| 1. |
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| 2. |
- Bratt, Anna S., 1969-, et al.
(författare)
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An internet-based compassion course for healthcare professionals : Rationale and protocol for a randomised controlled trial
- 2022
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Ingår i: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 28
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Tidskriftsartikel (refereegranskat)abstract
- Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals. Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience. Method: Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time. Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.
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| 3. |
- Carnesten, Hillewi, et al.
(författare)
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Caring approach for patients with chest pain : Swedish registered nurses’ lived experiences in Emergency Medical Services
- 2021
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Encountering patients with chest pain is common for Registered Nurses (RNs) in Emergency Medical Services (EMS) who are responsible for the patient’s medical and nursing care . From a lifeworld perspective, bodily illness is related to existential suffering, requiring knowledge to asses the situation from a holistic perspective . The aim of this study is to describe the caring approach when RNs encounter patients with chest pain.Methods: A phenomenological methodology to capture RNs’ lived experiences was chosen. Seven qualitative in-depth interviews were conducted at three ambulance stations in Sweden.Results: The essence of the caring approach while encountering patients with chest pain comprises two constituents; “trust based on confidence and competence” and “the collegial striving towards the best possible care”. Trust is two-parted; trust in oneself, and striving towards gaining the patient’s trust . Competence and experience when combined, develop into confidence especially in stressful situations. The caring approach is nurtured in a well-functioning collegial team.Conclusions: This study contributes to understanding the caring approach based on the specific patient’s lifeworld in holistic EMS care. By trusting oneself, the patient, and one’s colleague, RNs in EMS shift focus from medical-orientated care to a holistic lifeworld caring approach. More research is needed on trust as a phenomenon in EMS, both from caregivers’ and patients’ perspectives.
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| 4. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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A matter of participation? : A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. METHODS: An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. RESULTS: Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. CONCLUSIONS: Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
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| 5. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Balancing power : Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:3, s. 766-776
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patient participation is considered to promote well- being and is, there-fore, central in care contexts. Care- dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.Method: A phenomenological hermeneutical method was used to analyse tran-scripts of narrative interviews with 11 ambulance personnel.Results: The ambulance personnel's lived experience of older persons' participa-tion includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that em-powers participation. The main theme ‘Balancing dignity in relation to manipulat-ing the body’ included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well- being and being guided by reactions. The main theme ‘Balancing influence in relation to per-ceived health risks’ included the themes Agreeing on a common perspective, Directing decision- making mandate, and Sharing responsibility for well- being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.Conclusion: Care- dependent older persons' participation in care from the per-spective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balanc-ing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve am-bulance care to benefit older persons in critical life situations.
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| 6. |
- Hjalmarsson, Anna, 1976-
(författare)
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Being provided with a safe haven : Care-dependent older persons' participation in prehospital emergency care
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Participation in care is a key concept in many welfare societies and serves to guide clinical practice and adapt care to personal preferences and needs in order to promote well-being and quality of life. Previous research has shown that practicing participation in care is complex due to the concept not being clearly defined. A significant risk is, therefore, that participation in care is practiced based on the professional caregivers' own definitions, which might be inconsistent with the cared-for persons' perceptions of what participation is.Older persons can continue to live in their own homes with the support of municipal home care services that meet everyday care needs. Care-dependent older persons are known to have increased emergency care needs, which in Sweden require inter-organizational and inter-professional collaboration involving a care transfer between welfare levels. This thesis aimed to deepen the understanding of care-dependent older persons' participation in prehospital emergency care from lifeworld and welfare perspectives. The inductive design was based on a lifeworld approach and included triangulation of the phenomenon of participation in care using descriptive, interpretative, and comparative methods.From the perspective of care-dependent older persons, participation in prehospital emergency care means a forced transfer of life responsibility to professional caregivers when being existentially unsafe and incapacitated due to acute illness. Through authorized representation, the professional caregivers act for the older person, with the power to bring about change and create opportunities for existence. Care-dependent older persons' participation in prehospital emergency care involves a deepened dependence that necessitates coexistence and being provided with a 'safe haven' through the entire emergency care chain. A 'safe haven' can be understood as an unconditional, calm, and sheltered interpersonal space for emotional rest that is provided to the older person during an existentially challenging situation. From the perspective of care-dependent older persons, the emergency care chain transcends organizational boundaries and includes mobile safety alarm services and emergency department attendance.The involved professionals must be supported in practicing participation in care based on a comprehensive understanding of the concept, and emergency care options must be aligned with the care-dependent older persons' need for coordinated and continuous care. Collaborative challenges related to unstructured collaboration and professional hierarchy need to be addressed to support well-functioning collaboration in situations involving acutely ill older persons. The involved organizations need to recognize care-dependent older persons' deepened dependence when acutely ill, as well as their extended view of the prehospital emergency care chain.
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| 7. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden : a total population study
- 2020
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Ingår i: BMC Emergency Medicine. - : BioMed Central. - 1471-227X. ; 20, s. 1-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18– 69 years requiring emergency care at home in Sweden.Methods: A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns.Results: Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00– 11:59 interval (p < 0.001, χ2 = 1224.08).Conclusion: The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
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| 8. |
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| 9. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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Entrusting life to professionals : A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services.
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.Design: This study has a qualitative design with a lifeworld approach.Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70–93 years.Results: Care-dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.Conclusion: Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.Implications for practice: Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.
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| 10. |
- Hjalmarsson, Anna, 1976-, et al.
(författare)
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When older persons need Emergency Medical Services at home : a critical incident study on Swedish municipal care personnel
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Older persons in Sweden can continue to live at home, assisted by the municipal home care services. Older age raises the risk of emergency situations that require involvement of the emergency medical services (EMS). Such situations intersect two different organizations, the municipal social care services and the regional EMS. The transfer of care between the organizations might impact the older persons´ health, and quality of life or death. Research question: How do municipal care personnel describe their experiences of and actions in situations when older persons are in need of EMS? Design: The study has a qualitative inductive design. Sample: Municipal care personnel (n=19) consisting of home care personnel and security alarm responders. Data collection and analysis: Data was collected through group interviews and free text written critical incidents analyzed according to critical incident technique. Results: Experiences related to the two main areas Lifesaving competence, and Collaborative care, which encompass the four categories Emergency knowledge, Companionship in a vulnerability, Limited caring options and Conditions for EMS collaboration. Actions related to the one main area Adjusting actions to actual conditions, which encompasses the three categories Adapting care to emergency needs, Safeguarding the person, and Adapting actions to EMS leadership.
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| 11. |
- Holmberg, Mats, 1958, et al.
(författare)
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A Longitudinal Study of Medial Temporal Lobe Volumes in Graves Disease
- 2022
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 107:4, s. 1040-1052
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Tidskriftsartikel (refereegranskat)abstract
- Context: Neuropsychiatric symptoms are common features of Graves disease (GD) in hyperthyroidism and after treatment. The mechanism behind these symptoms is unknown, but reduced hippocampal volumes have been observed in association with increased thyroid hormone levels. Objective: This work aimed at investigating GD influence on regional medial temporal lobe (MTL) volumes. Methods: Sixty-two women with newly diagnosed GD underwent assessment including magnetic resonance (MR) imaging in hyperthyroidism and 48 of them were followed up after a mean of 16.4±4.2 SD months of treatment. Matched thyroid-healthy controls were also assessed twice at a 15-month interval. MR images were automatically segmented using multiatlas propagation with enhanced registration. Regional medial temporal lobe (MTL) volumes for amygdalae and hippocampi were compared with clinical data and data from symptom questionnaires and neuropsychological tests. Results: Patients had smaller MTL regions than controls at inclusion. At follow-up, all 4 MTL regions had increased volumes and only the volume of the left amygdala remained reduced compared to controls. There were significant correlations between the level of thyrotropin receptor antibodies (TRAb) and MTL volumes at inclusion and also between the longitudinal difference in the levels of free 3,5,3′-triiodothyronine and TRAb and the difference in MTL volumes. There were no significant correlations between symptoms or test scores and any of the 4 MTL volumes. Conclusion: Dynamic alterations in the amygdalae and hippocampi in GD reflect a previously unknown level of brain involvement both in the hyperthyroid state of the condition and after treatment. The clinical significance, as well as the mechanisms behind these novel findings, warrant further study of the neurological consequences of GD.
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| 12. |
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| 13. |
- Holmberg, Mats, 1958
(författare)
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Outcome of Graves disease
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Graves' disease (GD) is an autoimmune condition with elevated thyroid hormone levels and symptoms suggesting an affected brain. These symptoms often resolve with treatment but, for some patients, GD results in a long period of reduced well-being. The overall aim of this thesis is to characterize the consequences of GD with a special focus on the brain. Three studies were conducted with data from questionnaires and clinical assessments of patients with GD in both the hyperthyroid and the euthyroid phase. Paper I was a longitudinal cohort study that assessed long-term treatment results 6–10 years after the onset of GD. Among 1186 included patients, the 774 who were initially treated with antithyroid drugs had a 40% chance of being euthyroid without thyroid medication at follow-up. One in four patients did not feel fully recovered. Paper II was a longitudinal case-control study designed to characterize affective and cognitive symptoms in 65 premenopausal women with newly diagnosed untreated GD. At onset of GD, the patients were significantly more affected with depression, anxiety, and mental fatigue compared to controls. At follow-up after 15 months, these symptoms remained in a significant proportion of patients. Patients with eye symptoms or a history of psychiatric conditions were more likely to be affected with brain-related symptoms. Paper III was a longitudinal case-control study of 65 premenopausal women with newly diagnosed untreated GD designed to investigate the effect of GD on hippocampal volumes. At onset of GD, hippocampus and amygdala volumes of the patients were smaller compared to controls. These brain structures became larger with treatment and, after 15 months, only the left amygdala remained smaller than in controls. At inclusion, there was an inverse correlation between thyroid-stimulating hormone receptor antibody (TRAb) and the volumes of both amygdalae and the right hippocampus. There were also inverse correlations between TRAb and free triiodothyronine recovery and the recovery of most of the four assessed brain volumes. GD is a condition where a minority of patients can hope for a long-lasting restored thyroid function. A large proportion of GD patients do not feel recovered after 8 years. Mental fatigue is an important concept for understanding the brain-derived symptoms in GD. In summary, the studies demonstrate that Graves' hyperthyroidism has unexpected long-term consequences for many patients, provide extensive new data on the serious and chronic nature of GD, and show for the first time that GD is accompanied by reversible brain changes.
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| 14. |
- Holmberg, Mats, 1958, et al.
(författare)
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Structural brain changes in hyperthyroid Graves' disease: protocol for an ongoing longitudinal, case-controlled study in Göteborg, Sweden-the CogThy project.
- 2019
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive impairment and reduced well-being are common manifestations of Graves' disease (GD). These symptoms are not only prevalent during the active phase of the disease but also often prevail for a long time after hyperthyroidism is considered cured. The pathogenic mechanisms involved in these brain-derived symptoms are currently unknown. The overall aim of the CogThy study is to identify the mechanism behind cognitive impairment to be able to recognise GD patients at risk.The study is a longitudinal, single-centre, case-controlled study conducted in Göteborg, Sweden on premenopausal women with newly diagnosed GD. The subjects are examined: at referral, at inclusion and then every 3.25 months until 15 months. Examinations include: laboratory measurements; eye evaluation; neuropsychiatric and neuropsychological testing; structural MRI of the whole brain, orbits and medial temporal lobe structures; functional near-infrared spectroscopy of the cerebral prefrontal cortex and self-assessed quality of life questionnaires. The primary outcome measure is the change in medial temporal lobe structure volume. Secondary outcome measures include neuropsychological, neuropsychiatric, hormonal and autoantibody variables. The study opened for inclusion in September 2012 and close for inclusion in October 2019. It will provide novel information on the effect of GD on medial temporal lobe structures and cerebral cortex functionality as well as whether these changes are associated with cognitive and affective impairment, hormonal levels and/or autoantibody levels. It should lead to a broader understanding of the underlying pathogenesis and future treatment perspectives.The study has been reviewed and approved by the Regional Ethical Review Board in Göteborg, Sweden. The results will be actively disseminated through peer-reviewed journals, national and international conference presentations and among patient organisations after an appropriate embargo time.44321 at the public project database for research and development in Västra Götaland County, Sweden (https://www.researchweb.org/is/vgr/project/44321).
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| 15. |
- Holmberg, Mats, 1958, et al.
(författare)
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Supporting sexuality and improving sexual function in transgender persons.
- 2019
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Ingår i: Nature reviews. Urology. - : Springer Science and Business Media LLC. - 1759-4820 .- 1759-4812. ; 16, s. 121-139
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Forskningsöversikt (refereegranskat)abstract
- Sexuality is important for most cisgender as well as transgender persons and is an essential aspect of quality of life. For both the patient and their clinicians, managing gender dysphoria includes establishing a comfortable relationship with sexual health issues, which canevolve throughout the course of gender-affirming treatment. Gender-affirming endocrine treatment of transgender men and women has considerable effects on sex drive and sexual function. Gender-affirming surgery (GAS) can improve body satisfaction and ease gender dysphoria, but surgery itself can be associated with sexual sequelae associated with physical constraints of the new genitals or postsurgical pain, psychological difficulties with accepting thenew body, or social aspects of having changed gender. In general, a positive body image is associated with better sexual function and satisfaction, but satisfaction with sexual function after GAS can be present despite dissatisfaction with the surgery and vice versa. Factors involved inthe integrated experience of gender-affirming treatment and the way in which sexuality is perceived are complex, and supporting sexuality and improving sexual function in transgender patients is, correspondingly, multifaceted. As the transgender patient moves through their life before, during, and after gender-affirming treatment, sexuality and sexual function should be considered and maximized at all stages in order to improve quality of life.
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| 16. |
- Johansson, Birgitta, 1957, et al.
(författare)
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The relationship between mental fatigue, depression, and cognition in Graves' disease.
- 2023
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Ingår i: European thyroid journal. - 2235-0640 .- 2235-0802. ; 12:4
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Tidskriftsartikel (refereegranskat)abstract
- Mental fatigue, depression, anxiety, and cognitive complaints are common in Graves' disease (GD). Our aims were to assess the relationship between these variables in patients with GD during both hyperthyroidism and a long stable euthyroidism.A prospective longitudinal case-control study where 65 premenopausal women diagnosed with GD and 65 matched controls were assessed twice with 15 months in between. The first visit for patients was in overt hyperthyroidism and the second after treatment.During the hyperthyroid phase, mental fatigue, depression, and anxiety were significantly increased for GD patients compared to controls (all P < 0.001). Among GD patients, 89% reported mental fatigue and among controls 14%. No difference in cognitive tests was found. After 15 months, significant improvements for GD patients after treatment were found for the items of mental fatigue, depression, and anxiety (all P < 0.001), but these were unchanged in controls. GD patients reported residual mental fatigue (38%), 23% without depression, and 15% mental fatigue combined with depression. Self-reported cognitive complaints were pronounced while cognitive tests did not reveal any deficiencies.Mental fatigue and emotional distress are common in the hyperthyroid phase. These improve with treatment but are still more common in GD patients after 15 months of therapy than in controls. The residual mental fatigue is shown to be a phenomenon distinct from depression in this study. This indicates the importance of assessing mental fatigue in GD patients and underlines the need for rehabilitation and healthcare support as fatigue will have consequences for work ability.
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| 17. |
- Kilpatrick, L. A., et al.
(författare)
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Cross sex hormone treatment is linked with a reversal of cerebral patterns associated with gender dysphoria to the baseline of cisgender controls
- 2019
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Ingår i: European Journal of Neuroscience. - : Wiley. - 0953-816X .- 1460-9568. ; 50:8, s. 3269-3281
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Tidskriftsartikel (refereegranskat)abstract
- Transgender persons experience incongruence between their gender identity and birth-assigned sex. The resulting gender dysphoria (GD), is frequently treated with cross-sex hormones. However, very little is known about how this treatment affects the brain of individuals with GD, nor do we know the neurobiology of GD. We recently suggested that disconnection of fronto-parietal networks involved in own-body self-referential processing could be a plausible mechanism, and that the anatomical correlate could be a thickening of the mesial prefrontal and precuneus cortex, which is unrelated to sex. Here, we investigate how cross-sex hormone treatment affects cerebral tissue in persons with GD, and how potential changes are related to self-body perception. Longitudinal MRI measurements of cortical thickness (Cth) were carried out in 40 transgender men (TrM), 24 transgender women (TrW) and 19 controls. Cth increased in the mesial temporal and insular cortices with testosterone treatment in TrM, whereas anti-androgen and oestrogen treatment in TrW caused widespread cortical thinning. However, after correction for treatment-related changes in total grey and white matter volumes (increase with testosterone; decrease with anti-androgen and oestrogen), significant Cth decreases were observed in the mesial prefrontal and parietal cortices, in both TrM and TrW (vs. controls) – regions showing greater pre-treatment Cth than in controls. The own body – self congruence ratings increased with treatment, and correlated with a left parietal cortical thinning. These data confirm our hypothesis that GD may be associated with specific anatomical features in own-body/self-processing circuits that reverse to the pattern of cisgender controls after cross-sex hormone treatment. © 2019 Federation of European Neuroscience Societies and John Wiley & Sons Ltd
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| 18. |
- Sj?lin, G., et al.
(författare)
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The Long-Term Outcome of Treatment for Graves' Hyperthyroidism
- 2019
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Ingår i: Thyroid. - : Mary Ann Liebert Inc. - 1050-7256 .- 1557-9077. ; 29:11, s. 1545-1557
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Tidskriftsartikel (refereegranskat)abstract
- Background: The treatment efficacy of antithyroid drug (ATD) therapy, radioactive iodine (I-131), or surgery for Graves' hyperthyroidism is well described. However, there are a few reports on the long-term total outcome of each treatment modality regarding how many require levothyroxine supplementation, the need of thyroid ablation, or the individual patient's estimation of their recovery. Methods: We conducted a pragmatic trial to determine the effectiveness and adverse outcome in a patient cohort newly diagnosed with Graves' hyperthyroidism between 2003 and 2005 (n = 2430). The patients were invited to participate in a longitudinal study spanning 8 +/- 0.9 years (mean +/- standard deviation) after diagnosis. We were able to follow 1186 (60%) patients who had been treated with ATD, I-131, or surgery. We determined the mode of treatment, remission rate, recurrence, quality of life, demographic data, comorbidities, and lifestyle factors through questionnaires and a review of the individual's medical history records. Results: At follow-up, the remission rate after first-line treatment choice with ATD was 45.3% (351/774), with I-131 therapy 81.5% (324/264), and with surgery 96.3% (52/54). Among those patients who had a second course of ATD, 29.4% achieved remission (vs. the 45.3% after the first course of ATD). The total number of patients who had undergone ablative treatment was 64.3% (763/1186), of whom 23% (278/1186) had received surgery, 43% (505/1186) had received I-131 therapy, including 2% (20/1186) who had received both surgery and I-131. Patients who received ATD as first-line treatment and possibly additional ATD had 49.7% risk (385/774) of having undergone ablative treatment at follow-up. Levothyroxine replacement was needed in 23% (81/351) of the initially ATD treated in remission, in 77.3% (204/264) of the I-131 treated, and in 96.2% (50/52) of the surgically treated patients. Taken together after 6-10 years, and all treatment considered, normal thyroid hormone status without thyroxine supplementation was only achieved in 35.7% (423/1186) of all patients and in only 40.3% of those initially treated with ATD. The proportion of patients that did not feel fully recovered at follow-up was 25.3%. Conclusion: A patient selecting ATD therapy as the initial approach in the treatment of Graves' hyperthyroidism should be informed that they have only a 50.3% chance of ultimately avoiding ablative treatment and only a 40% chance of eventually being euthyroid without thyroid medication. Surprisingly, 1 in 4 patients did not feel fully recovered after 6-10 years. The treatment for Graves' hyperthyroidism, thus, has unexpected long-term consequences for many patients.
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| 19. |
- Sjölin, Gabriel, 1979-, et al.
(författare)
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Long term outcome after toxic nodular goitre
- 2022
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Ingår i: Thyroid Research. - : Springer Science and Business Media LLC. - 1756-6614. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of treating toxic nodular goitre (TNG) is to reverse hyperthyroidism, prevent recurrent disease, relieve symptoms and preserve thyroid function. Treatment efficacies and long-term outcomes of antithyroid drugs (ATD), radioactive iodine (RAI) or surgery vary in the literature. Symptoms often persist for a long time following euthyroidism, and previous studies have demonstrated long-term cognitive and quality of life (QoL) impairments. We report the outcome of treatment, rate of cure (euthyroidism and hypothyroidism), and QoL in an unselected TNG cohort. Methods: TNG patients (n = 638) de novo diagnosed between 2003-2005 were invited to engage in a 6-10-year follow-up study. 237 patients responded to questionnaires about therapies, demographics, comorbidities, and quality of life (ThyPRO). Patients received ATD, RAI, or surgery according clinical guidelines. Results: The fraction of patients cured with one RAI treatment was 89%, and 93% in patients treated with surgery. The rate of levothyroxine supplementation for RAI and surgery, at the end of the study period, was 58% respectively 64%. Approximately 5% of the patients needed three or more RAI treatments to be cured. The patients had worse thyroid-related QoL scores, in a broad spectrum, than the general population. Conclusion: One advantage of treating TNG with RAI over surgery might be lost due to the seemingly similar incidence of hypothyroidism. The need for up to five treatments is rarely described and indicates that the treatment of TNG can be more complex than expected. This circumstance and the long-term QoL impairments are reminders of the chronic nature of hyperthyroidism from TNG.
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| 20. |
- Sjölin, Gabriel, 1979-, et al.
(författare)
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Treatment of patients with Graves' disease in Sweden compared to international surveys of an 'index patient'
- 2021
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Ingår i: Endocrinology, Diabetes & Metabolism. - : Wiley. - 2398-9238. ; 4:3
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The treatment strategies for a 42-year-old female index patient with moderate Graves' disease (GD) vary according to several international surveys. The important question whether surveys of treatment preferences in theoretical patient cases also match how real patients are treated has not yet been addressed. Materials and Methods From a Swedish cohort of 1186 GD patients (TT-12 cohort), 27 women were identified using the same criteria as from the index patient surveys from the European and American Thyroid Associations. This 'index patient cohort' was age 40-45, otherwise healthy female, with two children and uncomplicated GD. The applied first-line treatment of the patients in the index cohort, together with its variations, was compared with the treatment preferences according to international surveys. A comparison with the TT-12 cohort was also performed. Results In the 'Index cohort', 77.8% were treated with antithyroid drugs (ATD), and 22.2% were treated with radioiodine (I-131). This preference for ATD is in line with most countries/regions, with the exception of USA and the Middle East/North Africa, where I-131 was preferred. The distribution of treatment in the TT-12 cohort did not significantly differ from the index cohort. ATD was the preferred treatment in male and young (age 19-22) patients, as was RAI in old (age 69-73) patients. The age-related, but not the gender-related, cases differed significantly from the entire TT-12 cohort. Conclusion The treatment choice in an index patient in Sweden seems in line with European practice, where ATD is the preferred first choice. This differs compared to US and North African survey intentions, where I-131 is more often used. Age more than gender influences the treatment choice of GD patients. This is, to our best knowledge, the first time an index patient from 'real life' has been presented and compared to treatment preferences of international thyroid association surveys.
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| 21. |
- Tammelin, Karin, et al.
(författare)
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β 1-adrenergic and Muscarinic Acetylcholine Type 2 Receptor Antibodies are Increased in Graves' Hyperthyroidism and Decrease during Antithyroid Therapy
- 2021
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Ingår i: Experimental and Clinical Endocrinology and Diabetes. - : Georg Thieme Verlag KG. - 0947-7349 .- 1439-3646. ; 129:11, s. 783-790
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Tidskriftsartikel (refereegranskat)abstract
- Objective To determine the association between autoantibodies to G-protein-coupled receptors with effect on the cardiovascular system and the cardiac biomarker N-terminal pro-brain natriuretic peptide reflecting heart function in Graves' disease. Design and Methods Sixty premenopausal women with Graves' disease were analyzed for IgG autoantibodies against β 1-adrenergic, muscarinic acetylcholine type 2 and angiotensin II type 1 receptors using enzyme-linked immunosorbent assays based on cell membranes overexpressing receptors in their native conformations. N-terminal pro-brain natriuretic peptide and heart symptoms were analyzed in hyperthyroidism and after 7.5 months of antithyroid treatment. Matched thyroid healthy controls were also assessed. Results Serum levels of antibodies against the β 1-adrenergic and the muscarinic acetylcholine type 2 receptors were higher in hyperthyroid patients than in controls (median β 1-adrenergic receptor antibodies 1.9 [IQR 1.3-2.7] vs. 1.1 [0.8-1.7] μg/mL, P <0.0001; muscarinic acetylcholine type 2 receptor 20.5 [14.0-38.3] vs. 6.0 [3.2-9.9] U/mL, P <0.0001). These antibodies decreased in euthyroidism (P <0.01), but were still higher than in controls (P <0.01). Angiotensin II type 1 receptor levels did not differ. N-terminal pro-brain natriuretic peptide was higher in hyperthyroidism (240 [134-372] vs. <35 [<35-67] ng/L, P <0.0001), normalized after treatment and did not correlate with autoantibodies. Conclusion Autoantibodies against the β 1-adrenergic and the muscarinic acetylcholine type 2 receptors were increased in Graves' patients, decreased with treatment, but did not correlate with cardiac function. However, an autoimmune effect on the heart cannot be excluded in subpopulations, as the functional properties of the analyzed antibodies remain to be determined. © 2021 Georg Thieme Verlag. All rights reserved.
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| 22. |
- Tesch, Per, et al.
(författare)
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Peak oxygen uptake using a training device for combined resistance and aerobic exercise in space and on earth
- 2008
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Ingår i: 13th Annual Congress of the European College of Sports Science. - Cologne : Sportools. - 9789727351565 ; , s. 523-
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Konferensbidrag (refereegranskat)abstract
- Astronauts traveling in Orbit are mandated to perform both aerobic and resistance exercise to combat cardiovascular and muscular deconditioning. A non-gravity dependent flywheel resistance exercise device (FWD), proven to be effective in blunting muscle atrophy when used by bedridden subjects, has been configured to allow for aerobic exercise as well. The current study aimed at determining aerobic energy yield and related physiological demands during exercise using this novel apparatus. Methods: Eight men and women (23±3 yrs, 65±5 kg, 170±6 cm) performed all-out, indoor, stationary rowing exercise randomly on either a commercially available Concept II ergometer (CII) or the FWD. Using a magnetic brake system, the FWD and similar to the CII, produced mainly concentric resistance exercise with the aid of the inherent inertia of rotating flywheels. Progressive exercise protocols (increased frequency and magnetic force) assessed peak oxygen uptake and heart rate, rate of perceived exertion and post lactate concentration. Results Peak oxygen uptake averaged 3.18±0.50 and 3.11±0.49 l/min, respectively during exercise using CII and FWD. Peak oxygen uptake, plasma lactate concentration, heart rate and rate of perceived exertion were not different (p>0.05) across exercise using these two devices. However, time to exhaustion was somewhat (p<0.05) longer for the FWD. Conclusion: Collectively the current results suggest that the novel method of offering an aerobic exercise stimulus is as effective as the most established technology for indoor rowing used by crew. Given that the space agencies have recognized the need for effective exercise countermeasures hardware that has a feasible mass and envelope and features allowing for multiple purposes (e.g., concentric/eccentric resistance and aerobic exercise) in a single piece of apparatus, the current technology should be considered for use in space.
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| 23. |
- Törring, Ove, et al.
(författare)
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Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves’ Hyperthyroidism : A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey
- 2019
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Ingår i: Thyroid. - : Mary Ann Liebert. - 1050-7256 .- 1557-9077. ; 29:3, s. 322-331
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hyperthyroidism is known to have a significant impact on the quality of life (QoL) at least in the short term. The purpose of the present study was to assess QoL in patients at 6-10 years after treatment for Graves' disease (GD) with radioiodine (RAI) to those treated with thyroidectomy or antithyroid drugs (ATD) as assessed with both a thyroid-specific (ThyPRO) and general (SF-36) QoL surveys.METHODS: We evaluated 1186 GD patients in a sub-cohort from an incidence study 2003-2005 which had been treated according to routine clinical practice at seven participating centers. Patients were included if they had returned the ThyPRO (n=975) and/or the SF-36 questionnaire (n=964) and informed consent at follow-up. Scores from ThyPRO were compared with scores from a general population sample (n=712), using multiple linear regression adjusting for age and gender as well as multiple testing. Treatment related QoL outcome for ATD, RAI and surgery were compared including adjustment for the number of treatments received, sex, age and co-morbidity.RESULTS: Regardless of treatment modality, patients with GD had worse thyroid-related QoL 6-10 years after diagnosis compared with the general population. Patients treated with RAI had worse thyroid-related and general QoL than patients treated with ATD or thyroidectomy on the majority of QoL-scales. Sensitivity analyses supported the relative negative comparative effects of RAI treatment on QoL in patients with hyperthyroidism.CONCLUSIONS: Graves' disease is associated with a lower QoL many years after treatment compared to the general population. In a previous, small RCT we did not show any difference in patient satisfaction years after ATD, RAI or surgery. We now report that in a large non-randomized cohort, patients who received RAI had adverse scores on ThyPRO and SF-36. These findings in a Swedish population are limited by comparison to normative data from Denmark, by older age and possibly a more prolonged course in those patients who received radioiodine, and a lack of information regarding thyroid status at the time of evaluation. The way RAI may adversely affect QoL is unknown but since the results may be important for future considerations regarding treatment options for GD they need to be substantiated in further studies.
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| 24. |
- Åkeson, Margaretha, 1944, et al.
(författare)
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A population-based 5-year cohort study including all cases of epithelial ovarian cancer in western Sweden: 10-year survival and prognostic factors.
- 2009
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Ingår i: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. - 1525-1438. ; 19:1, s. 116-23
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Tidskriftsartikel (refereegranskat)abstract
- Epithelial ovarian cancer (EOC) is the major gynecologic cancer mortality cause in Sweden. The aim of the present study was to investigate the long-term survival and prognostic factors of a complete population-based 5-year cohort of 682 patients with invasive EOC in western Sweden (population around 1.6 million). Data relating to residual tumor after surgery, FIGO stage, grade, histopathologic subtype, ploidy status, adjuvant chemotherapy (the prepaclitaxel period), and disease state (recurrence and death) were reported to a quality register in a prospectively kept database and were controlled against the Swedish National Cancer Registry for completeness. The median follow-up durations for the prospectively collected data in the Cox analysis and for the survival analysis that was made for all patients were 81 months (range, 52-109 months) and 11.7 years (range, 8.7-14.1 years), respectively. No patient was lost to follow-up. The relative 10-year survival rate was 38.4% (95% confidence interval, 34.5%-42.8%). The median relative survival time was 4.3 years (95% confidence interval, 3.6%-5.2%). In the univariate Cox regression analysis, prognostic significances for age, stage, residual tumor, histopathologic subtype of serous cystadenocarcinoma, grade, CA-125, and ploidy status were seen. In the multivariate analysis, age, stage, residual tumor after surgery, and postoperative CA-125 were of prognostic significance. In conclusion, 4 major prognostic factors were found for EOC in this population-based cohort study that also presents nearly accurate long-term survival owing to the nonselective nature and completeness regarding patients and follow-up of the study.
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