| 1. |
- Mazzoni, Anne-Sophie, et al.
(författare)
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The Role of Long-Term Physical Activity in Relation to Cancer-Related Health Outcomes : A 12-Month Follow-up of the Phys-Can RCT
- 2023
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Ingår i: Integrative Cancer Therapies. - : Sage Publications. - 1534-7354 .- 1552-695X. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Purpose:While moderate-to-vigorous intensity physical activity (MVPA) is associated with various health improvements shortly after completion of exercise interventions, it remains unclear which health benefits can be expected when MVPA levels are maintained in the long term in cancer survivors. We aimed to assess the associations of (1) MVPA level at 12-month follow-up and (2) long-term MVPA patterns (from immediately post-intervention to 12-month follow-up) with different cancer-related health outcomes. Methods:In the Physical training and Cancer (Phys-Can) RCT, 577 participants diagnosed with breast (78%), prostate (19%), or colorectal (3%) cancer were randomized to 6 months of exercise during curative cancer treatment. Accelerometer-assessed physical activity and outcome data (ie, cancer-related fatigue, health-related quality of life [HRQoL], anxiety and depression, functioning in daily life, cardiorespiratory fitness, sedentary time and sleep) were collected immediately post-intervention and at 12-month follow-up. Based on the sample's median of MVPA immediately post-intervention (65 minutes/day) and the changes between the 2 measurement points, 4 categories with different long-term MVPA patterns were created: High & Increasing, High & Decreasing, Low & Increasing, and Low & Decreasing. Multiple linear regression analyses were performed for the analyses. Results:A total of 353 participants were included in the analyses. At 12-month follow-up, a higher MVPA level was significantly associated with lower fatigue in 3 domains (general fatigue [& beta; = -.33], physical fatigue [& beta; = -.53] and reduced activity [& beta; = -.37]), higher cardiorespiratory fitness (& beta; = .34) and less sedentary time (& beta; = -.35). For long-term MVPA patterns, compared to the participants in the "Low & Decreasing" category, those in the "High & Increasing" category reported significantly lower fatigue in 3 domains (general fatigue [& beta; = -1.77], physical fatigue [& beta; = -3.36] and reduced activity [& beta; = -1.58]), higher HRQoL (& beta; = 6.84) and had less sedentary time (& beta; = -1.23). Conclusion:Our results suggest that long-term physical activity is essential for improving health outcomes post-intervention in cancer survivors. Cancer survivors, including those who reach recommended MVPA levels, should be encouraged to maintain or increase MVPA post-intervention for additional health benefits.
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| 2. |
- Sjövall, K., et al.
(författare)
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Evaluating patient reported outcomes and experiences in a novel proton beam clinic : challenges, activities, and outcomes of the ProtonCare project
- 2023
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Ingår i: BMC Cancer. - : Springer Nature. - 1471-2407. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The ProtonCare Study Group (PCSG) was formed with the purpose to develop and implement a framework for evaluation of proton beam therapy (PBT) and the related care at a novel clinic (Skandionkliniken), based on patient reported data.METHOD: A logic model framework was used to describe the process of development and implementation of a structured plan for evaluation of PBT for all diagnoses based on patient reported data. After the mission for the project was determined, meetings with networks and stakeholders were facilitated by PCSG to identify assumptions, resources, challenges, activities, outputs, outcomes, and outcome indicators. RESULT: This paper presents the challenges and accomplishments PCSG made so far. We describe required resources, activities, and accomplished results. The long-term outcomes that were outlined as a result of the process are two; 1) Improved knowledge about health outcomes of patients that are considered for PBT and 2) The findings will serve as a base for clinical decisions when patients are referred for PBT. CONCLUSION: Using the logical model framework proved useful in planning and managing the ProtonCare project. As a result, the work of PCSG has so far resulted in long-lasting outcomes that creates a base for future evaluation of patients' perspective in radiotherapy treatment in general and in PBT especially. Our experiences can be useful for other research groups facing similar challenges. Continuing research on patients´ perspective is a central part in ongoing and future research. Collaboration, cooperation, and coordination between research groups/networks from different disciplines are a significant part of the work aiming to determine the more precise role of PBT in future treatment options.
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| 3. |
- Lindström, Rebecca, et al.
(författare)
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Swedish translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©)—A validated tool for screening and assessing malnutrition in clinical practice and research
- 2024
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 38:3, s. 589-601
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. Aim: To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. Methods: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. Results: The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). Conclusion: The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty with the physical examination, training of Swedish HCPs in using the PG-SGA is essential before implementing the professional component into clinical practice or research.
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| 4. |
- Möllerberg, Marie-Louise, et al.
(författare)
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Evaluation of skin reactions during proton beam radiotherapy – Patient-reported versus clinician-reported
- 2021
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Ingår i: Technical Innovations and Patient Support in Radiation Oncology. - : Elsevier Ireland Ltd. - 2405-6324. ; 19, s. 11-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Skin reaction is a common side-effect of radiotherapy and often only assessed as clinician-reported outcome (CRO). The aim was to examine and compare patient-reported outcome (PRO) of skin reactions with CRO for signs of acute skin reactions for patients with primary brain tumour receiving proton beam radiotherapy (PBT). A further aim was to explore patients’ experiences of the skin reactions. Methods: Acute skin reactions were assessed one week after start of treatment, mid-treatment and end of treatment among 253 patients with primary brain tumour who underwent PBT. PRO skin reactions were assessed with the RSAS and CRO according to the RTOG scale. Fleiss’ kappa was performed to measure the inter-rater agreement of the assessments of skin reactions. Results: The results showed a discrepancy between PRO and CRO acute skin reactions. Radiation dose was associated with increased skin reactions, but no correlations were seen for age, gender, education, occupation, other treatment or smoking. There was a poor agreement between patients and clinicians (κ = −0.016) one week after the start of PBT, poor (κ = −0.045) to (κ = 0.396) moderate agreement at mid treatment and poor (κ = −0.010) to (κ = 0.296) moderate agreement at end of treatment. Generally, patients’ symptom distress toward skin reactions was low at all time points. Conclusion: The poor agreement between PRO and CRO shows that the patient needs to be involved in assessments of skin reactions for a more complete understanding of skin reactions due to PBT. This may also improve patient experience regarding involvement in their own care. © 2021 The Author(s)
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| 5. |
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| 6. |
- Marklinder, Ingela, 1959-, et al.
(författare)
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A Structural Equation Model Demonstrating the Relationship between Food Safety Background, Knowledge, Attitudes and Behaviour among Swedish Students
- 2022
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Ingår i: Foods. - : MDPI. - 2304-8158. ; 11:11
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Tidskriftsartikel (refereegranskat)abstract
- Traditionally, food safety knowledge has been seen as a factor in improving food safety behaviour. However, the relationship between knowledge and behavior is complex. The aim of the present study was to investigate self-reported data from 408 university students regarding food safety background, knowledge, attitudes, and behaviour using Structural Equation Model (SEM) to examine the influence of different factors on food safety behaviour. The SEM was applied to four factors derived from the data: Background, Knowledge, Attitude and Behaviour. The novelty of this current investigation is the inclusion of the Background factor (genus; experience of cooking and handling different food items; experience of a food safety education course; the foremost sources of food safety knowledge). The factors were constructed from variables with sufficient factor loadings and set up in a predetermined structure confirmed to be valid in previous studies. The results, demonstrated as regression coefficients between factors, confirm that the Background factor strongly influenced Knowledge (0.842). The Knowledge factor, in turn, strongly affected Attitude (0.605), while it did not directly affect Behaviour (0.301) in the same way as Attitude. Attitude had a stronger influence on Behaviour (0.438) than Knowledge. Thus, the Attitude factor seemed to play a mediating role between Knowledge and Behaviour. This indicates that students ' attitudes towards the importance of food safety may have an impact on their food safety behavior, which should have implications for the development of food safety education. This warrants further investigation and practical development.
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| 7. |
- Marklinder, Ingela, 1959-, et al.
(författare)
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Food safety knowledge, sources thereof and self-reported behaviour among university students in Sweden
- 2020
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Ingår i: Food Control. - : Elsevier. - 0956-7135 .- 1873-7129. ; 113
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Tidskriftsartikel (refereegranskat)abstract
- International studies have noted shortcomings in food safety knowledge and behaviour among university students. In general students do not constitute a pronounced risk group but there are wider implications. In a foreseeable future some of them will become pregnant and a majority will be responsible for vulnerable groups in their near environment. A crucial question exists, therefore, about their food safety knowledge and safe food handling practices.The aim of this study is to investigate food safety knowledge, sources thereof and self-reported food safety behavior among university students in Sweden.A quantitative study design using a web-based questionnaire was chosen as the data collection method. The questionnaire was distributed through social media and e-mail.Among the 606 respondents from 24 Swedish universities 80% were 18-30 years and 78% were women. The average number of correct answers on the knowledge questions was 7.61 out of 12 (63.4%). The foremost source of food safety knowledge was "Family and friends" (45%). Just 21.1% reported Food safety education as a source, although 35.6% had experience of a course in food hygiene/safety and/or microbiology. Respondents who reported "Family and friends" to be the foremost food safety source of knowledge also got a significantly lower rate of correct answers. Students who estimated their food safety knowledge to be good also had more correct answers. Experience of food safety education at secondary school/university/working place/polytechnic school significantly correlated with more correct answers on the knowledge questions and indicated a safer self-reported behaviour. Those with fewer correct answers also reported more unfavourable behaviours. The present study indicates that education promotes more optimal behaviors. The authors would suggest a more systematic food safety education at younger ages.
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| 8. |
- Gillman, Anna, et al.
(författare)
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Oseltamivir-Resistant Influenza A (H1N1) Virus Strain with an H274Y Mutation in Neuraminidase Persists without Drug Pressure in Infected Mallards
- 2015
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Ingår i: Applied and Environmental Microbiology. - : American Society for Microbiology. - 0099-2240 .- 1098-5336. ; 81:7, s. 2378-2383
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Tidskriftsartikel (refereegranskat)abstract
- Influenza A virus (IAV) has its natural reservoir in wild waterfowl, and emerging human IAVs often contain gene segments from avian viruses. The active drug metabolite of oseltamivir (oseltamivir carboxylate [OC]), stockpiled as Tamiflu for influenza pandemic preparedness, is not removed by conventional sewage treatment and has been detected in river water. There, it may exert evolutionary pressure on avian IAV in waterfowl, resulting in the development of resistant viral variants. A resistant avian IAV can circulate among wild birds only if resistance does not restrict viral fitness and if the resistant virus can persist without continuous drug pressure. In this in vivo mallard (Anas platyrhynchos) study, we tested whether an OC-resistant avian IAV (H1N1) strain with an H274Y mutation in the neuraminidase (NA-H274Y) could retain resistance while drug pressure was gradually removed. Successively infected mallards were exposed to decreasing levels of OC, and fecal samples were analyzed for the neuraminidase sequence and phenotypic resistance. No reversion to wild-type virus was observed during the experiment, which included 17 days of viral transmission among 10 ducks exposed to OC concentrations below resistance induction levels. We conclude that resistance in avian IAV that is induced by exposure of the natural host to OC can persist in the absence of the drug. Thus, there is a risk that human-pathogenic IAVs that evolve from IAVs circulating among wild birds may contain resistance mutations. An oseltamivir-resistant pandemic IAV would pose a substantial public health threat. Therefore, our observations underscore the need for prudent oseltamivir use, upgraded sewage treatment, and surveillance for resistant IAVs in wild birds.
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| 9. |
- Langegård, Ulrica, 1969, et al.
(författare)
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Health-related quality of life in patients with primary brain tumors during and three months after treatment with proton beam therapy
- 2021
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Ingår i: Technical Innovations & Patient Support in Radiation Oncology. - : Elsevier BV. - 2405-6324. ; 17, s. 5-17
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Tidskriftsartikel (refereegranskat)abstract
- Background Proton beam therapy (PBT) is increasingly administered to patients with primary brain tumors. Benefits of new treatments must be weighed against side effects and possible deterioration in health-related quality of life (HRQoL). The aim of this study was to describe and compare HRQoL, including acute symptom experiences and associated factors, in patients with malignant and benign brain tumors treated with PBT. Materials and Methods Adult PBT-treated patients with primary brain tumors (n=266) were studied. HRQoL was assessed with EORTC QLQ-C30, QLQ-BN20, HADS, ISI and MFI before, during and three months after treatment. Associations with demographic and medical factors were explored. Results Between baseline and three months post-treatment: HRQoL decreased significantly in the global health/QOL domains physical functioning, role functioning and cognitive functioning in the malignant group, global health/QOL and physical functioning decreased significantly in the benign group, more comorbidity was significantly associated with increased motor dysfunction, leg weakness, headache and future uncertainty. Fatigue and depression were the most frequent symptoms in both groups. Independent predictors of risk factor recognition were age, sex, chemotherapy, comorbidity and education level. Discussion Global health/QOL in patient with brain tumors is very complex and multidimensional. Symptoms are interrelated and related to patient, tumor and treatment factors. It is important to identify aspects of HRQoL that may be affected by treatment. These include both benefits, expected to improve HRQoL, and negative changes such as symptom experience and influencing factors. Evidence-based guidelines are needed for symptom management, and for high quality of care for patients experiencing low PBT-related HRQoL.
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| 10. |
- Sjövall, Katarina, et al.
(författare)
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To become part of the team-patient experiences of participating in decision-making for a new treatment (proton beam therapy)
- 2024
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Ingår i: Supportive Care in Cancer. - : Springer Nature. - 0941-4355 .- 1433-7339. ; 32:7
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to explore patients' experience of participation in the treatment decision of proton beam therapy versus conventional radiotherapy. BACKGROUND: Proton beam therapy (PBT) has become a treatment option for some cancer patients receiving radiotherapy. The decision to give PBT instead of conventional radiotherapy (CRT) needs to be carefully planned together with the patient to ensure that the degree of participation is based on individuals' preferences. There is a knowledge gap of successful approaches to support patients' participation in the decision-making process, which is particularly important when it comes to the situation of having to choose between two treatment options such as PBT and CRT, with similar expected outcomes.METHOD: We conducted a secondary analysis of qualitative data collected from interviews with patients who received PBT for their brain tumor. Transcribed verbatims from interviews with 22 patients were analyzed regarding experiences of participation in the decision-making process leading to PBT.FINDINGS: Participants experienced their participation in the decision-making process to a varying degree, and with individual preferences. Four themes emerged from data: to be a voice that matters, to get control over what will happen, being in the hand of doctors' choice, and feeling selected for treatment.CONCLUSION: A decision for treatment with PBT can be experienced as a privilege but can also cause stress as it might entail practical issues affecting everyday life in a considerable way. For the patient to have confidence in the decision-making process, patients' preferences, expectations, and experiences must be included by the healthcare team. Including the patient in the healthcare team as an equal partner by confirming the person enables and facilitates for patients' voice to be heard and reckoned with. Person-centered care building on a partnership between patients and healthcare professionals should provide the right basis for the decision-making process.
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