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  • 101.
    Hatfield, Megan
    et al.
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Falkmer, Marita
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia; Jonköping University, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Ciccarelli, Marina
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Effectiveness of the BOOST-A (TM) online transition planning program for adolescents on the autism spectrum: a quasi-randomized controlled trial2017In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, article id 54Article in journal (Refereed)
    Abstract [en]

    Background: The majority of existing transition planning programs are focused on people with a disability in general and may not meet the specific need of adolescents on the autism spectrum. In addition, these interventions focus on specific skills (e.g. job readiness or self-determination) rather than the overall transition planning process and there are methodological limitations to many of the studies determining their effectiveness. The Better OutcOmes amp; Successful Transitions for Autism (BOOST-A (TM)) is an online program that supports adolescents on the autism spectrum to prepare for leaving school. This study aimed to determine the effectiveness of the BOOST-A T in enhancing self-determination. Methods: A quasi-randomized controlled trial was conducted with adolescents on the autism spectrum enrolled in years 8 to 11 in Australian schools (N = 94). Participants had to have basic computer skills and the ability to write at a year 5 reading level. Participants were allocated to a control (n = 45) or intervention (n = 49) group and participants were blinded to the trial hypothesis. The intervention group used the BOOST-A T for 12 months, while the control group participated in regular practice. Outcomes included self-determination, career planning and exploration, quality of life, environmental support and domain specific self-determination. Data were collected from parents and adolescents. Results: There were no significant differences in overall self-determination between groups. Results indicated significant differences in favor of the intervention group in three areas: opportunity for self-determination at home as reported by parents; career exploration as reported by parents and adolescents; and transition-specific self-determination as reported by parents. Conclusions: Results provide preliminary evidence that the BOOST-A T can enhance some career-readiness outcomes. Lack of significant outcomes related to self-determination at school and career planning may be due to the lack of face-to-face training and parents being the primary contacts in the study. Further research is needed to determine effectiveness of the BOOST-A T related to post-secondary education and employment.

  • 102.
    Hatfield, Megan
    et al.
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Falkmer, Marita
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia; Jonköping univ, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia; La Trobe University, Australia.
    Ciccarelli, Marina
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Evaluation of the effectiveness of an online transition planning program for adolescents on the autism spectrum: trial protocol2016In: CHILD AND ADOLESCENT PSYCHIATRY AND MENTAL HEALTH, ISSN 1753-2000, Vol. 10, article id 48Article in journal (Refereed)
    Abstract [en]

    Background: The transition from high school to post-secondary education and work is difficult for adolescents on the autism spectrum. Transition planning can be an effective way of supporting adolescents on the autism spectrum to prepare for leaving school and to succeed in obtaining employment; however, there is a need for an autism-specific transition planning program with proven effectiveness. This paper describes a trial protocol for evaluating the Better OutcOmes amp; Successful Transitions for Autism (BOOST-A (TM)); an online interactive program that empowers adolescents on the autism spectrum to plan their transition from school to further study, training, or employment. Methods: The trial will involve adolescents on the autism spectrum in high school and their parents, who will be alternately assigned to a control group (regular practice) or an intervention group (using the BOOST-A (TM)). The BOOST-A (TM) was developed using the PRECEDE-PROCEED model, and is based on the self-determination model, and the strengths-and technology-based approaches. It involves participants completing a series of online modules. The primary outcome will be self-determination, because high self-determination has been linked to successful transition to employment among adolescents on the autism spectrum. Secondary outcomes will include domain-specific self-determination, career planning and exploration, quality of life, and environmental support. Data will be obtained from questionnaires completed by the adolescent on the autism spectrum and their parent/s. Data collection will take place at baseline (Time point 1) and 12 months later (Time point 2). Discussion and conclusions: This trial will provide evidence of the effectiveness of the BOOST-A T to assist adolescents on the autism spectrum to successfully transition from school.

  • 103.
    Hatfield, Megan
    et al.
    Curtin Univ, Australia; Cooperat Res Ctr Living Autism Autism CRC, Australia.
    Falkmer, Marita
    Curtin Univ, Australia; Cooperat Res Ctr Living Autism Autism CRC, Australia; Jonkoping Univ, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia; Cooperat Res Ctr Living Autism Autism CRC, Australia.
    Ciccarelli, Marina
    Curtin Univ, Australia; Cooperat Res Ctr Living Autism Autism CRC, Australia.
    Process Evaluation of the BOOST-A (TM) Transition Planning Program for Adolescents on the Autism Spectrum: A Strengths-Based Approach2018In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 48, no 2, p. 377-388Article in journal (Refereed)
    Abstract [en]

    A process evaluation was conducted to determine the effectiveness, usability, and barriers and facilitators related to the Better OutcOmes amp; Successful Transitions for Autism (BOOST-A (TM)), an online transition planning program. Adolescents on the autism spectrum (n = 33) and their parents (n = 39) provided feedback via an online questionnaire. Of these, 13 participants were interviewed to gain in-depth information about their experiences. Data were analyzed using descriptive statistics and thematic analysis. Four themes were identified: (i) taking action to overcome inertia, (ii) new insights that led to clear plans for the future, (iii) adolescent empowerment through strengths focus, and (iv) having a champion to guide the way. The process evaluation revealed why BOOST-A (TM) was beneficial to some participants more than others. Trial registration #ACTRN12615000119594.

  • 104.
    Hatfield, Megan
    et al.
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Murray, Nina
    Curtin University, Australia.
    Ciccarelli, Marina
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Falkmer, Marita
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia; Jonköping University, Sweden.
    Pilot of the BOOST-A: An online transition planning program for adolescents with autism2017In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 64, no 6, p. 448-456Article in journal (Refereed)
    Abstract [en]

    BackgroundMany adolescents with autism face difficulties with the transition from high school into post-school activities. The Better OutcOmes amp; Successful Transitions for Autism (BOOST-A) is an online transition planning program which supports adolescents on the autism spectrum to prepare for leaving school. This study describes the development of the BOOST-A and aimed to determine the feasibility and viability of the program. MethodsTwo pilot studies were conducted. In Pilot A, the BOOST-A was trialled by six adolescents on the autism spectrum, their parents, and the professionals who worked with them, to determine its feasibility. In Pilot B, 88 allied health professionals (occupational therapists, speech pathologists, and psychologists) reviewed the BOOST-A to determine its viability. ResultsParticipants rated the BOOST-A as a feasible tool for transition planning. The majority of allied health professionals agreed that it was a viable program. Based on participant feedback, the BOOST-A was modified to improve usability and feasibility. ConclusionThe BOOST-A is a viable and feasible program that has the potential to assist adolescents with autism in preparing for transitioning out of high school. Future research will determine the effectiveness of the BOOST-A with adolescents across Australia.

  • 105.
    Henning, Belindi
    et al.
    James Cook University, Australia.
    Cordier, Reinie
    James Cook University, Australia; Curtin University, Australia.
    Wilkes-Gillan, Sarah
    Australian Catholic University, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia.
    A pilot play-based intervention to improve the social play interactions of children with autism spectrum disorder and their typically developing playmates2016In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 63, no 4, p. 223-232Article in journal (Refereed)
    Abstract [en]

    Background/aimOccupational therapists play a key role in addressing the social difficulties of children with ASD. However, interventions are often time intensive, without outcomes generalising beyond the clinic setting. To examine the feasibility and preliminary effectiveness of an intervention to address the social play skills of children with ASD. MethodsParticipants in this multiple case study design were five children with autism spectrum disorder (ASD), five typically developing playmates and five parents of children with ASD. Two therapists and parents delivered the intervention involving clinic play sessions and home modules. Parents treatment adherence was recorded. The Test of Playfulness was scored by a blinded rater to examine child outcomes following the intervention. Line graphs were used to examine case data. Percentage of non-overlapping data (PND) was used to calculate the single-case effect size for each child. ResultsParents completed 92.2% of the intervention. Childrens case data showed an upwards trend from pre- to post-intervention in four of the five pairs (child with ASD and playmate). However, there was a decrease in scores from post-intervention to the two-month home follow-up for all but one pair. PND indicated the intervention was effective for two children with ASD and three of their playmates, had a questionable effect on three children with ASD and no observable effect on two playmates. ConclusionThe intervention demonstrated preliminary feasibility and effectiveness for improving the social play skills of some children with ASD. Careful consideration is needed to identify which children with ASD and which playmates would be best suited for this intervention approach.

  • 106.
    Hesselstrand, Malin
    et al.
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Samuelsson, Kersti
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Liedberg, Gunilla
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Occupational Therapy Interventions in Chronic Pain - A Systematic Review2015In: Occupational Therapy International, ISSN 0966-7903, E-ISSN 1557-0703, Vol. 22, no 4, p. 183-194Article, review/survey (Refereed)
    Abstract [en]

    The use of interventions based on the best available evidence in occupational therapy is essential, and evaluation of research is part of an evidence-based practice. The aim of this study was to assess the quality of studies describing and evaluating the effects of occupational therapy interventions on chronic pain. A systematic review of studies with diverse designs was carried out. A quality assessment was conducted, and the level of evidence was defined using the Research Pyramid Model. Of 19 included studies, three received the highest evidence level, and three were considered to be of high quality. The clinical recommendations that can be derived from this study are the following: occupational therapy interventions should start from the identified needs of the person with chronic pain; no support exists for the effectiveness of electromyographic biofeedback training as a supplement, more studies are needed to confirm this result; the efficacy of instructions on body mechanics was significant during work-hardening treatment; and occupational therapists need to perform and present more clinical studies of high quality and high-evidence level to build up a trustworthy arsenal of evidence-based interventions, for example, in persons with chronic pain. Copyright (C) 2015 John Wiley & Sons, Ltd.

  • 107.
    Horlin, Chiara
    et al.
    Curtin University, Australia.
    Black, Melissa
    Curtin University, Australia.
    Falkmer, Marita
    Curtin University, Australia; Jonköping University, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; La Trobe University, Australia.
    Proficiency of individuals with autism spectrum disorder at disembedding figures: A systematic review2016In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 19, no 1, p. 54-63Article in journal (Refereed)
    Abstract [en]

    Objective: This systematic review examines the proficiency and visual search strategies of individuals with autism spectrum disorders (ASD) while disembedding figures and whether they differ from typical controls and other comparative samples. Methods: Five databases, including Proquest, Psychinfo, Medline, CINAHL and Science Direct were used to identify published studies meeting the inclusion and exclusion criteria. Results: Twenty articles were included in the review, the majority of which matched participants by mental age. Outcomes discussed were time taken to identify targets, the number correctly identified, and fixation frequency and duration. Conclusions: Individuals with ASD perform at the same speed or faster than controls and other clinical samples. However, there appear to be no differences between individuals with ASD and controls for number of correctly identified targets. Only one study examined visual search strategies and suggests that individuals with ASD exhibit shorter first and final fixations to targets compared with controls.

  • 108.
    Hughes, B. P.
    et al.
    Curtin University, Australia.
    Anund, A.
    Swedish Rd and Transport Research Institute, S-58195 Linkoping, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; La Trobe University, Australia.
    System theory and safety models in Swedish, UK, Dutch and Australian road safety strategies2015In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 74, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Road safety strategies represent interventions on a complex social technical system level. An understanding of a theoretical basis and description is required for strategies to be structured and developed. Road safety strategies are described as systems, but have not been related to the theory, principles and basis by which systems have been developed and analysed. Recently, road safety strategies, which have been employed for many years in different countries, have moved to a vision zero, or safe system style. The aim of this study was to analyse the successful Swedish, United Kingdom and Dutch road safety strategies against the older, and newer, Australian road safety strategies, with respect to their foundations in system theory and safety models. Analysis of the strategies against these foundations could indicate potential improvements. The content of four modern cases of road safety strategy was compared against each other, reviewed against scientific systems theory and reviewed against types of safety model. The strategies contained substantial similarities, but were different in terms of fundamental constructs and principles, with limited theoretical basis. The results indicate that the modern strategies do not include essential aspects of systems theory that describe relationships and interdependencies between key components. The description of these strategies as systems is therefore not well founded and deserves further development.

  • 109.
    Hughes, B. P.
    et al.
    Curtin University, Australia.
    Anund, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Swedish Rd and Transport Research Institute, S-58195 Linkoping, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; La Trobe University, Australia.
    A comprehensive conceptual framework for road safety strategies2016In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 90, p. 13-28Article in journal (Refereed)
    Abstract [en]

    Road safety strategies (generally called Strategic Highway Safety Plans in the USA) provide essential guidance for actions to improve road safety, but often lack a conceptual framework that is comprehensive, systems theory based, and underpinned by evidence from research and practice. This paper aims to incorporate all components, policy tools by which they are changed, and the general interactions between them. A framework of nine mutually interacting components that contribute to crashes and ten generic policy tools which can be applied to reduce the outcomes of these crashes was developed and used to assess 58 road safety strategies from 22 countries across 15 years. The work identifies the policy tools that are most and least widely applied to components, highlighting the potential for improvements to any individual road safety strategy, and the potential strengths and weaknesses of road safety strategies in general. The framework also provides guidance for the development of new road safety strategies, identifying potential consequences of policy tool based measures with regard to exposure and risk, useful for both mobility and safety objectives. (C) 2016 Elsevier Ltd. All rights reserved.

  • 110.
    Husberg, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hallert, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Costs and disease activity in early rheumatoid arthritis in 1996-2000 and 2006-2011, improved outcome and shift in distribution of costs: a two-year follow-up2018In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 47, no 5, p. 378-383Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate changes in healthcare utilization, costs, and disease activity from 1996 to 2011 for patients with early rheumatoid arthritis (RA).Method: Two cohorts of patients with early RA, included in 1996-1998 (T1) and 2006-2009 (T2), were followed regularly. Healthcare utilization, costs, and disease activity were compared between cohorts during 2years after diagnosis.Results: Disease activity was significantly improved in T2 vs T1. Drug costs increased in T2 vs T1 (EUR 911 vs EUR 535, respectively; p=0.017), and costs for RA-related hospitalization decreased. More than 90% in T2 were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion compared to 50% in T1. At 2year follow-up, levels were still amp;gt;90% in T2, while corresponding values in T1 were just above 70%. Comparing T2 to T1, total direct costs were slightly higher in T2 (EUR 3941 vs EUR 3364, respectively; ns), sick leave decreased (EUR 3511 vs EUR 5672; p=0.025), while disability pension increased slightly (EUR 4889 vs EUR 4244; ns), but total indirect costs remained unchanged (EUR 8400 vs EUR 9916; ns). Total direct and indirect costs did not differ between the cohorts (EUR 12342 in T2 vs EUR 13280 in T1; ns), and loss of productivity still represented the largest component of total costs.Conclusion: T2 patients were prescribed DMARDs earlier and more aggressively than T1 patients. Stable and better improvements in disease activity, function, and quality of life were achieved in T2 compared to T1. There was a shift within the components in direct costs and indirect costs, but total costs remained essentially unchanged.

  • 111.
    Håkansson, Irene
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Gouveia-Figueira, Sandra
    Umea Univ, Sweden.
    Ernerudh, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Ghafouri, Nazdar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Nording, Malin
    Umea Univ, Sweden; Univ Calif Davis, CA 95616 USA.
    Oxylipins in cerebrospinal fluid in clinically isolated syndrome and relapsing remitting multiple sclerosis2018In: Prostaglandins & other lipid mediators, ISSN 1098-8823, E-ISSN 2212-196X, Vol. 138, p. 41-47Article in journal (Refereed)
    Abstract [en]

    Although oxylipins are involved in inflammation, data on these lipid mediators in multiple sclerosis are sparse. In this study, a panel of oxylipins were analysed swith liquid chromatography tandem mass spectrometry in cerebrospinal fluid (CSF) from 41 treatment naive patients with clinically isolated syndrome (CIS) or relapsing remitting MS (RRMS) and 22 healthy controls. CSF levels of 9-hydroxyoctadecadienoic acid (9-HODE) and 13-hydroxyoctadecadienoic acid (13-HODE) were significantly higher in patients than in healthy controls (9-HODE median 380 nM (interquartile range 330-450 nM) in patients and 290 nM (interquartile range 250-340 nM) in controls, 13-HODE median 930 nM (interquartile range 810-1080 nM) in patients and 690 nM (interquartile range 570-760 nM) in controls, p amp;lt; 0.001 in Mann-Whitney U tests). 9-HODE and 13-HODE performed well for separation of patients and healthy controls (AUC 0.85 and 0.88, respectively, in ROC curve analysis). However, baseline CSF levels of the oxylipins did not differ between patients with signs of disease activity during one, two and four years of follow-up and patients without. In conclusion, this study indicates that 9-HODE and 13-HODE levels are increased in CSF from CIS and RRMS patients compared with healthy controls, but does not support 9-HODE or 13-HODE as prognostic biomarkers of disease activity in patients during follow-up.

  • 112.
    Jacob, Andrew
    et al.
    Curtin University, Australia.
    Scott, Melissa
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    Falkmer, Marita
    Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia; Jonköping University, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; Cooperat Research Centre Living Autism Autism CRC, Australia.
    The Costs and Benefits of Employing an Adult with Autism Spectrum Disorder: A Systematic Review2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 10, p. e0139896-Article, review/survey (Refereed)
    Abstract [en]

    Background Despite an ambition from adults with Autism Spectrum Disorder (ASD) to be employed, there are limited opportunities for competitive employment for this group. Employment is not only an entitlement enjoyed by others in society, but employing adults with ASD also has economic benefits by decreasing lost productivity and resource costs for this group. Few studies have explored the cost-benefit ratio for employing adults with ASD and even fewer have taken the viewpoint of the employer, particularly applying this situation to ASD. Until such study occurs, employers may continue to be reluctant to employ adults from this group. Objective This review aimed to examine the costs, benefits and the cost-benefit ratio of employing adults with ASD, from a societal perspective and from the perspective of employers. Methods Eight databases were searched for scientific studies within defined inclusion criteria. These databases included CINAHL Plus, Cochrane Library, Emerald, Ovid Medline, ProQuest, PsycINFO, Scopus and Web of Science. Results and Conclusion Enhancing the opportunities for adults with ASD to join the workforce is beneficial from a societal perspective, not only from an inclusiveness viewpoint, but also from a strict economic standpoint. Providing supported employment services for adults with ASD does not only cut the cost compared with providing standard care, it also results in better outcomes for adults with ASD. Despite the fact that ASD was the most expensive group to provide vocational rehabilitation services for, adults with ASD have a strong chance of becoming employed once appropriate measures are in place. Hence, rehabilitation services could be considered as a worthwhile investment. The current systematic review uncovered the fact that very few studies have examined the benefits, the costs and the cost-benefit ratio of employing an adult with ASD from the perspective of employers indicating a need for this topic to be further explored.

  • 113.
    Jasim, Hajer
    et al.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Folktandvarden Stockholm AB, Sweden.
    Carlsson, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Hedenberg-Magnusson, Britt
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Folktandvarden Stockholm AB, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ernberg, Malin
    Karolinska Inst, Sweden; Karolinska Inst, Sweden.
    Saliva as a medium to detect and measure biomarkers related to pain2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 3220Article in journal (Refereed)
    Abstract [en]

    Saliva is often neglected as a body fluid of diagnostic or prognostic value, even though generally well accepted by the patients. This is due to lack of a standardized collection procedure. The aim of this study was to identify the ideal saliva collection technique and develop new sensitive methods to detect and analyse markers related to pain in healthy pain-free subjects. Plasma and five different saliva collection approached was evaluated during strictly controlled conditions. Levels of nerve growth factor (NGF), calcitonin gene-related peptide (CGRP) and brain derived neurotropic factor (BDNF) were determined using novel western blotting based technology. Glutamate and substance P (SP) was determined using commercial available methods. Several new isoforms were found for NGF, CGRP and BDNF in saliva. The isoform pattern showed significant variation in both expression and chemiluminescence levels between different collection methods. New sensitive methods to study pain related markers in saliva were developed in this study. Furthermore, we are first to demonstrate a correlation between the Glutamate concentration in stimulated whole saliva and blood. However, the fundamental conclusion drawn is the importance of consistency in the collection method.

  • 114.
    Jasim, Hajer
    et al.
    Karolinska Institute, Sweden; Scandinavian Centre Orofacial Neurosci SCON, Sweden; Folktandvarden Stockholm AB, Sweden.
    Olausson, Patrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Hedenberg-Magnusson, Britt
    Karolinska Institute, Sweden; Scandinavian Centre Orofacial Neurosci SCON, Sweden; Folktandvarden Stockholm AB, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden; Scandinavian Centre Orofacial Neurosci SCON, Sweden.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    The proteomic profile of whole and glandular saliva in healthy pain-free subjects2016In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 6, article id 39073Article in journal (Refereed)
    Abstract [en]

    Determination of the variability in the salivary proteome is a prerequisite for the development of saliva as a diagnostic and prognostic tool in particular physiological states. In this context, it is important that technical variability induced by sample collection and processing is kept at minimum to be able to reproducibly assess variability in states of health and disease. In the current study, the proteome profile in unstimulated and stimulated whole, parotid and sublingual saliva was investigated using two-dimensional gel electrophoresis. Saliva samples were structurally collected from ten examined and characterized healthy individuals during the exactly same conditions. The results demonstrated that different collection methods provide clear differences in the snapshot of the salivary proteome and also in the relative amount of specific proteins. The variable nature of the salivary proteome suggests that different approaches may have to be adopted when studying its composition or its possible role as an indicator for particular physiological states. The results emphasize the importance of consistency when collecting saliva samples for proteomic analysis.

  • 115.
    Joosten, Annette
    et al.
    Curtin University, Australia.
    Girdler, Sonya
    Curtin University, Australia.
    Albrecht, Matthew A.
    Curtin University, Australia.
    Horlin, Chiara
    Curtin University, Australia.
    Falkmer, Marita
    Curtin University, Australia; Jonköping University, Sweden.
    Leung, Denise
    Curtin University, Australia.
    Ordqvist, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Fleischer, Håkan
    Jonköping University, Sweden.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia.
    Gaze and visual search strategies of children with Asperger syndrome/high functioning autism viewing a magic trick2016In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 19, no 2, p. 95-102Article in journal (Refereed)
    Abstract [en]

    Objective: To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA. Methods: Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants eye movements were recorded using a head-mounted eye-tracker. Results: Children with AS/HFA looked less frequently and had shorter fixation on the magicians direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magicians face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze. Conclusions: Information may enhance effective visual strategies in children with and without AS/HFA.

  • 116.
    Järemo, Pirjo
    et al.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Arman, M.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gottberg, K.
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska University, Huddinge, Sweden.
    Illness beliefs among patients with chronic widespread pain - associations with self-reported health status, anxiety and depressive symptoms and impact of pain2017In: BMC Psychology, E-ISSN 2050-7283, Vol. 5, no 24Article in journal (Refereed)
    Abstract [en]

    Chronic widespread pain (CWP) is a disabling condition associated with a decrease in health. Illness beliefs are individual and are acquired during life. Constraining beliefs may prevent patients from regaining health. Understanding these patients’ illness beliefs may be a way to improve the health care they are offered. The aim of this study was to describe illness beliefs among patients with CWP and associations with self-reported health, anxiety and depressive symptoms, and impact of pain.

  • 117.
    Jöud, Anna
    et al.
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
    Björk, Jonas
    Division of Occupational and Environmental Medicine, Department of Laboratory Medicine Lund, Lund University, Lund, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Grimby-Ekman, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Health Metrics, University of Gothenburg, Gothenburg, Sweden..
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    The association between pain characteristics, pain catastrophizing and health care use: Baseline results from the SWEPAIN cohort2017In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 16, p. 122-128, article id S1877-8860(17)30122-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: Pain is common and adds to the global burden of disease. However, individuals suffering from pain are a heterogeneous group in terms of pain spreading, intensity and duration. While pain influences overall health care consultation not everyone with pain consult health care. To be able to provide health care matching the patients' needs increased knowledge about what factors determines the decision to consult health care is essential. The aim of this study was to explore the combined importance of pain spreading, intensity, duration and pain catastrophizing for consulting health care.

    METHODS: In this cross-sectional study we used population based survey data from southeast Sweden (SWEPAIN) including 7792 individuals' aged 16-85 reporting pain. We used Modified Poisson regressions to analyse factors of importance related to the decision to consult health care.

    RESULTS: High and moderate pain intensity, as compared to low, increases the probability of consulting health care (High PR=1.7 [95% CI 1.51-1.88], moderate PR=1.2 [1.15-1.41]). Having widespread pain, as compared to localised pain, increased the probability of consulting health (PR=1.2 [1.03-1.36). Pain duration was not associated with increased probability of consulting health care (PR=1.0 CI0.88-1.07). However an interaction (p=0.05) between pain duration and pain catastrophizing beliefs was seen indicating a combined importance of the two when consulting health care.

    CONCLUSION: Our result suggests that pain intensity, pain spreading and pain catastrophizing independently influence the decision to consult health care while there is an interaction effect between pain duration and pain catastrophizing beliefs where the importance of pain catastrophizing believes differ with pain duration; the importance of pain catastrophizing believes differ with pain duration.

    IMPLICATIONS: Treatment and rehabilitation strategies should incorporate this finding in order to meet the individual's needs focusing on the biopsychosocial model within health care focusing not only on actual pain reliefs but also on for example acceptance and behavioural changes.

  • 118.
    Kallman, Thomas F.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Salivary beta-endorphin and substance P are not biomarkers of neuropathic chronic pain propensity2018In: Heliyon, ISSN 2405-8440, Vol. 4, no 8, article id e00718Article in journal (Refereed)
    Abstract [en]

    Objective

    The pathophysiology of chronic pain is complex, with most of our knowledge being derived from preclinical studies. The search for biomarkers mirroring the pathophysiology of chronic pain is ongoing, and there is an increasing interest in saliva as a diagnostic tool. Given what is known about salivary substance Pand salivary gland innervation, we hypothesized that salivary substance P and/or beta-endorphin might reflect the basal activity of these neuropeptides in the central nervous system, thereby perhaps mirroring a general propensity to chronic pain. Based on this overall hypothesis, our aim was to compare salivary levels of these neuropeptides in chronic neuropathic pain patients with healthy controls. An additional aim was to relate salivary levels to plasma levels.

    Materials and methods

    We compared salivary concentrations of beta-endorphin and substance P in 14 chronic neuropathic pain patients with concentrations in 18 healthy controls using a Luminex technology kit. Salivary-to-plasma quotients were also calculated.

    Results

    We found no significant difference between the groups' salivary concentrations of substance P and beta-endorphin. No correlation was found between salivary and plasma concentrations of each neuropeptide, which we hypothesize might point to local production of beta-endorphin and/or substance P in the salivary glands. Given high substance P salivary-to-plasma quotients, such a local production seems more likely for substance P than for beta-endorphin.

    Conclusions

    Propensity to neuropathic chronic pain was not substantiated by our analysis of salivary levels of substance P and/or beta-endorphin. However, we report salivary-to-plasma quotients that give potentially important physiological insight about these neuropeptides.

  • 119.
    Karlsson, Linn
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center.
    Bäckryd, Emmanuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Olausson, Patrik
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ghafouri, Nazdar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Intramuscular pain modulatory substances before and after exercise in women with chronic neck pain2015In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 19, no 8, p. 1075-1085Article in journal (Refereed)
    Abstract [en]

    BackgroundIn peripheral tissue, several substances influence pain and pain modulation. Exercise has been found to decrease pain and improve function for chronic pain conditions, but how and why exercise produces beneficial effects remains unclear. This study investigates whether aspects of pain and concentrations of substances with algesic, analgesic and metabolic functions differ between women with chronic neck shoulder pain (CNSP) and healthy women (CON) and whether changes are found after an exercise intervention for CNSP. MethodsForty-one women with CNSP and 24 CON subjects were included. The participants attended two microdialysis sessions with 4-6 months between the experiments. During this period, the CNSP subjects underwent an exercise intervention. Expression levels of substance P, beta-endorphin, cortisol, glutamate, lactate and pyruvate as well as pain intensity and pressure pain thresholds were analysed. ResultsAt baseline, higher concentrations of glutamate and beta-endorphin and lower concentrations of cortisol in CNSP than CON were found. After exercise, decreased levels of substance P and possibly of glutamate, increased levels of beta-endorphin and cortisol as well as decreased pain intensity and increased pain pressure thresholds were found for CNSP. ConclusionsThe findings at baseline indicated algesic and analgesic alterations in the painful trapezius muscles. The findings for CNSP after the exercise intervention, with changes in peripheral substances and decreased pain intensity and sensitivity, could reflect a long-term physiological effect of the exercise.

  • 120.
    Karlsson, Linn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Takala, Esa-Pekka
    Work-Related Diseases, Finnish Institute of Occupational Health,.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Associations between psychological factors and the effect of home-based physical exercise in women with chronic neck and shoulder pain.2016In: SAGE open medicine, E-ISSN 2050-3121, Vol. 4, article id 2050312116668933Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise is often used in the treatment of chronic neck and shoulder muscle pain. It is likely that psychological aspects have an impact on the results of exercise-based treatments.

    OBJECTIVES: (1) To examine the associations between psychological factors and the effect of a home-based physical exercise intervention. (2) To examine differences in psychological factors at baseline between (a) subjects who continued in the trial and those who did not and (b) subjects who completed the intervention and those who did not.

    METHOD: A total of 57 women with chronic neck and shoulder pain were included in a home-based exercise intervention trial. Pain intensity, disability, and psychological factors (anxiety and depression symptoms, catastrophizing, fear-avoidance beliefs, self-efficacy, and pain acceptance) were measured at baseline, after 4-6 months, and after 1 year of exercise. Associations between the psychological factors and changes in pain intensity and disability were analysed, as well as differences in psychological factors at baseline between subjects who continued in and completed the intervention, and those who did not.

    RESULTS: Associations between positive changes in pain intensity and disability were found for low fear-avoidance beliefs and low-pain self-efficacy at baseline. In addition, fear-avoidance beliefs at baseline were higher in the subjects who dropped out of the intervention than in those who continued. Pain acceptance at baseline was higher in the subjects who completed the intervention at the end of the trial.

    CONCLUSION: Particularly, fear-avoidance beliefs and pain self-efficacy should be taken into consideration when implementing home-based physical exercise as treatment for chronic neck pain. In addition, high pain acceptance might improve the adherence to prescribed exercise.

  • 121.
    Karlsson, Linn
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Takala, Esa-Pekka
    Finnish Inst Occupat Hlth, Finland.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research. Karolinska Inst, Sweden.
    Larsson, Britt
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Experiences and attitudes about physical activity and exercise in patients with chronic pain: a qualitative interview study2018In: Journal of Pain Research, ISSN 1178-7090, E-ISSN 1178-7090, Vol. 11, p. 133-144Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to describe how patients with chronic pain experience physical activity and exercise (PAamp;E). Method: This qualitative interview study included 16 women and two men suffering from chronic pain and referred to a multimodal pain rehabilitation program. Semi-structured interviews were conducted and qualitative content analysis was used to analyze the interviews. Results: One main theme emerged: "To overcome obstacles and to seize opportunities to be physically active despite chronic pain." This main theme was abstracted from five themes: "Valuing a life with physical activity," "Physical activity and exercise - before and after pain," "A struggle - difficulties and challenges," "The enabling of physical activity," and "In need of continuous and active support." Conclusion: Although these participants valued PAamp;E, they seldom achieved desirable levels, and performance of PAamp;E was undermined by difficulties and failure. The discrepancy between the intention to perform physical activity and the physical activity accomplished could be related to motivation, self-efficacy, and action control. The participants desired high-quality interaction with healthcare providers. The findings can be applied to chronic pain rehabilitation that uses PAamp;E as treatment.

  • 122.
    Kim, Jong Yeob
    et al.
    Yonsei Univ, South Korea.
    Son, Min Ji
    Yonsei Univ, South Korea.
    Son, Chei Yun
    Washington Univ, MO 63110 USA.
    Radua, Joaquim
    Kings Coll London, England; CIBERSAM, Spain; Karolinska Inst, Sweden; Inst Invest Biomed August Pi and Sunyer IDIBAPS, Spain.
    Eisenhut, Michael
    Luton and Dunstable Univ Hosp NHS Fdn Trust, England.
    Gressier, Florence
    Bicetre Univ Hosp, France.
    Koyanagi, Ai
    Univ Barcelona, Spain; CIBERSAM, Spain.
    Carvalho, Andre F.
    Ctr Addict and Mental Hlth, Canada; Univ Toronto, Canada.
    Stubbs, Brendon
    South London and Maudsley NHS Fdn Trust, England; Kings Coll London, England.
    Solmi, Marco
    Kings Coll London, England; Univ Padua, Italy; Univ Padua, Italy.
    Rais, Theodor B.
    Univ Toledo, OH 43606 USA.
    Lee, Keum Hwa
    Yonsei Univ, South Korea; Severance Childrens Hosp, South Korea.
    Kronbichler, Andreas
    Med Univ Innsbruck, Austria.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Il Shin, Jae
    Yonsei Univ, South Korea; Severance Childrens Hosp, South Korea.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Environmental risk factors and biomarkers for autism spectrum disorder: an umbrella review of the evidence2019In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 6, no 7, p. 590-600Article, review/survey (Refereed)
    Abstract [en]

    Background Numerous studies have identified potential risk factors and biomarkers for autism spectrum disorder. We aimed to study the strength and validity of the suggested environmental risk factors or biomarkers of autism spectrum disorder. Methods We did an umbrella review and systematically appraised the relevant meta-analyses of observational studies. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for papers published between database inception and Oct 17, 2018, and screened the reference list of relevant articles. We obtained the summary effect, 95% CI, heterogeneity, and 95% prediction intervals. We examined small study effects and excess significance. We did analyses under credibility ceilings. This review is registered with PROSPERO, number CRD42018091704. Findings 46 eligible articles yielded data on 67 environmental risk factors (544 212 cases, 81 708 787 individuals) and 52 biomarkers (15 614 cases, 15 433 controls). Evidence of association was convincing for maternal age of 35 years or over (relative risk [RR] 1.31, 95% CI 1.18-1.45), maternal chronic hypertension (odds ratio [OR] 1.48, 1.29-1.70), maternal gestational hypertension (OR 1.37, 1.21-1.54), maternal overweight before or during pregnancy (RR 1.28, 1.19-1.36), pre-eclampsia (RR 1.32, 1.20-1.45), prepregnancy maternal antidepressant use (RR 1.48, 1.29-1.71), and maternal selective serotonin reuptake inhibitor (SSRI) use during pregnancy (OR 1.84, 1.60-2.11). Only two associations, maternal overweight before or during pregnancy and SSRI use during pregnancy, retained their high level of evidence under subset sensitivity analyses. Evidence from biomarkers was scarce, being supported by p values close to the significance threshold and too few cases. Interpretation Convincing evidence suggests that maternal factors, such as age and features of metabolic syndrome, are associated with risk of autism spectrum disorder. Although SSRI use during pregnancy was also associated with such risk when exposed and non-exposed groups were compared, this association could be affected by other confounding factors, considering that prepregnancy maternal antidepressant use was also convincingly associated with higher risk of autism spectrum disorder. Findings from previous studies suggest that one possible confounding factor is underlying maternal psychiatric disorders. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

  • 123.
    Kosek, Eva
    et al.
    Karolinska University Hospital, Sweden; Lowenstromska Hospital, Sweden.
    Martinsen, Sofia
    Karolinska University Hospital, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden.
    Löfgren, Monika
    Danderyd Hospital, Sweden.
    Bileviciute-Ljungar, Indre
    Danderyd Hospital, Sweden.
    Fransson, Peter
    Karolinska University Hospital, Sweden.
    Schalling, Martin
    Karolinska Institute, Sweden.
    Ingvar, Martin
    Karolinska University Hospital, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Jensen, Karin B.
    Karolinska University Hospital, Sweden.
    The translocator protein gene is associated with symptom severity and cerebral pain processing in fibromyalgia2016In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 58, p. 218-227Article in journal (Refereed)
    Abstract [en]

    The translocator protein (TSPO) is upregulated during glia activation in chronic pain patients. TSPO constitutes the rate-limiting step in neurosteroid synthesis, thus modulating synaptic transmission. Related serotonergic mechanisms influence if pro- or anti-nociceptive neurosteroids are produced. This study investigated the effects of a functional genetic polymorphism regulating the binding affinity to the TSPO, thus affecting symptom severity and cerebral pain processing in fibromyalgia patients. Gene-to-gene interactions with a functional polymorphism of the serotonin transporter gene were assessed. Fibromyalgia patients (n = 126) were genotyped regarding the polymorphisms of the TSPO (rs6971) and the serotonin transporter (5-HTTLPR/rs25531). Functional magnetic resonance imaging (n = 24) was used to study brain activation during individually calibrated pressure pain. Compared to mixed/low TSPO affinity binders, the high TSPO affinity binders rated more severe pain (p = 0.016) and fibromyalgia symptoms (p = 0.02). A significant interaction was found between the TSPO and the serotonin transporter polymorphisms regarding pain severity (p amp;lt; 0.0001). Functional connectivity analyses revealed that the TSPO high affinity binding group had more pronounced pain-evoked functional connectivity in the right frontoparietal network, between the dorsolateral prefrontal area and the parietal cortex. In conclusion, fibromyalgia patients with the TSPO high affinity binding genotype reported a higher pain intensity and more severe fibromyalgia symptoms compared to mixed/low affinity binders, and this was modulated by interaction with the serotonin transporter gene. To our knowledge this is the first evidence of functional genetic polymorphisms affecting pain severity in FM and our findings are in line with proposed glia-related mechanisms. Furthermore, the functional magnetic resonance findings indicated an effect of translocator protein on the affective-motivational components of pain perception. (C) 2016 The Authors. Published by Elsevier Inc.

  • 124.
    Larsson, Anette
    et al.
    Univ Gothenburg, Sweden.
    Palstam, Annie
    Univ Gothenburg, Sweden.
    Bjersing, Jan
    Sahlgrens Univ Hosp, Sweden.
    Lofgren, Monika
    Karolinska Inst, Sweden; Danderyd Hosp, Sweden.
    Ernberg, Malin
    Karolinska Inst, Sweden; SCON, Sweden.
    Kosek, Eva
    Karolinska Inst, Sweden; Stockholm Spine Ctr, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Mannerkorpi, Kaisa
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia2018In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 19, article id 121Article in journal (Refereed)
    Abstract [en]

    Background: Health and physical capacity are commonly associated with disease, age, and socioeconomic factors. The primary objective of this study was to investigate the degree to which physical capacity, defined as muscle strength and walking ability, is decreased in women with fibromyalgia (FM), as compared to healthy women, who are matched for age and level of education. The secondary aim was to investigate whether muscle strength and walking ability are associated with age, symptom duration, activity limitations and, Body Mass Index (BMI) in women with FM and control subjects. Methods: This controlled, cross-sectional, multi-center study comprised 118 women with FM and 93 age-and education-level-matched healthy women. The outcome measures were isometric knee-extension force, isometric elbow-flexion force, isometric hand-grip force, and walking ability. Differences between the groups were calculated, and for the women with FM analyses of correlations between the measures of physical capacity and variables were performed. Results: The women with FM showed 20% (p amp;lt; 0.001) lower isometric knee-extension force, 36% (p amp;lt; 0.001) lower isometric elbow-flexion force, 34% (p amp;lt; 0.001) lower isometric hand-grip force, and 16% lower walking ability (p amp;lt; 0.001), as compared to the healthy controls. All measures of muscle strength in women with FM showed significant weak to moderate relationship to symptom duration (r(s) = -0.23-0.32) and walking ability (r(s) = 0.25-0.36). Isometric knee-extension force correlated with activity limitations, as measured using the SF-36 Physical function subscale (r(s)= 0.23, p = 0.011). Conclusions: Physical capacity was considerably decreased in the women with FM, as compared to the age-and education-level-matched control group. All measures of physical capacity showed a significant association with symptom duration. Knee-extension force and walking ability were significantly associated with activity limitations, age, and BMI. It seems important to address this problem and to target interventions to prevent decline in muscle strength. Assessments of muscle strength and walking ability are easy to administer and should be routinely carried out in the clinical setting for women with FM.

  • 125.
    Larsson, Anette
    et al.
    University of Gothenburg, Sweden.
    Palstam, Annie
    University of Gothenburg, Sweden.
    Loefgren, Monika
    Karolinska Institute, Sweden; Danderyd Hospital, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden; SCON, Sweden.
    Bjersing, Jan
    Sahlgrens University Hospital, Sweden.
    Bileviciute-Ljungar, Indre
    Karolinska Institute, Sweden; Danderyd Hospital, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Karolinska Institute, Sweden; Stockholm Spine Centre, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; University of Gothenburg, Sweden; Sahlgrens University Hospital, Sweden.
    PAIN AND FEAR AVOIDANCE PARTIALLY MEDIATE CHANGE IN MUSCLE STRENGTH DURING RESISTANCE EXERCISE IN WOMEN WITH FIBROMYALGIA2017In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, no 9, p. 744-750Article in journal (Refereed)
    Abstract [en]

    Objectives: Resistance exercise results in health benefits in fibromyalgia. The aim of this study was to determine the factors that mediate change in muscle strength in women with fibromyalgia as a result of resistance exercise. Methods: Sixty-seven women with fibromyalgia (age range 25-64 years) were included. Tests of muscle strength and questionnaires related to pain, fear avoidance and physical activity were carried out. Multivariable stepwise regression was used to analyse explanatory factors for change and predictors for final values of knee-extension force, elbow-flexion force and hand-grip force. Results: Change in knee-extension force was explained by fear avoidance beliefs about physical activity at baseline, together with change in pain intensity, knee-extension force at baseline, age and body mass index (BMI) (R-2= 0.40, p = 0.013). Change in elbow-flexion force was explained by pain intensity at baseline, together with baseline fear avoidance beliefs about physical activity, BMI and elbow-flexion force at baseline (R-2 = 0.32, p = 0.043). Change in hand-grip force was explained by hand-grip force at baseline, change in pain intensity and baseline fear avoidance (R-2 = 0.37, p = 0.009). Final muscle strength was predicted by the same variables as change, except pain. Conclusion: Pain and fear avoidance are important factors to consider in rehabilitation using resistance exercise for women with fibromyalgia.

  • 126.
    Larsson, Anette
    et al.
    University of Gothenburg, Sweden; University of Gothenburg, Sweden.
    Palstam, Annie
    University of Gothenburg, Sweden; University of Gothenburg, Sweden.
    Lofgren, Monika
    Karolinska Institute, Sweden.
    Ernberg, Malin
    Karolinska Institute, Sweden.
    Bjersing, Jan
    Sahlgrens University Hospital, Sweden.
    Bileviciute-Ljungar, Indre
    Karolinska Institute, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Kosek, Eva
    Karolinska Institute, Sweden.
    Mannerkorpi, Kaisa
    University of Gothenburg, Sweden; University of Gothenburg, Sweden; University of Gothenburg, Sweden.
    Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia: a randomized controlled trial2015In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 17, no 161Article in journal (Refereed)
    Abstract [en]

    Introduction: Fibromyalgia (FM) is characterized by persistent widespread pain, increased pain sensitivity and tenderness. Muscle strength in women with FM is reduced compared to healthy women. The aim of this study was to examine the effects of a progressive resistance exercise program on muscle strength, health status, and current pain intensity in women with FM. Methods: A total of 130 women with FM (age 22-64 years, symptom duration 0-35 years) were included in this assessor-blinded randomized controlled multi-center trial examining the effects of progressive resistance group exercise compared with an active control group. A person-centred model of exercise was used to support the participants self-confidence for management of exercise because of known risks of activity-induced pain in FM. The intervention was performed twice a week for 15 weeks and was supervised by experienced physiotherapists. Primary outcome measure was isometric knee-extension force (Steve Strong (R)), secondary outcome measures were health status (FIQ total score), current pain intensity (VAS), 6MWT, isometric elbow-flexion force, hand-grip force, health related quality of life, pain disability, pain acceptance, fear avoidance beliefs, and patient global impression of change (PGIC). Outcomes were assessed at baseline and immediately after the intervention. Long-term follow up comprised the self-reported questionnaires only and was conducted after 13-18 months. Between-group and within-group differences were calculated using non-parametric statistics. Results: Significant improvements were found for isometric knee-extension force (p = 0.010), health status (p = 0.038), current pain intensity (p = 0.033), 6MWT (p = 0.003), isometric elbow flexion force (p = 0.02), pain disability (p = 0.005), and pain acceptance (p = 0.043) in the resistance exercise group (n = 56) when compared to the control group (n = 49). PGIC differed significantly (p = 0.001) in favor of the resistance exercise group at post-treatment examinations. No significant differences between the resistance exercise group and the active control group were found regarding change in self-reported questionnaires from baseline to 13-18 months. Conclusions: Person-centered progressive resistance exercise was found to be a feasible mode of exercise for women with FM, improving muscle strength, health status, and current pain intensity when assessed immediately after the intervention.

  • 127.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bjork, Jonas
    Lund Univ, Sweden; Skane Univ Hosp Lund, Sweden.
    Positive psychological well-being predicts lower severe pain in the general population: a 2-year follow-up study of the SwePain cohort2019In: Annals of General Psychiatry, ISSN 1744-859X, E-ISSN 1744-859X, Vol. 18, article id 8Article in journal (Refereed)
    Abstract [en]

    BackgroundPositive psychology indicators like well-being and life satisfaction may play a pivotal role in pain-related outcomes. In this study, we aimed to examine the prospective associations of positive well-being and life satisfaction with pain severity.Methods and SubjectsThis longitudinal study, with a follow-up of 2years, included 9361 participants (4266 males, 5095 females; mean age: 52.5years; SD: 17.5) without and with chronic pain (CP) at baseline. All analyses were stratified by the two sub-cohortsparticipants without CP (sub-cohort 1) and participants with CP (sub-cohort 2) at baseline. The predictive associations, assessed using ordinal regression in a Generalized Linear Model, were adjusted for baseline potential confounders and reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs).ResultsAfter adjustments, in sub-cohort 1 positive well-being at baseline was associated with lower severe pain at follow-up compared to participants with severe distress (OR: 0.64; 95% CI 0.49-0.84; pamp;lt;0.001). In sub-cohort 2, both positive well-being and life satisfaction at baseline were associated with lower severe pain at follow-up compared to participants with severe distress and not satisfied with life (OR: 0.80; 95% CI 0.65-0.98; p=0.031 and OR: 0.82; 95% CI 0.69-0.96; p=0.014, respectively).ConclusionsPositive well-being is predictive of lower pain severity both among participants without and with CP at baseline, whereas life satisfaction was found predictive of lower pain severity only for subjects with CP. Future research should emphasize implementing treatments associated with promoting and maintaining positive well-being and life satisfaction in patients who suffer from chronic pain and in risk populations.

  • 128.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Grimby-Ekman, Anna
    Health Metrics, University of Gothenburg, Gothenburg, Sweden.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Ejork, Jonas
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Predictors of chronic pain intensity, spread, and sensitivity in the general population: A two-year follow-up study from the SWEPAIN cohort2019In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 51, no 3, p. 183-192Article in journal (Refereed)
    Abstract [en]

    Objective: To determine whether the intensity, spread and sensitivity of chronic pain can be predicted using demographic features, socioeconomic conditions and comorbidities.

    Design: A longitudinal study design was employed. Data was collected at baseline and at 2-year follow-up. Setting: General population in south-eastern Sweden.

    Subjects: A representative stratified random sample of 34,000 individuals, between 18 and 85 years of age, selected from a sampling frame of 404,661 individuals based on the Swedish Total Population Register.

    Methods: Eligible individuals were sent postal surveys in 2013 and 2015. The 2 surveys included the same questions about basic demographic data, comorbidities, and chronic pain intensity, spread and sensitivity.

    Results: Several socio-demographic features and comorbidities at baseline were significant predictors of characteristics of pain (intensity, spread and sensitivity) at the 2-year follow-up. When characteristics of pain at baseline were included in the regression analyses they were relatively strong significant predictors of characteristics of pain after 2 years. After this adjustment there were fewer socio-demographic and comorbidity predictors; the effect estimates for those significant predictors had decreased.

    Conclusion: Clinical assessment should focus on several characteristics of pain and include a broad medical screening to capture the overall burden of pain in adults from a longitudinal perspective.

  • 129.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gard, Gunvor
    Lund University, Sweden.
    Karlsson, Linn
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Persson, Ann L.
    DIGNITY Danish Institute Torture, Denmark.
    Patient expectations for a multimodal pain rehabilitation programme: active participation and coping skills. A qualitative study2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 20-21, p. 2135-2143Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe what patients with chronic pain expect from a multimodal pain rehabilitation programme. Material and method: Qualitative interviews were used to uncover expectations about a multimodal rehabilitation programme offered at the Pain and Rehabilitations Centre, The University Hospital; Linkoping, Sweden. Sixteen women and two men (mean age 37 years; standard deviation 10 years) with chronic benign pain participated. The interviews were analysed using qualitative content analyses. Results: To participate actively in the multimodal pain rehabilitation programme and to learn adequate coping strategies to improve daily life emerged as a main category. It was based on the following four categories comprising expectations about: participating actively in the programme, interacting with the professionals and fellow patients, cognitive effects of the programme and tools for coping, and explicit effects from the programme. Conclusions: Many patients expressed expectations which may reflect that the information before the programme had started rehabilitation process at the time point for this study. The results could be applied in rehabilitation programmes by acknowledging expectations to interact with professional team members and fellow patients, by early addressing of positive and negative expectations about the future pain and by incorporating and strengthen expectations of learning to cope with pain.

  • 130.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Distinctive subgroups derived by cluster analysis based on pain and psychological symptoms in Swedish older adults with chronic pain - a population study (PainS65+)2017In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, article id 200Article in journal (Refereed)
    Abstract [en]

    Background: Improved knowledge based on clinical features of chronic pain in older adults would be valuable in terms of patient-orientated approaches and would provide support for health care systems in optimizing health care resources. This study identifies subgroups based on pain and psychological symptoms among Swedish older adults in the general population and compares derived subgroups with respect to socio-demographics, health aspects, and health care costs. Methods: This cross-sectional study uses data collected from four registers and one survey. The total sample comprised 2415 individuals amp;gt;= 65 years old. A two-step cluster analysis was performed. Data on pain intensity, number of pain sites, anxiety, depression, and pain catastrophizing were used as classification variables. Differences in socio-demographics, quality of life, general health, insomnia, and health care costs among the clusters were investigated. Association of the clusters with the above parameters was further evaluated using multinomial logistic regression. Results: Four major clusters were identified: Subgroup 1 (n = 325; 15%) - moderate pain and high psychological symptoms; Subgroup 2 (n = 516; 22%) - high pain and moderate psychological symptoms; Subgroup 3 (n = 686; 30%) - low pain and moderate psychological symptoms; and Subgroup 4 (n = 767; 33%) - low pain and low psychological symptoms. Significant differences were found between the four clusters with regard to age, sex, educational level, family status, quality of life, general health, insomnia, and health care costs. The multinomial logistic regression analysis revealed that Subgroups 1 and 2, compared to Subgroup 4, were significantly associated with decreased quality of life, decreased general health, and increased insomnia. Subgroup 3, compared to Subgroup 4, was associated with decreased general health and increased insomnia. In addition, compared to Subgroup 4, Subgroups 1 and 2 were significantly associated with higher health care costs. Conclusions: Two high risk clusters of older adults suffering from chronic pain; one mainly based on psychological symptoms and one mainly on pain intensity and pain spread, associated with decreased quality of life and health and increased health care costs were identified. Our findings indicate that subgroup-specific treatment will improve pain management and reduce health care costs.

  • 131.
    Larsson, Britt
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Björk, Jonas
    Lund University, Sweden.
    Grimby-Ekman, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. University of Gothenburg, Sweden.
    Pain Sensitivity and its Relation to Spreading on the Body, Intensity, Frequency, and Duration of Pain A Cross-Sectional Population-based Study (SwePain)2017In: The Clinical Journal of Pain, ISSN 0749-8047, E-ISSN 1536-5409, Vol. 33, no 7, p. 579-587Article in journal (Refereed)
    Abstract [en]

    Objectives:Individuals with chronic pain often report increased pain sensitivity compared with pain-free individuals; hence, it is crucial to determine whether and how different pain characteristics influence or interact with pain sensitivity. An alternative to experimental pain sensitivity testing is the self-reported pain sensitivity questionnaire (PSQ), which captures pain sensitivity in various body areas.This study compares PSQ in individuals with and without pain and clarifies how pain sensitivity relates to spreading of pain on the body, and to intensity, frequency, duration of pain and to age and sex.Materials and Methods:A total of 5905 individuals with pain and 572 individuals without pain from the general population in southeastern Sweden completed and returned a postal questionnaire.Results:The mean PSQ score was 3.9 (95% confidence interval [CI], 3.88-3.98) in individuals with pain and 3.5 (95% CI, 3.38-3.64) in pain-free individuals. Hence, PSQ was the highest among individuals with pain, with a difference of 0.4 (95% CI, 0.30-0.56). There was a considerable variation in the PSQ values (mean=3.5; SD=1.54) among pain-free individuals. Pain sensitivity was positively related to spreading, intensity, and frequency of pain, with a correlation coefficient of 0.3. PSQ was higher in widespread pain, 4.5 (95% CI, 4.27-4.69) in women and 4.3 (95% CI, 3.94-4.71) in men, than in local pain, 3.7 (95% CI, 3.61-3.91) in women and 3.8 (95% CI, 3.66-3.95) in men. The score for women with regional pain was between local and widespread pain at 4.0 (95% CI, 3.95-4.11) and that for men with regional pain was 3.8 (95% CI, 3.69-3.87), which is equal to that of local pain.Discussion:The positive association between pain sensitivity and spreading of pain on the body provides some evidence that the extent of spreading may be related to the degree of pain sensitivity. Before clinical use of PSQ, psychometric development and further research are needed.

  • 132.
    Lee, Elinda Ai Lim
    et al.
    Curtin Univ Technol, Australia; Curtin Univ, Australia.
    Black, Melissa H.
    Curtin Univ Technol, Australia; Curtin Univ, Australia.
    Tan, Tele
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ Technol, Australia; Curtin Univ, Australia.
    Girdler, Sonya
    Curtin Univ Technol, Australia; Curtin Univ, Australia.
    Im Destined to Ace This2019In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 49, no 8, p. 3089-3101Article in journal (Refereed)
    Abstract [en]

    As postsecondary outcomes of adolescents with Autism Spectrum Disorder (ASD) are poor, there is a need for programs that aim to improve employment and education outcomes. This study employed a grounded theory approach to explore the key factors contributing to successful work placement experience and the perceived benefits of these placements from the perspective of adolescents with ASD (n=5), their parents (n=6) and employers (n=6). Key factors contributing to success include preparing for the workplace, harnessing strengths and interests and developing work related skills, while the benefits include insight into the workplace, recognising and realising potential, working as a team and the pathway ahead. The findings articulate a framework which could underpin future transition interventions for adolescents with ASD.

  • 133.
    Lemming, Dag
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Multimodal Rehabilitation Programs (MMRP) for patients with longstanding complex pain conditions – The need for quality control with follow-up studies of patient outcomes2016In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 10, p. 104-105Article in journal (Refereed)
  • 134.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Single-point but not tonic cuff pressure pain sensitivity is associated with level of physical fitness: a study of non-athletic healthy subjects2015Data set
    Abstract [en]

    Exercise is often used for pain rehabilitation but the link between physical activity level and pain sensitivity is still not fully understood. Pressure pain sensitivity to cuff algometry and conditioned pain modulation (CPM) were evaluated in highly active men (n=22), normally active men (n=26), highly active women (n=27) and normally active women (n=23) based on the Godin Leisure-Time Exercise Questionnaire. Cuff pressure pain sensitivity was assessed at the arm and lower leg. The subjects scored the pain intensity on an electronic Visual Analogue Scale (VAS) during ten minutes with 25 kPa constant cuff pressure and two minutes with zero pressure. The maximal VAS score and area under the VAS-curve were extracted. Pressure pain thresholds (PPT) were recorded by manual pressure algometry on the ipsilateral tibialis anterior muscle before, during and after the tonic arm stimulation.

    Tonic cuff stimulation of the arm and leg resulted in higher VAS peak scores in women compared with men (p<0.04). In all groups the PPTs were reduced during and after the cuff stimulation compared with baseline (p=0.001). PPT were higher in men compared with women (p=0.03) and higher in highly physical active compared with normal active (p=0.048). 

    Besides the well-known gender difference in pressure pain sensitivity this study demonstrates  that a high physical fitness degree in non-athletic subjects is associated with increased pressure pain thresholds but does not affect cuff pressure pain sensitivity in healthy people.

  • 135.
    Lemming, Dag
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Börsbo, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Sjörs, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Lind, Eva-Britt
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Arendt-Nielsen, Lars
    Laboratory for Experimental Pain Research and Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
    Graven-Nielsen, Thomas
    Center for Neuroplasticity and Pain, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects2017In: Pain medicine (Malden, Mass.), ISSN 1526-2375, E-ISSN 1526-4637, Vol. 18, no 8, p. 1573-1581Article in journal (Refereed)
    Abstract [en]

    Purpose. The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated.

    Method. Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated.

    Result. Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm (P = 0.002), PTTs were lower in the arm and leg (P < 0.001), and the VAS-PTT was higher in the arm and leg (P < 0.033). Highly active participants compared with less active had higher PDT (P = 0.027) in the leg. Women showed facilitated spatial summation (P < 0.014) in the arm and leg and a steeper VAS slope (i.e., the slope of the VAS pressure curve between PDT and PPT) in the arm and leg (P < 0.003).

    Conclusion. This study indicates that reduced pressure pain sensitivity is associated both with male sex and physical activity level.

  • 136.
    Levin, Britta
    et al.
    Totalförsvarets forskningsinstitut, FOI, Stockholm.
    Tribukait, Arne
    Omgivningsfysiologi, Kungl. Teknsika Högskolan, Stockholm.
    Lemming, Dag
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Eiken, Ola
    Omgivningsfysiologi, Kungl. Teknsika Högskolan, Stockholm.
    Utvärdering av utbildning i spatial desorientering; redovisning av frågeformulär2011Report (Other academic)
    Abstract [en]

    A combined introductory training course in spatial disorientation (SD) and flight with night vision goggles (NVG) is provided by AMST Systemtechnik GmbH, on-site in the Ranshofen facility in Austria. This course was subject to an extensive evaluation in conjunction with the participation of two groups of Swedish pilots in the fall of 2010. The part of the evaluation included in this report concerns the students' own opinions and is based on open and rating questions together with additional free comments. The students believed that it is important to perform both basic and recurrent SDtraining. In general, SD-theory was much appreciated and they requested a more comprehensive theoretical education than previously received. The students also stated that the training at AMST in an efficient manner increases ones understanding of illusions, gives an increased ability to recognize an illusion, and to overcome an illusion should it occur. Regarding the night vision (NV) part the students claimed that the training efficiently increases ones understanding of NVrelated problems associated with night vision goggles (NVG), gives an increased ability to recognize NV-related phenomena, and enhances ones preparedness for flight using NVG. The students stressed that the course to a larger extent should have been coordinated with their previous or currently planned SD/NV training both regarding timeframe and content. In cases when a student already on a previous occasion had experienced a given illusion or NV-phenomenon, the present training was considered a valuable addition and a rehearsal. The students regarded the training as partially inefficient and had expected more theory and time spent in the simulator. A large number of students in combination with limited access to simulator equipment led to substantial delay between missions. The students believed that their SD-training could be improved and proposed a number of ideas for development.

  • 137.
    Lih Lee, Wee
    et al.
    Curtin University, Australia.
    Tan, Tele
    Curtin University, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia.
    Hong Leung, Yee
    Curtin University, Australia.
    Single-trial event-related potential extraction through one-unit ICA-with-reference2016In: Journal of Neural Engineering, ISSN 1741-2560, E-ISSN 1741-2552, Vol. 13, no 6, article id 066010Article in journal (Refereed)
    Abstract [en]

    Objective. In recent years, ICA has been one of the more popular methods for extracting event-related potential (ERP) at the single-trial level. It is a blind source separation technique that allows the extraction of an ERP without making strong assumptions on the temporal and spatial characteristics of an ERP. However, the problem with traditional ICA is that the extraction is not direct and is time-consuming due to the need for source selection processing. In this paper, the application of an one-unit ICA-with-Reference (ICA-R), a constrained ICA method, is proposed. Approach. In cases where the time-region of the desired ERP is known a priori, this time information is utilized to generate a reference signal, which is then used for guiding the one-unit ICA-R to extract the source signal of the desired ERP directly. Main results. Our results showed that, as compared to traditional ICA, ICA-R is a more effective method for analysing ERP because it avoids manual source selection and it requires less computation thus resulting in faster ERP extraction. Significance. In addition to that, since the method is automated, it reduces the risks of any subjective bias in the ERP analysis. It is also a potential tool for extracting the ERP in online application.

  • 138.
    Lim, Yi Huey
    et al.
    Curtin Univ, Australia.
    Lee, Hoe C.
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia.
    Allison, Garry T.
    Curtin Univ, Australia.
    Tan, Tele
    Curtin Univ, Australia.
    Lee, Wee Lih
    Curtin Univ, Australia.
    Morris, Susan L.
    Curtin Univ, Australia.
    Effect of Optic Flow on Postural Control in Children and Adults with Autism Spectrum Disorder2018In: Neuroscience, ISSN 0306-4522, E-ISSN 1873-7544, Vol. 393, p. 138-149Article in journal (Refereed)
    Abstract [en]

    Individuals with autism spectrum disorder (ASD) have been associated with sensorimotor difficulties, commonly presented by poor postural control. Postural control is necessary for all motor behaviors. However, findings concerning the effect of visual motion on postural control and the age progression of postural control in individuals with ASD are inconsistent. The aims of the present study were to examine postural responses to optic flow in children and adults with and without ASD, postural responses to optic flow in the central and peripheral visual fields, and the changes in postural responses between the child and adult groups. Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD were assessed on quiet standing for 60 seconds under conditions of varying optic flow illusions, consisting of different combinations of optic flow directions and visual field display. The results showed that postural responses to most optic flow conditions were comparable between children with and without ASD and between adults with and without ASD. However, adults with ASD appeared more responsive to forward-moving optic flow in the peripheral visual field compared with typically developed adults. The findings suggest that children and adults with ASD may not display maladaptive postural responses all the time. In addition, adults in the ASD group may have difficulties prioritizing visual information in the central visual field over visual information in the peripheral visual field when in unfamiliar environments, which may have implications in understanding their motor behaviors in new surroundings. (C) 2018 IBRO. Published by Elsevier Ltd. All rights reserved.

  • 139.
    Lim, Yi Huey
    et al.
    Curtin Univ, Australia.
    Lee, Hoe C.
    Curtin Univ, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin Univ, Australia.
    Allison, Garry T.
    Curtin Univ, Australia.
    Tan, Tele
    Curtin Univ, Australia.
    Lee, Wee Lih
    Curtin Univ, Australia.
    Morris, Susan L.
    Curtin Univ, Australia.
    Postural control adaptation to optic flow in children and adults with autism spectrum disorder2019In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 72, p. 175-181Article in journal (Refereed)
    Abstract [en]

    Background: Sensory reweighting is important for humans to flexibly up-weigh and down-weigh sensory information in dynamic environments. There is an element of time involved in the sensory reweighting process. A longer time spent on sensory reweighting may increase the destabilizing effect of postural control. Individuals with autism spectrum disorder (ASD) are reported to have poor postural control. It is uncertain if a different sensory reweighting process underlies the postural control deficit in children and adults with ASD. Research question: To explore the sensory reweighting capability in ASD, the present study examined whether the temporal domains of postural control differed in children and adults, with and without ASD under various optic flow conditions. Methods: Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD underwent quiet standing in six radial optic flow conditions. Each condition lasted for 60 s and was shown twice to all participants. For each optic flow condition, changes in postural response within-trial and between-trials were measured. Results: Under various optic flow illusions, both children with and without ASD took a longer time to restore their posture compared with adults with and without ASD. Nonetheless, all groups demonstrated comparable abilities to adjust their posture to one that is close to the baseline position after one exposure to the optic flow stimulation. Significance: The present study showed that the temporal domains of postural control under different optic flow conditions were similar between individuals with and without ASD from the same age group. The ability to down-weigh visual information efficiently comes with the developmental progression of the sensory reweighting system. These findings suggest that the sensory reweighting process does not elucidate the postural control deficits in individuals with ASD and thus alternative explanations to determine the underlying mechanism for postural instability are needed.

  • 140.
    Lindbäck, Yvonne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, 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 Spinal Surgery.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Bond University, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Altered somatosensory profile according to quantitative sensory testing in patients with degenerative lumbar spine disorders scheduled for surgery2017In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 18, article id 264Article in journal (Refereed)
    Abstract [en]

    Background: Somatosensory profiling in affected and non-affected body regions can strengthen our insight regarding the underlying pain mechanisms, which can be valuable in treatment decision making and to improve outcomes, in patients with degenerative lumbar spine disorders pre-surgery. The aim was to describe somatosensory profiles in patients with degenerative lumbar spine disorders, to identify the proportion with altered somatosensory profile, and to analyze demographic characteristics, self-reported function, pain, and health pre- and 3 months post-surgery. Methods: In this prospective cohort study in a Spine Clinic, 105 patients scheduled for surgery for spinal stenosis, disc herniation, degenerative disc disease, or spondylolisthesis were consecutively recruited. Exclusion criteria were; indication for acute surgery or previous surgery at the same spinal level or severe grade of pathology. Quantitative sensory testing (QST) and self-reported function, pain, and health was measured pre- and 3 months post-surgery. The somatosensory profile included cold detection threshold, warmth detection threshold, cold pain threshold, heat pain threshold and pressure pain threshold in affected and non-affected body regions. Results: On a group level, the patients somatosensory profiles were within the 95% confidence interval (CI) from normative reference data means. On an individual level, an altered somatosensory profile was defined as having two or more body regions (including a non-affected region) with QST values outside of normal ranges for reference data. The 23 patients (22%) with altered somatosensory profiles, with mostly loss of function, were older (P = 0.031), more often female (P = 0.005), had higher back and leg pain (P = 0.016, 0.020), lower mental health component summary score (SF 36 MCS) (P = 0.004) and larger pain distribution (P = 0.047), compared to others in the cohort. Post-surgery there was a tendency to worse pain, function and health in the group with altered somatosensory profile pre-surgery. Conclusions: On a group level, patients with degenerative lumbar spine disorders scheduled for surgery were within normal range for the QST measurements compared to reference values. On an individual level, an altered somatosensory profile outside of normal range in both affected and non-affected body regions occurred in 22% of patients, which may indicate disturbed somatosensory function. Those patients had mostly loss of sensory function and had worse self-reported outcome pre-surgery, compared to the rest of the cohort. Future prospective studies are needed to further examine whether these dimensions can be useful in predicting post-surgery outcome and guide need of additional treatments.

  • 141.
    Lindbäck, Yvonne
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, 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 Spinal Surgery.
    Enthoven, Paul
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Abbott, Allan
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.
    Öberg, Birgitta
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Association between pain sensitivity in the hand and outcomes after surgery in patients with lumbar disc herniation or spinal stenosis.2017In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 26, no 10, p. 2581-2588Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate the association between pain sensitivity in the hand pre-surgery, and patient-reported outcomes (PROs) in function, pain and health pre- and post-surgery in patients with disc herniation or spinal stenosis.

    METHODS: This is a prospective cohort study with 82 patients. Associations between pressure-, cold- and heat pain threshold (PPT, CPT, HPT) in the hand pre-surgery and Oswestry, VAS pain, EQ-5D, HADS, and Self-Efficacy Scale, pre- and three months post-surgery; were investigated with linear regression.

    RESULTS: Patients with disc herniation more sensitive to pressure pain pre-surgery showed lower function and self-efficacy, and higher anxiety and depression pre-surgery, and lower function, and self-efficacy, and higher pain post-surgery. Results for cold pain were similar. In patients with spinal stenosis few associations with PROs were found and none for HPT and PROs.

    CONCLUSIONS: Altered pain response in pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery had associations with higher pain, lower function and self-efficacy post-surgery in patients with disc herniation.

  • 142.
    Lindström, Pål
    et al.
    Susano Rehab AB, Malmö, Sweden.
    Lemming, Dag
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Lantz Lenander, Eva
    Susano Rehab AB, Malmö, Sweden.
    Jönsson, Rolf
    Apport Rehab, Kristianstad, Sweden.
    Sverige behöver riktlinjer för oberoende medicinska utredningar [Sweden needs guidelines for independent medical evaluations]2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DHRZArticle in journal (Other academic)
    Abstract [sv]

    En oberoende medicinsk utredning kräver ett tydligt etiskt ställningstagande från utövaren, anser Pål Lindström och medförfattare. De föreslår tydliga etiska riktlinjer baserade på internationell standard, anpassade för svenska förhållanden.

  • 143.
    Ljunggren, Stefan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Bengtsson, Torbjorn
    Orebro Univ, Sweden.
    Karlsson, Helen
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Region Östergötland, Heart and Medicine Center, Occupational and Environmental Medicine Center. Linköping University, Faculty of Medicine and Health Sciences.
    Starkhammar Johansson, Carin
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Public Dental Health Care.
    Palm, Eleonor
    Orebro Univ, Sweden.
    Nayeri, Fariba
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Davies, Julia
    Malmo Univ, Sweden.
    Svensater, Gunnel
    Malmo Univ, Sweden.
    Lönn, Johanna
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences. Orebro Univ, Sweden; Malmo Univ, Sweden.
    Modified lipoproteins in periodontitis: a link to cardiovascular disease?2019In: Bioscience Reports, ISSN 0144-8463, E-ISSN 1573-4935, Vol. 39, no 3, article id BSR20181665Article in journal (Refereed)
    Abstract [en]

    There is a strong association between periodontal disease and atherosclerotic cardiovascular disorders. A key event in the development of atherosclerosis is accumulation of modified lipoproteins within the arterial wall. We hypothesise that patients with periodontitis have an altered lipoprotein profile towards an atherogenic form. Therefore, the present study aims at identifying modifications of plasma lipoproteins in periodontitis. Lipoproteins from ten female patients with periodontitis and gender- and age-matched healthy controls were isolated by density-gradient ultracentrifugation. Proteins were separated by 2D gel-electrophoresis and identified by map-matching or by nano-LC followed by MS. Apolipoprotein (Apo) A-I (ApoA-I) methionine oxidation, Oxyblot, total antioxidant capacity and a multiplex of 71 inflammation-related plasma proteins were assessed. Reduced levels of apoJ, phospholipid transfer protein, apoF, complement C3, paraoxonase 3 and increased levels of alpha-1-antichymotrypsin, apoA-II, apoC-III were found in high-density lipoprotein (HDL) from the patients. In low-density lipoprotein (LDL)/very LDL (VLDL), the levels of apoL-1 and platelet-activating factor acetylhydrolase (PAF-AH) as well as apo-B fragments were increased. Methionine oxidation of apoA-I was increased in HDL and showed a relationship with periodontal parameters. alpha-1 antitrypsin and alpha-2-HS glycoprotein were oxidised in LDL/VLDL and antioxidant capacity was increased in the patient group. A total of 17 inflammation-related proteins were important for group separation with the highest discriminating proteins identified as IL-21, Fractalkine, IL-17F, IL-7, IL-1RA and IL-2. Patients with periodontitis have an altered plasma lipoprotein profile, defined by altered protein levels as well as post-translational and other structural modifications towards an atherogenic form, which supports a role of modified plasma lipoproteins as central in the link between periodontal and cardiovascular disease (CVD).

  • 144.
    Lundberg, Gunnar
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Musculoskeletal signs in female homecare personnel: A longitudinal epidemiological study2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 58, no 2, p. 135-147Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden, homecare services take care of elderly and disabled people, work that often requires heavy lifting and forward bending, resulting in high prevalences of pain and work accidents. OBJECTIVE: Using an eight-year follow-up, this study determines the prognostic importance of certain musculoskeletal signs reported in earlier studies [1, 2] with respect to aspects of pain and perceived disability. METHODS: Baseline data has been reported in earlier studies of 607 women [1-3]. This study uses a postal questionnaire survey and reports the results of eight years post initial study. RESULTS: Segmental pain at L4-L5 and/or L5-S1 levels was associated with higher low back pain intensity and disability at the eight-year follow-up. A decrease in low back pain intensity over eight years was larger for those with segmental pain. The important signs in the longitudinal analyses of pain aspects and disability were lumbar spinal mobility and segmental pain at L4-L5 and L5-S1 levels, but the explained variations were low. CONCLUSION: Evaluation of low lumbar segmental pain provocation and mobility should be considered in routine clinical assessments, as this type of evaluation provides prognostic pain and disability information over time.

  • 145.
    Lundberg, Gunnar
    et al.
    Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    The relationships between pain, disability, and health-related quality of life: an 8-year follow-up study of female home care personnel2016In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 3, p. 235-244Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the development of pain conditions, disability, and health-related quality of life over an 8-year period in home care personnel. Method: In earlier studies of 607 women, we reported baseline data concerning home care personnel. This study reports the results from an 8-year follow-up using a postal questionnaire. Results: The questionnaire was completed by 87%. Prevalences of pain in upper back, lower back, and knees as well as pain intensity of the low back had decreased. Participants with the highest pain intensities of the low back at baseline had relatively lower pain intensities at follow-up. Anatomical spreading of pain was associated with higher average pain intensity. Disability had increased significantly during the time period. In the regression of disability at follow-up, average pain intensity together with disability rating index at baseline were the most important regressors; a similar pattern was found for quality of life. Conclusions: The development of disability differed from that of low-back pain intensity. Spreading of pain and pain intensity across the anatomical regions influenced disability and quality of life over 8 years. When assessing pain, it seems important to determine the spread of pain rather than just focusing on the area with intense pain.Implications for RehabilitationSpreading of pain and the average intensity of pain across the involved anatomical regions have importance for future pain and disability and quality of life.The clinical assessment of subjects with chronic pain prior to rehabilitation interventions has to determine the spreading of pain rather than just focusing on the area with the most intense pain.The different developments over time for pain intensity and disability indicate the need for applying a bio-psycho-social view of pain both when assessing the patient with pain and when discussing the prognosis and course of the actual pain condition with the patient.

  • 146.
    Lundberg, Peter
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Radiation Physics. Linköping University, Faculty of Medicine and Health Sciences.
    Engström, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Medicine and Health Sciences.
    van Ettinger-Veenstra, Helene
    Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Pain disrupts thalamic and nucleus accumbens functional connectivity in chronic widespread pain2016Conference paper (Refereed)
  • 147.
    Marcusson, Jan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Nord, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Johansson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Activity and Health.
    Alwin, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Dannapfel, Petra
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Thomas, Kristin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Poksinska, Bozena
    Linköping University, Department of Management and Engineering, Logistics & Quality Management. Linköping University, Faculty of Science & Engineering.
    Sverker, Annette
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Olaison, Anna
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Cedersund, Elisabet
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Kelfve, Susanne
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Motel-Klingebiel, Andreas
    Linköping University, Department of Social and Welfare Studies, Division Ageing and Social Change. Linköping University, Faculty of Arts and Sciences.
    Hellstrom, Ingrid
    Norrkoping Univ, Sweden.
    Kullberg, Agneta
    Linköping University, Department of Social and Welfare Studies, Social Work. Linköping University, Faculty of Arts and Sciences.
    Böttiger, Ylva
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology.
    Dong, Huan-Ji
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Peolsson, Anneli
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Wass, Malin
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Lyth, Johan
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Regional Board, Research and Development Unit.
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e027847Article in journal (Refereed)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

    Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

    Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 148.
    Maroti, Daniel
    et al.
    Karolinska Institute, Sweden; Danderyd Hospital, Sweden.
    Molander, Peter
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Bileviciute-Ljungar, Indre
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Department of Clinical Sciences, Karolinska Institutet and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden.
    Differences in alexithymia and emotional awareness in exhaustion syndrome and chronic fatigue syndrome2017In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 58, no 1, p. 52-61Article in journal (Refereed)
    Abstract [en]

    Symptoms of Exhaustion Syndrome (ES) and Chronic Fatigue Syndrome (CFS) are overlapping and create difficulties of differential diagnosis. Empirical studies comparing ES and CFS are scarce. This study aims to investigate if there are any emotional differences between ES and CFS. This cross-sectional study compared self-reported alexithymia and observer-rated emotional awareness in patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30). Self-reported alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20) and emotional awareness with an observer-rated performance test, the Level of Emotional Awareness Scale (LEAS). Additionally, depression and anxiety were scored by the Hospital Anxiety and Depression Scale (HADS). Results show that patients with ES expressed higher self-reported alexithymia in the TAS-20 compared to HC, but had similar emotional awareness capacity in the observer-rated performance test, the LEAS. Patients with CFS expressed more difficulties in identifying emotions compared to HCs, and performed significantly worse in the LEAS-total and spent more time completing the LEAS as compared to HC. Correlation and multiple regressions analyses revealed that depression and anxiety positively correlated with and explained part of the variances in alexithymia scores, while age and group explained the major part of the variance in LEAS. Findings of this study indicate that emotional status is different in patients with ES and CFS with respect to both self-reported alexithymia and observer-rated emotional awareness. Emotional parameters should be approached both in clinical investigation and psychotherapy for patients with ES and CFS.

  • 149.
    Mayo, Leah M.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Asratian, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Lindé, Johan
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Holm, Lovisa
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Nätt, Daniel
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Augier, Gaëlle
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Stensson, Niclas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Vecchiarelli, Haley A.
    Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Departments of Cell Biology and Anatomy and Psychiatry, University of Calgary, Canada.
    Balsevich, Georgia
    Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Departments of Cell Biology and Anatomy and Psychiatry, University of Calgary, Canada.
    Aukema, Robert J.
    Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Departments of Cell Biology and Anatomy and Psychiatry, University of Calgary, Canada.
    Ghafouri, Bijar
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Spagnolo, Primavera A.
    National Institute on Alcohol Abuse and Alcoholism and National Institute of Neurological Disorders and Stroke, NIH, Bethesda, USA.
    Lee, Francis S.
    Institute for Developmental Psychobiology, Weill Cornell Medical College of Cornell University, New York, USA.
    Hill, Matthew N.
    Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education, Departments of Cell Biology and Anatomy and Psychiatry, University of Calgary, Canada.
    Heilig, Markus
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Protective effects of elevated anandamide on stress and fear-related behaviors: translational evidence from humans and mice2018In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578Article in journal (Refereed)
    Abstract [en]

    Post-traumatic stress disorder (PTSD) is a common, debilitating condition with limited treatment options. Extinction of fear memories through prolonged exposure therapy, the primary evidence-based behavioral treatment for PTSD, has only partial efficacy. In mice, pharmacological inhibition of fatty acid amide hydrolase (FAAH) produces elevated levels of anandamide (AEA) and promotes fear extinction, suggesting that FAAH inhibitors may aid fear extinction-based treatments. A human FAAH 385C-greater thanA substitution encodes an FAAH enzyme with reduced catabolic efficacy. Individuals homozygous for the FAAH 385A allele may therefore offer a genetic model to evaluate the impact of elevations in AEA signaling in humans, helping to inform whether FAAH inhibitors have the potential to facilitate fear extinction therapy for PTSD. To overcome the challenge posed by low frequency of the AA genotype (appr. 5%), we prospectively genotyped 423 individuals to examine the balanced groups of CC, AC, and AA individuals (n = 25/group). Consistent with its loss-of-function nature, the A allele was dose dependently associated with elevated basal AEA levels, facilitated fear extinction, and enhanced the extinction recall. Moreover, the A-allele homozygotes were protected against stress-induced decreases in AEA and negative emotional consequences of stress. In a humanized mouse model, AA homozygous mice were similarly protected against stress-induced decreases in AEA, both in the periphery, and also in the amygdala and prefrontal cortex, brain structures critically involved in fear extinction and regulation of stress responses. Collectively, these data suggest that AEA signaling can temper aspects of the stress response and that FAAH inhibition may aid the treatment for stress-related psychiatric disorders, such as PTSD.

  • 150.
    McAuliffe, Tomomi
    et al.
    Curtin University, Australia.
    Cordier, Reinie
    Curtin University, Australia.
    Vaz, Sharmila
    Curtin University, Australia.
    Thomas, Yvonne
    University of Worcester, England.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Curtin University, Australia; La Trobe University, Australia; Cooperat Research Centre Living Autism Spectrum Disorders, Australia.
    Quality of Life, Coping Styles, Stress Levels, and Time Use in Mothers of Children with Autism Spectrum Disorders: Comparing Single Versus Coupled Households2017In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 47, no 10, p. 3189-3203Article in journal (Refereed)
    Abstract [en]

    This study aimed to examine the influence of differences in household status on the parental stress, coping, time use and quality of life (QoL) among mothers of children with autism spectrum disorders. Forty-three single and 164 coupled mothers completed the survey. Data were analysed using multivariate logistic regression. We found that single mothers were 1.05 times more likely to report lower levels of environmental QoL. Whilst they were 1.73 times more likely to use acceptance coping style, this association did not persist after adjusting for total number of children, household income and employment status. There was no difference in time use and stress between these mothers. Possible environmental issues for single mothers and implications for future research are discussed.

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