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Nedstrand, Elizabeth
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Publications (10 of 21) Show all publications
Sydsjö, G., Lindell Pettersson, M., Bladh, M., Skoog Svanberg, A., Lampic, C. & Nedstrand, E. (2019). Evaluation of risk factors’ importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older. BMC Pregnancy and Childbirth, 19, Article ID 92.
Open this publication in new window or tab >>Evaluation of risk factors’ importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 92Article in journal (Refereed) Published
Abstract [en]

Background

Women of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergoneART while adjusting for marital status across the age groups.

Method

Women of advanced age who had given birth in Sweden during 2007–2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.

Results

Women of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate’s health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.

Conclusions

Women who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Advanced maternal age; Pregnancy; Delivery; Neonate status
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-155894 (URN)10.1186/s12884-019-2239-1 (DOI)000461291500002 ()30866838 (PubMedID)2-s2.0-85062845776 (Scopus ID)
Note

Funding Agencies|Research Council in the southeast of Sweden, FORSS

Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2019-07-01Bibliographically approved
Lindh-Åstrand, L., Spetz, A.-C., Sydsjö, G., Andersson, G., Carlbring, P. & Nedstrand, E. (2015). Internet-delivered applied relaxation for vasomotor symptoms in postmenopausal women: Lessons from a failed trial.. Maturitas, 80(4), 432-434
Open this publication in new window or tab >>Internet-delivered applied relaxation for vasomotor symptoms in postmenopausal women: Lessons from a failed trial.
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2015 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 80, no 4, p. 432-434Article in journal (Refereed) Published
Abstract [en]

Internet-delivered therapies have a short history and promising results have been shown for several health problems, particularly for psychiatric conditions. This study was a first attempt to evaluate whether Internet-delivered applied relaxation for hot flushes in postmenopausal women may be useful. Due to a high drop-out rate the study was prematurely terminated after inclusion of approximately two thirds of calculated women. The Internet-delivered applied relaxation must probably be modified for such populations and settings before it can be used further. This article will discuss the benefits and pitfalls to learn in order to meet the challenges of future studies.

Keywords
Applied relaxation; Failed trial; Hot flushes; Internet-delivered therapy; Menopause; RCT
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-116334 (URN)10.1016/j.maturitas.2015.01.010 (DOI)000353085900014 ()25700856 (PubMedID)
Available from: 2015-03-31 Created: 2015-03-25 Last updated: 2018-01-11
Lindh-Astrand, L. & Nedstrand, E. (2013). Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial. Menopause: The Journal of the North American Menopause, 20(4), 401-408
Open this publication in new window or tab >>Effects of applied relaxation on vasomotor symptoms in postmenopausal women: a randomized controlled trial
2013 (English)In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 20, no 4, p. 401-408Article in journal (Refereed) Published
Abstract [en]

Objective: This work aimed to study the efficacy of group therapy with applied relaxation on vasomotor symptoms and health-related quality of life in postmenopausal women. less thanbrgreater than less thanbrgreater thanMethods: In this open, randomized controlled trial, 60 healthy postmenopausal women with at least seven moderate to severe hot flashes per 24 hours were randomized to either group therapy with applied relaxation (n = 33) or untreated control group (n = 27) for 12 weeks. A follow-up visit was scheduled 3 months after the end of therapy or participation in the control group. Salivary cortisol was measured three times during a 6-month period. Hot flashes were recorded in self-registered diaries, and health-related quality of life was assessed with the Womens Health Questionnaire. less thanbrgreater than less thanbrgreater thanResults: The number of hot flashes decreased by 5.0 per 24 hours in the applied relaxation group compared with 1.9 in the control group on the 12th week (P andlt; 0.001) and still remained at the same level at the 3-month follow-up (P andlt; 0.001). Health-related quality of life for vasomotor symptoms, sleep, and memory improved significantly on the 12th week measurement in the applied relaxation group compared with the control group. Salivary cortisol concentration was lowered markedly in the applied relaxation group on a single measurement but was otherwise mainly stable in both groups. less thanbrgreater than less thanbrgreater thanConclusions: Applied relaxation can be used to treat vasomotor symptoms in healthy postmenopausal women.

Place, publisher, year, edition, pages
Lippincott, Williams and Wilkins, 2013
Keywords
Randomized controlled trial, Menopause, Hot flashes, Applied relaxation, Health-related quality of life, Salivary cortisol
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91934 (URN)10.1097/gme.0b013e318272ce80 (DOI)000316800700008 ()
Note

Funding Agencies|County Council of Ostergotland||Swedish Federation of Gynecology and Obstetrics||

Available from: 2013-05-06 Created: 2013-05-06 Last updated: 2017-12-06
Zaborowska, E., Brynhildsen, J., Damberg, S., Fredriksson, M., Lindh-Åstrand, L., Nedstrand, E., . . . Hammar, M. (2007). Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women – an analysis of two prospective, parallel, randomised studies. Climacteric, 10(1), 38-45
Open this publication in new window or tab >>Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women – an analysis of two prospective, parallel, randomised studies
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2007 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 10, no 1, p. 38-45Article in journal (Refereed) Published
Abstract [en]

Objective: To assess if transdermal or oral estrogens, acupuncture and applied relaxation decrease the number of menopausal hot flushes/24 h and improve climacteric symptoms, as assessed by the Kupperman index, more than transdermal placebo treatment.

Setting: An outpatient clinic at a Swedish university hospital.

Methods: A total of 102 postmenopausal women were recruited to two studies performed in parallel. In Study I, the women were randomized between transdermal placebo or estrogen treatment and, in Study II, between oral estrogens, acupuncture or applied relaxation for 12 weeks. Climacteric symptoms were measured with daily logbooks on hot flushes. Women completed the assessment questionnaire for the Kupperman index at baseline and after 12 weeks.

Results: The number of flushes/24 h decreased significantly after 4 and 12 weeks in all groups except the placebo group. Both at 4 and 12 weeks, acupuncture decreased the number of flushes more (p < 0.05; p < 0.01, respectively) than placebo. At 12 weeks, applied relaxation decreased the number of flushes more (p < 0.05) than placebo. The Kupperman index score decreased in all groups except the placebo group. The decrease in score was significantly greater in all treatment groups than in the placebo group (p < 0.01).

Conclusion: Acupuncture and applied relaxation both reduced the number of hot flushes significantly better than placebo and should be further evaluated as alternatives to hormone therapy in women with menopausal vasomotor complaints.

Place, publisher, year, edition, pages
Climacteric, 2007
Keywords
VASOMOTOR SYMPTOMS, HOT FLUSHES, ACUPUNCTURE, APPLIED RELAXATION, PLACEBO
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-11718 (URN)10.1080/13697130601165059 (DOI)
Note
Original publication: Ewa Zaborowska, Jan Brynhildsen, Sara Damberg, Mats Fredriksson, Lotta Lindh-Åstrand, Elisabeth Nedstrand, Yvonne Wyon and Mats Hammar, Effects of acupuncture, applied relaxation, estrogens and placebo on hot flushes in postmenopausal women – an analysis of two prospective, parallel, randomised studies, 2007, Climacteric, (10), 1, 38-45. http://dx.doi.org/10.1080/13697130601165059. Copyright © Taylor & Francis Group, an informa businessAvailable from: 2008-05-02 Created: 2008-05-02 Last updated: 2017-12-13
Nedstrand, E., Wyon, Y., Hammar, M. & Wijma, K. (2006). Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom. Journal of Psychosomatic Obstetrics and Gynaecology, 27(4), 193-199
Open this publication in new window or tab >>Psychological well-being improves in women with breast cancer after treatment with applied relaxation or electro-acupuncture for vasomotor symptom
2006 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 27, no 4, p. 193-199Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the effect of applied relaxation and electro-acupuncture (EA) on psychological well-being in breast cancer-treated women with vasomotor symptoms. Thirty-eight breast cancer-treated postmenopausal women with vasomotor symptoms were included in the study. They were randomized to either treatment with electro-acupuncture (EA) (N = 19, three of them with tamoxifen) or applied relaxation (AR) (n = 19, five of them with tamoxifen) over a 12-week study period with six months follow-up. Vasomotor symptoms were registered daily. A visual analog scale was used to assess climacteric symptom, estimation of general well-being was made using the Symptom Checklist, and mood using the Mood Scale. These were applied during treatment and at follow-up. In total 31 women completed 12 weeks of treatment and six months of follow-up. Hot flushes were reduced by more than 50%. Climacteric symptoms significantly decreased during treatment and remained so six months after treatment in both groups. Psychological well-being significantly improved during therapy and at follow-up visits in both groups. Mood improved significantly in the electro-acupuncture treated group. In conclusion psychological well-being improved in women with breast cancer randomized to treatment with either AR or EA for vasomotor symptoms and we therefore suggest that further studies should be performed in order to evaluate and develop these alternative therapies. © 2006 Informa UK Ltd.

Keywords
Acupuncture, Applied relaxation, Breast cancer, Menopause, Vasomotor symptoms, Well-being
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50058 (URN)10.1080/01674820600724797 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12
Nedstrand, E., Wijma, K., Wyon, Y. & Hammar, M. (2005). Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Maturitas, 51(2), 154-162
Open this publication in new window or tab >>Applied relaxation and oral estradiol treatment of vasomotor symptoms in postmenopausal women
2005 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 51, no 2, p. 154-162Article in journal (Refereed) Published
Abstract [en]

Objective: The aim was to evaluate and compare the effects of applied relaxation and oral estradiol treatment on hot flushes, mood and psychological wellbeing in postmenopausal women.

Patients and methods: In a prospective study, 30 postmenopausal women with vasomotor symptoms were randomized to applied relaxation or oral estradiol treatment during 12 weeks with 6 months follow-up. Number and severity of flushes were registered daily and Kupperman’s Index and a general estimate of climacteric symptoms, Mood Scale and Symptom Check List were completed at baseline, 4, 8 and 12 weeks of treatment, and 3 and 6 months after therapy.

Results: After 12 weeks of treatment, the number of flushes/24 h decreased significantly over time in both treatment groups. In the group receiving applied relaxation, the mean number of flushes/24 h decreased from 6.0 (95% CI 4.5–7.6) to 3.0 (95% CI 2.1–3.9) after 12 weeks of treatment. The mean number of flushes/24 h was 1.7 (95% CI 0.7–2.5) at 6 months follow-up; i.e. a 72% decrease. In the estrogen group, the mean number of flushes/24 h decreased from 8.4 to 0.8; i.e a 90% decrease in the number of flushes after 12 weeks of treatment. The significant change in flushes reached after 12 weeks of treatment and remained to 6 months after end of treatment in both groups. Estrogen therapy reduced flushes significantly faster than applied relaxation. General climacteric symptoms according to the Visual Analogue Scale and the Kupperman’s Index decreased significantly over time in both groups. General mood (Mood Scale) increased significantly in the estrogen group, but not in the group receiving applied relaxation. Psychological wellbeing according to Symptom Checklist, increased significantly from baseline to 12 weeks in both groups.

Conclusions: We suggest that applied relaxation may be used as an alternative treatment of vasomotor symptoms for postmenopausal women but should be further evaluated.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-29369 (URN)10.1016/j.maturitas.2004.05.017 (DOI)14701 (Local ID)14701 (Archive number)14701 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
Nedstrand, E. (2005). Applied relaxation as treatment of vasomotor symptoms in postmenopausal women. (Doctoral dissertation). Linköping: Linköping Universitet
Open this publication in new window or tab >>Applied relaxation as treatment of vasomotor symptoms in postmenopausal women
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Vasomotor symptoms often disturb the night sleep and may lead to tiredness and mood disturbances. Many women who suffer from vasomotor symptoms ask for medical help and are often prescribed hormonal treatment. During the last years the popularity of HRT among women and doctors has decreased, probably because of the findings of long-term risks of HRT on breast cancer and the fact that the positive effects on cardiovascular health has not been confirmed in prospective randomized studies. The most effective treatment for hot flushes is HR T but for various reasons there is a need for developing alternative treatments. Relaxation therapy and behavioral therapies have been suggested for vasomotor symptoms but there are few randomized, controlled studies in this field, especially in women with breast cancer.

The general aim of this thesis was to evaluate a technique in behavior therapy, applied relaxation, as a possible treatment of vasomotor symptoms in healthy women and women treated for breast cancer.

The specific aims were:

• to assess if stress coping differed between postmenopausal women, who wanted therapy for vasomotor symptoms and postmenopausal women without symptoms and to assess if stress coping changed when women with vasomotor symptoms received estrogen therapy. 18 women were recruited to the target group and 17 women to the comparison group

• to evaluate if training applied relaxation for 12 weeks would decrease the number ofvasomotor symptoms and to evaluate if applied relaxation for 12 weeks would affect wellbeing in postmenopausal women seeking medical advice for vasomotor symptoms. 30 postmenopausal women were recruited and randomized to applied relaxation or estrogen therapy. In this study we also aimed to compare applied relaxation and estradiol as treatment of vasomotor symptoms in healthy postmenopausal women and also to compare the effects of applied relaxation and estradiol on wellbeing in healthy postmenopausal women

• to evaluate if applied relaxation or electro-acupuncture for 12 weeks would decrease the number of vasomotor symptoms in postmenopausal women treated for breast cancer and to evaluate if applied relaxation or electro-acupuncture for 12 weeks would affect wellbeing in postmenopausal women treated for breast cancer. 38 women with breast cancer and with moderate to sever vasomotor symptoms were recruited.

The main results were: Postmenopausal women bothered by vasomotor symptoms had significant lower stress coping ability measured with SCI, than women without symptoms.

Eleven out of 12 healthy postmenopausal women randomised to treatment with applied relaxation had a mean decrease of flushes about 77% six months after end of therapy. The reduction was significant and persisted six months after end of therapy. General psychological wellbeing and mood were significantly ameliorated in healthy postmenopausal women treated with applied relaxation.

Ten out of 14 breast cancer treated women randomised to treatment with applied relaxation had a mean decrease of flushes with 78 %. General psychological wellbeing was significantly ameliorated and this phenomenon appeared after the flushes were significantly reduced. Both the significant reduction of flushes and significantly ameliorated wellbeing persisted 6 months after end of therapy.

In summary: This thesis shows that that behavioral therapy with applied relaxation significantly decreases flushes and ameliorates general psychological wellbeing in postmenopausal women bothered by climacteric symptoms. Therefore we suggest that applied relaxation is a viable alternative treatment of vasomotor symptoms in healthy postmenopausal women and in women treated for breast cancer.

Place, publisher, year, edition, pages
Linköping: Linköping Universitet, 2005. p. 88
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 900
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-30120 (URN)15595 (Local ID)91-85299-13-8 (ISBN)15595 (Archive number)15595 (OAI)
Public defence
2005-09-22, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-10-02Bibliographically approved
Wyon, Y., Nedstrand, E. & Hammar, M. (2005). Klimakteriebesvär: Mer forskning behövs om olika behandlingsformer - inklusive akupunktur.. Läkartidningen, 1664-1665
Open this publication in new window or tab >>Klimakteriebesvär: Mer forskning behövs om olika behandlingsformer - inklusive akupunktur.
2005 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, p. 1664-1665Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28865 (URN)14058 (Local ID)14058 (Archive number)14058 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Nedstrand, E., Wijma, K., Wyon, Y. & Hammar, M. (2005). Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study. Climacteric, 8(3), 243-250
Open this publication in new window or tab >>Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study
2005 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 8, no 3, p. 243-250Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effect of applied  relaxation and electro-acupuncture on vasomotor symptoms in women treated for breast cancer.

Methods: Thirty-eight postmenopausal women with  breast cancer and vasomotor symptoms were randomized to treatment with electro-acupuncture (n = 19) or applied relaxation (n = 19) during 12 weeks. The number of hot flushes was registered daily in a logbook before and during treatment and after 3 and 6 months of follow-up.

Results: Thirty-one women completed 12 weeks of treatment and 6  months of follow-up. After 12 weeks of applied relaxation, the number of flushes/24 h had decreased from 9.2 (95% confidence interval (CI) 6.6-11.9) at baseline to 4.5 (95% CI 3.2-5.8) and to 3.9 (95% CI 1.8-6.0) at 6 months follow-up (n = 14). The flushes/24 h were reduced from 8.4 (95% CI 6.6-10.2) to 4.1 (95% CI 3.0-5.2) after 12 weeks of treatment with electro-acupuncture and to 3.5 (95% CI 1.7-5.3) after 6 months follow-up (n = 17). In both groups, the mean Kupperman Index score was significantly reduced after treatment and remained unchanged 6 months after end of treatment.

Conclusion: We suggest that applied relaxation and  electro-acupuncture should be further evaluated as possible treatments for vasomotor symptoms in postmenopausal women with breast cancer.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2005
Keywords
Vasomotor symptoms; Menopause; Breast cancer; Applied relaxation; Acupuncture
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-11901 (URN)10.1080/13697130500118050 (DOI)
Note
Original publication: E. Nedstrand, K. Wijma, Y. Wyon, M. Hammar, Vasomotor symptoms decrease in women with breast cancer randomized to treatment with applied relaxation or electro-acupuncture: a preliminary study, 2005, Climacteric, (8), 3, 243-250. http://dx.doi.org/10.1080/13697130500118050. Copyright © Taylor & Francis Group, an informa businessAvailable from: 2008-05-23 Created: 2008-05-23 Last updated: 2017-12-13
Wyon, Y., Wijma, K., Nedstrand, E. & Hammar, M. (2004). A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women. Climacteric, 7(2), 153-164
Open this publication in new window or tab >>A comparison of acupuncture and oral estradiol treatment of vasomotor symptoms in postmenopausal women
2004 (English)In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 7, no 2, p. 153-164Article in journal (Refereed) Published
Abstract [en]

Objective To compare the effects of electro-acupuncture with oral estradiol and superficial needle insertion on hot flushes in postmenopausal women.

Material and methods  Forty-five postmenopausal women with vasomotor symptoms were randomized to electro-acupuncture, superficial needle insertion or oral estradiol treatment during 12 weeks, with 6 months' follow-up. The number and severity of flushes were registered daily and the Kupperman index and a general estimate of climacteric symptoms were completed before, during and after therapy.

Results In the electro-acupuncture group, the mean number of flushes/24 h decreased from 7.3 to 3.5 (ANOVA, p  < 0.001). Eleven of the 15 women had at least a 50% decrease in number of flushes (with a mean decrease of 82%). Superficial needle insertion decreased the number of flushes/24 h from 8.1 to 3.8 (p  < 0.001). In seven out of 13 women, the number of flushes decreased by at least 50% (mean decrease 83%). In the estrogen group, the number of flushes decreased from 8.4 to 0.8 (p < 0.001). The decrease in number of flushes persisted during the 24-week follow-up period in all treatment groups. The Kupperman index and the general climacteric symptom score decreased, and remained unchanged 24 weeks after treatment in all groups (p < 0.001). Electro-acupuncture decreased the number of flushes/24 h significantly over time, but not to the same extent as the estrogen treatment. No significant difference in effect was found between electro-acupuncture and the superficial needle insertion.

Conclusion We suggest that acupuncture is a viable alternative treatment of vasomotor symptoms in postmenopausal women and cannot recommend superficial needle insertion as an inactive control treatment.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22013 (URN)10.1080/13697130410001713814 (DOI)1041 (Local ID)1041 (Archive number)1041 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
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