| 51. |
- Dean, E., et al.
(författare)
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What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain?
- 2015
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Other than activity and exercise, lifestyle practices such as not smoking and healthy nutrition, well established for preventing and managing lifestyle-related non-communicable diseases (i.e., heart disease, cancer, hypertension, stroke, obstructive lung disease, diabetes, and obesity), are less emphasized in the physical therapy guidelines for addressing chronic pain, e.g., back pain. This state-of-the-art review examines the relationships between lifestyle behaviours and musculoskeletal health, with special reference to chronic pain, and their clinical and research implications. Discussion: A state-of-the-art review was conducted to synthesize evidence related to lifestyle factors (not smoking, healthy diet, healthy weight, optimal sleep and manageable stress, as well as physical activity) and musculoskeletal health, with special reference to chronic pain. The findings support that health behaviour change competencies (examination/assessment and intervention/treatment) may warrant being included in first-line management of chronic pain, either independently or in conjunction with conventional physical therapy interventions. To address knowledge gaps in the literature however three lines of clinical trial research are indicated: 1) to establish the degree to which traditional physical therapy interventions prescribed for chronic pain augment the benefits of lifestyle behaviour change; 2) to establish the degree to which adopting healthier lifestyle practices, avoids or reduces the need for conventional physical therapy; and 3) to establish whether patients/clients with healthier lifestyles and who have chronic pain, respond more favourably to conventional physical therapy interventions than those who have less healthy lifestyles. Summary: Lifestyle behaviour change is well accepted in addressing lifestyle-related non-communicable diseases. Compelling evidence exists however supporting the need for elucidation of the role of negative lifestyle behaviours on the incidence of chronic pain, and the role of positive lifestyle behaviours on its incidence and effective management. Addressing lifestyle behaviour change in patients/clients with chronic pain, e.g., back pain, as a first-line intervention might not only constitute a novel approach, but also reduce the socioeconomic burden related to chronic pain as well as non-communicable diseases.
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| 52. |
- Dean, Elizabeth, et al.
(författare)
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Why COVID-19 strengthens the case to scale up assault on non- communicable diseases : role of health professionals including physical therapists in mitigating pandemic waves
- 2021
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Ingår i: AIMS PUBLIC HEALTH. - : AMER INST MATHEMATICAL SCIENCES-AIMS. - 2327-8994. ; 8:2, s. 369-375
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Tidskriftsartikel (refereegranskat)abstract
- As SARS-CoV-2, the virus responsible for COVID-19, spread globally, the most severely affected sub-populations were the elderly and those with multi-morbidity largely related to noncommunicable diseases (NCDs), e.g., heart disease, hypertension, type 2 diabetes, obesity. NCDs are largely preventable with healthy nutrition, regular activity, and not smoking. This perspective outlines the rationale for health professionals' including physical therapists' role in reducing COVID-19 susceptibility. Evidence is synthesized supporting the pro-inflammatory effects of the western diet, increasingly consumed globally, inactivity, and smoking; and the immune-boosting, anti-inflammatory effects of a whole food plant-based diet, regular physical activity, and not smoking. An increased background of chronic low-grade systemic inflammation associated with unhealthy lifestyle practices appears implicated in an individual's susceptibility to SARS-CoV-2. It is timely to re-double efforts across healthcare sectors to reduce the global prevalence of NCDs on two fronts: one, to reduce SARS-CoV-2 susceptibility; and two, to reduce the impact of subsequent waves given high blood pressure and blood sugar, common in people with multi-morbidity, can be improved within days/weeks with anti-inflammatory healthy lifestyle practices, and weight loss and atherosclerosis reduction/reversal, within months/years. With re-doubled efforts to control NCD risk factors, subsequent waves could be less severe. Health professionals including physical therapists have a primary role in actively leading this initiative.
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| 53. |
- Dolinska, Monika, et al.
(författare)
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Characterization of Bone Marrow Niche in Chronic Myeloid Leukemia Patients Identifies CXCL14 as a New Therapeutic Option
- 2023
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 142:1, s. 73-89
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Tidskriftsartikel (refereegranskat)abstract
- Although tyrosine kinase inhibitors (TKIs) are effective in treating chronic myeloid leukemia (CML), they often fail to eradicate the leukemia-initiating stem cells (LSCs), causing disease persistence and relapse. Evidence indicates that LSC persistence may be because of bone marrow (BM) niche protection; however, little is known about the underlying mechanisms. Herein, we molecularly and functionally characterize BM niches in patients with CML at diagnosis and reveal the altered niche composition and function in these patients. Long-term culture initiating cell assay showed that the mesenchymal stem cells from patients with CML displayed an enhanced supporting capacity for normal and CML BM CD34+CD38- cells. Molecularly, RNA sequencing detected dysregulated cytokine and growth factor expression in the BM cellular niches of patients with CML. Among them, CXCL14 was lost in the BM cellular niches in contrast to its expression in healthy BM. Restoring CXCL14 significantly inhibited CML LSC maintenance and enhanced their response to imatinib in vitro, and CML engraftment in vivo in NSG-SGM3 mice. Importantly, CXCL14 treatment dramatically inhibited CML engraftment in patient-derived xenografted NSG-SGM3 mice, even to a greater degree than imatinib, and this inhibition persisted in patients with suboptimal TKI response. Mechanistically, CXCL14 upregulated inflammatory cytokine signaling but downregulated mTOR signaling and oxidative phosphorylation in CML LSCs. Together, we have discovered a suppressive role of CXCL14 in CML LSC growth. CXCL14 might offer a treatment option targeting CML LSCs.
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| 54. |
- Egeland, Jens, et al.
(författare)
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Effects of auditory white noise stimulation on sustained attention and response time variability
- 2023
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Ingår i: Frontiers in Psychology. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: “The moderate brain arousal model” claims that white noise improves attention by optimizing brain arousal. We analyze Conners’ Continuous Performance Test-3 (CCPT-3) performance, expecting to find reduced reaction time variability with noise mediated by decrease under long event-rates and in later parts of the test, indicating that noise reverse fall in phasic and tonic arousal. Methods: Sixty-five children with high or lower ADHD-symptoms from a child psychiatric unit, succeeded to complete the CCPT-3 with and without white noise. Results: Noise reduced overall variability, improved performance in later parts of the test, and reduced response variability under the longest event rate particularly in the high symptoms group. No overall change in omissions and commissions, but the high symptoms group made fewer omissions during noise compared the low symptom group. Discussion: The study indicates an arousal effect of noise but should be replicated with other noise variants and amplitudes to improve effect and compliance.
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| 55. |
- Eklund, Caroline, 1983-, et al.
(författare)
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At two step evaluation procedure of the web-application My Stress Control: feasibility and effect
- 2019
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Context: Stress preventive interventions should support behaviour change. Web-based programs are less resource demanding than face-to-face solutions. For the purpose of supporting behaviour change in persons with work related stress, the web-based program My Stress Control (MSC) was developed. The aim of this study was to evaluate the feasibility and effect of MSC.Methods: MSC’s feasibility was tested with 14 end-users before evaluating its effect in a two-armed RCT with 95 persons. The same procedure as for the RCT was used in the feasibility study. Questionnaires were used as data collection method. The primary outcome was perceived stress.Intervention: MSC was built on evidence regarding theoretical frame, content and informational design. MSC is tailored to each individual by Stages of Change and with a functional behaviour analysis (FBA) conducted by the users in interactive assignments, steering the user to stress-management strategies. Techniques supporting behavioural change are integrated throughout the program.Results: The feasibility of MSC reached above the pre-set cut-off score. The results of the RCT revealed no significant differences between groups in the primary outcome, but a small effect size was shown between intervention and wait-list group. Adherence was low with 25% of the participants in the intervention group responding to post assessment. Conclusions: It is still uncertain if MSC is an effective method for supporting behaviour change in persons with work related stress. Further development must be conducted regarding adherence before next evaluation study. Nevertheless, the small effect size encourages further development and evaluation of MSC.
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| 56. |
- Eklund, Caroline, 1983-
(författare)
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Development and evaluation of a web application for stress management : Supporting behaviour change in persons with work related stress
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stress is the most common reason for sick leave in Sweden. Stress can lead to health-related problems such as burnout syndrome, depression, sleep disorders, cardiovascular disease and pain. It is important to handle stress at an early stage before it could lead to health-related problems. The web enables to reach many persons at a low cost. Web-applications have proven to be effective regarding several health-related problems. However, adherence is often low and many of the available stress management-programs have not been based on evidence. The overall aim of the thesis was to develop and evaluate a fully automated, evidence-based web-application for stress management for persons experiencing work related stress. The thesis compiles of four studies. Study I contained the systematic development of the program in three phases. Phase one included the development of the program's theoretical framework and content, and phase two consisted of structuring the content and developing the platform to deliver the content from. The third phase consisted of coding the behaviour change supporting content, validation of the program among experts and testing it with one possible end-user. The result was an interactive web-application tailored to the individual's need for stress management supporting behaviour change in several ways; My Stress Control (MSC). In study I, MSC was also tested regarding how to proceed through the program. The results showed that the participants had trouble to reach the program’s end. In study II the feasibility of the coming RCT study procedure was investigated as well as how feasible MSC, the web-application, was to be applied in a larger study. 14 persons participated in study II. The findings proved the scientific study procedure feasible with minor changes, but some changes were required for the web-application to increase the chance for success in a larger, more costly study. In study III nine of the 14 persons that participated in study II were interviewed. The interviews aimed for a better understanding of how the participants experienced the program to further develop it. One theme was identified: Struggling with what I need when stress management is about me. It described an understanding for that stress management takes time and is complex but that it was difficult to find the time for working with it. In study IV, a randomized controlled trial, MSC was evaluated regarding its effect on stress. One group with access to MSC was compared to a wait-list group. 92 persons participated in study IV. The results showed that there were no significant between- or within group differences on perceived stress. A small effect size of MSC on perceived stress was shown between intervention- and wait-list groups, but adherence to the program was low.These studies support that a web-application based on the evidence within multiple fields may have effect on perceived stress. However, to handle stress on one’s own is complex and the paradox in having one more thing to do when already stressed contribute to a conflict on how to handle the task. How to facilitate adherence to the fully automated program should be further investigated in future studies.
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| 57. |
- Eklund, Caroline, et al.
(författare)
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Development of the web application My Stress Control—Integrating theories and existing evidence
- 2018
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Ingår i: Cogent Psychology. - : Cogent OA. - 2331-1908. ; 5:1, s. 1-19
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To describe the systematic development of an evidence-based, tailored, interactive web application for self-management of work-related stress, and to test usability issues regarding how to proceed through the programme. Methods: Evidence from the fields of stress management, behaviour change and web-based interventions was the foundation for the theoretical framework and content. The next step was the development process of the web application and validation among experts and one possible end user. Last, a usability test with 14 possible end users was conducted. Results: The web-application, My Stress Control (MSC), was built on a solid theoretical framework. It consists of 12 modules including: introduction, psychoeducation, ambivalence, stress management strategies, lifestyle change, and maintenance. Self-monitoring, goal-setting, re-evaluating goals, feedback, and prompting formulation of intention to change are central techniques supporting behaviour change. The usability test revealed difficulties in understanding how to proceed through the programme. Conclusion: The development contributes to filling a gap in the literature regarding development of complex web-based interventions. MSC is dissimilar to existing programs in the field, considering the tailoring and multi-tracked opportunities. Although developed from the evidence in multiple fields, the web application would benefit from further development to support users in reaching the end module.
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| 58. |
- Eklund, Caroline, 1983-, et al.
(författare)
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Evaluation of a Web-Based Stress Management Application : A Feasibility Study
- 2018
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Ingår i: Journal of Technology in Behavioral Science. - : Springer. - 2366-5963. ; 3:3, s. 150-160
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program’s acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study’s process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study’s procedure were considered as feasible and can be carried out in a randomized controlled trial.
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| 59. |
- Eklund, Caroline, 1983-, et al.
(författare)
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Evaluation of the web application My Stress Control, a stress management program for persons experiencing work related stress : A randomized controlled trial
- 2020
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Ingår i: JMIR Mental Health. - : JMIR Publications Inc.. - 2368-7959. ; 8:12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change.Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress.Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes.Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25).Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made.
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| 60. |
- Eklund, Caroline, 1983-, et al.
(författare)
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The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement : An Empirical Phenomenological Study
- 2021
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 101:8
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveSedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement.MethodsThe study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64–75. Data were analyzed using the empirical phenomenological psychological method.ResultsThe participants described that voluntary sedentary time was positively related to general health and well-being, while involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants’ descriptions formed three typologies: in light of meaningful sedentary behavior, in the shadow of involuntary sedentary behavior, and a dual process – postponing sedentary behavior with physical activity.ConclusionsIncreased SB was perceived as natural when aging, but something that may be postponed by conscious choices. SB was perceived as associated with health, rest and recovery but also with the risk of deteriorating health.ImpactThis knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.Lay SummaryThis study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.
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