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  • 1.
    Albinsson-Stenholm, Erina
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Bergsen, Johannes
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Ingues, Simon
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Vilhelmsson, Nathalie
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Guldbrand, Hans
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Local Health Care Services in West Östergötland, "Primary Health Care in Motala". Linköping University, Faculty of Medicine and Health Sciences.
    Nyström, Fredrik H
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum, Norrköping.
    Subjects with high fasting insulin also have higher postprandial GLP-1 and glucagon levels than controls with lower insulin2019In: Nutrition Research, ISSN 0271-5317, E-ISSN 1879-0739, Vol. 72, p. 111-120Article in journal (Refereed)
    Abstract [en]

    Little is known about postprandial release of serum ghrelin, glucagon, and glucagon-like peptide-1 (GLP-1) in relation with differing fasting insulin levels. We hypothesized that these hormones are affected by insulin resistance, and hence, we compared different postprandial responses of GLP-1, glucagon, and ghrelin in subjects with relatively high (RHI) or relatively low (RLI) fasting insulin levels. The trial was a randomized crossover study with 4 different meal conditions. Fourteen nonobese or obese, healthy, men and 14 women were randomly assigned to the order of supervised intake of a 750 kcal drink with the same protein contents but with 20 energy-percent (E%) or 55 E% from carbohydrates, and the remaining energy from fat. Participants were also randomized to consume the drinks as 1 large beverage or as five 150-kcal portions every 30 minutes. The 28 subjects were divided into 2 equally sized groups based on fasting insulin levels. Statistics were done with general linear mixed model. Fasting insulin levels were 3-fold higher in the group with RHI compared with the RLI group (RHI: 1004 +/- 510 pg/mL, RLI: 324 +/- 123 pg/mL, P amp;lt; .0005). Serum GLP-1 was highest in the RHI group after both single meals and after 5 drinks and following high- and low-carbohydrate meals (both P amp;lt;= .002), and this was the case also for glucagon levels (both P amp;lt;= .018), whereas ghrelin levels did not differ between groups. Thus, subjects with RHI displayed both higher postprandial serum GLP-1 and glucagon than the participants with RLI, suggesting that glucagon could play a role in the advent of dysglycemia by insulin resistance. (C) 2019 Elsevier Inc. All rights reserved.

  • 2.
    Allemann, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Poli, Arianna
    Linköping University, Department of Culture and Society, Division of Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Designing and evaluating information and communication technology-based interventions? Be aware of the needs of older people2020In: article id 1474515119897398Article in journal (Refereed)
    Abstract [en]

    n/a

  • 3.
    Andersson, Asa
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Vilhelmsson, Mattias
    Reg Hosp Vaxjo, Sweden.
    Fomichov Casaballe, Victoria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Business support and Development, Regional Cancer Center.
    Lindhoff Larsson, Anna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Björnsson, Bergthor
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Sandström, Per
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Drott, Jenny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Patient involvement in surgical care-Healthcare personnel views and behaviour regarding patient involvement2020In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Background All professions in surgical care have a responsibility to include patients in their health care. By Swedish law, all care should be done in dialogue with the patient. The essential part of health care is the meeting between patient and healthcare professional. In the interaction, a decision can be made, and needs can be identified to a safer care. Previous studies on patient participation have focussed on patients perspectives in surgical care, but there is a paucity of studies about the personnels perspective of estimated patient involvement in surgical care. Aim The aim of this study was to identify and describe healthcare personnels view and behaviour regarding patient involvement in surgical care. Method A quantitative study with various professions was conducted. A validated questionnaire was used, remaining questions grouped under following areas: patient involvement, acute phase, hospital time, discharge phase and questions on employment and workplace. Results A total of 140 questionnaires were sent out to a surgical clinic in Sweden, and 102 questionnaires were answered. All professionals stated that clear information is an important part of patient involvement in surgical care. Statistically significant differences existed between the professions in the subscale information. Physicians rated their information higher than the Registered Nurses (p = 0.005) and the practical nurses did (p = 0.001). Hindrances to involving patients were lack of time and other priority tasks. Conclusions Professionals in surgical care graded information to be the most important thing for patient involvement. Participation in important decisions, including the possibility to express personal views and ask questions, is important factors for patient involvement. Barriers against patient involvement are lack of time and prioritisation of other work activities.

  • 4.
    Ax, Anna-Karin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Johansson, Birgitta
    Department of Immunology, Genetics and Pathology and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Carlsson, Maria
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nordin, Karin
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway.
    Börjeson, Sussanne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology. Linköping University, Faculty of Medicine and Health Sciences.
    Exercise: A positive feature on functioning in daily life during cancer treatment – Experiences from the Phys-Can study2020In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Nursing, Vol. 44, article id 101713Article in journal (Refereed)
    Abstract [en]

    Purpose

    Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life.

    Methods

    Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis.

    Results

    Two main themes evolved: “Striving to maintain a normal life in a new context” and “Struggling with impairments from side effects of cancer treatment”. The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities.

    Conclusions

    Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.

  • 5.
    Bergström, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sverker, Annette
    Linköping University, Department of Culture and Society, Division of Social Work. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Larsson Ranada, Åsa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Valtersson, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Thyberg, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Ostlund, Gunnel
    Malardalen Univ, Sweden.
    Björk, Mathilda
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Significant others influence on participation in everyday life - the perspectives of persons with early diagnosed rheumatoid arthritis2020In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 42, no 3, p. 385-393Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe the meaning of significant others in relation to participation in everyday life of persons with early diagnosed rheumatoid arthritis (RA). Materials and methods: Fifty-nine persons participated in this interview study. Inclusion criteria were three years experience of diagnosis and being of working age. Semi-structured interviews were conducted using critical incident technique (CIT), and the material was analysed using content analysis. Results: Four categories were revealed: (1) My early RA causes activity adaptations for us all, referring to the person and significant others modifying activities. (2) Making the significant others balance between shortfalls and participation, where the participants distinguished between needing help and feeling involved in activities. (3) Physical interactions with significant others, referring to both the problematic and manageable impact RA could have on body contact. (4) Emotions in relation to activities with others, where participants described feelings of failing others, and anxiety about future activities. Conclusions: For persons with early diagnosed RA, significant others can be both hindering and facilitating for participation in everyday life. As a clinical implication, it is valuable to identify how significant others can be involved in the rehabilitation process, to enhance participation in everyday life early in the disease process.

  • 6.
    Changa Zetterström, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences.
    Hasselblad, Theodor
    Linköping University, Department of Health, Medicine and Caring Sciences.
    Fysioterapeuters upplevelser av Basal Kroppskännedom som behandling vid posttraumatiskt stressyndrom: En kvalitativ intervjustudie2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: Posttraumatic Stress Disorder (PTSD) is a psychiatric diagnosis as a result of an exposure to an earlier traumatic experience. Basic Body Awareness Therapy (BBAT) is a physiotherapeutic treatment where the purpose is to make the patient more aware of their own body. Earlier studies have investigated the effects and experiences of the BBAT as treatment for PTSD but the physiotherapist’s perspective in the field have not yet been investigated. 

    Purpose: To investigate physiotherapist’s experiences of Basic Body Awareness Therapy as treatment for Posttraumatic Stress Disorder.

    Method: Qualitative interview study. Seven physiotherapist’s with therapeutic competence in BBAT were interviewed using semi-structured interview. Qualitative content analysis where used to analyse data. 

    Results: Three categories and ten subcategories where identified. Approaches and roles between patient and physiotherapist described experiences of the interaction between the physiotherapist and patient. The physiotherapist’s strategy and treatment described reasoning about evaluation and treatment of patients. BBAT:s function as a treatment described experiences of the patient group, BBAT:s role as treatment together with other therapies and experiences of the situation in the health-care system for PTSD today. 

    Conclusion: BBAT is described by physiotherapist’s as a respectful and adaptable method to implement in treating post-traumatic issues. There is an experienced need in using the body as a starting point in order to process and manage trauma. BBAT can be used as a complement or first-line treatment in treating patients with PTSD.

  • 7.
    Drott, Jenny
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Fomichov Casaballe, Victoria
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
    Börjeson, Sussanne
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
    Berterö, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Sense of coherence and health-related quality of life in patients with neurotoxicity after cancer chemotherapy: Assessment from a real-time mobile phone-based system2020In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 29, no 1, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Objective In the present study, we aimed to assess sense of coherence (SOC) and health-related quality of life (HRQOL) during and after adjuvant chemotherapy by mobile phone-based reporting in patients with colorectal cancer experiencing neurotoxicity. Methods In this prospective descriptive cohort study, a mobile phone-based system was used to receive a series of real-time longitudinal patient-reported assessments of SOC (13-item), HRQOL (Functional Assessment of Cancer Therapy-General (FACT-G) 27-item), and neurotoxicity (OANQ 29-item) from 43 patients with colorectal cancer after being treated with chemotherapy including oxaliplatin. Measurements were conducted during the whole treatment period (mean 5 cycles) and up to 12 months after completing chemotherapy. Results In total, 817 questionnaire responses (226 SOC, 221 FACT-G, 370 OANQ) answered during and after chemotherapy treatment were available for analysis. Even though all patients experienced neurotoxicity during the treatment period, HRQOL was stable over time. Over time, the ratings of physical wellbeing tended to increase, while the subscale of social wellbeing tended to decrease. Overall SOC, including the three components comprehensibility, manageability, and meaningfulness was stable during the entire study period. No internal data was missing due to the mobile phone-based system. Conclusions All patients had neurotoxicity during the treatment period that seemed to affect the social wellbeing component of HRQOL, but SOC seemed unaffected. Real-time patient-reported assessment using mobile phone technology could be valuable in the clinical setting to provide continuous individualised monitoring to help identify patients who need further evaluation to maintain or improve their psychosocial health.

  • 8.
    Ekstrand, Jan
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Aspetar Orthopaed and Sports Med Hosp, Qatar.
    Spreco, Armin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Windt, Johann
    Linköping University, Faculty of Medicine and Health Sciences. US Olymp Comm, CO USA; US Coalit Prevent Illness and Injury Sport, CO USA.
    Khan, Karim M.
    Linköping University, Faculty of Medicine and Health Sciences. Univ British Columbia, Canada.
    Are Elite Soccer Teams Preseason Training Sessions Associated With Fewer In-Season Injuries? A 15-Year Analysis From the Union of European Football Associations (UEFA) Elite Club Injury Study2020In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, article id 0363546519899359Article in journal (Refereed)
    Abstract [en]

    Background: Preseason training develops players physical capacities and prepares them for the demands of the competitive season. In rugby, Australian football, and American football, preseason training may protect elite players against in-season injury. However, no study has evaluated this relationship at the team level in elite soccer. Purpose/Hypothesis: The aim of this study was to investigate whether the number of preseason training sessions completed by elite soccer teams was associated with team injury rates and player availability during the competitive season. It was hypothesized that elite soccer teams who participate in more preseason training will sustain fewer injuries during the competitive season. Study Design: Descriptive epidemiology study. Methods: We used the Union of European Football Associations (UEFA) injury dataset to analyze 44 teams for up to 15 seasons (total, 244 team-seasons). Separate linear regression models examined the association between the number of team preseason training sessions and 5 in-season injury measures. Injury-related problems per team were quantified by totals of the following: (1) injury burden, (2) severe injury incidence, (3) training attendance, (4) match availability, and (5) injury incidence. Results: Teams averaged 30 preseason training sessions (range, 10-51). A greater number of preseason training sessions was associated with less injury load during the competitive season in 4 out of 5 injury-related measures. Our linear regression models revealed that for every 10 additional preseason training sessions that the team performed, the in-season injury burden was 22 layoff days lower per 1000 hours (P = .002), the severe injury incidence was 0.18 severe injuries lower per 1000 hours (P = .015), the training attendance was 1.4 percentage points greater (P = .014), and the match availability was 1.0 percentage points greater (P = .042). As model fits were relatively low (adjusted R-2 = 1.3%-3.2%), several factors that contribute to in-season injury outcomes were unaccounted for. Conclusion: Teams that performed a greater number of preseason training sessions had "healthier" in-season periods. Many other factors also contribute to in-season injury rates. Understanding the benefit of preseason training on in-season injury patterns may inform sport teams planning and preparation.

  • 9.
    Engström, Karolina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Vanky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Rehnberg, Malin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Trinks, Cecilia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Jonasson, Jon
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Green, Anna
    Orebro Univ, Sweden.
    Gunnarsson, Cecilia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical genetics.
    Novel SMAD3 p.Arg386Thr genetic variant co-segregating with thoracic aortic aneurysm and dissection2020In: Molecular Genetics & Genomic Medicine, ISSN 2324-9269, article id e1089Article in journal (Refereed)
    Abstract [en]

    Background Pathogenic variants in the SMAD3 gene affecting the TGF-beta/SMAD3 signaling pathway with aortic vessel involvement cause Loeys-Dietz syndrome 3, also known as aneurysms-osteoarthritis syndrome. Methods Description of clinical history of a family in Sweden using clinical data, DNA sequencing, bioinformatics, and pedigree analysis. Results We report a novel SMAD3 variant, initially classified as a genetic variant of uncertain clinical significance (VUS), and later found to be co-segregating with aortic dissection in the family. The index patient presented with a dissecting aneurysm of the aorta including the ascending, descending, and abdominal parts. Genotype analysis revealed a heterozygous missense SMAD3 variant: NM_005902.3(SMAD3): c.11576G amp;gt; C (p.Arg386Thr). The same variant was also identified in a 30 years old formalin-fixed paraffin-embedded block of tissue from a second cousin, who died at 26 years of age from a dissecting aneurysm of the aorta. Conclusion A "variant of uncertain significance" according to the ACMG guidelines has always a scope for reappraisal. Genetic counselling to relatives, and the offering of surveillance service is important to families with aortic aneurysm disease. The report also highlight the potential use of FFPE analysis from deceased relatives to help in the interpretation of variants.

  • 10.
    Fountoulakis, Konstantinos N.
    et al.
    Aristotle Univ Thessaloniki, Greece.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Theofilidis, Antonis T.
    Aristotle Univ Thessaloniki, Greece.
    Wiklund, Tobias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Karolinska Huddinge Univ Hosp, Sweden.
    Atmatzidis, Xenofon
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Huddinge Univ Hosp, Sweden.
    Nimatoudis, Ioannis
    Aristotle Univ Thessaloniki, Greece.
    Thys, Erik
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Wampers, Martien
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Hranov, Luchezar
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Hristova, Trayana
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Aptalidis, Daniil
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Milev, Roumen
    Queens Univ, Canada.
    Iftene, Felicia
    Queens Univ, Canada.
    Spaniel, Filip
    Natl Inst Mental Hlth, Czech Republic.
    Knytl, Pavel
    Natl Inst Mental Hlth, Czech Republic.
    Furstova, Petra
    Natl Inst Mental Hlth, Czech Republic.
    From, Tiina
    Univ Turku, Finland.
    Karlsson, Henry
    Univ Turku, Finland.
    Walta, Maija
    Univ Turku, Finland.
    Salokangas, Raimo K. R.
    Univ Turku, Finland.
    Azorin, Jean-Michel
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Bouniard, Justine
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Montant, Julie
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Juckel, Georg
    Ruhr Univ Bochum, Germany.
    Haussleiter, Ida S.
    Ruhr Univ Bochum, Germany.
    Douzenis, Athanasios
    Univ Athens, Greece.
    Michopoulos, Ioannis
    Univ Athens, Greece.
    Ferentinos, Panagiotis
    Univ Athens, Greece.
    Smyrnis, Nikolaos
    Univ Athens, Greece.
    Mantonakis, Leonidas
    Univ Athens, Greece.
    Nemes, Zsofia
    Nyiro Gyula Hosp, Hungary.
    Gonda, Xenia
    Semmelweis Univ, Hungary.
    Vajda, Dora
    Semmelweis Univ, Hungary.
    Juhasz, Anita
    Semmelweis Univ, Hungary.
    Shrivastava, Amresh
    Western Univ, Canada.
    Waddington, John
    Royal Coll Surgeons Ireland, Ireland.
    Pompili, Maurizio
    Sapienza Univ Rome, Italy.
    Comparelli, Anna
    Sapienza Univ Rome, Italy.
    Corigliano, Valentina
    Sapienza Univ Rome, Italy.
    Rancans, Elmars
    Riga Stradins Univ, Latvia.
    Navickas, Alvydas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Hilbig, Jan
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Bukelskis, Laurynas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Stevovic, Lidija Injac
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Vodopic, Sanja
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Esan, Oluyomi
    Univ Ibadan, Nigeria.
    Oladele, Oluremi
    Univ Ibadan, Nigeria.
    Osunbote, Christopher
    Univ Ibadan, Nigeria.
    Rybakowski, Janusz K.
    Poznan Univ Med Sci, Poland.
    Wojciak, Pawel
    Poznan Univ Med Sci, Poland.
    Domowicz, Klaudia
    Poznan Univ Med Sci, Poland.
    Figueira, Maria Luisa
    Santa Maria Univ Hosp, Portugal.
    Linhares, Ludgero
    Santa Maria Univ Hosp, Portugal.
    Crawford, Joana
    Santa Maria Univ Hosp, Portugal.
    Panfil, Anca-Livia
    Univ Med and Pharm Targu Mures, Romania.
    Smirnova, Daria
    Samara State Med Univ, Russia.
    Izmailova, Olga
    Samara State Med Univ, Russia.
    Lecic-Tosevski, Dusica
    Inst Mental Hlth, Serbia; Serbian Acad Arts and Sci, Serbia.
    Temmingh, Henk
    Univ Cape Town, South Africa.
    Howells, Fleur
    Univ Cape Town, South Africa.
    Bobes, Julio
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Portilla, Maria Paz
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Alvarez, Leticia
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Erzin, Gamze
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    Karadag, Hasan
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    De Sousa, Avinash
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Bendre, Anuja
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Hoschl, Cyril
    Natl Inst Mental Hlth, Czech Republic.
    Bredicean, Cristina
    Univ Med and Farm Timisoara, Romania.
    Papava, Ion
    Univ Med and Farm Timisoara, Romania.
    Vukovic, Olivera
    Univ Belgrade, Serbia.
    Pejuskovic, Bojana
    Royal Coll Surgeons Ireland, Ireland.
    Russell, Vincent
    Royal Coll Surgeons Ireland, Ireland.
    Athanasiadis, Loukas
    Aristotle Univ Thessaloniki, Greece.
    Konsta, Anastasia
    Aristotle Univ Thessaloniki, Greece.
    Stein, Dan
    Univ Cape Town, South Africa.
    Berk, Michael
    Deakin Univ, Australia; Orygen, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia.
    Dean, Olivia
    Deakin Univ, Australia.
    Tandon, Rajiv
    Univ Florida, FL 32611 USA.
    Kasper, Siegfried
    Med Univ Vienna, Austria.
    De Hert, Marc
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study2019In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 22, no 11, p. 681-697Article in journal (Refereed)
    Abstract [en]

    Introduction: A specific clinically relevant staging model for schizophrenia has not yet been developed.The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method. Methods: Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 +/- 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed. Results: Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified amp;gt;85% of patients. Discussion: This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

  • 11.
    Golding, Leigh
    et al.
    Australasian Coll Sport and Exercise Phys, Australia.
    Gillingham, Rory Giles
    Royal Prince Alfred Hosp, Australia.
    Perera, Nirmala
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Univ Oxford, England; Nottingham Univ Hosp NHS Trust, England; La Trobe Univ, Australia.
    The prevalence of depressive symptoms in high-performance athletes: a systematic review2020In: Physician and sportsmedicine, ISSN 0091-3847, E-ISSN 2326-3660Article, review/survey (Refereed)
    Abstract [en]

    Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities. Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged amp;gt;= 17 years were included. Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias. Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%. Data synthesis: Higher levels of competition, injuries, amp;gt; 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores. Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.

  • 12.
    Grundström, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Rauden, Anna
    Cty Council Gavleborg, Sweden.
    Olovsson, Matts
    Uppsala Univ, Sweden.
    Cross-cultural adaptation of the Swedish version of Endometriosis Health Profile-302020In: Journal of Obstetrics and Gynaecology, ISSN 0144-3615, E-ISSN 1364-6893Article in journal (Refereed)
    Abstract [en]

    The Endometriosis Health Profile-30 (EHP-30) is focusing on the effect of endometriosis symptoms upon health-related quality of life. The aim of this study was to pre-test and culturally adapt the Swedish version of EHP-30. Eighteen Swedish-speaking women with laparoscopically verified diagnosis of endometriosis answered the questionnaire and 17 were interviewed regarding their interpretations of the questionnaire. Demographics, distribution of answers, roof-ceiling effects and missing answers were analysed. The interviews were analysed using the qualitative approach proposed by Beaton et al. The Swedish version of EHP-30 was experienced as accessible with 100% data completeness and a roof effect (11%) in one dimension. Some women had difficulties with the instructions and one word should be replaced in order to culturally adapt the questionnaire. In conclusion, the Swedish version of EHP-30 is a useful and well-accepted questionnaire for women with endometriosis in Sweden, but a minor change of wording is recommended.Impact statement What is already known on this subject? Cross-cultural adaptation and psychometric testing are crucial when introducing translated questionnaires. Cross-cultural adaptation is a process that looks at both translational and cultural issues when a questionnaire is being prepared for use in another country than the original. EHP-30 has been translated into Swedish but has not yet been cross-culturally adapted. What do the results of this study add? The Swedish version of EHP-30 was experienced as a useful and well-accepted questionnaire for women with endometriosis, but a minor change of wording is recommended in one question to make the questionnaire convergent with the original version.

  • 13.
    Gutefeldt, Kerstin
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Hedman, Christina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Thyberg, Ingrid
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Bachrack Lindström, Margareta
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Arnqvist, Hans
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Spångeus, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
    Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration2020In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165Article in journal (Refereed)
    Abstract [en]

    Purpose: To compare health-related quality of life (HRQOL) in type 1 diabetes and non-diabetic controls and possible links to upper extremity impairments (UEIs). Prevalence of sick-leave and causes were investigated.

    Materials and methods: This Swedish population-based case-control study included type 1 diabetes patients <67 years old and with a diabetes duration ≥20 years. Participants completed a postal questionnaire including Short Form 36, and questions regarding UEIs, and sick-leave.

    Results: In total, 773 patients, aged 50 ± 10 years (diabetes duration 35 ± 10 years), and 708 non-diabetic controls, aged 54 ± 9 years, completed the study. Patients reported significantly lower HRQOL compared with controls. The difference was greatest for general health, vitality, and bodily pain. Patients with shoulder or hand but not finger impairments scored significantly lower than asymptomatic patients. The prevalence of sick leave was higher in patients vs. controls (23% vs. 9%, p < 0.001), and nearly half cited impairments from back, muscles, or joints as the main reason.

    Conclusions: Health-related quality of life is lower in type 1 diabetes than controls and in patients with shoulder and hand impairments than in asymptomatic. Musculoskeletal impairments (back/muscle/joints) have impact on work ability. Identification of UEIs is important for initiating preventative-, therapeutic-, and rehabilitative interventions.

    • Implications for rehabilitation
    • Upper extremity impairments (UEIs) that are common in type 1 diabetes, and associated with reduced health-related quality of life, should preferably be screened for on a regular basis along with other known diabetes complications.

    • Early identification of UEIs is important to improve health by initiating preventive as well as therapeutic multi-professional rehabilitative interventions.

    • Sick leave is higher in type 1 diabetes than in controls. Musculoskeletal impairments, including the back, muscles, and joints, are a common cause for sick leave warranting further studies.

  • 14.
    Hedman, Kristofer
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Stanford University, Stanford, USA.
    Moneghetti, Kegan J.
    Stanford University, Stanford, USA.
    Hsu, David
    Stanford University, Stanford, USA.
    Christle, Jeffrey W.
    Stanford University, Stanford, USA.
    Patti, Alessandro
    Stanford University, Stanford, USA; Univ Padua, Italy.
    Ashley, Euan
    Stanford University, Stanford, USA.
    Hadley, David
    Cardiac Insight Inc, WA USA.
    Haddad, Francois
    Stanford University, Stanford, USA.
    Froelicher, Victor
    Stanford University, Stanford, USA.
    Limitations of Electrocardiography for Detecting Left Ventricular Hypertrophy or Concentric Remodeling in Athletes2020In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 133, no 1, p. 123-132.e8Article in journal (Refereed)
    Abstract [en]

    Background

    Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype.

    Methods

    A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) > 102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥ 1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated.

    Results

    ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62).

    Conclusion

    The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.

  • 15.
    Hendriks, Jeroen
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Andreae, Christina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Ågren, Susanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Univ Med Ctr Utrecht, Netherlands.
    Eriksson, Helene
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Hjelm, Carina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Walfridsson, Ulla
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ski, Chantal F.
    Queens Univ Belfast, North Ireland.
    Thylén, Ingela
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Uppsala Univ, Sweden; Univ Med Ctr Utrecht, Netherlands.
    Cardiac disease and stroke: Practical implications for personalised care in cardiac-stroke patients. A state of the art review supported by the Association of Cardiovascular Nursing and Allied ProfessionsIn: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id 1474515119895734Article, review/survey (Refereed)
    Abstract [en]

    Cardiac and stroke conditions often coexist because of common risk factors. The occurrence of stroke may have significant consequences for patients with cardiac conditions and their caregivers and poses a major burden on their lives. Although both cardiac and stroke conditions are highly prevalent, primary stroke prevention in cardiac patients is crucial to avert disabling limitations or even mortality. In addition, specific interventions may be needed in the rehabilitation and follow-up of these patients. However, healthcare systems are often fragmented and are not integrated enough to provide specifically structured and individualised management for the cardiac-stroke patient. Cardiac rehabilitation or secondary prevention services are crucial from this perspective, although referral and attendance rates are often suboptimal. This state of the art review outlines the significance of primary stroke prevention in cardiac patients, highlights specific challenges that cardiac-stroke patients and their caregivers may experience, examines the availability of and need for structured, personalised care, and describes potential implications for consideration in daily practice.

  • 16.
    Hendriks, Jeroen
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Maastricht Univ, Netherlands; Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Tieleman, Robert G.
    Martini Hosp Groningen, Netherlands.
    Vrijhoef, Hubertus J. M.
    Maastricht Univ, Netherlands; Vrije Univ Brussel, Belgium; Panaxea Bv, Netherlands.
    Wijtvliet, Petra
    Maastricht Univ, Netherlands; Martini Hosp Groningen, Netherlands.
    Gallagher, Celine
    Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Prins, Martin H.
    Maastricht Univ, Netherlands.
    Sanders, Prashanthan
    Univ Adelaide, Australia; Royal Adelaide Hosp, Australia.
    Crijns, Harry J. G. M.
    Maastricht Univ, Netherlands.
    Integrated specialized atrial fibrillation clinics reduce all-cause mortality: post hoc analysis of a randomized clinical trial2019In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 21, no 12, p. 1785-1792Article in journal (Refereed)
    Abstract [en]

    Aims An integrated chronic care programme in terms of a specialized outpatient clinic for patients with atrial fibrillation (AF), has demonstrated improved clinical outcomes. The aim of this study is to assess all-cause mortality in patients in whom AF management was delivered through a specialized outpatient clinic offering an integrated chronic care programme. Methods and results Post hoc analysis of a Prospective Randomized Open Blinded Endpoint Clinical trial to assess all-cause mortality in AF patients. The study included 712 patients with newly diagnosed AF, who were referred for AF management to the outpatient service of a University hospital. In the specialized outpatient clinic (AF-Clinic), comprehensive, multidisciplinary, and patient-centred AF care was provided, i.e. nurse-driven, physician supervised AF treatment guided by software based on the latest guidelines. The control group received usual care by a cardiologist in the regular outpatient setting. After a mean follow-up of 22months, all-cause mortality amounted 3.7% (13 patients) in the AF-Clinic arm and 8.1% (29 patients) in usual care [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.23-0.85; P = 0.014]. This included cardiovascular mortality in 4 AF-Clinic patients (1.1%) and 14 patients (3.9%) in usual care (HR 0.28; 95% CI 0.09-0.85; P = 0.025). Further, 9 patients (2.5%) died in the AF-Clinic arm due to a non-cardiovascular reason and 15 patients (4.2%) in the usual care arm (HR 0.59; 95% CI 0.26-1.34; P = 0.206). Conclusion An integrated specialized AF-Clinic reduces all-cause mortality compared with usual care. These findings provide compelling evidence that an integrated approach should be widely implemented in AF management.

  • 17.
    Hindocha, Nishma
    et al.
    Zealand Univ Hosp, Denmark.
    Manhem, Filip
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Bäckryd, Emmanuel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bågesund, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences.
    Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized cross-over study2019In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 19, no 1, article id 227Article in journal (Refereed)
    Abstract [en]

    Background: Topical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa. Methods: A total of 40 patients aged 10.7-19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi(2) test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables. Results: When ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 +/- 0.06) while buccal injection produced an increased relative heart rate (1.02 +/- 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa. Conclusion: The cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.

  • 18.
    Hägglund, Ewa
    et al.
    Karolinska Inst, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Hagerman, Inger
    Karolinska Inst, Sweden.
    Lynga, Patrik
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Theory Testing of Patient Perspectives Using a Mobile Health Technology System in Heart Failure Self-care2019In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 34, no 6, p. 448-453Article in journal (Refereed)
    Abstract [en]

    Background: There is an increasing interest in mobile health (mHealth), the use of mobile devices for supporting self-care in persons with heart failure. However, an established theoretical framework to explain, predict, and understand the phenomena of mHealth to support self-care is lacking. Objective: The aim of this study was to deductively test if the situation-specific theory of heart failure self-care could be applied in the context of persons with heart failure using an mHealth system with a tablet computer connected to a weighing scale to support their self-care. We wanted to test whether the 3 phases of the self-care process (ie, self-care maintenance, symptom perception, and self-care management) could be validated in the experiences of persons with heart failure using an mHealth tool. Methods: A qualitative study design was used with semistructured interviews. Data were analyzed deductively using content analysis and coded according to a structured matrix into 1 of the 3 predefined categories: self-care maintenance, symptom perception, or self-care management Results: Seventeen persons with heart failure, with mean age of 75 years, participated. The mHealth system was found to be feasible, influencing adherence and providing support for maintaining self-care as well as influencing both physical and psychological symptom perception. In persons with heart failure, the mHealth tool experience influenced the development and use of skills and fostered independence in self-care management. An interaction with healthcare professionals was sometimes needed in combination with the mHealth tool. Conclusions: The findings confirmed that "the situation-specific theory of heart failure self-care" could be applied in this context.

  • 19.
    Israelsson, Johan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health.
    Health-related quality of life after cardiac arrest2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Cardiac arrest is a major health problem worldwide. For many of the afflicted, cardiac arrest is the natural end of life. For others, it is an unexpected event suddenly striking in the middle of life. During the last decades, major efforts in treatment have contributed to more people surviving their cardiac arrest. However, previous research has mainly focused on survival, while the knowledge about health-related quality of life in survivors is sparse. Hence, there is a need for more research in order to extend the knowledge about the living situations among survivors and their spouses. For example, factors associated with health-related quality of life are not sufficiently investigated. Knowledge about such factors is important in order to develop interventions and to be able to improve post cardiac arrest care. In addition, existing research shows incongruent results concerning differences in characteristics and survival between men and women. In order to provide equitable care between sexes, further studies are warranted.

    Aim: The overall aim of this thesis was to increase the knowledge of survival and health-related quality of life among people suffering cardiac arrest with focus on sex and other related factors. The specific aims were: to describe in-hospital cardiac arrest events with regard to sex and investigate if sex is associated with survival after controlling for known predictors and interaction effects (study I), to describe health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex (study II), to investigate factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter defibrillator in relation to sex, and to compare their health-related quality of life with a general population, (study III) and to investigate if type D personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partners’ health-related quality of life (study IV).

    Methods: The general design in all studies (I-IV) was quantitative, cross-sectional and correlational. This thesis is based on four different data collections. Data was systematically collected using national quality registries (I and II) or by sending questionnaires to survivors (III and IV) and their spouses (IV), treated at several different hospitals in Sweden. The sample size varied between 126 and 990 across the studies. The outcomes and explanatory study variables were chosen with respect to Wilson and Cleary’s conceptual model of health-related quality of life. The main outcome variables were survival after resuscitation, survival at hospital discharge, survival at 30 days post cardiac arrest (I), and health-related quality of life measured by the Hospital Anxiety and Depression Scale (II and III) and the EuroQol-5 dimensions (II-IV). In this thesis descriptive and inferential statistics were applied. The main statistics consisted of logistic and linear regression analyses, and structural equation modelling.

    Results: Male sex was associated with a better chance of survival to hospital discharge, but no associations between sex and survival after resuscitation or at 30 days were identified. More men than women received resuscitation attempts when suffering an in-hospital cardiac arrest (study I). Health-related quality of life among most cardiac arrest survivors was good (II-IV), even when compared to a general population (III). However, a significant proportion reported low health status and symptoms of anxiety and depression (II and III). Women reported worse health-related quality of life compared to men, and female sex was associated with poorer health-related quality of life in the multiple regression models (II and III). Several additional factors were identified to be associated with poorer health-related quality of life: being unemployed, having a type D personality, perceiving less control, suffering from more comorbidities and suffering from more ICD-related concerns (III). In addition, older age was associated with poorer (EQ VAS) or better (HADS Anxiety) health-related quality of life, depending of outcome measure (II). Moreover, perceived control and type D personality among the survivors were associated with health-related quality of life among their spouses, but not vice versa.

    Conclusions: Although, sex does not appear to be an important predictor for survival, the difference between men and women regarding the proportion of resuscitation attempts should be further investigated. The majority of survivors and their spouses report good health-related quality of life similar to general populations. However, a substantial proportion suffer from health problems. Since women in general report worse health-related quality of life compared to men a higher proportion of women may be in need of support. Several factors associated with worse health-related quality of life were identified and might be used during follow-up and rehabilitation. For example, identifying type D personality might be important when screening patients at risk for health problems. Perceiving more control could be targeted by health-supportive interventions, for example person-centered care. Healthcare professionals should make efforts to identify survivors at risk of poor health-related quality of life and offer individualized support when needed. Characteristics among survivors were associated with health-related quality of life in their spouses. Including spouses in follow-up care is therefore important. Wilson and Cleary’s conceptual model for health-related quality of life appears to be applicable for choosing outcomes in cardiac arrest research and might be helpful when designing interventions to improve post cardiac arrest care.

    List of papers
    1. Is there a difference in survival between men and women suffering in-hospital cardiac arrest?
    Open this publication in new window or tab >>Is there a difference in survival between men and women suffering in-hospital cardiac arrest?
    2014 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 43, no 6, p. 510-515Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To describe in-hospital cardiac arrest (CA) events with regard to sex and to investigate if sex is associated with survival. Background: Previous studies exploring differences between sexes are incongruent with regard to clinical outcomes. In order to provide equality and improve care, further investigations into these aspects are warranted. Methods: This registry study included 286 CAs. To investigate if sex was associated with survival, logistic regression analyses were performed. Results: The proportion of CA with a resuscitation attempt compared to CA without resuscitation was higher among men. There were no associations between sex and survival when controlling for previously known predictors and interaction effects. Conclusions: Sex does not appear to be a predictor for survival among patients suffering CA where resuscitation is attempted. The difference regarding proportion of resuscitation attempts requires more attention. It is important to consider possible interaction effects when studying the sex perspective.

    Place, publisher, year, edition, pages
    Elsevier, 2014
    Keywords
    Heart arrest; Hospital; Sex; Survival; Predictor
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-112817 (URN)10.1016/j.hrtlng.2014.05.012 (DOI)000344837600007 ()25005828 (PubMedID)
    Note

    Funding Agencies|county council of Kalmar

    Available from: 2015-01-08 Created: 2014-12-17 Last updated: 2020-02-17Bibliographically approved
    2. Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
    Open this publication in new window or tab >>Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender
    Show others...
    2017 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, p. 27-33Article in journal (Refereed) Published
    Abstract [en]

    Aim: To describe health status and psychological distress among in -hospital cardiac arrest (IHCA) survivors in relation to gender. Methods: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQVAS among survivors were 0.78 (ql-q3 = 0.67-0.86) and 70 (ql -q3 = 50-80) respectively. The values were significantly lower (p amp;lt; 0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self -care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p amp;lt; 0.001) and symptoms of depression (p amp;lt; 0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found. Conclusions: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed. (C) 2017 Elsevier B.V. All rights reserved.

    Place, publisher, year, edition, pages
    ELSEVIER IRELAND LTD, 2017
    Keywords
    Anxiety; Depression; Health status; Heart arrest; Hospitals; Gender
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-138921 (URN)10.1016/j.resuscitation.2017.02.006 (DOI)000402487800021 ()28216089 (PubMedID)
    Note

    Funding Agencies|Swedish Heart and Lung Association; Medical Research Council of Southeast Sweden

    Available from: 2017-06-27 Created: 2017-06-27 Last updated: 2020-02-17
    3. Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
    Open this publication in new window or tab >>Factors associated with health-related quality of life among cardiac arrest survivors treated with an implantable cardioverter-defibrillator
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    2018 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 132, p. 78-84Article in journal (Refereed) Published
    Abstract [en]

    Aim: To explore factors associated with health-related quality of life (HRQoL) among cardiac arrest (CA) survivors treated with an implantable cardioverter-defibrillator (ICD) in relation to gender, and to compare their HRQoL with a general population. Methods: This cross-sectional study included 990 adults treated with an ICD after suffering CA. All participants received a questionnaire including demographics, comorbidities and instruments to measure HRQoL (EQ-5D-3L and HADS), ICD-related concerns (ICDC), perceived control (CAS), and type D personally (DS-14). HRQoL (EQ-5D-3L) was compared to a general Swedish population, matched for age and gender. Linear regression analyses were used to explore factors associated with HRQoL. Results: The CA survivors reported better HRQoL in EQ index and less pain/discomfort compared to the general population (p amp;lt; 0.001). In contrast, they reported more problems in mobility and usual activities (p amp;lt; 0.01). Problems with anxiety and depression were reported by 15.5% and 7.4% respectively. The following factors were independently associated with all aspects of worse HRQoL: being unemployed, suffering more comorbidity, perceiving less control, and having a type D personally. Further, being female and suffering ICD-related concerns were independently associated with worse HRQoL in three of the four final regression models. Conclusions: This extensive population-based study showed that most CA survivors living with an ICD rate their HRQoL as acceptable. In addition, their HRQoL is similar to a general population. Women reported worse HRQoL compared to men. Several factors associated with HRQoL were identified, and might be used when screening patients for health problems and when developing health promoting interventions.

    Place, publisher, year, edition, pages
    ELSEVIER IRELAND LTD, 2018
    Keywords
    Health-related quality of life; Health status; Psychological distress; Cardiac arrest; Implantable cardioverter-defibrillator; Gender
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-152373 (URN)10.1016/j.resuscitation.2018.09.002 (DOI)000446854900019 ()30201535 (PubMedID)
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden; Swedish Heart and Lung Association

    Available from: 2018-11-05 Created: 2018-11-05 Last updated: 2020-02-17
    4. Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model
    Open this publication in new window or tab >>Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor-partner interdependence model
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    2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id UNSP 1474515119890466Article in journal (Refereed) Epub ahead of print
    Abstract [en]

    Background: There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each others health-related quality of life. Aims: The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partners health-related quality of life. Methods: This dyadic cross-sectional study used the actor-partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale). Results: In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses. Conclusions: Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

    Place, publisher, year, edition, pages
    SAGE PUBLICATIONS LTD, 2019
    Keywords
    Heart arrest; survivor; partner; health; quality of life; dyads
    National Category
    Public Health, Global Health, Social Medicine and Epidemiology
    Identifiers
    urn:nbn:se:liu:diva-162500 (URN)10.1177/1474515119890466 (DOI)000498130000001 ()31752502 (PubMedID)
    Note

    Funding Agencies|Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation; Medical Research Council of Southeast Sweden

    Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-02-17
  • 20.
    Kaveckyte, Vaiva
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Univ Hosp, Sweden.
    Persson, Linda
    Swedish Radiat Safety Author, Sweden.
    Malusek, Alexandr
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Benmakhlouf, Hamza
    Karolinska Univ Hosp, Sweden.
    Alm Carlsson, Gudrun
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics.
    Carlsson Tedgren, Åsa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Karolinska Univ Hosp, Sweden.
    Investigation of a synthetic diamond detector response in kilovoltage photon beams2020In: Medical physics (Lancaster), ISSN 0094-2405Article in journal (Refereed)
    Abstract [en]

    Purpose An important characteristic of radiation dosimetry detectors is their energy response which consists of absorbed-dose and intrinsic energy responses. The former can be characterized using Monte Carlo (MC) simulations, whereas the latter (i.e., detector signal per absorbed dose to detector) is extracted from experimental data. Such a characterization is especially relevant when detectors are used in nonrelative measurements at a beam quality that differs from the calibration beam quality. Having in mind the possible application of synthetic diamond detectors (microDiamond PTW 60019, Freiburg, Germany) for nonrelative dosimetry of low-energy brachytherapy (BT) beams, we determined their intrinsic and absorbed-dose energy responses in 25-250 kV beams relative to a Co-60 beam, which is usually the reference beam quality for detector calibration in radiotherapy. Material and Methods Three microDiamond detectors and, for comparison, two silicon diodes (PTW 60017) were calibrated in terms of air-kerma free in air in six x-ray beam qualities (from 25 to 250 kV) and in terms of absorbed dose to water in a Co-60 beam at the national metrology laboratory in Sweden. The PENELOPE/penEasy MC radiation transport code was used to calculate the absorbed-dose energy response of the detectors (modeled based on blueprints) relative to air and water depending on calibration conditions. The MC results were used to extract the relative intrinsic energy response of the detectors from the overall energy response. Measurements using an independent setup with a single ophthalmic BEBIG I25.S16 I-125 BT seed (effective photon energy of 28 keV) were used as a qualitative check of the extracted intrinsic energy response correction factors. Additionally, the impact of the thickness of the active volume as well as the presence of extra-cameral components on the absorbed-dose energy response of a microDiamond detector was studied using MC simulations. Results The relative intrinsic energy response of the microDiamond detectors was higher by a factor of 2 in 25 and 50 kV beams compared to the Co-60 beam. The variation in the relative intrinsic energy response of silicon diodes was within 10% over the investigated photon energy range. The use of relative intrinsic energy response correction factors improved the agreement among the absorbed dose to water values determined using microDiamond detectors and silicon diodes, as well as with the TG-43 formalism-based calculations for the I-125 seed. MC study of microDiamond detector design features provided a possible explanation for inter-detector response variation at low-energy photon beams by differences in the effective thickness of the active volume. Conclusions MicroDiamond detectors had a non-negligible variation in the relative intrinsic energy response (factor of 2) which was comparable to that in the absorbed-dose energy response relative to water at low-energy photon beams. Silicon diodes, in contrast, had an absorbed-dose energy dependence on photon energy that varied by a factor of 6, whereas the intrinsic energy dependence on beam quality was within 10%. It is important to decouple these two responses for a full characterization of detector energy response especially when the user and reference beam qualities differ significantly, and MC alone is not enough.

  • 21.
    Kypri, Kypros
    et al.
    Univ Newcastle, Australia.
    Bowe, Steven J.
    Deakin Univ, Australia.
    Karlsson, Nadine
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    McCambridge, Jim
    Univ York, England.
    Enrolment-latency in randomized behavior change trials: individual participant data meta-analysis showed association with attrition but not effect-size2020In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 118, p. 55-59Article in journal (Refereed)
    Abstract [en]

    Objectives: Nonresponse can bias prevalence estimates in population surveys. Effects of selective participation in behavior change intervention trials have been little studied. We tested hypotheses that trial participants who are hard to recruit are (1) more likely to be lost-to-follow-up and (2) less responsive to intervention. Study Design and Setting: We undertook a two-stage individual participant data meta-analysis of four alcohol intervention trials involving 9,251 university students in Australia, New Zealand, and Sweden, comparing participants who enrolled "late" (after the final invitation to participate) vs. "early" (before that). Outcomes were whether participants completed assessments at each trials primary endpoint (late/early) and number of drinks consumed per week (intervention/control) among late enrolees vs. early enrolees. Results: Late enrolees were more likely to be lost-to-follow-up than early enrolees (OR 2.3, 95% CI: 1.7, 2.9). Intervention effect estimates were smaller for late vs. early enrolees, but not significantly so (RR = 0.93; 95% CI: 0.79, 1.08). Conclusion: Greater effort to recruit trial participants was associated with higher attrition, but there was no clear evidence of bias in effect estimation. The possibility that intervention effect estimates do not generalize beyond a relatively compliant minority of trial participants may warrant further study. (C) 2019 Published by Elsevier Inc.

  • 22.
    Landén Ludvigsson, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Rehabilitation in Motala.
    Peterson, Gunnel
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Widh, Simon
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Peolsson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Exercise, headache, and factors associated with headache in chronic whiplash Analysis of a randomized clinical trial2019In: Medicine (Baltimore, Md.), ISSN 0025-7974, E-ISSN 1536-5964, Vol. 98, no 48, article id e18130Article in journal (Refereed)
    Abstract [en]

    Background: Almost 40% of individuals with chronic whiplash-associated disorders (WAD) report headache after 5 years, making it one of the most common persistent symptoms besides neck pain, but randomized treatment studies are lacking.This study aimed to evaluate the effect of 3 different exercise approaches on headache in chronic WAD grades 2 and 3, and to identify potential factors associated with such headache, and whether they differ depending on 3 different aspects of such headache (current headache, maximum headache, or headache bothersomeness). Methods: This was an analysis of a randomized clinical trial of people with chronic WAD and headache (n = 188), who were randomized to either 12 weeks of neck-specific exercise without (NSE) or with a behavioral approach (NSEB) or physical activity prescription (PPA). Data were collected at baseline and at 3, 6, and 12 months. Physical and psychosocial factors were tested for association with headache. Multivariate regression models and linear mixed models were used. Results: The NSE/NSEB groups reported reduced headache both over time and compared to PPA. Up to 51% (NSE) and 61% (NSEB) reported at least 50% reduction in their headache at 12 months. The PPA group was not improved over time. Neck pain and dizziness were associated with headache regardless of aspect of headache. The only associated psychosocial factor was anxiety, which was associated with headache bothersomeness. Other factors were mainly physical, and up to 51% of the variance was explained. Conclusion: Headache in chronic WAD, may be reduced with neck-specific exercise with or without a behavioral approach. Chronic headache was associated with neck pain and dizziness regardless of aspect tested. Other factors associated with headache in chronic WAD were mainly physical rather than psychosocial.

  • 23.
    Liljeroos, Maria
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Uppsala Univ, Sweden.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    van der Wal, Martje H. L.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Univ Groningen, Netherlands.
    Brons, Maaike
    Univ Med Ctr Utrecht, Netherlands.
    Luttik, Marie Louise
    Univ Appl Sci Groningen, Netherlands.
    van Veldhuisen, Dirk J.
    Univ Groningen, Netherlands.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors2020In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed)
    Abstract [en]

    Background: Patients self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied. Aims: (1) To describe the trajectory of patients self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour. Methods: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of amp;gt; 70 was used to define good self-care behaviour. Results: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p amp;lt; 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p amp;lt; 0.05). Conclusion: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.

  • 24.
    Müssener, Ulrika
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Löf, Marie
    Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.
    Bendtsen, Preben
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Bendtsen, Marcus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences.
    Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study2020In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 1, no 9Article in journal (Refereed)
    Abstract [en]

    Background: Unhealthy lifestyle behaviors such as insufficient physical activity, unhealthy diet, smoking, and harmful use of alcohol tend to cluster (ie, individuals may be at risk from more than one lifestyle behavior that can be established in early childhood and adolescence and track into adulthood). Previous research has underlined the potential of lifestyle interventions delivered via mobile phones. However, there is a need for deepened knowledge on how to design mobile health (mHealth) interventions taking end user views into consideration in order to optimize the overall usability of such interventions. Adolescents are early adopters of technology and frequent users of mobile phones, yet research on interventions that use mobile devices to deliver multiple lifestyle behavior changes targeting at-risk high school students is lacking.

    Objective: This protocol describes a participatory design study with the aim of developing an mHealth lifestyle behavior intervention to promote healthy lifestyles among high school students.

    Methods: Through an iterative process using participatory design, user requirements are investigated in terms of technical features and content. The procedures around the design and development of the intervention, including heuristic evaluations, focus group interviews, and usability tests, are described.

    Results: Recruitment started in May 2019. Data collection, analysis, and scientific reporting from heuristic evaluations and usability tests are expected to be completed in November 2019. Focus group interviews were being undertaken with high school students from October through December, and full results are expected to be published in Spring 2020. A planned clinical trial will commence in Summer 2020. The study was funded by a grant from the Swedish Research Council for Health, Working Life, and Welfare.

    Conclusions: The study is expected to add knowledge on how to design an mHealth intervention taking end users’ views into consideration in order to develop a novel, evidence-based, low-cost, and scalable intervention that high school students want to use in order to achieve a healthier lifestyle.

  • 25.
    Nelzen, P. Oskar E.
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Not Found:Linkoping Univ, Dept Thorac and Vasc Surg Ostergotland, SE-58185 Li.
    Skoog, Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Öster, Malin
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Zachrisson, Helene
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping.
    Impact on venous haemodynamics after treatment of great saphenous vein incompetence using plethysmography and duplex ultrasound2020In: Phlebology, ISSN 0268-3555, E-ISSN 1758-1125, article id 0268355519898952Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate postoperative venous haemodynamics and quality of life after treatment of great saphenous vein (GSV) incompetence. Methods Radiofrequency ablation and high ligation and stripping were performed in 62 patients (65 limbs) and 58 (65 limbs), respectively. Phlebectomies were performed in both modalities. Strain-gauge plethysmography on the foot combined with superficial venous occlusion was used to measure refilling time after knee bends. Strain-gauge plethysmography, duplex ultrasound and quality of life were assessed before and one month after treatment. Results Duplex ultrasound displayed successful intervention in all but two limbs. Refilling time increased similar in radiofrequency ablation and high ligation and stripping after treatment (p amp;lt; 0.001). Postoperatively, strain-gauge plethysmography detected remaining reflux in 71% of the patients. Multivariate analysis showed that two or more incompetent calf branches were associated with remaining reflux (OR 4.82 (95% CI: 1.33-17.5), p = 0.02). No difference in quality of life was seen in patients with remaining reflux. Conclusions Despite successful treatment, a majority of the limbs showed remaining reflux, in which incompetent calf branches appear to play an important role. Clinicaltials.gov: Lower Limb Venous Insufficiency and the Effect of Radiofrequency Treatment Versus Open Surgery. Nr: NCT02397226

  • 26.
    Samuelsson, John
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Samuelsson, Ulf
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping.
    Hanberger, Lena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, H.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus Linköping/Motala.
    Bladh, Marie
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Åkesson, Karin
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp, Sweden.
    Poor metabolic control in childhood strongly correlates to diabetes-related premature death in persons <30 years of age-A population-based cohort study2020In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448Article in journal (Refereed)
    Abstract [en]

    Background/objective The importance of metabolic control in childhood regarding excess risk of death in young persons has not been well studied. This registry-based study aimed to investigate mortality rates and cause of death related to metabolic control in young persons (amp;lt;= 29 years) in Sweden with type 1 diabetes. Methods All 12 652 subjects registered in the Swedish pediatric diabetes quality register, from 2006 to 2014, were included. Data were merged with the Swedish Cause of Death Register. Standardized mortality rates were calculated using the official Swedish population register. Results Of 68 deaths identified, 38.2% of the deaths were registered as being due to diabetes whereof the major cause of death was acute complications. Overall standardized mortality ratio was 2.7 (2.1-3.4, 95% CI). Subjects who died from diabetes had a mean HbA1c of 74 +/- 19 mmol/mol (8.9 +/- 1.7%) during childhood vs 62 +/- 12 mmol/mol (7.8 +/- 1.1%) in those still alive (P amp;lt; .001). Conclusions In this nationwide cohort of young subjects with type 1 diabetes, there was a high mortality rate compared to the general population. Mean HbA1c in childhood was significantly higher in those who died from diabetes, compared to subjects who were still alive. To decrease mortality in young persons with type 1 diabetes it is essential not only to achieve but also to maintain a good metabolic control during childhood and adolescence.

  • 27.
    Sonesson, Sofi
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Kvist, Joanna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden.
    Yakob, Jafar
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Hedevik, Henrik
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gauffin, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Orthopaedics in Linköping.
    Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 5-Year Follow-up of a Prospective, Randomized Study2020In: ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, Vol. 8, no 1, article id 2325967119893920Article in journal (Refereed)
    Abstract [en]

    Background: Arthroscopic meniscal surgery is a common orthopaedic procedure in middle-aged patients, but the efficacy of this procedure has been questioned. In this study, we followed up the only randomized controlled trial that has shown a 1-year benefit from knee arthroscopic surgery with an exercise program compared with an exercise program alone. Purpose: To (1) evaluate whether knee arthroscopic surgery combined with an exercise program provided an additional 5-year benefit compared with an exercise program alone in middle-aged patients with meniscal symptoms, (2) determine whether baseline mechanical symptoms affected the outcome, and (3) compare radiographic changes between treatment groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Of 179 eligible patients aged 45 to 64 years, 150 were randomized to either a 3-month exercise program (nonsurgery group) or to the same exercise program plus knee arthroscopic surgery (surgery group) within 4 weeks. Radiographs were assessed, according to the Kellgren-Lawrence grade, at baseline and at the 5-year follow-up. The primary outcome was the change in Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain (KOOSPAIN) subscore from baseline to the 5-year follow-up. We performed an as-treated analysis. Results: A total of 102 patients completed the 5-year questionnaire. At the 5-year follow-up, both groups had significant improvement in KOOSPAIN subscores, although there was no significant change from the 3-year scores. There was no between-group difference in the change in the KOOSPAIN subscore from baseline to 5 years (3.2 points [95% CI, -6.1 to 12.4]; adjusted P = .403). In the surgery group, improvement was greater in patients without mechanical symptoms than in those with mechanical symptoms (mean difference, 18.4 points [95% CI, 8.7 to 28.1]; P amp;lt; .001). Radiographic deterioration occurred in 60% of patients in the surgery group and 37% of those in the nonsurgery group (P = .060). Conclusion: Knee arthroscopic surgery combined with an exercise program provided no additional long-term benefit after 5 years compared with the exercise program alone in middle-aged patients with meniscal symptoms. Surgical outcomes were better in patients without mechanical symptoms than in patients with mechanical symptoms during the preoperative period. Radiographic changes did not differ between treatment groups. Registration: NCT01288768 ( identifier).

  • 28.
    Törnudd, Mattias
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Ramström, Sofia
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Orebro Univ, Sweden.
    Kvitting, John-Peder Escobar
    Oslo Univ Hosp, Norway.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Pihl, Richard
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery. Sci, Linkoping, Sweden; Linkoping Univ, Dept Clin Chem, Linkoping, Sweden; Linkoping Univ, Dept Clin and Expt Med, Linkoping, Sweden.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Protamine stimulates platelet aggregation in vitro with activation of the fibrinogen receptor and alpha-granule release, but impairs secondary activation via ADP and thrombin receptors2020In: Platelets, ISSN 0953-7104, E-ISSN 1369-1635Article in journal (Refereed)
    Abstract [en]

    Heparin and protamine are fundamental in the management of anticoagulation during cardiac surgery. Excess protamine has been associated with increased bleeding. Interaction between protamine and platelet function has been demonstrated but the mechanism remains unclear. We examined the effect of protamine on platelet function in vitro using impedance aggregometry, flow cytometry, and thrombin generation. Platelets were exposed to protamine at final concentrations of 0, 20, 40, and 80 mu g/mL, alone or together with adenosine diphosphate (ADP) or thrombin PAR1 receptor-activating peptide (TRAP). We found that in the absence of other activators, protamine (80 mu g/mL) increased the proportion of platelets with active fibrinogen receptor (binding of PAC-1) from 3.6% to 97.0% (p amp;lt; .001) measured with flow cytometry. Impedance aggregometry also increased slightly after exposure to protamine alone. When activated with ADP or TRAP protamine at 80 mu g/mL reduced aggregation, from 73.8 +/- 29.4 U to 46.9 +/- 21.1 U (p amp;lt; .001) with ADP and from 126.4 +/- 16.1 U to 94.9 +/- 23.7 U (p amp;lt; .01) with TRAP. P-selectin exposure (a marker of alpha-granule release) measured by median fluorescence intensity (MFI) increased dose dependently with protamine alone, from 0.76 +/- 0.20 (0 mu g/mL) to 10.2 +/- 3.1 (80 mu g/mL), p amp;lt; .001. Protamine 80 mu g/mL by itself resulted in higher MFI (10.16 +/- 3.09) than activation with ADP (2.2 +/- 0.7, p amp;lt; .001) or TRAP (5.7 +/- 2.6, p amp;lt; .01) without protamine. When protamine was combined with ADP or TRAP, there was a concentration-dependent increase in the alpha-granule release. In conclusion, protamine interacts with platelets in vitro having both a direct activating effect and impairment of secondary activation of aggregation by other agonists.

  • 29.
    Xi-Ming, Yuan
    Linköping University, Department of Health, Medicine and Caring Sciences.
    Macrophage NCOR1 protects from atherosclerosis by repressing a pro-atherogenic PPARγ signature.2019In: Eur Heart JArticle in journal (Refereed)
  • 30.
    Yngman Uhlin, Pia
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Kjellsdotter, Anna
    Univ Skovde, Sweden.
    Uhlin, Fredrik
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Tallinn Univ Technol, Estonia.
    Edéll-Gustafsson, Ulla
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Sleep Quality, Fatigue, and Health-Related Quality of Life in Patients on Initial Peritoneal Dialysis and Multiple Modalities after Two Years: A Prospective Study2019In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 46, no 6, p. 615-+Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to investigate changes in sleep quality, fatigue, mental health, and health-related quality of life (HRQoL) over a two-year period among patients undergoing peritoneal dialysis treatment at home. We further explored the extent to which sleep quality, fatigue, and mental health predicted health-related quality of life outcomes. This prospective study included 55 patients. Sleep parameters changed over two years, independently of treatment. Sleep variables at baseline, to some extent, predicted sleep quality after two years. Daytime sleepiness can be a long-term problem. Findings indicate improvements in nocturnal sleep over a two-year time period, independently of dialysis treatment. In contrast, fatigue remained unchanged over the same time period Dansplantation seems to generally benefit the outcome of HRQoL. Strategies to improve sleep and HRQoL may include systematic risk factor modification and efforts to optimise symptomatic treatment.

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