| 1. |
- Gonzalez Lindh, Margareta, 1965-, et al.
(författare)
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Subjective swallowing symptoms and related risk factors in COPD
- 2019
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Ingår i: ERJ Open Research. - : European Respiratory Society. - 2312-0541. ; 5:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study aimed to investigate the prevalence of subjective (i.e. self-reported) swallowing symptoms in a large cohort of patients with stable chronic obstructive pulmonary disease (COPD) and to identify potential related risk factors.Methods: A total of 571 patients with COPD, investigated in a stable phase, participated in this multicentre study (335 females, 236 males; mean age: 68.6 years (sd 7.7)). Data were derived from spirometry, a questionnaire and a 30-metre walking test.Results: In total, 33% (n=186) patients reported at least some degree of swallowing problem. The most frequently reported symptom was food lodging in the throat (23%). A significant relationship was found between swallowing symptoms and dyspnoea, assessed as modified Medical Research Council (mMRC) ≥2 compared with <2 (46% versus 22%; p<0.001) and health-related quality of life, assessed as the COPD Assessment Test (CAT) ≥10 (40% versus 19%; p<0.001). Swallowing problems were also related to lower physical capacity (p=0.02) but not to lung function (p>0.28).Conclusion: Subjective swallowing symptoms seem to be a common problem in patients with stable COPD. This problem is seen in all stages of the disease, but is more common in symptomatic patients and in patients with lower physical capacity.
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| 2. |
- Johansson, Hans-Erik, 1960-
(författare)
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The Impact of Bariatric Surgery on Obesity related Metabolic Traits with Specific Emphasis on Glucose, Insulin and Proinsulin
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hyperproinsulinemia is associated with type 2 diabetes (T2DM) and obesity and is a predictor for future coronary heart disease. This thesis examines the effect of bariatric surgery on glucometabolic status including insulin and proinsulin responses after meal. Further we explored longitudinally the effects of bariatric surgery on glucose, insulin and proinsulin secretion as well as lipids, liver enzymes and magnesium concentrations. We explored by a standardised meal test the postprandial dynamics of proinsulin and insulin and effects on glucose and lipids in patients treated with gastric bypass (RYGBP) surgery and in patients treated with bileopancreatic diversion with duodenal switch surgery (BPD-DS). Comparisons were made to morbidly obese patients and normal weight controls (NW). RYGBP surgery markedly lowers fasting and postprandial proinsulin concentrations although BMI was higher compared to NW-controls. BPD-DS surgery induces a large weight loss and normalises postprandial responses of glucose, proinsulin and insulin and markedly lowers triglycerides. We evaluated non-diabetic morbidly obese patients who underwent bariatric surgery followed-up for up to four years after surgery. Long-term follow-up showed that RYGBP surgery is not only characterized by markedly and sustained lowered BMI but also lowered concentrations of proinsulin, insulin, ALT and increased HDL-C possibly via reduced hepatic insulin resistance. We also examined how magnesium status is affected by bariatric surgery as magnesium has been shown to be inversely related to glucose and to insulin resistance. The serum magnesium concentrations increased by 6% after RYGBP and 10% after BPD-DS. In summary, RYGBP and BPD-DS surgery results in marked weight loss, alterations in insulin and proinsulin dynamics, lowered fasting and postprandial proinsulin concentrations and improved glucometabolic and magnesium status.
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| 3. |
- Eriksson, Lars, 1967-
(författare)
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Car Users' Switching to Public Transport for the Work Commute
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis was to investigate the determinants of car users’ switching to public transport when driving to work. Since the quality of services is particularly low in medium-sized cities, making the car a much more attractive option, the studies focus on car-use in such cities. Four studies were conducted. In the first (Paper I), an Internet survey addressing what people using their cars to commute to work in a medium-size city believe would make them reduce their car-use as well as what improvements to public transport services they believe would make them use those services was conducted. The results showed that, the further to work and/or bus stops - the more the participants desired increased frequencies and shorter travel times, but less often lower fares. In the second study (Paper II), using a web-based experimental simulation, participants were given the task of planning their travel to and from work, including the performing of additional activities in accordance with predetermined agendas. The main results of this were that shorter travel times and good access to bus stops led to greater bus use while constraints imposed by a busy daily agenda led to greater car-use, in particular if car costs were low. In the third study (Paper III) a scale for measuring satisfaction with travel was developed. A new measure of travel-related subjective well-being (SWB), a 9-item self-report Satisfaction with Travel Scale (STS), was developed. The results showed that STS is reliable and differentiates between changes in travel conditions. In the fourth study (Paper IV) which attributes other than time and cost contribute to the preference of car over bus in the choice of travel mode was investigated. Using STS, developed in Paper III the effect of different travel modes on satisfaction with travel was studied. The conclusions of this thesis are that a public transport system must appear attractive, not only to its present users, but also to prospective users who currently use their cars. To appear attractive, it must not be too expensive and must have timetables and routes that allow users to travel in an efficient manner. One measure that can be used to force commuters out of their cars is higher car-use costs; however, car-use costs may need to be substantially higher than the cost of using public transport in order to be effective. As the present research has indicated, the perceived difficulty of using public transport is also an important factor. Raising car-use costs will thus be insufficient unless changes are made to public transport services. A factor complicating this is activity patterns, which are often complex. As has been indicated in the present research, the more complex the activity pattern - the more the car is used as a means of transport.
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| 4. |
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| 5. |
- Johansson, Barbro, 1957-
(författare)
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Tonårsflickor berättar om att vara eller inte vara i behov av särskilt stöd : En longitudinell fallstudie
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to describe teenage girls’ experiences and perceptions of participation and influence during learning processes. The UN Convention on the Rights of the Child and the view that children are social actors with their own agency were central to the study. The girls, who were 13 years old when the study began, and 16 when it ended, were interviewed once per semester for three years. Classroom observations formed the basis of the interviews, which provided insight into the learning environment and its working methods. These, in turn, were discussed during the interviews. Nine girls were selected through the IEPs that the school had established for them. They attended regular classes for most of the school day, but received at least one session of special education in smaller groups each week. Their special needs were due to reading and writing difficulties. All of them received special support in English, while seven of the girls also received special support in mathematics. The girls described current events in their life, regarding both school and their spare time, as well as their thoughts about the future, and how efforts to accommodate their special educational needs have affected their schooling. In addition to the girls’ narratives, the IEPs and grades provided the school’s narrative about the girls. The theoretical basis of the thesis comprises cultural-historical ideas of teaching and learning, and the importance of relationships to group-based learning. Descriptive qualitative analyses were based on the teenage girls’ narratives and resulted in five themes; a sixth theme discussed the school’s assessment of the girls through the IEPs and their grades from lower secondary school. Feeling included or not in the group was the overarching theme of all the stories, which involved the girls’ perceptions of how they were treated by the people around them. The results indicate that the girls needed to have instructions repeated to them. There was also a need for continuous encouragement and affirmation in order for them to dare to take on assignments. When it came to collaborative learning together with classmates, the girls preferred to hide their perceived weaknesses, which only made them more dependent on the teacher’s aid. In addition, the girls felt that the teachers were unhappy with the way they handled their school work, and felt overlooked rather than “seen”. In both the stories and the IEPs, concentration difficulties were highlighted as a consistent problem. The analyses show that it is not possible to speak of concentration difficulties without further specification. Since the girls also explained that they were able to maintain concentration, it is necessary to identify which conditions allow pupils to maintain their skills, and when these skills are lost. One finding was that experiences of playing sports created unexpected development opportunities for performing under pressure, even in test situations. According to the girls, visual strengths could compensate for difficulties remembering comprehensive information. The teaching provided opportunities to demonstrate an understanding of facts through visual expression, but creative elements were not included in graded assessments. The study shows that the girls’ leisure-time experiences created opportunities for generalisation regarding learning strategies in school situations.
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| 6. |
- Johansson, Gunvi, 1950-
(författare)
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On Oral Health-Related Quality of Life in Swedish Young Adults
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Young adults in Sweden have grown up with dental care free of charge until the age of twenty. Their self-perceived oral health has been reported as being good, but rapid changes in society have led to a weaker economic situation for many young adults, which may influence their dental attendance and priorities concerning oral health and oral health care. The overall aim of this thesis was to explore the views of young adults on dental care, oral health and Oral Health-Related Quality of Life (OHRQoL).The thesis is based on four scientific papers which all apply a qualitative approach. In Paper I, the views of young adults on dental care were explored. Paper II investigated the views of young adults on their oral health and OHRQoL. In Paper III, measures of OHRQoL were described and analysed from a public health perspective, and in Paper IV, the views of young adults on the relevance of three measures of OHRQoL were explored. In Paper I, II, and IV, data collection was performed through qualitative interviews. The selection of informants was strategic with reference to age (21-29 years), sex and education. For Paper III, a literature search for OHRQoL measures was made in the PubMed database. The data in Paper I was analysed in accordance with the constant comparative method (inspired by Grounded Theory), and in Papers II, III and IV, qualitative content analysis was used.The results showed that young adults were satisfied with the dental care that they had received but reported specific views and demands on dental care (Paper I). They perceived their oral health as good, but an array of oral health problems was described (Paper II). The young adults’ perceived control of their OHRQoL depended on their future prospects of oral health, in relation to their perceptions of their past and present oral health. In Paper III, the search for measures of OHRQoL in the PubMed database generated 22 measures. The measures were analysed with regard to their theoretical framework and in relation to four principles of health promotion. Some elements of public health principles were found in all the measures, but most of them originated in disease-oriented theories. The occurrence of oral problems was reflected in young adults’ views on the measures of OHRQoL (Paper IV). The analysed measures were deemed to have both advantages and disadvantages but to be fairly equal.The conclusions are that young adults’ OHRQoL was dependent on their earlier experiences of dental care and their former and present oral health, as well as their future prospects regarding oral health. Elements of public health principles were present to a varying degree in all the measures of OHRQoL. Young adults regarded the frequently used measures of OHRQoL as being equal. The measures were mainly disease-oriented and no specific measures had been developed for young adults.
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| 7. |
- Johansson, Margareta
(författare)
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Becoming a father : Sources of information, birth preference, and experiences of childbirth and postnatal care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The period of pregnancy and childbirth is an important and sensitive time for men’s upcoming parenthood. Research into fathers’ experiences of childbearing has received less attention compared to maternal experiences. The purpose of this thesis was to study the sources fathers use to obtain information about pregnancy and childbirth, fathers’ preference for the mode of birth of their baby, and fathers’ childbirth experience and their perception of postnatal care quality.In 2007, 1105 expectant fathers were enrolled in the study when their partner had reached the middle of pregnancy. The fathers were followed until one year after the birth of their baby. The fathers were living in the county of Västernorrland in Sweden and their babies were born in one of the three hospitals in the county. Data was analysed using descriptive and inferential statistics, and content analysis. An index was created from a combination of fathers’ experiences of postnatal care quality.iiiCommon sources of information about pregnancy and childbirth used by prospective fathers were the Internet, their partners and the midwife. Fathers who were expecting their first baby (OR 1.4; 1.2-1.7), had a high level of education (OR 1.3; 1.2-1.5) and fathers with previous experience of caesarean section (OR 1.3; 1.1-1.6) were the greatest users of the Internet. Of the prospective fathers 71 (6.4%) desired caesarean section for the birth of their baby. Previous negative birth experience (PR 8.6; 2.6-28.3) and the experience of caesarean section (PR 5.7; 2.8-11.9) were factors associated with the wish that the baby would be born by caesarean section. A desire to plan the day of the baby’s birth (PR 6.0; 1.5-24.1) was associated with a preference for caesarean section for the men who were expecting their first baby. Two months after the birth of the baby 604 (74%) of the fathers in this group had had a positive birth experience. A correlation with a less-positive birth experience was with emergency caesarean section (OR 7.5; 4.1-13.6), instrumental vaginal birth (OR 4.2; 2.3-8.0) and if the man was unhappy with the medical care which the partner received (OR; 4.6; 2.7-7.8). Positive experience of healthcare professionals’ knowledge and attitudes was related to a satisfactory birth experience. The deficiencies in the postnatal care were mainly related to deficiencies in the information on the baby’s care and needs, and fathers’ experiences of their partners’ inadequate check-ups and medical care. A year after the birth 488 (79%) of the fathers were satisfied with the overall postnatal care, although they had pointed to deficiencies in the provision. Deficiencies in the attitude of the staff (OR 5.01; 2.80-8.98) and the medical care and check-ups their partner received were associated with fathers’ dissatisfaction with the overall postnatal care (OR 2.13; 1.25-3.62).ivMost fathers in this study had a positive birth experience and were happy with the postnatal care. The thesis highlights, however, opportunities for improvements in intrapartum and postnatal care. Healthcare professionals should be informed regarding the information provided via the web and to discuss the information that expectant fathers receive about pregnancy and childbirth. Prospective fathers should be given the opportunity to discuss their preferences and attitudes to the mode of birth. In addition, professionals should provide supportive information and be present in the delivery room. The information about the newborn baby’s care and needs can be strengthened, both before and after birth.
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| 8. |
- Johansson, Yvonne, 1956-
(författare)
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Self-Perceived Health and Nutritional Status among Home-Living Older People : A Prospective Study
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim was to follow the development of nutritional status and its significance for general health status using an epiemiologic method in a representative population‐based selection of older individuals in two cohorts. The main focus was to prospectively examine the significance of demographic, social and medical factors and to establish a basis to investigate the possibilities of preventive measures.Methods: Five hundred and eighty‐three individuals (278 women and 305 men), 75 and 80 years old, when included, living in a municipality in Östergötland in Sweden, participated in this study. Data collection took place 2001‐2006 with one examination yearly. The examination included a single question regarding self‐perceived health demographical questions, different questionnaires in the areas of nutritional status, symptoms of depression, cognitive function, health‐related quality of life and well being and objective assessments such as anthropometrical, physical and biochemical measurements.Results: Fifty percent of the women (I) and 58% of the men (II) perceived themselves as healthy. Important factors for women’s health (I) at baseline were no or few symptoms of depression, better physical mobility and better physical health. Among men who perceived themselves as healthy (II) at baseline, important factors were better physical health, maintaining a social network and the ability to walk outdoors. After one year 69% of the women and 75% of the men still perceived themselves as healthy. Among those women (I) who perceived themselves as healthy after one year, better physical mobility and better physical health were still important, with the addition of less or no pain. Important predictors for preserving health among men (II) were no symptoms of depression and the ability to walk up and down stairs. The prevalence of risk for malnutrition (III) was 14.5% (n=84), among women 18.8% and men 10.6%. Risk factors for malnutrition at baseline were a lower TSF, lower handgrip strength and worse physical health according to the PGC MAI. The incidence was 7.6%‐16.2%, and was distributed equally among women and men over time. Predictors for developing malnutrition were lower self‐perceived health, increased number of symptoms of depression. Especially men with symptoms of depression ran a higher risk. Reported energy intake (IV) was low in relation to the estimated requirement, on average 74% among women and 67% among men. Intake of vitamins A, D, E and folate was below the recommended intake and the same pattern was found over time. A smaller weight loss was found among women and men from baseline to Follow‐up 2.Conclusions: The experience of a good physical health was the only common factor for a good self‐perceived health among women and men. The highest risk for developing malnutrition was a combination of impaired self‐perceived health and increased number of symptoms of depression.Clinical implications: A combination of nutritional status, self‐perceived health and symptoms of depression can be a base for clinical judgement and can be used by different professionals in ealth and medical care and in home care service.
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| 9. |
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| 10. |
- Klingspor, L., et al.
(författare)
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Epidemiology of fungaemia in Sweden: A nationwide retrospective observational survey
- 2018
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Ingår i: Mycoses. - : Wiley. - 0933-7407 .- 1439-0507. ; 61:10, s. 777-785
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates to identify the epidemiology and antifungal susceptibilities of Candida spp. among blood culture isolates in Sweden. MethodsThe study was a retrospective, observational nationwide laboratory-based surveillance for fungaemia and fungal meningitis and was conducted from September 2015 to August 2016. ResultsIn total, 488 Candida blood culture isolates were obtained from 471 patients (58% males). Compared to our previous study, the incidence of candidaemia has increased from 4.2/100000 (2005-2006) to 4.7/100000 population/year (2015-2016). The three most common Candida spp. isolated from blood cultures were Candida albicans (54.7%), Candida glabrata (19.7%) and species in the Candida parapsilosis complex (9.4%). Candida resistance to fluconazole was 2% in C.albicans and between 0% and 100%, in non-albicans species other than C.glabrata and C.krusei. Resistance to voriconazole was rare, except for C.glabrata, C.krusei and C.tropicalis. Resistance to anidulafungin was 3.8% while no Candida isolate was resistant to amphotericin B. ConclusionsWe report an overall increase in candidaemia but a minor decrease of C.albicans while C.glabrata and C.parapsilosis remain constant over this 10-year period.
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