| 1. |
- Heddini, Ulrika, et al.
(author)
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GCH1-polymorphism and pain sensitivity among women with provoked vestibulodynia
- 2012
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In: Molecular Pain. - : SAGE Publications. - 1744-8069. ; 8, s. 68-
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Journal article (peer-reviewed)abstract
- Background: Provoked vestibulodynia (PVD) is a pain disorder localized in the vestibular mucosa. It is the most common cause of dyspareunia among young women and it is associated with general pain hypersensitivity and other chronic pain conditions. Polymorphism in the guanosine triphosphate cyclohydrolase (GCH1) gene has been found to influence general pain sensitivity and the risk of developing a longstanding pain condition. The aim of this study was to investigate GCH1-polymorphism in women with PVD and healthy controls, in correlation to pain sensitivity. Results: We found no correlation between the previously defined pain-protective GCH1-SNP combination and the diagnosis of PVD. Nor any correlation with pain sensitivity measured as pressure pain thresholds on the arm, leg and in the vestibule, coital pain scored on a visual analog scale and prevalence of other bodily pain conditions among women with PVD (n = 98) and healthy controls (n = 102). However, among patients with current treatment (n = 36), there was a significant interaction effect of GCH1-gene polymorphism and hormonal contraceptive (HC) therapy on coital pain (p = 0.04) as well as on pressure pain thresholds on the arm (p = 0.04). PVD patients carrying the specified SNP combination and using HCs had higher pain sensitivity compared to non-carriers. In non-HC-users, carriers had lower pain sensitivity. Conclusions: The results of this study gave no support to the hypothesis that polymorphism in the GCH1-gene contributes to the etiology of PVD. However, among patients currently receiving treatment an interaction effect of the defined SNP combination and use of hormonal contraceptives on pain sensitivity was found. This finding offers a possible explanation to the clinically known fact that some PVD patients improve after cessation of hormonal contraceptives, indicating that PVD patients carrying the defined SNP combination of GCH1 would benefit from this intervention.
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| 2. |
- Heddini, Ulrika, et al.
(author)
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Provoked Vestibulodynia-Medical Factors and Comorbidity Associated with Treatment Outcome
- 2012
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In: Journal of Sexual Medicine. - : Oxford University Press (OUP). - 1743-6095 .- 1743-6109. ; 9:5, s. 1400-1406
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Journal article (peer-reviewed)abstract
- Introduction. Provoked vestibulodynia (PVD) is the most common cause of dyspareunia in young women. The etiology is unclear, and there is little knowledge of how to predict treatment outcome. Aim. The aim of this study was to identify medical factors associated with treatment outcome and coital pain in women with PVD. Methods. Seventy women previously treated for PVD at a vulvar open care unit completed questionnaires and a quantitative sensory testing session. Main Outcome Measures. Concomitant bodily pain and treatment outcome were surveyed using a study specific questionnaire. Coital pain was rated on a visual analog scale (VAS), range 0100. Psychometric screening was carried out using the Hospital Anxiety and Depression Scale. Pressure pain thresholds on the arm, leg, and in the vestibulum were measured using pressure algometers. Results. Major improvement/complete recovery was more likely in PVD patients with a maximum of one other concomitant pain disorder compared with patients with four or more (odds ratio = 7.8, confidence interval: 1.249.4, P = 0.03). In a multiple linear regression model, the number of other pain disorders (P < 0.01) and a diagnosis of primary PVD (P = 0.04) were positively associated with the coital VAS pain score. Women with secondary PVD reported major improvement/complete recovery to a higher extent than women with primary PVD (z = 2.11, P = 0.04). Conclusion. A successful treatment outcome was more likely in PVD patients with fewer other concomitant pain conditions. The number of other bodily pain conditions was also associated to the intensity of the coital pain. Additionally, the results indicate higher incomplete response rates to treatment in women with primary PVD compared with secondary PVD.
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| 3. |
- Heddini, Ulrika, et al.
(author)
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Serotonin Receptor Gene (5HT-2A) Polymorphism is Associated with Provoked Vestibulodynia and Comorbid Symptoms of Pain
- 2014
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In: Journal of Sexual Medicine. - : ELSEVIER SCI LTD. - 1743-6095 .- 1743-6109. ; 11:12, s. 3064-3071
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Journal article (peer-reviewed)abstract
- IntroductionProvoked vestibulodynia (PVD) is a common type of dyspareunia among young women. The patho-physiology remains largely unclear. Women with PVD have general pain hypersensitivity and often report additional pain symptoms. Signs point towards PVD being a chronic pain disorder similar to other syndromes of longstanding pain, including a common comorbidity of anxiety and depression. Polymorphism in the serotonin receptor gene, 5HT-2A, has been associated with other chronic pain disorders such as fibromyalgia but has not been investigated in PVD patients. AimWe aimed to investigate a possible contribution of polymorphism in the 5HT-2A gene to the etiology of PVD as well as a potential influence on pain sensitivity. MethodsIn this case-control study 98 women with PVD and 103 healthy controls between 18 and 44 years and in the same menstrual cycle phase completed questionnaires and underwent quantitative sensory testing. Venous blood samples were collected for DNA isolation. Main Outcome MeasuresConcomitant pain was reported, a bodily pain score was created and pressure pain thresholds (PPTs) on the arm, leg, and in the vestibule were measured. Intensity of coital pain was rated on a visual analog scale, range 0-100. The T102C (rs6313) and A-1438G (rs6311) single nucleotide polymorphisms (SNPs) in the 5HT-2A gene were analyzed. ResultsThe probability of PVD was elevated in participants carrying the 1438G- and 102C-alleles of the 5HT-2A gene (OR 2.9). The G-/C- genotypes were also associated with more concomitant bodily pain in addition to the dyspareunia, but not with experimental PPTs or coital pain ratings. PVD patients reported more concomitant bodily pain and had lower PPTs compared with controls. ConclusionThe results indicate a contribution of alterations in the serotonergic system to the patho-genesis of PVD and gives further evidence of PVD being a general pain disorder similar to other chronic pain disorders. Heddini U, Bohm-Starke N, Gronbladh A, Nyberg F, Nilsson KW, and Johannesson U. Serotonin receptor gene (5HT-2A) polymorphism is associated with provoked vestibulodynia and comorbid symptoms of pain. J Sex Med 2014;11:3064-3071.
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| 4. |
- Haraldson, Philip, et al.
(author)
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Botulinum Toxin A as a Treatment for Provoked Vestibulodynia A Randomized Controlled Trial
- 2020
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In: Obstetrics and Gynecology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0029-7844 .- 1873-233X. ; 136:3, s. 524-532
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate pain reduction after two injections of 50 units botulinum toxin A compared with placebo for provoked vestibulodynia. METHODS: We conducted a double-blinded, placebo-controlled randomized trial of 50 units botulinum toxin A or placebo injected in the bulbocavernosus muscles twice, 3 months apart, in women with provoked vestibulodynia. Primary outcome was self-reported dyspareunia or pain at tampon use on a visual analog scale (VAS, 0-100). Secondary outcomes were pain at weekly tampon insertion (VAS score), reduction of pelvic floor hypertonicity (measured with a vaginal manometer), adverse events, and sexual function and distress. A sample size of 38 participants for each group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (0-100) (mean score range 56-76 +/- 31 SD). RESULTS: Between May 2016 and June 2018, 124 women with provoked vestibulodynia were assessed, and 88 were randomized to botulinum toxin A (BTA group, n=44) or placebo (placebo group, n=44). Primary outcome showed a lower but statistically nonsignificant pain rating by 7 VAS units (95% CI -15.0 to 0.4) in the BTA group compared with the placebo group. Secondary results showed a significant decrease in pain at weekly tampon insertion by 11 VAS units (95% CI -16.6 to 6.0) with botulinum toxin A injection. The vaginal manometer measured lower maximum contraction strength by 7 mm Hg (95% CI -12.7 to -2.4) and lower 10-second endurance strength by 4 mm Hg (95% CI -7.72 to -1.16) in the BTA group compared with the placebo group. No changes were observed for sexual function and distress, but there was a significant increase in women attempting vaginal intercourse in the BTA group (0.27, 95% CI 0.06-0.48). No severe adverse events were reported. CONCLUSION: Twice-repeated injections of 50 units of botulinum toxin A in women with provoked vestibulodynia did not reduce dyspareunia or pain at tampon use, but secondary outcomes suggested positive effects of the treatment.
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| 5. |
- Haraldson, Philip, et al.
(author)
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Botulinum Toxin A for Provoked Vestibulodynia : 12 Months’ Follow-up of a Randomized Controlled Trial
- 2022
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In: Journal of Sexual Medicine. - : Elsevier B.V.. - 1743-6095 .- 1743-6109. ; 19:11, s. 1670-1679
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Journal article (peer-reviewed)abstract
- Background: Provoked vestibulodynia (PVD) is a common pain disorder afflicting primarily young women, and botulinum toxin A (BTA) has been to a limited extent tested as a treatment. Aim: Evaluate outcome 12 months after injection with BTA as a treatment for PVD. Methods: We conducted a double-blinded, placebo-controlled trial of twice repeated injections of 50 units of BTA or placebo in the bulbocavernosus muscles, 3 months apart, in women with PVD. Treatment outcome after six months’, failed to show any significant difference in pain reduction between the groups, as previously reported. Here, we report treatment outcomes 12 months after the first injections. In addition to injections, participants where instructed to perform pelvic floor exercises during month 6-12. 38 participants/group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (mean score range 56-76±31 SD). Outcomes: Primary outcome was self-reported dyspareunia or pain at tampon use, using a visual analogue scale (VAS) 0-100. Secondary outcomes were vaginal pressure measurements, psychological health, sexual function and distress. Results: From the initial 88 randomized women with PVD, 75 remained at 12 months; 38 in the BTA and 37 in the placebo group. There was no significant difference in primary outcome between the groups. Vaginal pressure in the BTA group had been restored to pre-treatment levels, with no differences between the groups at 12 months. There was an increase in sexual function in the BTA group, with a Female Sexual Function Index of 22.8 (±4.8) compared to the placebo group to 19.7 (±5.0), P=.048. No differences were observed in sexual distress, stress and anxiety. There was an increase in number of women attempting intercourse in the BTA group (74%) compared with placebo (43%), P=.005. Too few patients performed the pelvic floor exercises for this intervention to be analyzed. Clinical Implications: This study highlights BTA as a safe treatment option for patients with PVD. Strengths and limitations: The randomized, double-blinded design and repeated treatments are the major strengths of this study and it is the first study to objectively evaluate muscular effect after BTA injections. The major shortcoming is that few participants performed the pelvic floor exercises, preventing analyses. Conclusion: At 12 months’ follow up, no significant difference in reduction of dyspareunia or pain at tampon use was observed. Women receiving BTA attempted intercourse more often and improved their sexual function compared with women receiving placebo. Haraldson P, Mühlrad H, Heddini U, et al. Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial. J Sex Med 2022;19:1670–1679.
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| 6. |
- Lundqvist, Johanna, 1975-, et al.
(author)
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Differentierad undervisning och integrerade digitala verktyg i förskola och skola: En storskalig studie
- 2021
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In: Utbildning och Lärande / Education and Learning. - Falun : Högskolan Dalarna. - 2001-4554. ; 15:3, s. 9-31
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Journal article (peer-reviewed)abstract
- In Swedish preschool and school classrooms, all children should be offered an education that includes instruction and digital devices. The instruction should be meaningful and interesting for all children, and the digital devices should facilitate teachers’ work and children’s learning. This study concerns differentiated instruction as well as uses and possible benefits gained by digital devices in Swedish preschools and school classrooms. The study is part of a large-scale co-production project between academy and the surrounding society. Sixty-seven teachers and head-teachers, who value digital devices, participated, and shared their experiences and views on these two matters. A qualitative research approach, including research circles and thematic analyses, was used. The themes prove, for example, the importance of acknowledging children’s interests, joint exploration, provision of parallel support as well as extra challenges, association to children’s previous experiences and integration of digital devices of various kind. The result of the study can form a basis for interesting preschool and school discussions. It has relevance for teachers and head-teachers in training, researchers in special education as well as for those who are interested in differentiated instruction and the integration of digital devices.
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| 7. |
- Lundqvist, Johanna, 1975-, et al.
(author)
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Digitala verktyg och differentierad undervisning i tidiga skolår : Ett storskaligt utvecklings- och forskningsprojekt för lärarprofessionen i framtidens förskola och skola (2019–2021)
- 2024
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Reports (other academic/artistic)abstract
- The development and research collaboration project concerned digital tools and differentiated instruction in early school years. It was conducted in Södermanland, Sweden. By the concept early school years was meant preschool, preschool class, school-age educare, and grades 1 to 3. In the project, knowledge and school development were co-produced by researchers and junior lecturers together with school leaders and teachers in several preschools and schools.By the concept teachers was meant for example preschool teachers, teachers in school-age educare, teachers in school, special needs teachers, special educators, ICT (InformationCommunication-Technology) educators and school librarians. The concept school leaders included headteacher in preschool, headteacher in school and also deans.The aim of the development part of the collaboration project was to develop teachers’ and school leader’s digital and didactic competence. Two lines for co-production of development were used. In first line, researchers and junior lecturers from Mälardalen university arranged day conferences for teachers and school leaders in Södermanland. Sixtyseven teachers and school leaders participated. The day conferences contained popular science lectures, exchange of experiences, research circles, retrospects of previous day conferences and municipality meetings. The day conferences concerned how instruction is made meaningful and interesting for all children in preschool and school, choice and use of digital tools in preschool and school instruction and also evaluations. In second line, the sixtyseven teachers and school leaders spread the contents of the day conferences further to colleagues at their respective workplaces. They also conducted activities with these colleagues, for example implemented a new digital tool in the instruction and also evaluated the use of a digital tool. In total, 243 persons participated.The aim of the research part of the collaboration project was to describe and analysedifferentiated and digitalised instruction in early school years in Södermanland. The collection of data for the project was made in connection with the day conferences in the first line: the research circles and retrospects of previous day conferences were recorded and constituted data for the research part of the collaboration project. Results from the development and research collaboration project were presented for the project participants. Results from the project, two research articles, were also published in ascientific journal and in the present final report. Moreover, results were presented at international research conferences, courses at universities, regional network meetings and kick-off-days in preschool. The final activities for the project were two regional day conferences. Participating teachers and school leaders were invited, and also other persons who were interested in digital tools and differentiated teaching.
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