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1521.
  • Öhman, Ann, 1954- (författare)
  • Profession on the move Changing conditions and gendered development in physiotherapy
  • 2001
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Physiotherapy in Sweden has developed from a practical, hands-on, assistant job predominantly taught at college level to a university-based academic discipline emphasising evidence-based practice and research. Women are in majority although an increasing number of men have entered the profession. Women and men physiotherapists tend to undertake different career paths. The overall aim of the present thesis was to use a gender perspective to describe and analyse attitudes to the professional role, health care work and the development of the profession among actors engaged in physiotherapy education.A questionnaire was distributed in 1997 to all Swedish physiotherapy students in the second semester of the education (n=273). The same cohort was investigated in 1999 at the completion of the education. The response rate was 93 percent at both occasions. For an international comparison, the same questionnaire was distributed in 1997 and in 1999 to a group of Canadian physiotherapy students in their first and last semesters (n=60). Qualitative research interviews were conducted with 8 novices in physiotherapy and with 14 women educators in academia. Five focus group discussions with clinical supervisors were conducted (10 women and 5 men). Methods used were Grounded theory, factor analysis, logistic regression and path analysis. Feminist theories and Bourdieu's theory of culture constituted a theoretical frameworkFour ideal types were identified among the novices representing attitudes to the professional role. The Treater and The Supervisor were attitudes found among the women, whereas The Coach and The Entrepreneur were attitudes among the men. Type of health care facility was important for their positioning in the organisational hierarchy. Swedish students favour future employment in private practice. Sports medicine clinics and fitness centres are health care facilities highly endorsed, as is health promotion. Neither care of elderly nor hospital work are preferable fields of practice. Research is not favoured. Men students are more likely to have chosen the profession because of their interest in physical activity and sports. They are also more likely to prefer owning a private clinic and working with alternative approaches such as fitness training in sports medicine clinics. Women students are more likely to prefer an employment in private practice. The Canadian men students favour private practice whereas the women prefer the public sector of health care. The academic educators experience a gap between theory and practice which causes conflicting messages to students. Competing professions, emergent societal change and a conservative clinical practice constitute threats to the profession. The uniqueness of professional competency, theoretical development and new arenas such as home rehabilitation, consulting and research constitute a vision for future development of the profession. Masculinity is highly valued for status and power whereas femininity symbolises empathy and caring. The clinical supervisors update their theoretical knowledge base through supervision of students, but claim that students lack hands-on skills. Stress at work, unequal power relations in the hierarchy and restructuring of health care are factors that influence work satisfaction negatively. To conclude, gendered habitus, different symbolic capital and different attitudes towards health care work and development of the profession were found in the sub-fields of physiotherapy.
1522.
  • Öman, Mikael, 1956- (författare)
  • Intraperitoneal 5-Fluorouracil treatment of cancer - clinical and experimental studies
  • 2004
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Background:Pancreas cancer is a most aggressive malignancy. More than 80% of patients diagnosed with pancreas cancer, exhibit such advanced disease, that curative surgery is impossible. Systemic chemotherapy prolongs survival to 5-9 months. High concentrations of chemotherapeutic agents in the abdominal cavity and in the lymphatics draining the area is achieved by intraperitoneal administration. Vasopressin decreases splanchnic blood flow, reducing the intraperitoneal uptake of drugs, thus raising the local and lymphatic dose intensity.Aim: The aim of the study was to investigate the feasibility and tumour response of intraperitoneal 5-Fluorouracil (5-FU) treatment in non-resectable pancreas cancer, using vasopressin to improve the pharmacokinetic profile. Further, to study the effect of vasopressin on peritoneal blood flow, altered by intraperitoneal 5-FU or the presence of peritoneal carcinomatosis.Methods: In the animal experiments, the 133Xe-clearance technique and as a comparison Laser doppler flow, were used to identify changes of peritoneal blood flow caused by vasopressin in unmanipulated animals and in animals with peritoneal carcinomatosis or animals given intraperitoneal 5-FU. In the clinical studies, 68 (39 women/29 men) patients, with a non-resectable ductal pancreas cancer and a Karnovsky Index ≥70 were included. Patients were treated with 750-1500 mg/m2 5-FU intraperitoneally through a Port-a-cath and Leucovorin 100 mg/m2 intravenously on two consecutive days every 21 days until progression. Seventeen patients, receiving 750 mg/m2 5-FU, were given concomitant vasopressin 0.1 IU/min during 180 minutes, alternatively day 1 or 2.Results: In the animal experiments, vasopressin 0.07 IU/kg/min significantly reduced the 133Xe-clearance. Intraperitoneal 5-FU decreased the basal peritoneal blood flow and abrogated the vasopressin effect for 1-2 days. The presence of peritoneal carcinomatosis did not influence the basal peritoneal blood flow, nor the reduction of peritoneal blood flow caused by vasopressin. In the clinical studies, the treatment with intraperitoneal 5-FU was well tolerated, with no WHO Grade 3 or 4 toxicity with doses up to 1250 mg/m2. Thirty patients achieved at least stable disease at three months. The median survival time was 8.0 (range 0.8-54.1) months. There was a significant reduction of 5-FU Cmax on day 2, but no significant reduction of AUC, when vasopressin was given.Conclusion: Peritoneal blood flow changes caused by vasopressin can be estimated with the 133Xe-clearance technique. Intraperitoneal 5-FU but not peritoneal carcinomatosis decreases the vasopressin induced 133Xe-clearance reduction, 1-2 days after administration. In patients with non-resectable pancreas cancer, intraperitoneal 5-FU up to 1250 mg/m2 for two days every third week can be given without WHO grade 3 and 4 toxicity. The treatment is well tolerated with few and minor side effects. Tumour responses were observed. Addition of vasopressin does not significantly enhance the pharmacokinetics of intraperitoneal 5-Flurorouracil, but adds toxicity.
1523.
  • Öresland, Stina, 1952- (författare)
  • Nurses go visiting ethics and gender in home-based nursing care
  • 2011
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The overall aim of this thesis is to explore how nursing is constructed in home-based nursing care from the viewpoint of patients and nurses who are receiving or giving care. Since nursing both constructs and is in turn constructed by the context in which it serves, language plays a central part in those constructions and in this thesis. The thesis has been guided by social constructionism, meaning that the positions the patients and the nurses inhabits have been considered as social phenomenon constructed in discursive processes. There are two ideas that guided this thesis. One idea was that home-based nursing care promotes the association of caring abilities in relation to nursing, women and the private sphere. Another idea was that the place where the care was carried out has ethical implications. Data was collected from interviews with 10 home-based nurses (study I) working in community in the western part of Sweden and 10 patients cared for in their home by these nurses (study II). Nurses and patients were interviewed about their experiences of giving respectively receiving home-based nursing care. The interviews were transcribed verbatim and analyzed with a discourse analytic method in study I and II. The findings in study I show that the nurses described their subject positions as "guests" and "professionals" and that they have to make a choice between these positions, as it is impossible to perform both positions at the same time. Dependent on the situation, both an ethics of care and an ethics of justice were applied by the nurses, that is, to perform according to the subject positions of "guest" or "professional." In study II, the patients describe their own subject position as "safeguard" and the nurses‟ positions as "substitutes". These subject positions provided the opportunities, and the obstacles, for the patients‟ possibilities to receive care in their home which included which kind of strategies, habits and activities the patients described and what tasks and how they considered or expected the nurses to perform. These findings are discussed within a theoretical framework, i.e. a gendered dichotomy of the private spheres versus the public spheres. Inherent in this framework is a discussion of the findings related to the habits that are essential in the nurses‟ and the patients‟ constructions of subject positions. In study III, metaphors used by home-based nurses‟ were explored as a means to discover values and norms held by nurses working in home-based nursing care. Ten interviews with nurses working in home-based nursing care (the same interviews as in study I) were analyzed and interpreted with a metaphor analytic method. In the analysis metaphoric linguistic expressions (MLE) were explored and patterns of MLEs formed two entailments. After exploring MLEs and entailments on an explicit surface level the analysis went to a broader underlying dimension of conceptual metaphors identifying the overall metaphor: "Home-based nursing care is an endless journey". The metaphor "Home-based nursing care is an endless journey" exposed home-based nursing care in constant motion, thereby requiring nurses to adjust to circumstances. This adjustment required ethical maturity based on experience, knowledge, and creativity. The study III focuses on the importance of further developing reflections over experiences related to everyday ethical issues. In study IV, the findings from study I were the starting point for a philosophical exploration of the concept "guest" and its relation to other adjacent concepts such as hosts and hospitality. The question to be answered was as follows: In what ways can home-based nurses‟ description of being "guests" in patients‟ home be understood? The exploration was based on Derrida‟s philosophy of unconditional and conditional hospitality, Levinas‟ philosophy of "face" and "the Other" and Arendt‟s philosophy of "go visiting". The findings indicated that the concept "guest" was not appropriate for the nurses to use when describing their position in home-based nursing care, since the concept was problematic for the content and the complexity of home-based nursing care. The findings also showed that exposing concepts as binaries is fruitful since they show relationship between concepts. Just illuminating the concept "guest" did not reveal the power relationship between the "guest" and the "host" and their relationship to hospitality. The distinction between diverse ethical perspectives could be seen as problematic or as an opportunity. According to this study, the nurses used a plurality of different ethical ideas, such as an ethics of care, an ethics of justice, an ethics of virtue and an "everyday ethics." A possible interpretation could be that this was a sign of a difficulty to maintain distinction between ethical theories in clinical practice.  Ethical issues in the private sphere are less commonly explored compared to ethical issues in the public sphere, for example in hospital care. As showed in this thesis, the distinction between the private and the public spheres was problematic. It does not describe two spatially separate spheres, but rather it describes functionally dependent activities, interests and relations, such as diverse areas of ethical ideas and "feminine" and "masculine" positions. Home-based nursing care is a complex area and discourse analysis of the relation between home-based nursing care, subject positions, ethics and gender is more or less lacking. Exploring home-based nursing care outgoing from discourse analytic perspectives and methods is rewarding for nurses‟ practice, education and research as it opens up new perspectives of home-based nursing care.
1524.
  • Öster, Inger, 1949- (författare)
  • Bildterapi vid bröstcancer Kvinnors berättelser i ord och bild
  • 2007
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • The overall aims of this thesis are to describe women’s experiences of breast cancer from a gender perspective, describe women’s experiences of an art therapy intervention and the effects of an art therapy intervention on self-rated coping resources and quality of life. The thesis presents results from a study with 42 women with primary breast cancer without distance metastasis who participated in a randomized intervention study with art therapy carried out between 2001 and 2004. All women were recruited as they were referred to the Department of Oncology at Umeå University Hospital in northern Sweden for postoperative radiotherapy. They were randomized to an intervention group (n = 20) with individual art therapy for 1 hour/week during postoperative radiotherapy, or to a control group (n = 22). The women were between 37–69 years old and had a range of educational and socioeconomic backgrounds. All 42 women completed questionnaires in connection with three interview occasions during six months: at baseline (start of radiotherapy), two and six months later. The questionnaires assessed coping resources, quality of life, symptoms, and self-image. In addition, all women were interviewed about their experiences, and were asked to write a weekly diary about their experiences of breast cancer during the six months of participation. All women signed a written consent form in which they were assured voluntariness and that ending their participation would not affect the care or medical treatment in any way. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). In this thesis, part of results from the study is reported.The results presented in the first study show an overall increase in coping resources as measured by the Coping Resources Inventory (CRI) among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study group and the control group in the total score on the second occasion and in the social domain on the second and third occasions.The second study reports results of the art therapy intervention, with regard to quality of life aspects as measured by the instruments WHOQOL-BREF and EORTC QLQ-BR23, at baseline (start of radiotherapy) and two and six months later. Significant increases in total health, total quality of life, physical health and psychological health were found in the art therapy group compared to the control group. A significant positive difference was also found within the intervention group, concerning future perspectives, body image and systemic therapy side effects.The third study builds on previous quantitative results, drawing on gender theories and, taking a discursive approach in analyzing the women’s use of interpretative repertoires in diaries and interviews. The results show a connection between participation in art therapy, talking about protecting one’s own boundaries, and scoring higher on the CRI compared to the control group. A connection between the control group, repertoire conflicts, and lower scores on the CRI was also found.The fourth study presents further knowledge about women’s trajectories, in art therapy, towards helpful management of restraining boundaries. We were inspired by discursive psychology and the analytic concept of subject position. The result shows that art therapy helped women to get access to subject positions that enabled them to protect and strengthen their boundaries and put forward their own needs.Taken together, the results from all four studies support art therapy as a valuable complement in oncology care and rehabilitation of women with primary breast cancer in similar contexts.
1525.
  • Österlind, Per Olov, 1947- (författare)
  • Medical and social conditions in the elderly gender and age differences the Umeå longitudinal study
  • 1993
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • In 1981, no representative study of the medical and social conditions among elderly persons in northern Scandinavia was performed. Nor was there such a study in a smaller Swedish town than Gothenburg. This study was initiated to fill that knowledge gap. The aim of the study was to evaluate gender and age differences in medical and social conditions among elderly people, including the reference intervals of clinical chemistry parameters and characteristic features of the 24-hour electrocardiogram (ECG) in healthy elderly. By way of longitudinal design with birth cohorts stratified by gender, it was assumed that the effects could be demonstrated. Also, the death risk of various social and medical variables was to be assessed.During the study period 1981 to 1990, the subjects were between 70 and 88 years of age. The proportion of persons living in private housing decreased from almost all at the age of 70 to slightly more than half at 88 years of age. The number of socially active persons decreased considerably during the period. The need of help increased from almost none to 60 % of the persons.The proportions of persons with normal sight and hearing decreased from two thirds to around one tenth The most frequent symptoms were general tiredness, pains, dyspnoea, constipation and dryness of the mouth. Cardiovascular diseases were the most frequent. Hypertensive disease became less, and congestive heart failure more frequent with age. The frequency of dementia increased steeply among the oldest persons; at 88 years of age, 40 % were demented.Drug consumption increased; the oldest persons in both age cohorts used 5 different drugs or more per person regularly. The consumption increase was mainly due to the increasing morbidity accompanying age. The most common drugs taken were cardiovascular preparations, psychoactive agents, drugs to alleviate gastrointestinal symptoms, and analgesics. Drug intake and symptom prevalence were generally higher in women, despite the fact that there was no gender difference in the number of diseases.The reference intervals of many blood components in healthy elderly were shown to be broader than those of younger persons. The intervals of P(lasma)-folate and P- potassium were on a lower and those of the erythrocyte sedimentation rate, P-creati- nine and, in women, S(erum)-cholesterol, were on a higher level than among younger persons.Several features of the 24-hour ECG, e.g. the number of episodes of supraventricular tachycardia as well as supraventricular and ventricular premature beats in healthy elderly were more frequent than among younger persons.Between 80 and 88 years of age, many functions crucial to the chances of living a rich and vital life were found deteriorating in the elderly persons. High age, male sex, dementia, congestive heart failure, and low values of S-creatinine were shown to be independent factors connected with an increased death risk.
1526.
  • Österlund, Camilla, 1978- (författare)
  • Activation of lung epithelial cells by group 2 mite allergens
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Throughout many parts of the world house dust mites (HDM) are considered as a major source of indoor aeroallergens and they are powerful inducers of allergic diseases. Proteolytic HDM allergens are recognised as being able to directly activate respiratory epithelial cells and thereby actively participate in innate immune responses. Although several major HDM allergens lack proteolytic activity, their possible ability to similarly interact with epithelial cells is not known. The overall aim of this thesis was therefore to elucidate if and how major non-proteolytic group 2 allergens from different mite species interact with respiratory epithelial cells. The effects of the structurally related Der p 2, Der f 2 and Eur m 2 from different HDM species as well as the storage mite allergen Lep d 2 were studied in vitro using human respiratory epithelial cells. Also the non-proteolytic, but structurally dissimilar, Fel d 1 from cat, Can f 2 from dog, Bet v 1 from birch and Phl p 5a from timothy were studied. In this thesis evidence that major group 2 mite allergens activate bronchial epithelial cells is presented. Following allergen exposure the secreted amount of the inflammatory mediators G-CSF, GM-CSF, IL-6, IL-8, MCP-1, MIP-3α and sICAM-1 was increased. Surface expression of ICAM-1 was also increased following allergen exposure. Moreover, Fel d 1 and Can f 2 induced secretion of the same mediators from bronchial epithelial cells, representing two additional protein structures being able to directly induce cell activation. In experiments using specific inhibitors and siRNA transfection, it was shown that the mite allergens engage TLR4 and activation through MyD88, MAPK and NF-κB signal transduction pathways. In conclusion, the novel findings in this thesis provide knowledge on how major aeroallergens, in addition to their ability to provoke specific adaptive immune responses, may aggravate a respiratory airway disease by adjuvant-like activation of inflammatory responses in bronchial epithelial cells. This differs from previously reported allergen-induction of epithelial cells by the clear independency of proteolytic activation.
1527.
  • Östlund, Nils, 1977- (författare)
  • Adaptive signal processing of surface electromyogram signals
  • 2006
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Electromyography is the study of muscle function through the electrical signals from the muscles. In surface electromyography the electrical signal is detected on the skin. The signal arises from ion exchanges across the muscle fibres’ membranes. The ion exchange in a motor unit, which is the smallest unit of excitation, produces a waveform that is called an action potential (AP). When a sustained contraction is performed the motor units involved in the contraction will repeatedly produce APs, which result in AP trains. A surface electromyogram (EMG) signal consists of the superposition of many AP trains generated by a large number of active motor units. The aim of this dissertation was to introduce and evaluate new methods for analysis of surface EMG signals.An important aspect is to consider where to place the electrodes during the recording so that the electrodes are not located over the zone where the neuromuscular junctions are located. A method that could estimate the location of this zone was presented in one study.The mean frequency of the EMG signal is often used to estimate muscle fatigue. For signals with low signal-to-noise ratio it is important to limit the integration intervals in the mean frequency calculations. Therefore, a method that improved the maximum frequency estimation was introduced and evaluated in comparison with existing methods.The main methodological work in this dissertation was concentrated on finding single motor unit AP trains from EMG signals recorded with several channels. In two studies single motor unit AP trains were enhanced by using filters that maximised the kurtosis of the output. The first of these studies used a spatial filter, and in the second study the technique was expanded to include filtration in time. The introduction of time filtration resulted in improved performance, and when the method was evaluated in comparison with other methods that use spatial and/or temporal filtration, it gave the best performance among them. In the last study of this dissertation this technique was used to compare AP firing rates and conduction velocities in fibromyalgia patients as compared with a control group of healthy subjects.In conclusion, this dissertation has resulted in new methods that improve the analysis of EMG signals, and as a consequence the methods can simplify physiological research projects.
1528.
  • Östman, Johan, 1971- (författare)
  • Mechanisms involved in amyloid induced cytotoxicity
  • 2005
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Amyloidoses comprise a group of diseases where normal or mutated protein precipitates into amyloid fibrils. The deposition of fibrils causes dysfunction of organs and toxicity to nervous tissue. Up to date, 24 different proteins and peptides are known to be able to form amyloid fibrils. The most well known are Amyloid beta peptide and Prione protein causing Alzheimer’s disease and Creutzfeld Jacob’s disease respectively.The aims of this thesis were to investigate the structural properties of cytotoxic amyloid and examine the mechanisms involved. The model protein mostly used in the studies was the plasma protein transthyretin (TTR). Familial Amyloidotic Polyneuropathy (FAP) is a hereditary, autosomal-dominant neurodegenerative disease caused by point mutations in the TTR gene. One of the most common variants of FAP is a mutation in position 30 where alanine is exchanged for methonine. This gives rise to “Skellefteåsjukan” in Sweden.TTR is secreted into the plasma as a tetramer. Point mutations destabilize the tetramer leading to disassembled monomers, which undergo partial denaturation as an initiation step to aggregation and amyloid fibril formation. In vivo amyloidogenesis takes a long time and does not occur until late in adult life. Most of the clinical TTR mutations do not form amyloid in vitro under physiological conditions. We have created amyloidogenic TTR mutants that are prone to aggregate and form fibrils under physiological conditions. This provides us with a model system on the cellular level for studies of the mechanisms of amyloid associated cytotoxicity as we can control the aggregation process and capture defined stages in the TTR amyloidogenic pathway.We used Atomic Force Microscopy (AFM) to follow the morphology of aggregates during fibril formation. Initially, amorphous aggregates were formed that subsequently matured into fibrillar structures, denoted protofilaments. This observation was interpreted as an optimisation of ß-strand registers. In addition we identified a correlation between the presence of early-formed aggregates of TTR and cytotoxicity. The toxic response was mediated via an apoptotic mechanism.We were not able to more carefully determine the structure and size of the toxic TTR species. To address this problem we turned to another amyloidogenic protein, equine lysozyme (EL). Intermediate samples corresponding to the aggregation and growth phase of amyloid fibrils of EL were collected. These samples were subjected to cytotoxicity assays as well as monomeric starting material and mature amyloid fibrillar species. The results clearly showed that the soluble oligomers were cytotoxic in contrast to the monomers and fibrils. Our data indicate that the toxic properties of the oligomers are size dependent.In this thesis we asked the question whether all mutated forms of TTR can be expressed and secreted or if there is a selection against the most aggressive mutations in vivo? We transfected hematopoetic K562 cells with wild type or mutant TTR, with or without the N-terminal signal peptide, responsible for secretion, to generate both extra- and intracellular TTR. We show that the post-translational quality control of the cells does not allow intracellular mutant TTR outside the secretory pathway, possibly due to the cytotoxic effects, while translocated to the secretory pathway made it escape the quality control permitting secretion and amyloid formation outside the cells.We have further analyzed the cytotoxic mechanisms induced by TTR oligomers with a focus on intracellular apoptotic signalling pathways. We show that TTR oligomers bind to the surface of the target cells but are not taken up, that is in contrast to mature fibrils that do not bind them at all. The apoptotic response occurred in a caspase-independent and a free radical dependent way.
1529.
  • Öström, Mats, 1959- (författare)
  • Vehicle-related injuries with emphasis on fatality prevention
  • 1993
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • According to WHO, Sweden should aim to reduce unintentional fatalities, particularly vehicle-related injuries, by 25% by the year 2000. The aim of this thesis was to analyze vehicle-related injuries and injury events, especially the contributory effects of alcohol and disease and the injury reducing capacity of helmets and airbags in order to point out some preventive measures.Alcohol: Alcohol is the main contributing factor in fatal traffic crashes. In a study on 121 traffic fatalities in Washtenaw County, Michigan, USA, different sources of data for alcohol involvement were compared. In police reports alcohol involvement was found in 51% of the fatalities, in autopsy reports in 63%, and in hospital emergency records in 91%. To avoid bias in the estimation of the fraction of alcohol-related fatalities, it is important to routinely investigate all severe and fatally injured cases in traffic crashes, ideally as soon as possible after the crash.In a study on traumatic car fatalities (n=597) in northern Sweden, 58% of the single vehicle (SV) drivers were inebriated (multi-vehicle, MV 10%), the mean blood alcohol concentration (BAC) was 1.9 g /l (MV 1.6 g/1), and liver steatosis was found in 37% of the cases (MV 2%). Increased BAC was associated with fatty liver, indicating chronic alcohol abuse. To reduce injuries among these types of victims, passive protection is of great importance.Disease: Autopsied drivers (n=126) in northern Sweden who had died from natural causes in traffic were studied. This fraction was 25% of all driver fatalities. Cardiovascular causes of death were found in 96% of the deceased. Neither the victims nor other occupants suffered severe traumatic injuries. A minority of the victims had experienced previous symtoms of disease. Further restriction of individuals with, for example, cardiovascular diseases would probably have no significant impact on traffic safety since at present the identification of high-risk individuals is difficult.Helmets: Head injuries in 948 injured bicyclists, including 105 fatalities, were analysed. Head/face injuries were found in 64% of the fatal and 38% of the nonfatal cases with a median age of 55 years and 18 years, respectively. Head trauma was mostly blunt with only a few severe face injuries. Of the nonfatal cases with head injuries, 48% might have had an injury reduction effect if a bicycle helmet had been used, compared with 67% of the fatalities with head injuries.A helmet with a hard shell, chin cover, accurate retention system, that reduces rotation and translation impact is recommended. To increase helmet use among bicyclists, a law is probably the most effective measure as has been shown for motorcyclists. However, head injuries were less frequent among snowmobile riders than among bicyclist and motorcyclist riders, and in most cases the snowmobile riders with head injuries but without helmet had broken other traffic laws, indicating that in this crash category there was a low compliance to compulsary laws.Airbags: In a field study of car crashes where an airbag deployed, the effectiveness of the bag, as well as injuries to the skin and eye from the deployment of the bag, is reported. In laboratory tests with airbag deployment on human volunteers, tethering was found to eliminate skin abrasion within a distance of 250-300 mm. At a distance of 225 mm, the folding technique had the optimal influence on abrasions followed by a marginal effect of tethering. However, injuries due to airbag deployment must be considered as negligible compared with the airbag's role in reduction of severe and fatal injuries.
1530.
  • Lindahl, Olof Anton, 1955- (författare)
  • The impression technique for assessment of tissue oedema : instrumentation, evaluation and applications
  • 1993
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • An instrument for clinical noninvasive assessment of tissue oedema based on an impression method was developed. The method measures and evaluates the decaying force, due to translocation of tissue fluid, during mechanical compression of any site of tissue. We applied the impression method on physical models, animal models, and patients. Significant parameters for the assessment of tissue oedema that estimated tissue fluid translocation and tissue pressure could be derived from the registered impression force curves.Accuracy was determined theoretically and reproducibility was estimated on plastic foam. We described the clinical procedure for the instrument, and preliminary results from patients with chronic pitting oedema showed that the instrument detected larger fluid translocation on oedematous sites than on non-oedematous sites. We concluded that the instrument was acceptable for accurate measurements on biological tissue.Evaluation was performed in a rat testis model in which testicular interstitial fluid volume could be changed both artificially by 30-min infusions of different fluids with different fluid resistance properties, and pharmacologically by administration of hormones. We found that tissue pressure increased with infused fluid volume, and changes as small as 16 μl (7 % of total testis interstitial fluid volume) could be detected. Fluid translocation changed depending upon the infused fluid's resistance properties. Hormone-induced changes in rat-testis oedema altered both fluid translocation and tissue pressure. Discrete changes in vascular permeability were monitored.Investigation of generalised oedema in patients suffering from burn injury showed that tissue fluid translocation increased up to a maximum value after 6 days postburn and declined thereafter. We found tissue pressure to be relatively high during the first 7 days postburn as compared with 3-week postburn values. Force curve analysis suggested a flux of water-like fluid from the vasculature to the interstitial space during the first 6 days postburn. The course of postburn tissue swelling could be followed and estimated with the impression technique.Comparison with a new tactile sensor that measured physical properties of soft tissue showed that both methods detected changes in silicone hardness/softness and in hormone-induced changes of rat-testis interstitial fluid. We concluded that impression force estimated hardness of soft tissue, which can be helpful when investigating hardness of oedematous tissue.
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