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Lindgren, Margareta
Publications (10 of 41) Show all publications
Källman, U., Bergstrand, S., Ek, A.-C., Engström, M. & Lindgren, M. (2016). Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.. International Wound Journal, 13(6), 1168-1175
Open this publication in new window or tab >>Nursing staff induced repositionings and immobile patients' spontaneous movements in nursing care.
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2016 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 6, p. 1168-1175Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
Nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-117445 (URN)10.1111/iwj.12435 (DOI)000387664400011 ()25779932 (PubMedID)
Note

Funding agencies: Research Council Sodra Alvsborg Boras Sweden; Research Council ostergotland Linkoping Sweden; SwedBank Sjuharad foundation for research at the Sodra Alvsborg Hospital Boras Sweden; Sodra Alvsborgs Hospital Boras Sweden; King Gustaf V and Queen Victorias F

Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2017-12-04Bibliographically approved
Harle, K., Lindgren, M. & Hallböök, O. (2015). Experience of living with an enterocutaneous fistula. Journal of Clinical Nursing, 24(15-16), 2175-2183
Open this publication in new window or tab >>Experience of living with an enterocutaneous fistula
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 15-16, p. 2175-2183Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. The purpose of this study was to describe patients experiences of living with an enterocutaneous fistula. Background. An enterocutaneous fistula is a complex and serious illness that usually occurs as a complication from surgery or spontaneously as a result of an underlying disease. The illness is demanding both physically and mentally and causes substantial medical and nursing problems for the afflicted individual. Design. A descriptive design with a qualitative approach. Methods. In-depth interviews were performed with nine participants who had experiences of living with an enterocutaneous fistula. The analysis was conducted using descriptive phenomenology according to Giorgi. Results. The essence of this study was that living with an enterocutaneous fistula is about handling an illness that causes several limitations in daily life and the following five themes emerged from the data: restrictions in daily life, approaches to illness, emotions, dependence and need of support. A constant fear of leakage from the fistula appliance, being dependent on intravenous fluids and being dependent on health care professionals caused isolation and social restriction. Conclusions. The participants had many strategies for handling their illness. By being well trained, engaged and having a positive and understanding approach, health care professionals can encourage hope, motivation and self-care. This can lead to decreased dependence and help the patient to better handle their illness. Relevance to clinical practice. The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.

Place, publisher, year, edition, pages
Wiley: 12 months, 2015
Keywords
enterocutaneous fistula; experience; nursing; phenomenology; Sweden
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121136 (URN)10.1111/jocn.12857 (DOI)000359259100012 ()25959706 (PubMedID)
Available from: 2015-09-08 Created: 2015-09-08 Last updated: 2017-12-04
Bergstrand, S., Källman, U., Ek, A.-C., Engström, M. & Lindgren, M. (2015). Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses. Journal of Wound Care, 24(8), 346-358
Open this publication in new window or tab >>Microcirculatory responses of sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses
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2015 (English)In: Journal of Wound Care, ISSN 0969-0700, E-ISSN 2052-2916, Vol. 24, no 8, p. 346-358Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to explore the interaction between interface pressure and pressure-induced vasodilation and reactive hyperemia with different pressureredistribution mattresses.

Method: A cross-sectional study was performed with a convenience sample of 42 healthy individuals between 18 and 64 years of age, 38 healthy individuals 65 years or older, and 35 inpatients 65 years or older at a university hospital in Sweden. Blood flow was measured at depths of 1 mm, 2 mm, and 10 mm using a combined system of laser Doppler flowmetry and photoplethysmography. The blood flow, interface pressure and skin temperature were measured in the sacral tissue before, during, and after load while lying on one standard hospital mattress and three different pressure-redistribution mattresses.

Results: There were significant differences between the three foam mattresses with regard to average sacral pressure, peak sacral pressure, and local probe pressure with the lowest values at the visco-elastic foam/air mattress (23.5 ± 2.5 mmHg, 49.3 ± 11.1 mmHg, 29.2 ± 14.0 mmHg respectively). A greater proportion of subjects had affected blood flow in terms of lack of pressure-induced vasodilation on the visco-elastic foam/air mattress compared to the alternating pressure mattress at tissue depths of 2 mm (39.0% vs. 20.0%, respectively) and 10 mm (56.9 % vs. 35.1%, respectively). Eleven individuals, including subjects in all three subject groups were identified with no pressure-induced vasodilation or reactive hyperemia in any mattress, and this was considered a high-risk blood flow response.

Conclusion: Interface pressure magnitudes considered not harmful during pressure-exposure lying on different pressure-redistribution mattresses can affect the microcirculation in different tissue structures. Despite having the lowest pressure values compared to the other mattresses, the visco-elastic foam/air mattress had the highest proportion of subjects with decreased blood flow indicating a more affected blood flow. Three young healthy individuals were identified with the high-risk blood flow response, indicating an innate vulnerability to pressure exposure and may not benefit from pressure-redistribution mattresses. Finally it was shown that the evaluation of pressure-redistribution support surfaces in terms of mean blood flow during and after tissue exposure is not feasible but assessment of pressure-induced vasodilation and reactive hyperemia could be a new possibility to assess individualized physiological measurements of mechanisms known to be related to pressure ulcer development.

Keywords
interface pressure, pressure-induced vasodilation, pressure ulcer, reactive hyperemia, tissue blood flow
National Category
Nursing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109951 (URN)10.12968/jowc.2015.24.8.346 (DOI)000359210200004 ()
Note

Vid tiden för disputationen var publikationen ett manuskript ("Exploring pressure-induced microcirculatory responses in sacral tissue in healthy individuals and inpatients on different pressure-redistribution mattresses")

Funding text: None declared. The study was funded by the Swedish Research Council, the Faculty of Health Sciences at Linkoping University, Region of Ostergotland., King GustafV and Queen Victoria's Freemason Foundation, NovaMedTech, and the European Union Regional Development Fund.

Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2017-12-05Bibliographically approved
Källman, U., Bergstrand, S., Ek, A.-C., Engström, M. & Lindgren, M. (2015). Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents.
Open this publication in new window or tab >>Sacral pressure-induced blood flow responses at different tissue depths during one hour supine bedrest in nursing home residents
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2015 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background. Pressure induced vasodilation (PIV) protects the skin from pressure induced ischemia. PIV responses at individual level during a long-term measurement period have not previously been described in an elderly population in a clinically relevant situation.

Aim. To describe individual PIV responses in a nursing home resident population for 1-hour periods of bed rest.

Method. From May 2011 to August 2012, blood flow at three tissue depths was measured for one hour over the sacrum in 0° supine position and 30° supine tilt position in 25 individuals aged 65 years or older while lying on a pressure redistributing mattress. Measurements were made using the non-invasive optical techniques Laser Doppler Flowmetry (LDF) and photoplethysmography. The individuals were divided into a PIV group and a non-PIV group based upon the LDF data.

Results. In the PIV group, the blood flow in almost all cases increased immediately and remained over baseline for the entire 60 minutes of loading in both positions, while the blood flow decreased immediately and remained below baseline in the non-PIV group. These blood flow patterns were also seen in deeper tissue layers although a PIV response was most common in the underlying tissue in both groups.

Conclusion. The cutaneous blood flow response among the nursing home residents was distinct, appeared early and remained during the one hour of loading in both the PIV and non-PIV group. The non-PIV group may be more vulnerable to pressure and thus may be at risk for pressure ulcer development. More research is needed in order to verify the results.

Keywords
Tissue blood flow, pressure-induced vasodilation, interface pressure, skin temperature, pressure ulcer, nursing home residents
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-117446 (URN)
Available from: 2015-04-27 Created: 2015-04-27 Last updated: 2015-04-27Bibliographically approved
Källman, U., Engström, M., Bergstrand, S., Ek, A.-C., Fredrikson, M., Lindberg, L.-G. & Lindgren, M. (2015). The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents. Biological Research for Nursing, 17(2), 142-151
Open this publication in new window or tab >>The Effects of Different Lying Positions on Interface Pressure, Skin Temperature, and Tissue Blood Flow in Nursing Home Residents
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2015 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 17, no 2, p. 142-151Article in journal (Refereed) Published
Abstract [en]

Background: Although repositioning is considered an important intervention to prevent pressure ulcers, tissue response during loading in different lying positions has not been adequately explored.

Aim: To compare the effects of different lying positions on interface pressure, skin temperature, and tissue blood flow in nursing home residents.

Method: From May 2011 to August 2012, interface pressure, skin temperature, and blood flow at three tissue depths were measured for 1 hr over the sacrum in 30 supine tilt and 0 supine positions and over the trochanter major in 30lateral and 90lateral positions in 25 residents aged 65 years or older. Measurement of interface pressure was accomplished using a pneumatic pressure transmitter connected to a digital manometer, skin temperature using a temperature sensor, and blood flow using photoplethysmography and laser Doppler flowmetry.

Results: Interface pressure was significantly higher in the 0supine and 90lateral positions than in 30supine tilt and 30 lateral positions. The mean skin temperature increased from baseline in all positions. Blood flow was significantly higher in the 30 supine tilt position compared to the other positions. A hyperemic response in the post pressure period was seen at almost all tissue depths and positions.

Conclusion: The 30supine tilt position generated less interface pressure and allowed greater tissue perfusion, suggesting that this position is the most beneficial.

Place, publisher, year, edition, pages
Sage Publications, 2015
Keywords
nursing home residents, patient repositioning, pressure ulcer, interface pressure, skin temperature, tissue blood flow
National Category
Clinical Medicine Nursing
Identifiers
urn:nbn:se:liu:diva-109318 (URN)10.1177/1099800414540515 (DOI)000349332300003 ()25037449 (PubMedID)
Note

The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This research project was funded by the Research Council, Sodra Alvsborg Hospital, Boras, Sweden [VGFOUSA-318701]; the Research Council, Ostergotland, Linkoping, Sweden [LIO-197101]; the Dermatology Department Research Foundation at Sodra Alvsborg Hospital, Boras Sweden [April 01, 2010]; the SwedBank Sjuharad Foundation for Research at the Sodra Alvsborg Hospital, Boras, Sweden [October 10, 2011]; the Sodra Alvsborg Hospital, Boras, Sweden [April 01, 2011]; the King Gustaf V and Queen Victoria's Freemason Foundation [December 2011]; the NovaMedTech and European Union-European Regional Development Fund [September 29, 2011]; Faculty of Health Science Linkoping University, Linkoping, Sweden [LIO-200671].

Available from: 2014-08-12 Created: 2014-08-12 Last updated: 2017-12-05
Karlsson, M., Lindgren, M., Jarnhed-Andersson, I. & Tarpila, E. (2014). Dressing the split-thickness skin graft donor site: a randomized clinical trial. Advances in Skin & Wound Care, 27(1), 20-25
Open this publication in new window or tab >>Dressing the split-thickness skin graft donor site: a randomized clinical trial
2014 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 1, p. 20-25Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The primary objective of this study was to compareAquacel (ConvaTec, Skillman, New Jersey), Allevyn (Smith &Nephew, St Petersburg, Florida), and Mediskin I (Mo¨ lnlycke, HealthCare AB, Gothenburg, Sweden) in the treatment of split-thicknessskin graft donor sites.

DESIGN: This study was performed as a prospective randomized,3-arm, clinical study.

SETTING: A clinical study performed at a hand and plastic surgerydepartment with burn unit.

PARTICIPANTS: The study included 67 adults with a total of73 donor sites, which were on the thigh, not reharvested, andranged between 30- and 400-cm2 area.

INTERVENTIONS: Subjects were randomly assigned to treatmentwith Aquacel, Allevyn, or Mediskin I.

MAIN OUTCOME MEASURES: The donor site was assessed onpostoperative days 3, 14, and 21 for healing, infection, pain,impact on everyday life, ease of use, and cost.

MAIN RESULTS: The obtained results demonstrate significantlyfaster re-epithelialization for patients treated with Aquacel orMediskin I compared with Allevyn. Regarding infections, therewere no significant differences between the groups. Patientswearing Aquacel experienced significantly less pain changing thedressing and less impact on everyday life than the patientswearing Allevyn. Aquacel was shown to be significantly easier forthe caregiver to use than Allevyn and Mediskin I. There is asignificant difference in cost of treatment between the dressings,whereas Mediskin I is the most expensive.

CONCLUSION: The authors’ results support the use of Aquacel in thetreatment of split-thickness skin graft donor sites. Aquacel has alow cost per unit, is user friendly, gives short healing time, andminimizes patient discomfort.

 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
Keywords
split-thickness skin grafting, donor sites, wound dressing
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-103995 (URN)10.1097/01.ASW.0000437786.92529.22 (DOI)000335388100005 ()24343389 (PubMedID)
Available from: 2014-02-05 Created: 2014-02-05 Last updated: 2017-12-06Bibliographically approved
Källman, U. & Lindgren, M. (2014). Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting. Advances in Skin & Wound Care, 27(2), 70-76
Open this publication in new window or tab >>Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting
2014 (English)In: Advances in Skin & Wound Care, ISSN 1527-7941, E-ISSN 1538-8654, Vol. 27, no 2, p. 70-76Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

The aims of this study were to examine and compare the predictive validity of 4 risk assessment scales used for the prediction of pressure ulcer (PrU) development and to identify risk factors.

DESIGN:

Cross-sectional descriptive study.

SETTING:

A general hospital in Sweden.

PARTICIPANTS:

Patients (all aged ≥18 years) admitted to medical, surgical, orthopedic, oncology, and rehabilitation wards. Of 412 patients available, a total of 346 patients participated in the study.

METHOD:

Data were collected using the Swedish version of the European Pressure Ulcer Advisory Panel minimum data set as well as the Norton, Modified Norton, Braden, and Risk Assessment Pressure Sore (Ulcer) (RAPS) scales. The predictive validity was estimated by measuring sensitivity, specificity, positive predictive value, and negative predictive value. Multiple logistic regression analysis was used to determine risk factors associated with PrUs.

RESULTS:

The RAPS scale reached best balance between sensitivity and specificity at the recommended cutoff level of ≤29, followed by the Braden scale and the Norton scale at recommended cutoff levels ≤18 versus ≤16, respectively. The modified Norton scale also reached an acceptable balance between sensitivity and specificity but at the cutoff level of ≤23, which is a higher cutoff level than recommended. General physical condition, physical activity, moisture, friction, and shear emerged as significant risk factors.

CONCLUSIONS:

The results support that the recommended cutoff levels of the RAPS, Norton, and Braden scales are valid in a general hospital setting. However, the recommended cutoff level of the modified Norton scale (≤20) has to be increased when used in this care context.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-104219 (URN)10.1097/01.ASW.0000439059.72199.41 (DOI)000335387600005 ()24440864 (PubMedID)
Available from: 2014-02-11 Created: 2014-02-11 Last updated: 2017-12-06Bibliographically approved
Bergstrand, S., Källman, U., Ek, A.-C., Lindberg, L.-G., Engström, M., Sjöberg, F. & Lindgren, M. (2014). Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions. Microcirculation, 21(8), 761-771
Open this publication in new window or tab >>Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions
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2014 (English)In: Microcirculation, ISSN 1073-9688, E-ISSN 1549-8719, Vol. 21, no 8, p. 761-771Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.

METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.

RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.

CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keywords
Pressure ulcer, photoplethysmography, laser Doppler flowmetry, non-invasive, tissue blood flow
National Category
Nursing Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-109950 (URN)10.1111/micc.12160 (DOI)000344789400010 ()25100630 (PubMedID)
Available from: 2014-08-29 Created: 2014-08-29 Last updated: 2017-12-05Bibliographically approved
Hellman, E. & Lindgren, M. (2014). Radiographers' perceptions of patients care needs during a computed tomography examination. Journal of Radiology Nursing, 33(4), 206-213
Open this publication in new window or tab >>Radiographers' perceptions of patients care needs during a computed tomography examination
2014 (English)In: Journal of Radiology Nursing, ISSN 1546-0843, Vol. 33, no 4, p. 206-213Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the radiographers' perceptions of the patient care that is needed by the latter undergoing a computed tomography (CT) examination. The study was conducted using phenomenography methodology. Eight female and four male radiographers were interviewed at three radiology departments in central Sweden. The radiographers highlighted that the patients' need for information regarding the whole examination was important for them to understand the procedure. The radiographers' perception was that the time required for a CT examination needs to be adjusted so that there is sufficient time for individualized patient care, while at the same time taking into account the patient's age and illness. There was also a need for the examination to be carried out by a knowledgeable professional radiographer. In conclusion, this study shows that patients are in need of good communication, information, physical/psychological care, and individualized adapted examination time. Radiographers' knowledge and ability to understand patients' needs have a significant impact if patients are involved in their examination.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113848 (URN)10.1016/j.jradnu.2014.07.003 (DOI)
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2018-03-06Bibliographically approved
Källman, U., Bergstrand, S., Ek, A.-C., Engström, M., Lindberg, L.-G. & Lindgren, M. (2013). Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients. Journal of Advanced Nursing, 69(1), 133-144
Open this publication in new window or tab >>Different lying positions and their effects on tissue blood flow and skin temperature in older adult patients
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2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 1, p. 133-144Article in journal (Refereed) Published
Abstract [en]

Aim. To report a study to compare the effects of different lying positions on tissue blood flow and skin temperature in older adult patients. This article reports the evaluation of study design and procedures. Background. To reduce risk of pressure ulcers, repositioning of immobile patients is a standard nursing practice; however, research into how different lying positions effect tissue microcirculation is limited. Design. Descriptive comparative design. Methods. From MarchOctober 2010, 20 inpatients, aged 65 years or older, were included in the study. Tissue blood flow and skin temperature were measured over bony prominences and in gluteus muscle in four supine and two lateral positions. Results. The blood flow over the bony prominence areas was most influenced in the superficial skin and especially in the 30 degrees lateral position, where the blood flow decreased significantly in comparison with the supine positions. There were significant individual differences in blood flow responses, but no common trend was identified among the patients considered at risk for pressure ulcer development. The study procedure worked well and was feasible to perform in an inpatient population. Conclusion. The lying positions seem to influence the tissue blood flow over the bony prominences in different ways in older adult inpatients, but further study is needed to confirm the results and to make recommendations to clinical practice. The study procedure worked well, although some minor adjustments with regard to heat accumulation will be made in future studies.

Place, publisher, year, edition, pages
Blackwell Publishing, 2013
Keywords
nursing, older adults, patient repositioning, pressure ulcer, prevention, skin temperature, tissue blood flow
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87459 (URN)10.1111/j.1365-2648.2012.06000.x (DOI)000312550600013 ()
Note

Funding Agencies|Research Council South Alvsborg||South Alvsborg Hospital and Dermatology Department Research Foundation||South Alvsborg Hospital, Boras||Swed Bank Sjuharads foundation for research at the hospital of South Alvsborg, Boras, Sweden||Swedish Research Council||Faculty of Health Sciences, Linkoping, Sweden||

Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2017-12-06
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