by phage display, five variants with a capability of blocking the interaction between complexes of soluble IL-6 receptor a (sIL-6R alpha) and IL6 and the co-receptor gp130 were identified. In cell assays designed to analyze any blocking capacity of the classical or the alternative (trans) signaling IL-6 pathways, one variant, Z(IL-6_13) with an affinity (K-D) for IL-6 of similar to 500 pM, showed the best performance. To construct fusion proteins ("AffiMabs") with dual cytokine specificities, Z(IL-6_13) was fused to either the N-or C-terminus of both the heavy and light chains of the anti-tumor necrosis factor (TNF) monoclonal antibody adalimumab (Humira (R)). One AffiMab construct with Z(IL-6_13) positioned at the N-terminus of the heavy chain, denoted Z(IL-6_13)-HCAda, was determined to be the most optimal, and it was subsequently evaluated in an acute Serum Amyloid A (SAA) model in mice. Administration of the AffiMab or adalimumab prior to challenge with a mix of IL-6 and TNF reduced the levels of serum SAA in a dose-dependent manner. Interestingly, the highest dose (70 mg/kg body weight) of adalimumab only resulted in a 50% reduction of SAA-levels, whereas the corresponding dose of the Z(IL-6_13)-HCAda AffiMab with combined IL-6/TNF specificity, resulted in SAA levels below the detection limit.

  • 973.
    Zamengo, Luca
    et al.
    AULSS 3, Italy.
    Tedeschi, Gianpaola
    AULSS 3, Italy.
    Frison, Giampietro
    AULSS 3, Italy.
    Griffoni, Carlo
    Veneto Eye Bank Fdn, Italy.
    Ponzin, Diego
    Veneto Eye Bank Fdn, Italy.
    Jones, A Wayne
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Inter-laboratory proficiency results of blood alcohol determinations at clinical and forensic laboratories in Italy2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 295, p. 213-218Article in journal (Refereed)
    Abstract [en]

    Background: Inter-laboratory proficiency schemes are widely used to control the performance of clinical and forensic toxicology laboratories. In 2016 the Laboratory of Environmental Hygiene and Forensic Toxicology - Venice (Italy) initiated an inter-laboratory proficiency test of blood-alcohol analysis. The number of participating laboratories gradually increased from 26 to 36. Furthermore, a few clinical laboratories were included if gas chromatographic (GC) methods were used for blood alcohol analysis. Procedure: Whole blood was obtained from the Blood Transfusion Centre of the Venice Hospital and a mixture of sodium fluoride and potassium oxalate was added as a preservative and anticoagulant, respectively. Aliquots of the blood were spiked with certified pure ethanol to obtain target blood-alcohol concentrations (BACs) ranging from 0 to 5.0 g/L. Two blood samples (4 mL each) were included in each shipment to the participating laboratories. The laboratories were asked to provide information about number of replicate BAC determinations they made, the types of ethanol reference standards used, and inherent measurement uncertainty. The aim of the testing was to obtain a mean consensus value for the target BAC and to assess inter-laboratory imprecision. All procedures for registration and submission of results were done on-line. A confidential report and statistical evaluations were returned to the participants one week later. Analytical methods: All participants used head-space GC (HS-GC) for the analysis of ethanol in blood. More than 85% of participants used HS-GC with flame-ionization detection, whereas the others used mass spectrometry (MS) as a detector. More than 40% of the participating laboratories kept the blood samples frozen (-20 degrees C) prior to analysis, whereas the others used refrigeration (+4 degrees C). The preliminary validation tests showed that there were no statistically significant differences between BAC in frozen or refrigerated samples for a period of 20 days. Results and conclusion: The statistical evaluation of results was done using an iterative procedure known as Algorithm A (ISO 13528:2015, C.3.1). This provides robust estimates for mean and standard deviation between laboratories and these were used as consensus values. More than 85% of participants provided satisfactory results (z-score amp;lt;1) and 94% of laboratories were within z-score amp;lt;2, based on five control samples. When a blood sample without any alcohol (blank) was sent for analysis, laboratories reported this as zero, 0.00 g/L, below limit of detection (LOD) or not detected. Some type of consensus should be reached for reporting blank samples. (C) 2018 Elsevier B.V. All rights reserved.

  • 974. Zarkada, Georgia
    et al.
    Heinolainen, Krista
    Mäkinen, Taija
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Vascular Biology.
    Kubota, Yoshiaki
    Alitalo, Kari
    VEGFR3 does not sustain retinal angiogenesis without VEGFR22015In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 112, no 3, p. 761-766Article in journal (Refereed)
    Abstract [en]

    Angiogenesis, the formation of new blood vessels, is regulated by vascular endothelial growth factors (VEGFs) and their receptors (VEGFRs). VEGFR2 is abundant in the tip cells of angiogenic sprouts, where VEGF/VEGFR2 functions upstream of the delta-like ligand 4 (DLL4)/Notch signal transduction pathway. VEGFR3 is expressed in all endothelia and is indispensable for angiogenesis during early embryonic development. In adults, VEGFR3 is expressed in angiogenic blood vessels and some fenestrated endothelia. VEGFR3 is abundant in endothelial tip cells, where it activates Notch signaling, facilitating the conversion of tip cells to stalk cells during the stabilization of vascular branches. Subsequently, Notch activation suppresses VEGFR3 expression in a negative feedback loop. Here we used conditional deletions and a Notch pathway inhibitor to investigate the cross-talk between VEGFR2, VEGFR3, and Notch in vivo. We show that postnatal angiogenesis requires VEGFR2 signaling also in the absence of Notch or VEGFR3, and that even small amounts of VEGFR2 are able to sustain angiogenesis to some extent. We found that VEGFR2 is required independently of VEGFR3 for endothelial DLL4 up-regulation and angiogenic sprouting, and for VEGFR3 functions in angiogenesis. In contrast, VEGFR2 deletion had no effect, whereas VEGFR3 was essential for postnatal lymphangiogenesis, and even for lymphatic vessel maintenance in adult skin. Knowledge of these interactions and the signaling functions of VEGFRs in blood vessels and lymphatic vessels is essential for the therapeutic manipulation of the vascular system, especially when considering multitargeted antiangiogenic treatments.

  • 975.
    Zekveld, Adriana
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Vrije Univ Amsterdam, Netherlands.
    Kramer, Sophia E.
    Section Ear & Hearing, Department of Otolaryngology-Head and Neck Surgery and Amsterdam Public Health research institute VU University Medical Center, Amsterdam, The Netherlands.
    Rönnberg, Jerker
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Rudner, Mary
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    In a Concurrent Memory and Auditory Perception Task, the Pupil Dilation Response Is More Sensitive to Memory Load Than to Auditory Stimulus Characteristics2019In: Ear and Hearing, ISSN 0196-0202, E-ISSN 1538-4667, Vol. 40, no 2, p. 272-286Article in journal (Refereed)
    Abstract [en]

    Objectives: Speech understanding may be cognitively demanding, but it can be enhanced when semantically related text cues precede auditory sentences. The present study aimed to determine whether (a) providing text cues reduces pupil dilation, a measure of cognitive load, during listening to sentences, (b) repeating the sentences aloud affects recall accuracy and pupil dilation during recall of cue words, and (c) semantic relatedness between cues and sentences affects recall accuracy and pupil dilation during recall of cue words.

    Design: Sentence repetition following text cues and recall of the text cues were tested. Twenty-six participants (mean age, 22 years) with normal hearing listened to masked sentences. On each trial, a set of four-word cues was presented visually as text preceding the auditory presentation of a sentence whose meaning was either related or unrelated to the cues. On each trial, participants first read the cue words, then listened to a sentence. Following this they spoke aloud either the cue words or the sentence, according to instruction, and finally on all trials orally recalled the cues. Peak pupil dilation was measured throughout listening and recall on each trial. Additionally, participants completed a test measuring the ability to perceive degraded verbal text information and three working memory tests (a reading span test, a size-comparison span test, and a test of memory updating).

    Results: Cue words that were semantically related to the sentence facilitated sentence repetition but did not reduce pupil dilation. Recall was poorer and there were more intrusion errors when the cue words were related to the sentences. Recall was also poorer when sentences were repeated aloud. Both behavioral effects were associated with greater pupil dilation. Larger reading span capacity and smaller size-comparison span were associated with larger peak pupil dilation during listening. Furthermore, larger reading span and greater memory updating ability were both associated with better cue recall overall.

    Conclusions: Although sentence-related word cues facilitate sentence repetition, our results indicate that they do not reduce cognitive load during listening in noise with a concurrent memory load. As expected, higher working memory capacity was associated with better recall of the cues. Unexpectedly, however, semantic relatedness with the sentence reduced word cue recall accuracy and increased intrusion errors, suggesting an effect of semantic confusion. Further, speaking the sentence aloud also reduced word cue recall accuracy, probably due to articulatory suppression. Importantly, imposing a memory load during listening to sentences resulted in the absence of formerly established strong effects of speech intelligibility on the pupil dilation response. This nullified intelligibility effect demonstrates that the pupil dilation response to a cognitive (memory) task can completely overshadow the effect of perceptual factors on the pupil dilation response. This highlights the importance of taking cognitive task load into account during auditory testing.

  • 976.
    Zineldin, Mosad
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Vasicheva, Valentina
    Linnaeus University, School of Business and Economics.
    Technological Tools for Value-Based Sustainable Relationships in Health: Emerging Research and Opportunities2018Book (Refereed)
    Abstract [en]

    The reach of technological advances can be found in many aspects of life, including the world of medical and healthcare. It is essential to understand these technologies so that those in healthcare professions can create and maintain bonds with the patients that rely on them as well as to identify the right tools for to support the improvement of patient care.

    Technological Tools for Value-Based Sustainable Relationships in Healthcare: Emerging Research and Opportunities is a critical scholarly resource that examines the effects of social and healthcare technologies on human interaction, on health, on life sciences and on well-being in a complex healthcare context. Featuring coverage on a wide range of topics such as, e-health, patient and medical relationship approaches, health information technology (HIT), cypernization of healthcare organizations and patient safety. This book is geared toward academicians, practitioners, students, and researchers seeking current research on the correlation between social and medical technologies and the cultivation of connections through those technologies especially in the healthcare field.

  • 977. Äng, Björn
    Impaired neck motor function and pronounced pain-related fear in helicopter pilots with neck pain - a clinical approach2008In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 18, no 4, p. 538-49Article in journal (Refereed)
  • 978. Äng, Björn
    et al.
    Harms-Ringdahl, K.
    Neck pain and related disability in helicopter pilots: A survey of prevalence and risk factors2006In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 77, no 7, p. 713-9Article in journal (Refereed)
  • 979. Äng, Björn
    et al.
    Kristoffersson, M.
    Neck muscle activity in fighter pilots wearing night-vision equipment during simulated flight2013In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 84, no 2, p. 125-33Article in journal (Refereed)
  • 980. Äng, Björn
    et al.
    Linder, J.
    Harms-Ringdahl, K.
    Neck strength and myoelectric fatigue in fighter and helicopter pilots with a history of neck pain2005In: Aviation, Space and Environmental Medicine, ISSN 0095-6562, E-ISSN 1943-4448, Vol. 76, no 4, p. 375-80Article in journal (Refereed)
  • 981. Äng, Björn
    et al.
    Monnier, A.
    Harms-Ringdahl, K.
    Neck/shoulder exercise for neck pain in air force helicopter pilots: a randomized controlled trial2009In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 34, no 16, p. E544-51Article in journal (Refereed)
  • 982.
    Ågren, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Elfving, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Självmedkänsla och hälsa: Psykoterapeutstudenter och legitimerade psykoterapeuter2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Självmedkänsla anses vara betydelsefull för vår fysiska och psykiska hälsa och ökar förutsättningarna för vår inre trygghet vid motgångar och svårigheter. Självmedkänsla motverkar nedstämdhet, stress och ökar förmågan till känslomässig självreglering och ger ökad kontakt med adaptiva aktiverande affekter med ökad förmåga till läkande och helande hos människan. Blivande psykoterapeuter och andra inom människovårdande yrken anses speciellt utsatta och självomsorg blir en viktig komponent. Självmedkänsla utvecklas i den trygga anknytningen och kan övas upp som vuxen, via meditation, mindfulness, affektfokuserade psykoterapier och i en trygg terapeutisk relation. Studiens syfte var att undersöka självskattad självmedkänsla och fysisk/psykisk hälsa bland psykoterapeutstudenter och göra en jämförelse med legitimerade psykoterapeuter. En enkät (Self-Compassion Scale, SF-36) som mäter självmedkänsla respektive fysisk/psykisk hälsa, distribuerades till studenterna i en klassrumssituation och till legitimerade psykoterapeuter via post. Totalt kom 33 psykoterapistudenter och 34 legitimerade psykoterapeuter att ingå i studien. Resultatet visar att psykoterapeutstudenterna, enligt självskattning, hade en signifikant bättre självmedkänsla men signifikant sämre fysisk och psykisk hälsa än de legitimerade psykoterapeuterna. Båda grupperna hade en medel nivå avseende självskattad självmedkänsla. Mindfulnessträning och meditation kan vara verktyg att stärka upp självmedkänslan och minska självkritiken.

  • 983.
    Åkerberg, Maria
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Thelander, Ann-Sofie
    Växjö University, Faculty of Humanities and Social Sciences, School of Health Sciences and Social Work.
    Anhörigas informationsbehov inom den palliativa vården.: En litteraturstudie2006Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Den palliativa vården innefattar inte bara patienten utan i många fall också de anhöriga. Syftet med studien var att undersöka anhörigas informationsbehov inom den palliativa vården. För att besvara syftet gjordes en litteraturstudie där vetenskapliga artiklar användes. Genom databas- och manuellsökning valdes elva kvalitativa och kvantitativa artiklar ut. En innehållsanalys av artiklarna gjordes utifrån en kvalitativ ansats. Resultatet visar att anhörigas informationsbehov främst består av medicinsk-, omvårdnads- och organisationsinformation. De två viktigaste fynden när det gäller upplevelser av information var att de individuella behoven måste bejakas och att källan till informationen ansågs viktig. Resultatet visar dessutom att god information minskar ovisshet och stress hos anhöriga. Genom att få sitt informationsbehov tillfredsställt skapas förutsättningar till mental förberedelse. Författarna kan utifrån studien se att god information kan kopplas samman med välbefinnande hos anhöriga i den palliativa vården.

  • 984.
    Åkerstedt, Torbjorn
    et al.
    Stockholms Universitet, Karolinska Institutet.
    Anund, Anna
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Axelsson, John
    Karolinska Institutet.
    Kecklund, Goran
    Stockholms Universitet.
    Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no 3, p. 240-252Article in journal (Refereed)
    Abstract [en]

    The main consequence of insufficient sleep is sleepiness. While measures of sleep latency, continuous encephalographical/electro-oculographical (EEG/EOG) recording and performance tests are useful indicators of sleepiness in the laboratory and clinic, they are not easily implemented in large, real-life field studies. Subjective ratings of sleepiness, which are easily applied and unobtrusive, are an alternative, but whether they measure sleepiness sensitively, reliably and validly remains uncertain. This review brings together research relevant to these issues. It is focused on the Karolinska Sleepiness Scale (KSS), which is a nine-point Likert-type scale.

    The diurnal pattern of sleepiness is U-shaped, with high KSS values in the morning and late evening, and with great stability across years. KSS values increase sensitively during acute total and repeated partial sleep deprivation and night work, including night driving. The effect sizes range between 1.5 and 3. The relation to driving performance or EEG/EOG indicators of sleepiness is highly significant, strongly curvilinear and consistent across individuals. High (>6) KSS values are associated particularly with impaired driving performance and sleep intrusions in the EEG. KSS values are also increased in many clinical conditions such as sleep apnea, depression and burnout. The context has a strong influence on KSS ratings. Thus, physical activity, social interaction and light exposure will reduce KSS values by 1–2 units. In contrast, time-on-task in a monotonous context will increase KSS values by 1–2 units. In summary, subjective ratings of sleepiness as described here is as sensitive and valid an indicator of sleepiness as objective measures, and particularly suitable for field studies.

  • 985.
    Åkerstedt, Torbjorn
    et al.
    Stockholms Universitet, Karolinska Institutet.
    Hallvig, David
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    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.
    Schwarz, Johanna
    Stockholms Universitet.
    Kecklund, Göran
    Stockholms Universitet.
    Having to stop driving at night because of dangerous sleepiness: awareness, physiology and behaviour2013In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 22, no 4, p. 380-388Article in journal (Refereed)
    Abstract [en]

    A large number of accidents are due to the driver falling asleep at the wheel, but details of this link have not been studied on a real road. The purpose of the present study was to describe the development of sleepiness indicators, leading to the drive being terminated prematurely by the onboard expert driving instructor because of imminent danger. Eighteen individuals participated during a day drive and a night drive on a motorway (both 90 min). Eight drivers terminated (N) prematurely (after 43 min) because of sleep-related imminent danger [according to the driving instructor or their own judgement (two cases)].

    The results showed very high sleepiness ratings (8.5 units on the Karolinska Sleepiness Scale) immediately before termination (<7 at a similar time interval for those 10 who completed the drive). Group N also showed significantly higher levels of sleep intrusions on the electroencephalography/electro-oculography (EEG/EOG) than those who completed the drive (group C). The sleep intrusions were increased in group N during the first 40 min of the night drive. During the day drive, sleep intrusions were increased significantly in group N. The night drive showed significant increases of all sleepiness indicators compared to the day drive, but also reduced speed and driving to the left in the lane. It was concluded that 44% of drivers during late-night driving became dangerously sleepy, and that this group showed higher perceived sleepiness and more sleep intrusions in the EEG/EOG.

  • 986.
    Åkerstedt, Torbjörn
    et al.
    Stockholms Universitet, Karolinska Institutet.
    Ingre, Michael
    Stockholms Universitet.
    Kecklund, Göran
    Stockholms Universitet, Karolinska Institutet.
    Anund, Anna
    Swedish National Road and Transport Research Institute, Traffic and road users, Human-vehicle-transport system interaction.
    Sandberg, David
    Chalmers Tekniska Högskola.
    Wahde, Mattias
    Chalmers Tekniska Högskola.
    Philip, Pierre
    CNRS .
    Kronberg, Peter
    Volvo Technology.
    Reaction of sleepiness indicators to partial sleep deprivation, time of day and time on task in a driving simulator: the DROWSI project2010In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 19, no 2, p. 298-309Article in journal (Refereed)
    Abstract [en]

    Studies of driving and sleepiness indicators have mainly focused on prior sleep reduction. The present study sought to identify sleepiness indicators responsive to several potential regulators of sleepiness: sleep loss, time of day (TOD) and time on task (TOT) during simulator driving. Thirteen subjects drove a high-fidelity moving base simulator in six 1-h sessions across a 24-h period, after normal sleep duration (8 h) and after partial sleep deprivation (PSD; 4 h).

    The results showed clear main effects of TOD (night) and TOT but not for PSD, although the latter strongly interacted with TOD. The most sensitive variable was subjective sleepiness, the standard deviation of lateral position (SDLAT) and measures of eye closure [duration, speed (slow), amplitude (low)]. Measures of electroencephalography and line crossings (LCs) showed only modest responses. For most variables individual differences vastly exceeded those of the fixed effects, except for subjective sleepiness and SDLAT.

    In a multiple regression analysis, SDLAT, amplitude/peak eye-lid closing velocity and blink duration predicted subjective sleepiness bouts with a sensitivity and specificity of about 70%, but were mutually redundant. The prediction of LCs gave considerably weaker, but similar results. In summary, SDLAT and eye closure variables could be candidates for use in sleepiness-monitoring devices. However, individual differences are considerable and there is need for research on how to identify and predict individual differences in susceptibility to sleepiness.

  • 987.
    Ålander, Ture
    et al.
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Scandurra, Isabella
    Örebro University, Örebro University School of Business.
    Experiences of Healthcare Professionals to the Introduction in Sweden of a Public eHealth Service: Patients' Online Access to their Electronic Health Records2015In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 216, p. 153-157Article in journal (Refereed)
    Abstract [en]

    Patients' increasing demands for medical information, the digitization of health records and the fast spread of Internet access form a basis of introducing new eHealth services. An international trend is to provide access for patients to health information of various kind. In Sweden, access by patients to their proper electronic health record (EHR) has been provided in a pilot county since November 2012. This eHealth service is controversial and criticism has arised from the clinical professions, mainly physicians. Two web surveys were conducted to discover whether the opinions of healthcare professionals differ; between staff that have had experience with patients accessing their own EHR and those who have no such expericence. Experienced nurses found the EHR more important for the patients and a better reform, compared to unexperienced nurses in the rest of the country. Similarly, physicians with their own experience had a more positive attitude compared to non-experienced physicians. The conclusion of this study is that healthcare professionals must be involved in the implementation of public eHealth services such as EHRs and that real experiences of the professionals should be better disseminated to their inexperienced peers.

  • 988. Åman, Malin
    et al.
    Forssblad, Magnus
    Larsén, Karin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology.
    National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries2019In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 27, no 3, p. 1000-1008Article in journal (Refereed)
    Abstract [en]

    Purpose: To examine acute injuries in licensed floorball, football, handball, and ice hockey players in all ages nationwide in Sweden, and to identify the most common and severe injuries in each body location and recommend injury prevention measures.

    Methods: Using national sport insurance data from years 2006–2015 was the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), calculated in the four team sports. The most common injury type and injured body part was identified, with a particular focus of the severe injuries. Comparison between sexes was made.

    Results: In total, there were 92,162 registered injuries in all sports together. Knee injuries were most common, and also had the highest incidence of PMI, in all ball sports and in female ice hockey players. In male ice hockey, the most common injury was a dental and face injury, and PMI injuries were mostly in the shoulder. The most severe PMI injuries were rare and most often a face/eye injury in male floorball and ice hockey, a concussion in female ice hockey, and a knee injury in female floorball, and in both sexes in football and handball.

    Conclusions: To achieve the greatest impact in reducing the adverse effects of acute sport injuries nationwide in Sweden, preventive measures should focus on knee injuries in all the investigated team sports. The severe head/face and upper limb injuries also need attention. Protective equipment, neuromuscular training programs, rules enforcements, and fair-play interventions may reduce the incidence of injuries

  • 989.
    Öberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    A multicentre study evaluating the effects of the Swedish ACE programme2017In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 56, no 11, p. 876-886Article in journal (Refereed)
    Abstract [en]

    Objective: This study investigated the effects of a modified Swedish version of an interactive group education programme, the Active Communication Education (ACE) programme, in five Swedish regions. This study also explored whether the pre- and post-programme outcomes differed with regard to region, age, gender, hearing loss (HL) or the attendance of significant others (SOs). Design: An intervention study with between- and within-group measurements was applied. Study sample: Seventy-seven individuals with hearing impairments and a mean age of 73.9 years (SD = 9.8) from five different regions in Sweden participated in this study. Results: Statistically significant short- and long-term effects on communication strategy use, activity and participation were observed. The ACE programme was most effective for older individuals, women and participants with more severe HL. Individuals who attended with an SO tended to use better communication strategies. No regional differences were observed. The qualitative results indicated that the programme increased individuals ability to cope and restored their social identities. Conclusions: The ACE programme is effective, is recommended for implementation in clinical settings and is considered an alternative or additional treatment to hearing aid rehabilitation. Additional studies that include younger individuals and a control group are recommended.

  • 990.
    Öberg, Marie
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Amulticenter study evaluating the effects of the Swedish ACE programme2017Conference paper (Other academic)
  • 991.
    Öberg, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Arlinger, Stig
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nordqvist, Peter
    3. Dept. of Speech, Music and Hearing School of Computer Science and Communication KTH - Royal Institute of.
    Swedish quality register of hearing aid rehabilitation – Results from a large data set2016In: Swedish quality register of hearing aid rehabilitation – Results from a large data set, 2016Conference paper (Refereed)
    Abstract [en]

    Abstract:

    Purpose

    The aim of the study is to present normative data of hearing aid rehabilitation for a Swedish population with regard to gender, age, return

    clients/first time user and bilateral/unilateral hearing aid use.

    Method

    Questionnaires with 19 items were sent by mail to clients 3-6 months after completed hearing aid rehabilitation. In addition to the seven IOI-HA

    items there were five items concerning satisfaction with reception, information and participation and seven items concerning functionality with the

    hearing aids.

    Results

    Approximately 60 000 hearing aid users returned the questionnaire during the period 2011-2014 (response rate 52.5%). Differences were found

    with regard to hearing aid experiences, gender and unilateral versus bilateral hearing aid fitting. Women compared to men and bilaterally fitted

    compared to unilaterally fitted, reported significantly higher scores for all seven items in IOI-HA. The largest differences in mean score were found

    for the item hearing aid use between experienced and first-time user where experienced users used the aids more. No correlation was found

    between mean IOI-HA score and average hearing threshold level.

    Conclusion

    When evaluating hearing aid rehabilitation differences between groups need to be considered.

  • 992.
    Öberg, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Elisabet, Sundewall Thorén
    Eriksholm Reserach Centre, Denmark.
    Hagejärd, Lena
    Avdelningen för logopedi, foniatri och audiologi, Lunds universitet, Lund Sverige.
    Teodorescu, Ina
    Avdelningen för logopedi, foniatri och audiologi, Lunds universitet, Lund Sverige.
    Online Individualized Active Communication Education- a Swedish pilot study2015Conference paper (Other academic)
  • 993.
    Öberg, Marie
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Ingo, Elisabet
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences.
    On-line supportsystem för audionomer och förstagångsbrukare2017Conference paper (Other academic)
  • 994.
    Öberg, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Wänström, Gunilla
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology in Linköping.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Lunner, Thomas
    Eriksholm Research Centre, Denmark.
    Behandlingsprocessens betydelse vid hörapparatanpassning2015Conference paper (Other academic)
  • 995.
    Öhlen, Joakim
    Ersta Sköndal University College, Palliative Reserch Centre, PRC.
    Do inequalities in end of life care matter?2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, no 2, p. 105-107Article in journal (Refereed)
  • 996.
    Öhlen, Joakim
    et al.
    Ersta Sköndal University College, Palliative Reserch Centre, PRC.
    Ekman, Inger
    Zingmark, Karin
    Bolmsjö, Ingrid
    Benzein, Eva
    Conceptual development of "at-homeness" despite illness and disease: a review.2014In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, p. 23677-Article in journal (Refereed)
    Abstract [en]

    Only one empirical study, the one by Zingmark, Norberg and Sandman published in 1995, explicitly focuses on at-homeness, the feeling of being metaphorically at-home, as a particular aspect of wellness. However, other studies reveal aspects of at-homeness, but if or how such aspects of at-homeness are related to each other is unclear. For this reason, the aim was to review Scandinavian nursing research related to at-homeness in the context of wellness-illness in severe and long-term conditions in order to take a step towards conceptual clarification of "at-homeness." The review included interpretive studies related to severe and long-term illness conducted in Sweden: 10 original articles and 5 doctoral theses. "At-homeness" was found to be a contextually related meaning of wellness despite illness and disease embedded in the continuum of being metaphorically at-home and metaphorically homeless. This was characterized by three interrelated aspects and four processes: being safe through expanding-limiting experiences of illness and time, being connected through reunifying-detaching ways of relating, and being centred through recognition-non-recognition of oneself in the experience and others giving-withdrawing a place for oneself. This conceptualization is to be regarded as a step in conceptual clarification. Further empirical investigation and theoretical development of "at-homeness" are needed. The conceptualization will be a step of plausible significance for the evaluation of interventions aimed at enhancing wellness for people with severe long-term illness, such as the frail elderly, and people with chronic illness or palliative care needs.

  • 997.
    Ölund, Victor
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Att komma hem: Vägen till att återanpassa sig till det civila Sverige för svenska veteraner utforskad genom tolkande fenomenologisk analys2017Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    There are many obstacles that veterans experience when readjusting, something that this study aim to explore due to lacking research within the area. The main problem the five participating veterans experience is lacking understanding from society, lacking support from their closer friends and relatives, that the swedish armed forces don’t do enough and that civilian health care lack satisfactory competence. The participants also express signs of uncertainty around their self-identity when coming home, not knowing what is expected from them. Through all this the participants show compassion and care for comrades even if they themselves have experienced substance abuse and two suicide attempts. In a nutshell the participants would like to see a more educated society in order to ease the readjustment to society and that the swedish armed forces increase their responsibility for taking care about their veterans.

  • 998.
    Öman-Olsson, Linn
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Gunnarsson, Anneli
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences.
    Sjuksköterskans stöd till en hälsosam förändring för överviktiga barn och deras familjer2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of this literature review was to describe how the nurse can support overweight children and their families and to describe what support these children and their families request from the nurse in order to make a healthy change. Furthermore the intent is to review the included articles quality regarding the data collection method.

    Method: A systematic research in the databases Cinahl and Academic Search Elite was used to find the articles. The systematic research lead to 11 articles that was included in this study.

    Result: Children suffering from overweight and their parents wish to get an increased support from the health care through in example individual programs for the entire family. The nurse can use a neutral language and the growth chart in order to make the families observe the overweight of the children. Another good method for the nurse to use is motivational interviewing. Different intervention programs have been produced to support overweight children and their parents and are a good way to highlight the living habits and to make an individual plan for the families. The data collection method is explicitly described in all of the 11 included articles.

    Conclusion: The present literature review shows that overweight children and their families want more support from nurses and healthcare. Nurses need more education to be able to pay attention to the kids and parents on the issue. By developing and strengthening the procedures and tools that have been developed, the nurse may be strengthened in their professional role in efforts to support overweight children and their parents.

  • 999.
    Östberg, Per
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Hansson, Viktoria
    Häägg, Sofia
    Adult norms and test-retest reliability for the Months Backward test: Durational and response accuracy measures2012In: Logopedics, Phoniatrics, Vocology, ISSN 1401-5439, E-ISSN 1651-2022, Vol. 37, no 1, p. 11-17Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to present adult norms and to estimate the test-retest reliability for durational and response accuracy measures on the word sequence production test, Months Backward. A total of 216 neurologically intact adults (aged 18-88) stratified by sex, age, and education took the test at maximum speed. Errors and speech duration were recorded. A retest was conducted with 40 participants after 3 weeks. Altogether 94% of the participants completed the test without error. Errors were associated with slow performance. Duration was predicted by years of education (beta = -0.39) and self-reported dyslexia (beta = 0.19). The test-retest reliability was 0.82 for duration and 0.97 for errors. A regression formula for adjustment of logarithmically transformed duration scores is provided.

  • 1000.
    Östlund, Martin
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Computer Science, Physics and Mathematics.
    Dahlbäck, Nils
    Linköping University.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    3D visualisation as a communicative aid in pharmaceutical advice-giving over distance2011In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 13, no 3, article id e50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information.

    OBJECTIVE:

    To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker.

    METHODS:

    We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies' call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features.

    RESULTS:

    In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P < .001), and efficiency (P < .001). Participants in both studies said that they would welcome this type of service as an alternative to the telephone and to face-to-face interaction when a physical meeting is not possible or not convenient. However, although AssistancePlus was considered as easy to use as the telephone, they would choose AssistancePlus over the telephone only when the complexity of the question demanded the higher level of expressiveness it offers. For simpler questions, a simpler service was preferred.

    CONCLUSIONS:

    3D visualization paired with video conferencing can be useful for advice-giving over distance, specifically for issues that require a higher level of communicative expressiveness than the telephone can offer. 3D-supported advice-giving can increase the range of issues that can be handled over distance and thus improve access to product information.

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