| 1. |
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| 2. |
- Adebahr, Roberth, et al.
(författare)
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A randomized controlled add-on trial of fluoxetine and cognitive behavioral therapy for help-seeking men with a sexual interest in children : presentation of the PARACHUTES trial protocol and initial feasibility data
- 2024
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sexual Interest in Children (SIC) is a major risk factor for sexual offending, yet clinical trials are sparse. The present protocol outlines a randomized controlled trial (RCT) that aims to investigate the effectiveness of fluoxetine and Cognitive Behavioral Therapy (CBT) in help-seeking men with SIC.Methods: Adult men contacting the Swedish telephone helpline PrevenTell are screened for inclusion and invited to further assessment on site. One hundred and eleven men with SIC (defined as DSM-5 pedophilic disorder or hebephilia) will be randomized (1:1:1 ratio) to receive one of three interventions for 14 weeks: (1) an internet-administered psychoeducational program (iPP), (2) iPP and the addition of fluoxetine 20-40 mg or (3) iPP and the addition of internet-administered CBT (iCBT). Exclusion criteria include severe psychiatric illness, contraindicating treatment and an elevated risk of committing hands-on sexual offences. Symptom intensity is assessed at baseline, pre-treatment, every other week for 12 weeks, and post treatment. The primary outcome measure is the Sexual Interest in Children: Current Assessment Scale (SIC: CAS) that quantifies sexual behaviors associated with SIC as well as perceived distress and impairment. Secondary outcomes include measures of dynamic risk-factors for committing sexual offences.Results: The data collected during the initial 20 months of recruitment were analyzed to predict the required number of individuals to be screened and estimate the probable length of the data collection phase. As of March 2022 to November 2023, 146 men have called PrevenTell and disclosed a sexual interest in minors. Following pre-screening, 110 men were excluded from participation in the trial. Current SSRI therapy was the primary reason for exclusion (n = 24; 22%), followed by an elevated risk of committing hands-on sexual offences (n = 14; 13%). Among the 31 men who underwent the screening procedure on site, 26 were allocated to either iPP, iPP+fluoxetine, or iPP+iCBT. The recruitment rate indicates that the trial will be concluded within the pre-estimated timeframe.Discussion: This is the first RCT of treatment with SSRI and iCBT in a population of help-seeking men with SIC. The significance of this trial and its methodological strengths and limitations are discussed.
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| 3. |
- Adebahr, Roberth, et al.
(författare)
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Reaching Men and Women at Risk of Committing Sexual Offences : Findings From the National Swedish Telephone Helpline PrevenTell
- 2021
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Ingår i: Journal of Sexual Medicine. - : Elsevier. - 1743-6095 .- 1743-6109. ; 18:9, s. 1571-1581
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2012 the Swedish Helpline project PrevenTell, targeting men and women with self-identified out-of-control and paraphilic sexual behavior, was launched by ANOVA, Karolinska University Hospital. The overall purpose was to reach the target group and via a telephone-contact encourage further on-site assessment and treatment.Aim: To describe men and women contacting PrevenTell during the first 7 years by delineate sexuality-related risk-factors for sexual violence, gender differences, and age-and gender-preferences when reporting a pedophilic interest.Method: A 52-item semi-structured telephone interview was conducted by experts in sexual medicine with individuals who contacted the helpline. The interview covered sociodemographic characteristics, problematic sexual behavior(s), and mental health and based on the information reported, interventions included recommending an appointment at ANOVA, supporting other appropriate healthcare, or motivation of individuals still ambivalent to treatment.Results: Data collection took place between March 2012 and October 2019. A total of 1573 respondents in the main target group (1454 men and 119 women) gave informed consent for participation. Compulsive sexual behavior was reported by 69% of respondents and 56% described at least one paraphilic interest. The prevalence of concomitant compulsive sexual behavior and a paraphilic interest was high, varying between 65% and 83%. Significant gender differences were found in socioeconomic and mental health variables, in which women showed fewer positive and stable life factors compared to men. A sexual preference for minors was reported by 24% of respondents. In this group, 63% reported use of child sexual exploitation material and 15% committed child sexual abuse. Respondents were offered anonymity, however 55% disclosed their identity and were enrolled for further assessment and treatment at ANOVA.Clinical Implications: The result of this study is of substantial relevance when developing secondary preventive initiatives targeting sexual violence in the community.Strengths and Limitations: This is the first study to present data from a national helpline targeting both men and women with a wide range of self-identified problematic sexual behaviors. Limitations include the lack of diagnostic confirmation on-site, hence, presented data provides only an indication of clinical conditions. Furthermore, the main objective of the interview was to motivate participants to seek further treatment, sometimes necessary to prioritize this over adherence to the semi-structured questionnaire, explaining the relatively high absence rate in some variables.Conclusion: Men and women at risk of committing sexual crimes can be reached through a national helpline service and motivated to undergo further assessment and treatment.
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| 4. |
- Boström, Adrian Desai E., et al.
(författare)
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HPA-axis dysregulation is not associated with accelerated epigenetic aging in patients with hypersexual disorder
- 2022
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Ingår i: Psychoneuroendocrinology. - : Elsevier. - 0306-4530 .- 1873-3360. ; 141
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundHypersexual disorder (HD) - a nonparaphilic sexual desire disorder with impulsivity component - was evaluated for inclusion as a diagnosis in the DSM-5 and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the ICD-11. Hypothalamic-pituitary-adrenal (HPA)-axis hyperactivity is believed to affect cellular senescence and has been implicated in HD. No previous study investigated HD or HPA-axis dysregulation in relation to measures of epigenetic age (EA) acceleration.MethodsThis study reports on a case-control study set-up from a well-characterized cohort, contrasting EA predictors in relation to 60 HD patients and 33 healthy volunteers (HV) and 19 mixed HD/HV exhibiting dexamethasone suppression test (DST) non-suppression to 73 mixed HD/HV DST controls. The genome-wide methylation pattern was measured in whole blood from 94 subjects using the Illumina Infinium Methylation EPIC BeadChip and preprocessed according to specialized protocols suitable for epigenetic age estimation. The online DNAm Age Calculator (https://dnamage.genetics.ucla.edu/) was implemented to retrieve various EA predictors, which were compared between the in-silico generated subgroups.ResultsQuality control analyses indicated strong correlations between the EA measure DNA methylation GrimAge (DNAm GrimAge – the EA clock most reliably associated with mortality risk) and chronological age in all sub-groups. The study was adequately powered to detect differences of 2.5 and 3.0 years in DNAm GrimAge minus age in relation to both HD and HPA-axis dysregulation, respectively. Baseline DNAm GrimAge exceeded chronological age by 2.8 years on average across all samples. No EA acceleration marker was associated with HD or DST suppression status (p > 0.05).ConclusionEA acceleration markers shown to be strongly predictive of physiological dysregulation and mortality-risk, are not related to HD or DST non-suppression status (measured after 0.5 mg dexamethasone). The independency of HPA-axis dysregulation to EA acceleration does not support the biological relevance of this dosage-regimen when applied to patients with HD. These findings do not support the notion of accelerated cellular senescence in HD. Studies stratifying DST non-suppressors according to established dosage-regimens in somatic settings are needed to fully elucidate the putative contribution of HPA-axis dysregulation to EA.
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| 5. |
- Chatzittofis, Andreas, et al.
(författare)
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HPA axis dysregulation in men with hypersexual disorder
- 2016
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Ingår i: Psychoneuroendocrinology. - : Elsevier. - 0306-4530 .- 1873-3360. ; 63, s. 247-253
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Tidskriftsartikel (refereegranskat)abstract
- Hypersexual disorder integrating pathophysiological aspects such as sexual desire deregulation, sexual addiction, impulsivity and compulsivity was suggested as a diagnosis for the DSM-5. However, little is known about the neurobiology behind this disorder. A dysregulation of the hypothalamic pituitary adrenal (HPA) axis has been shown in psychiatric disorders but has not been investigated in hypersexual disorder. The aim of this study was to investigate the function of the HPA axis in hypersexual disorder. The study includes 67 male patients with hypersexual disorder and 39 healthy male volunteers. Basal morning plasma levels of cortisol and ACTH were assessed and low dose (0.5 mg) dexamethasone suppression test was performed with cortisol and ACTH measured post dexamethasone administration. Non-suppression status was defined with DST-cortisol levels >= 138 nmol/l. The Sexual Compulsive scale (SCS), Hypersexual disorder current assessment scale (HD:CAS), Montgomery-Asberg Depression Scale-self rating (MADRS-S) and Childhood trauma questionnaire (CTQ), were used for assessing hypersexual behavior, depression severity and early life adversity. Patients with hypersexual disorder were significantly more often DST non-suppressors and had significantly higher DST-ACTH levels compared to healthy volunteers. The patients reported significantly more childhood trauma and depression symptoms compared to healthy volunteers. CTQ scores showed a significant negative correlation with DST-ACTH whereas SCS and HD:CAS scores showed a negative correlation with baseline cortisol in patients. The diagnosis of hypersexual disorder was significantly associated DST non-suppression and higher plasma DST-ACTH even when adjusted for childhood trauma. The results suggest HPA axis dysregulation in male patients with hypersexual disorder.
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| 6. |
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| 7. |
- Chatzittofis, Andreas, et al.
(författare)
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HPA axis dysregulation is associated with differential methylation of CpG-sites in related genes
- 2021
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- DNA methylation shifts in Hypothalamic–pituitary–adrenal (HPA) axis related genes is reported in psychiatric disorders including hypersexual disorder. This study, comprising 20 dexamethasone suppression test (DST) non-suppressors and 73 controls, examined the association between the HPA axis dysregulation, shifts in DNA methylation of HPA axis related genes and importantly, gene expression. Individuals with cortisol level ≥ 138 nmol/l, after the low dose (0.5 mg) dexamethasone suppression test (DST) were classified as non-suppressors. Genome-wide methylation pattern, measured in whole blood using the EPIC BeadChip, investigated CpG sites located within 2000 bp of the transcriptional start site of key HPA axis genes, i.e.: CRH, CRHBP, CRHR-1, CRHR-2, FKBP5 and NR3C1. Regression models including DNA methylation M-values and the binary outcome (DST non-suppression status) were performed. Gene transcripts with an abundance of differentially methylated CpG sites were identified with binomial tests. Pearson correlations and robust linear regressions were performed between CpG methylation and gene expression in two independent cohorts. Six of 76 CpG sites were significantly hypermethylated in DST non-suppressors (nominal P < 0.05), associated with genes CRH, CRHR1, CRHR2, FKBP5 and NR3C1. NR3C1 transcript AJ877169 showed statistically significant abundance of probes differentially methylated by DST non-suppression status and correlated with DST cortisol levels. Further, methylation levels of cg07733851 and cg27122725 were positively correlated with gene expression levels of the NR3C1 gene. Methylation levels of cg08636224 (FKBP5) correlated with baseline cortisol and gene expression. Our findings revealed that DNA methylation shifts are involved in the altered mechanism of the HPA axis suggesting that new epigenetic targets should be considered behind psychiatric disorders.
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| 8. |
- Chatzittofis, Andreas, et al.
(författare)
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Interpersonal violence, early life adversity, and suicidal behavior in hypersexual men
- 2017
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 6:2, s. 187-193
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: There are significant gaps in knowledge regarding the role of childhood adversity, interpersonal violence, and suicidal behavior in hypersexual disorder (HD). The aim of this study was to investigate interpersonal violence in hypersexual men compared with healthy volunteers and the experience of violence in relation to suicidal behavior. Methods: This case-control study includes 67 male patients with HD and 40 healthy male volunteers. The Childhood Trauma Questionnaire-Short Form (CTQ-SF) and the Karolinska Interpersonal Violence Scale (KIVS) were used for assessing early life adversity and interpersonal violence in childhood and in adult life. Suicidal behavior (attempts and ideation) was assessed with the Mini-International Neuropsychiatric Interview (version 6.0) and the Montgomery-Asberg Depression Rating Scale - Self-rating. Results: Hypersexual men reported more exposure to violence in childhood and more violent behavior as adults compared with healthy volunteers. Suicide attempters (n = 8, 12%) reported higher KIVS total score, more used violence as a child, more exposure to violence as an adult as well as higher score on CTQ-SF subscale measuring sexual abuse (SA) compared with hypersexual men without suicide attempt. Discussion: Hypersexuality was associated with interpersonal violence with higher total scores in patients with a history of suicide attempt. The KIVS subscale exposure to interpersonal violence as a child was validated using the CTQ-SF but can be complemented with questions focusing on SA for full assessment of early life adversity. Conclusion: Childhood adversity is an important factor in HD and interpersonal violence might be related to suicidal behavior in hypersexual men.
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| 9. |
- Chatzittofis, Andreas, et al.
(författare)
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Neurochemical and Hormonal Contributors to Compulsive Sexual Behavior Disorder
- 2022
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Ingår i: Current Addiction Reports. - : Springer Berlin/Heidelberg. - 2196-2952. ; 9, s. 23-31
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Forskningsöversikt (refereegranskat)abstract
- Purpose of Review: Compulsive sexual behavior disorder has been recently included in the 11th revision of the International Classification of Diseases (ICD-11), and the possible contribution of neurochemical and hormonal factors have been reported. However, relatively little is known concerning the neurobiology underlying this disorder. The aim of this article is to review and discuss published findings in the area.Recent Findings: Evidence suggests that the neuroendocrine systems are involved in the pathophysiology of compulsive sexual behavior. The hypothalamus-pituitary adrenal axis, the hypothalamus-pituitary–gonadal axis, and the oxytocinergic system have been implicated.Summary: Further studies are needed to elucidate the exact involvement of neuroendocrine and hormonal systems in compulsive sexual behavior disorder. Prospective longitudinal studies are particularly needed, especially those considering co-occurring psychiatric disorders and obtaining hormonal assessments in experimental circumstances with appropriate control groups.
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| 10. |
- Chatzittofis, Andreas, et al.
(författare)
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Normal Testosterone but Higher Luteinizing Hormone Plasma Levels in Men With Hypersexual Disorder
- 2020
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Ingår i: Sexual Medicine. - : Elsevier. - 2050-1161. ; 8:2, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Hypersexual disorder as suggested to be included in the Diagnostic and Statistical Manual of Mental Disorders-5 integrates aspects of sexual desire deregulation, impulsivity, and compulsivity. However, it is unknown how it affects gonadal activity and the function of the hypothalamus-pituitary-gonadal (HPG) axis.Aim: The aim of this study was to investigate testosterone and luteinizing hormone (LH) levels in hypersexual men compared with healthy controls. Furthermore, we investigated associations between epigenetic markers and hormone levels.Methods: Basal morning plasma levels of testosterone, LH, and sex hormone-binding globulin (SHBG) were assessed in 67 hypersexual men (mean age: 39.2 years) compared with 39 age-matched healthy controls (mean age: 37.5 years). The Sexual Compulsivity Scale and the Hypersexual Disorder: Current Assessment Scale were used for assessing hypersexual behavior, the Montgomery-Asberg Depression Scale-self rating was used for depression severity, and the Childhood Trauma Questionnaire (CTQ) was used for assessing history of childhood adversity. The genome-wide methylation pattern of more than 850 K CpG sites was measured in whole blood using the Illumina Infinium Methylation EPIC BeadChip. CpG sites located within 2,000 bp of the transcriptional start site of hypothalamus pituitary adrenal (HPA) and HPG axis-coupled genes were included.Main Outcome Measures: Testosterone and LH plasma levels in association with clinical rating and a secondary outcome was the epigenetic profile of HPA and HPG axis-coupled CpG sites with testosterone and LH levels.Results: LH plasma levels were significantly higher in patients with hypersexual disorder than in healthy volunteers. No significant differences in plasma testosterone, follicle stimulating hormone, prolactin, and SHBG levels were found between the groups. There were no significant associations between DNA methylation of HPA and HPG axis-coupled genes and plasma testosterone or LH levels after multiple testing corrections.Conclusions: Subtle dysregulation of the HPG axis, with increased LH plasma levels but no difference in testosterone levels may be present in hypersexual men.
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| 11. |
- Flanagan, John, et al.
(författare)
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High plasma oxytocin levels in men with hypersexual disorder
- 2022
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : Oxford University Press. - 0021-972X .- 1945-7197. ; 107:5, s. e1816-e1822
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Tidskriftsartikel (refereegranskat)abstract
- Context: Hypersexual disorder (HD) involves excessive, persistent sexual behaviors related to various mood states and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the 11th revision of the International Classification of Diseases. Although the neurobiology behind the disorder is not clear, some studies suggest dysregulated hypothalamic-pituitary-adrenal axis. Oxytocin acts as counterregulatory neuroendocrine hormone to cortisol and is also involved in sexual behavior.Objective: We hypothesized that oxytocin may play a role in the pathophysiology of HD with compensatory actions to cortisol.Design: Longitudinal.Setting: ANOVA clinic (Karolinska University Hospital).Patients or other participants: 64 males with HD and 38 age-matched healthy volunteers.Main Outcome Measures: Plasma oxytocin levels, measured with radioimmunoassay; Hypersexual Disorder Screening Inventory; and Hypersexual Disorder: Current Assessment Scale for assessing hypersexual symptoms.Interventions: A patient subgroup (n=30) completed the manual-based group-administered cognitive-behavioral therapy (CBT) program for HD, and posttreatment oxytocin levels were measured.Results: Hypersexual men (n=64) exhibited significantly higher oxytocin plasma levels (mean±SD: 31.0±9.9 pM) compared with healthy volunteers (16.9±3.9 pM; P<0.001). There were significant positive correlations between oxytocin levels and the rating scales measuring hypersexual behavior. Patients who completed CBT treatment (n=30) had a significant reduction of oxytocin plasma levels from pretreatment (30.5±10.1 pM) to posttreatment (20.2±8.0 pM; P<0.001).Conclusions: The results suggest that the hyperactive oxytocinergic system in hypersexual men may be a compensatory mechanism to attenuate hyperactive stress.
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| 12. |
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| 13. |
- Gidlund- Lindblad, Katarina, et al.
(författare)
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Critical Design and the creation of alternative visions : literally and metaphorically Critical
- 2014
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Rapport (refereegranskat)abstract
- Critical design methods and thinking is gaining increasing interest during design of artefacts, applied mainly by interaction designers in order to create designs that cause reflections (on roles, norms, values, practices, cultures). It forces reflection among the users of the artefacts, since the artefact is aimed to provoke, and to support visions of alternative realities, other ways of being and living. However, ways to create such provocations, reflections and visions among the professionals (designers, researchers and practitioners) is not explored as much. If considering critical design rather as a position than an approach for design, how can we support reflection among us as professionals? Thereby, enable usage of critical design in our profession? These, and related questions, will be reflected upon and discussed during the workshop.
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| 14. |
- Görts, Per, et al.
(författare)
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Structural brain differences related to compulsive sexual behavior disorder
- 2023
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 12:1, s. 278-287
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Compulsive sexual behavior disorder (CSBD) has been included as an impulse control disorder in the International Classification of Diseases (ICD-11). However, the neurobiological mechanisms underlying CSBD remain largely unknown, and given previous indications of addiction-like mechanisms at play, the aim of the present study was to investigate if CSBD is associated with structural brain differences in regions involved in reward processing.Methods: We analyzed structural MRI data of 22 male CSBD patients (mean = 38.7 years, SD = 11.7) and 20 matched healthy controls (HC; mean = 37.6 years, SD = 8.5). Main outcome measures were regional cortical thickness and surface area. We also tested for case-control differences in subcortical structures and the effects of demographic and clinical variables, such as CSBD symptom severity, on neuroimaging outcomes. Moreover, we explored case-control differences in regions outside our hypothesis including white matter.Results: CSBD patients had significantly lower cortical surface area in right posterior cingulate cortex than HC. We found negative correlations between right posterior cingulate area and CSBD symptoms scores. There were no group differences in subcortical volume.Conclusions: Our findings suggest that CSBD is associated with structural brain differences, which contributes to a better understanding of CSBD and encourages further clarifications of the neurobiological mechanisms underlying the disorder.
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| 15. |
- Görts Öberg, Katarina, et al.
(författare)
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Hypersexual Disorder According to the Hypersexual Disorder Screening Inventory in Help-Seeking Swedish Men and Women With Self-Identified Hypersexual Behavior
- 2017
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Ingår i: Sexual Medicine. - : Elsevier. - 2050-1161. ; 5:4, s. E229-E236
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The Hypersexual Disorder Screening Inventory (HDSI) was developed by the American Psychiatric Association for clinical screening of hypersexual disorder (HD). Aims: To examine the distribution of the proposed diagnostic entity HD according to the HDSI in a sample of men and women seeking help for problematic hypersexuality and evaluate some psychometric properties. Methods: Data on sociodemographics, the HDSI, the Sexual Compulsivity Scale (SCS), and the Cognitive and Behavioral Outcomes of Sexual Behavior were collected online from 16 women and 64 men who self-identified as hypersexual. Respondents were recruited by advertisements offering psychological treatment for hypersexual behavior. Main Outcome Measures: The HDSI, covering the proposed criteria for HD. Results: Of the entire sample, 50% fulfilled the criteria for HD. Compared with men, women scored higher on the HDSI, engaged more often in risky sexual behavior, and worried more about physical injuries and pain. Men primarily used pornography, whereas women had sexual encounters. The HD group reported a larger number of sexual specifiers, higher scores on the SCS, more negative effects of sexual behavior, and more concerns about consequences compared with the non-HD group. Sociodemographics had no influence on HD. The HDSI's core diagnostic criteria showed high internal reliability for men (a = 0.80) and women (a = 0.81). A moderate correlation between the HDSI and the SCS was found (0.51). The vast majority of the entire sample (76 of 80, 95%) fulfilled the criteria for sexual compulsivity according to the SCS. Conclusion: The HDSI could be used as a screening tool for HD, although further explorations of the empirical implications regarding criteria are needed, as are refinements of cutoff scores and specific sexual behaviors. Hypersexual problematic behavior causes distress and impairment and, although not included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, HD should be endorsed as a diagnosis to develop evidence-based treatment and future studies on its etiology. Copyright (C) 2017, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine. This is an open access article under the CC BY-NC-ND license.
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| 16. |
- Hallberg, Jonas, et al.
(författare)
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A Cognitive-Behavioral Therapy Group Intervention for Hypersexual Disorder : A Feasibility Study
- 2017
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Ingår i: Journal of Sexual Medicine. - : Elsevier. - 1743-6095 .- 1743-6109. ; 14:7, s. 950-958
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Tidskriftsartikel (refereegranskat)abstract
- Background: The proposed criteria of the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition for hypersexual disorder (HD) included symptoms reported by patients seeking help for excessive and out-of-control non-paraphilic sexual behavior, including sexual behaviors in response to dysphoric mood states, impulsivity, and risk taking. Although no prior studies of cognitive-behavioral therapy (CBT) for the treatment of HD have been performed, CBT has been found effective for dysphoric mood states and impulsivity. Aim: To investigate the feasibility of a CBT manual developed for HD explored through symptom decrease, treatment attendance, and clients' treatment satisfaction. Methods: Ten men with a diagnosis of HD took part in the CBT group program. Measurements were taken before, during, and at the end of treatment and 3 and 6 months after treatment. Outcomes: The primary outcome was the Hypersexual Disorder: Current Assessment Scale (HD: CAS) score that measured the severity of problematic hypersexual symptoms and secondary outcomes were the Hypersexual Disorder Screening Inventory (HDSI) score, the proportion of attended sessions, and the Client Satisfaction Questionnaire (CSQ-8) score. Results: Main results were significant decreases of HD symptoms from before to after treatment on HD: CAS and HDSI scores and a decrease in the number of problematic sexual behaviors during the course of therapy. A high attendance rate of 93% and a high treatment satisfaction score on CSQ-8 also were found. Clinical Implications: The CBT program seemed to ameliorate the symptoms of HD and therefore might be a feasible treatment option. Strengths and Limitations: This study provides data from a CBT program for the treatment of the specific proposed criteria of HD. Because of the small sample and lack of a control group, the results can be considered only preliminary. Conclusion: Although participants reported decreased HD symptoms after attending the CBT program, future studies should evaluate the treatment program with a larger sample and a randomized controlled procedure to ensure treatment effectiveness. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
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| 17. |
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| 18. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Employment Status and Suicidal Ideation during Economic Recession
- 2015
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Ingår i: Health science journal. - 1791-809X. ; 9:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County.Method:The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideationResults:Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation.Conclusion:There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.
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| 19. |
- Hiswåls, Anne-Sofie, et al.
(författare)
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Inequalities and Suicide Ideation during Recession Times
- 2014
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24:Suppl. 2, s. 361-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundSuicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.MethodsThe study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.ResultsPeople who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.ConclusionsThis study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.Key messagesSuicide ideation was more common among people out of labor force in Gävleborg County, Sweden.Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.
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| 20. |
- Jemtå, Lena, et al.
(författare)
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On intimacy, sexual activities and exposure to sexual abuse among children and adolescents with mobility impairment
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:5, s. 641-646
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The aim was to describe experiences of intimacy and sexual activity and exposure to sexual abuse among children and adolescents with mobility impairment, and to relate these experiences to socio-demographic data, disability characteristics and well-being. Methods: This study included semi-structured interviews with 141 children and adolescents aged 7-18 years with mobility impairment. Interpersonal experiences of intimacy and sexuality, socio-demographic data, disability characteristics and well-being were registered. Results: About half of the children and adolescents in the study had been in a boy- or a girlfriend relationship, and about a fifth had an ongoing relationship. Of the adolescents, 15% had at least one experience of a sexual relationship. Whereas no particular sexual dysfunction was reported, 15% had concerns about their future sexual activities, presumably related to mobility impairment. A history of sexual abuse was reported by 7% in the age cohort of 13-18 years. The socio-demographic and disability-related features had a marginal influence on the experiences of intimacy and sexual activities. Conclusion: Several aspects of sexual health are not fully realized for children and adolescents with impaired mobility, and there is a need for specialized sexual health care services to protect the sexual rights of this group.
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| 21. |
- Jemtå, Lena, et al.
(författare)
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Self-esteem in children and adolescents with mobility impairment : impact on well-being and coping strategies
- 2009
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 98:3, s. 567-572
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The first aim was to investigate dimension-specific and global self-esteem in children and adolescents with mobility impairment and to analyse the relation between self-esteem and demographic data and disability characteristics. The second aim was to identify the impact of five self-esteem dimensions on well-being and coping strategies. METHODS: A total of 138 children and adolescents aged 7-18 years with mobility impairment took part in a semi-structured interview. Demographic and disability characteristics were recorded and motor function was assessed. Self-esteem was measured by the 'I think I am' inventory. Perceived overall well-being was measured by a nine-grade visual scale, the Snoopy scale, and coping strategies by the Children's Coping Strategies Checklist. RESULTS: Although a majority estimated a relatively high level of dimension-specific and global self-esteem, several demographic and disability factors for lower self-esteem were identified. Those who estimated their 'physical characteristics' lower used the coping strategy 'distraction' more often. Three out of five dimensions of self-esteem were positively associated with perceived overall well-being: 'physical characteristics', 'psychological well-being' and 'relationships with others'. CONCLUSION: Awareness of vulnerability factors for lower self-esteem in children and adolescents with mobility impairment offer health care professionals specific opportunities to enhance self-esteem in this group.
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| 22. |
- Jokinen, Jussi, et al.
(författare)
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High Plasma Oxytocin Levels in Men With Hypersexual Disorder
- 2019
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Ingår i: Neuropsychopharmacology. - : Nature Publishing Group. - 0893-133X .- 1740-634X. ; 44, s. 114-114
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Hypersexual disorder (HD) integrating pathophysiological aspects such as sexual desire deregulation, sexual addiction, impulsivity and compulsivity was suggested as a diagnosis for the DSM-5. "Compulsive Sexual Behavior Disorder" is now presented as an impulse-control disorder in ICD-11. Recent studies showed dysregulated HPA axis in men with HD. Oxytocin (OXT) affects the function of the HPA axis; no studies have assessed OXT levels in patients with HD. Whether a CBT treatment for HD symptoms has an effect on OXT levels has not been investigated.Methods: We examined plasma OXT levels in 64 male patients with HD and 38 male age-matched healthy volunteers. Further, we examined correlations between plasma OXT levels and dimensional symptoms of HD using the rating scales measuring hypersexual behaviour: Hypersexual disorder screening inventory (HDSI) and the Sexual Compulsive scale (SCS). A part of the patients (N = 30) completed the manual-based group-administered CBT program for HD and had a secondary measurement of OXT at post-treatment. OXT was measured with Radioimmunoassay (RIA).Results: Patients with HD had significantly higher OXT (Mean 31.0 ± SD 9.9 pM) levels compared to healthy volunteers (Mean 16.9 ± SD 3.9 pM) (p < 0.001). There were significant positive correlations between OXT levels and the rating scales measuring hypersexual behaviour (Spearman rhos between HDSI r = 0.649, p < 0.001 and SCS r = 0.629, p < 0.001) in the study participants combined. Patients who completed CBT treatment had significant reduction of OXT levels from pre-treatment (30.5 ± 10.1pM) to post-treatment (20.2 ± 8.0pM) (p < 0.001). Patients with HD had a significant positive correlation of their changes in HD:CAS with plasma oxytocin level before and after CBT(r = 0.388, p value= 0.0344).Conclusions: The results suggest hyperactive oxytonergic system in male patients with hypersexual disorder which may be a compensatory mechanism to attenuate hyperactive stress system. A successful CBT group therapy may have effect on hyperactive oxytonergic system.
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| 23. |
- Jokinen, Jussi, et al.
(författare)
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Methylation of the HPA axis related genes in men with hypersexual disorder
- 2017
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 6, s. 23-23
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Hypersexual Disorder (HD) defined as non-paraphilic sexual desire disorder with components of compulsivity, impulsivity and behavioral addiction, was proposed as a diagnosis in the DSM 5. Some overlapping features between HD and substance use disorder including common neurotransmitter systems and dysregulated hypothalamic-pituitary-adrenal (HPA) axis function have been reported. In this study, comprising 67 male patients diagnosed with HD and 39 healthy male volunteers, we aimed to identify HPA-axis coupled CpG-sites, in which modifications of the epigenetic profile are associated with hypersexuality. Methods: The genome-wide methylation pattern was measured in whole blood using the Illumina Infinium Methylation EPIC BeadChip, measuring the methylation state of over 850 K CpG sites. Prior to analysis, the global DNA methylation pattern was pre-processed according to standard protocols and adjusted for white blood cell type heterogeneity. We included CpG sites located within 2000 bp of the transcriptional start site of the following HPAaxis coupled genes: Corticotropin releasing hormone (CRH), corticotropin releasing hormone binding protein (CRHBP), corticotropin releasing hormone receptor 1 (CRHR1), corticotropin releasing hormone receptor 2 (CRHR2), FKBP5 and the glucocorticoid receptor (NR3C1). We performed multiple linear regression models of methylation M-values to a categorical variable of hypersexuality, adjusting for depression, DST non-suppression status, Childhood Trauma Questionnaire total score and plasma levels of TNF-alpha and IL-6. Results: 76 individual CpG sites were tested, and four of these were nominally significant (p < 0.05), associated with the genes CRH, CRHR2 and NR3C1. Cg23409074 – located 48 bp upstream of the TSS of the CRH gene – was significantly hypomethylated in hypersexual patients after corrections for multiple testing using the FDR-method. Methylation levels of cg23409074 were positively correlated with gene expression of the CRH gene in an independent cohort of 11 healthy male subjects. Conclusions: CRH is an important integrator of neuroendocrine stress responses in the brain, modulating behavior and the autonomic nervous system. Our results show epigenetic changes in CRH gene related to hypersexual disorder in men.
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| 24. |
- Karlsson, Annika M., et al.
(författare)
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Biosensing of opioids using frog melanophores
- 2002
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Ingår i: Biosensors and Bioelectronics. - 0956-5663. ; 17:4, s. 331-335
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Tidskriftsartikel (refereegranskat)abstract
- Spectacular color changes of fishes, frogs and other lower vertebrates are due to the motile activities of specialized pigment containing cells. Pigment cells are interesting for biosensing purposes since they provide an easily monitored physiological phenomenon. Melanophores, containing dark brown melanin pigment granules, constitute an important class of chromatophores. Their melanin-filled pigment granules may be stimulated to undergo rapid dispersion throughout the melanophores (cells appear dark), or aggregation to the center of the melanophores (cells appear light). This simple physiological response can easily be measured in a photometer. Selected G protein coupled receptors can be functionally expressed in cultured frog melanophores. Here, we demonstrate the use of recombinant frog melanophores as a biosensor for the detection of opioids. Melanophores were transfected with the human opioid receptor 3 and used for opiate detection. The response to the opioid receptor agonist morphine and a synthetic opioid peptide was analyzed by absorbance readings in an aggregation assay. It was shown that both agonists caused aggregation of pigment granules in the melanophores, and the cells appeared lighter. The pharmacology of the expressed receptors was very similar to its mammalian counterpart, as evidenced by competitive inhibition by increasing concentrations of the opioid receptor inhibitor naloxone. Transfection of melanophores with selected receptors enables the creation of numerous melanophore biosensors, which respond selectively to certain substances. The melanophore biosensor has potential use for measurement of substances in body fluids such as saliva, blood plasma and urine.
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| 25. |
- Liberg, Benny, et al.
(författare)
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Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder
- 2022
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 11:2, s. 520-532
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Compulsive sexual behavior disorder (CSBD) is characterized by persistent patterns of failure to control sexual impulses resulting in repetitive sexual behavior, pursued despite adverse consequences. Despite previous indications of addiction-like mechanisms and the recent impulse-control disorder classification in the International Classification of Diseases (ICD-11), the neurobiological processes underlying CSBD are unknown.Methods: We designed and applied a behavioral paradigm aimed at disentangling processes related to anticipation and viewing of erotic stimuli. In 22 male CSBD patients (age: M = 38.7, SD = 11.7) and 20 healthy male controls (HC, age: M = 37.6, SD = 8.5), we measured behavioral responses and neural activity during functional magnetic resonance imaging (fMRI). The main outcomes were response time differences between erotic and non-erotic trials and ventral striatum (VS) activity during anticipation of visual stimuli. We related these outcomes with each other, to CSBD diagnosis, and symptom severity.Results: We found robust case-control differences on behavioral level, where CSBD patients showed larger response time differences between erotic and non-erotic trials than HC. The task induced reliable main activations within each group. While we did not observe significant group differences in VS activity, VS activity during anticipation correlated with response time differences and self-ratings for anticipation of erotic stimuli.Discussion and Conclusions: Our results support the validity and applicability of the developed task and suggest that CSBD is associated with altered behavioral correlates of anticipation, which were associated with ventral striatum activity during anticipation of erotic stimuli. This supports the idea that addiction-like mechanisms play a role in CSBD.
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| 26. |
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| 27. |
- Savard, Josephine, et al.
(författare)
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A randomised controlled trial of fluoxetine versus naltrexone in compulsive sexual behaviour disorder : presentation of the study protocol
- 2022
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Compulsive sexual behaviour disorder is a new disorder in the International Classification of Diseases (ICD-11), and is associated with negative consequences in different areas of life. Evidence for pharmacological treatment of compulsive sexual behaviour disorder is weak and treatment options are limited. This proposed study will be the largest and the first randomised controlled trial comparing the efficacy and tolerability of two active drugs in compulsive sexual behaviour disorder.Methods and analysis: Eighty adult participants with compulsive sexual behaviour disorder according to ICD-11 will be randomised to receive either naltrexone 25-50 mg or fluoxetine 20-40 mg for 8 weeks, followed by 6 weeks without treatment. The study will be conducted in a subspecialised outpatient sexual medicine unit at Karolinska University Hospital, Stockholm, Sweden. The study is financed by grants and entirely independent of the manufacturers. Exclusion criteria include severe psychiatric or psychical illness, changes to concurrent medication and non-compatible factors contraindicating the use of either drug. The primary outcome measure is the Hypersexual Disorder: Current Assessment Scale (HD: CAS), and tolerability will be assessed by the Udvalg for Kliniske Undersogelser side effect rating scale (UKU), drug accountability, adherence to treatment and drop-out rate. Participants will complete questionnaires at regular intervals, with the main endpoint for efficacy after 8 weeks (end of treatment) and after 14 weeks (follow-up). Blood chemistry will be repeatedly collected as a safety precaution and for research purposes. The results will be analysed using an appropriate analysis of variance model or a mixed model, depending on the distribution of HD: CAS and the extent of missing data.
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| 28. |
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| 29. |
- Savard, Josephine, 1985-
(författare)
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Compulsive sexual behavior disorder: clinical characteristics and treatment with Naltrexone
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Compulsive Sexual Behavior Disorder (CSBD) is characterized by sexual preoccupation and loss of control of sexual behaviors causing distress, negative consequences, and impairment. Despite its high prevalence, the condition is understudied in terms of background factors and treatment. Aims: The overall aim of this thesis is to investigate clinical characteristics with a specific focus on self-reported experience of interpersonal violence and various dimensions of impulsivity, and to evaluate treatment with naltrexone in help-seeking men with CSBD. Methods: In Study I, 67 men with CSBD were compared with 40 healthy, age-matched controls concerning interpersonal violence measured with the Karolinska Interpersonal Violence Scale (KIVS). In Study II, clinical, neurocognitive, and self-reported measures of impulsivity were compared between men with CSBD (n=20), a clinical control cohort with pedophilic disorder (n=55), and a healthy male control cohort (n=57). In Study III, 20 men with CSBD received four weeks of treatment with the opioid antagonist naltrexone, followed by a four-week follow-up phase. Adverse effects, adherence to treatment, and changes in compulsive sexual behavior were assessed. Study IV is an ongoing randomized controlled trial in which 80 individuals with CSBD receive either naltrexone or the selective serotonin reuptake inhibitor (SSRI) fluoxetine for eight weeks, followed by a six-week follow-up phase. The primary outcome measure is Hypersexual Disorder: Current Assessment Scale (HD:CAS), also used in Study III.Results: In Study I, men with CSBD had higher scores on self-reports of exposure to violence in childhood and use of violence as adults, as well as higher KIVS total scores compared with healthy controls. Those who had made a suicide attempt (n=8, 12%) reported higher scores of sexual abuse in childhood as well as the highest value of total experience of interpersonal violence. In Study II, neurodevelopmental disorders were common in both clinical cohorts, both of which also reported more compulsive sexuality and attentional impulsivity than controls. Self-reported attentional impulsivity was the only independent positive predictor of compulsive sexual behavior. In Study III, despite initial adverse effects being common, naltrexone was found tolerable and the study procedures were feasible. Self-reported measures of compulsive sexual behavior decreased during treatment with naltrexone. Conclusion: Interpersonal violence may be related to suicidal behavior in CSBD; and attentional impulsivity is linked to the level of compulsive sexual behavior. Screening for interpersonal violence and neurodevelopmental disorders should be part of routine assessment in disorders of problematic sexuality. Treatment with naltrexone was tolerable and might be a suitable option for treatment in CSBD if found efficacious in the ongoing randomized controlled trial.
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| 30. |
- Savard, Josephine, et al.
(författare)
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Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder
- 2021
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 10:3, s. 839-847
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Impulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity.Methods: Men with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors' Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files.Results: Approximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73-0.75) and attentional impulsivity (r = 0.36-0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001).Discussion: Self-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder.Conclusion: Neurodevelopmental disorders and attentional impulsivity - including suitable interventions - should be further investigated in both disorders.
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| 31. |
- Savard, Josephine, et al.
(författare)
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Naltrexone in Compulsive Sexual Behavior Disorder : A Feasibility Study of Twenty Men
- 2020
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Ingår i: Journal of Sexual Medicine. - : Elsevier. - 1743-6095 .- 1743-6109. ; 17:8, s. 1544-1552
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Tidskriftsartikel (refereegranskat)abstract
- Background: Compulsive sexual behavior disorder (CSBD) is a common disorder affecting different areas of life, although studies focusing on pharmacological treatment are sparse.Aim: To investigate whether the opioid receptor antagonist naltrexone is feasible and tolerable and can provide symptom reduction in CSBD.Methods: Twenty men aged 27-60 years (mean = 38.8 years, standard deviation = 10.3) with CSBD seeking treatment in an outpatient nonforensic clinic received four weeks of naltrexone 25-50 mg. Measurements were made before, during, and four weeks after treatment.Outcomes: The self-assessment Hypersexual Disorder: Current Assessment Scale (HD: CAS) score was the primary outcome measure, and secondary outcomes were the Hypersexual Behavior Inventory (HBI) score, reported adverse effects, adherence to treatment, and dropouts.Results: There was significant decrease on both HD: CAS and HBI scores during treatment with naltrexone. Even though some of the effects remained after treatment, the increased scores on HD: CAS indicated worsening of CSBD symptoms. The most reported side effects were fatigue (55%), nausea (30%), vertigo (30%), and abdominal pain (30%). However, there were no serious adverse effects leading to discontinuation of naltrexone.Clinical Implications: Despite side effects being common, naltrexone seems to be feasible in the treatment of CSBD.Strengths & Limitations: Being the first nonforensic prospective trial on naltrexone in CSBD, this study provides novel insights on a pharmacological intervention. However, owing to the small sample size and the lack of a control group, conclusions of effectiveness should be interpreted with caution.Conclusion: Naltrexone is feasible and tolerable and may reduce symptoms of CSBD; nevertheless, future studies should ensure a randomized controlled procedure to evaluate possible effectiveness.
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| 32. |
- Sefyrin, Johanna, et al.
(författare)
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Representational practices in demands driven development of public sector
- 2013
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Ingår i: ELECTRONIC GOVERNMENT (EGOV 2013). - Berlin, Heidelberg : Springer. - 9783642403576 - 9783642403583 ; , s. 200-211
-
Konferensbidrag (refereegranskat)abstract
- This paper concerns representational practices in demands driven development of public sector, and the problems they involve. The term demands driven development refers to a movement in public sector towards a closer cooperation with the citizens, primarily with regards to the development of public e-services. The objective with the paper is to explore representational practices through the analysis of practitioners' talk about demands driven development. There are several interrelated problems with representational practices, in this paper analysed through the discussions of practitioners who work with demands driven development of public sector. The conclusion is that these practitioners work with representational practices in a way which they at the same time seem to consider rather problematic.
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| 33. |
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| 34. |
- Svensson, Teresia, 1975-
(författare)
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Chlorine Transport in a Small Catchment
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- De senaste decenniernas forskning har påvisat att en omfattande bildning och nedbrytning av klororganiska föreningar sker i mark. Bildning av sådana föreningar sker genom att klorid binds in i organiskt material. Denna naturliga bildning har rönt uppmärksamhet dels för att många klorerade ämnen är giftiga och dels för man tidigare trott att alla klororganiska ämnen uteslutande kommer från mänsklig verksamhet. Huvudmålet för föreliggande avhandling var att (i) uppskatta transporten av klorerade föreningar i nederbörd och avrinningsvatten, (ii) diskutera de klorerade föreningarnas ursprung med utgångspunkt från hur deras förekomst varierar i avrinningsvatten, (iii) undersöka hur transporten av klorid (salt) påverkas av olika faktorer och (iv) studera hur frisättningen av flyktiga klorerade föreningar från mark påverkas av kväve.Avhandlingen bygger på en klorbudget som konstruerats utifrån fältstudier som genomförts i ett litet skogsbeklätt avrinningsområde i sydöstra Sverige. Dessutom har laboratoriestudier genomförts med jord som inhämtats från samma område. Resultaten visar att lagret av klor i marken är betydligt större än flödena och att det främst består av organiska ämnen medan flödet domineras av klorid (salt). Detta tyder på att en stor del av kloriden deltar i en biogeokemisk cykel vilket strider mot gängse uppfattning att klorid rör sig opåverkat genom mark. Hypotesen är att de översta marklagren fungerar som en sänka för klorid genom att omvandlas till organiskt bundet klor. De djupare jordlagren fungerar däremot som en kloridkälla genom att det klorerade organiska materialet transporterats med regnvatten från de ytligare till de djupare liggande lagren för att så småningom brytas ner, varvid klorid frisätts. Ovan beskrivna hypotes stöds av laboratoriestudierna där man kunnat notera att det sker såväl en fastläggning som en frisättning av klorid i mark. Resultaten från avhandlingen tillsammans med resultat från tidigare studier tyder på att en stor del av den klorid som finns i avrinningsvatten kommer från förmultnande organiskt material och att klorid med andra ord inte följer regnvattnets väg genom marken, vilket man tidigare trott. Studierna tyder alltså på att klorid till viss del ”gör en omväg” med en tidsfördröjning på troligen åtskilliga upp till hundratals år. Vidare tyder studierna på att flyktiga klorerade föreningar som kloroform och tetraklormetan bildas i mark och att tillsats av kväve orsakar en minskning av kloroform och en ökning av tetraklormetan.Avhandlingen visar tydligt att det är nödvändigt att rikta uppmärksamhet mot klors biogeokemi i mark och då inte minst mot de processer som påverkar transporten av klor från de övre marklagren till grundvatten och ytvatten om vi ska öka förståelsen av hur klorerade ämnen som tillförts naturen genom mänskliga aktiviteter beter sig.
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| 35. |
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| 36. |
- Öberg, Katarina, 1963-
(författare)
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On Conditions of Swedish Women’s Sexual Well-Being : An Epidemiological Approach
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: This descriptive epidemiological dissertation aims to identify conditions of Swedish women’s sexual well-being. The focus is on the relationship between their idiosyncratically reported levels, during the last 12 months, of 5 sexual functions/dysfunctions per se and distressing and their socio-psychological situation, including aspects of their sexual history. Levels of sexual functions/dysfunctions are also related to levels of sexual satisfaction and to other aspects of life satisfaction.Methods: Data on a randomized cross-sectional national sample of 1335 women aged 18-74 (59% of target sample) were gathered in 1996 using a combination of structured interviews and questionnaires/checklists. Analyses were performed for the total sample or for sub-samples aged 18-65 years. In 3 of the 4 dissertational articles, trichotomies of a 6-grade scale characterizing level of sexual dysfunctions into No/Mild/Manifest dysfunction were used.Main results: Mild sexual dysfunctions were, generally, much more common than were manifest, and dysfunctional distress was considerably less common than were dysfunctions per se. All dysfunctions, and in particular orgasmic dysfunction, were closely associated with level of sexual well-being. Four factors independently pair-wise linking levels of dysfunctions per se with levels of distressful dysfunction were identified. These were Sexual interest/Desire, Genital function (lubrication and dyspareunia), Orgasm, Vaginismus. Three of these (not vaginismus) were powerful classificators of gross level of sexual well-being. Many of socio-demographic and socio-psychological contextual life-conditions were significantly associated with the different sexual functions/dysfunctions. However, the most prominent contextual variables were satisfaction with partner relationship and partner’s levels of sexual functions.In conclusion, many different socio-psychological aspects must be taken into account to optimize treatment modalities and resources when dealing with women’s sexual dysfunction in order to secure a good level of sexual well-being.
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| 37. |
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| 38. |
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| 39. |
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| 40. |
- Öberg, Marie, et al.
(författare)
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Hearing difficulties, uptake and outcomes of hearing aids in people 85 years of age
- 2012
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Ingår i: International Journal of Audiology. - : Informa Healthcare. - 1499-2027 .- 1708-8186. ; 51:2, s. 108-115
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds. Design and study sample: Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly. Conclusion: Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this studys findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults awareness of hearing loss and the benefits of hearing rehabilitation.
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| 41. |
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| 42. |
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| 43. |
- Öberg, Sture, et al.
(författare)
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Segregationens mekanismer: Spelets dolda regler
- 1997
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Ingår i: Invandrare & minoriteter. - : Norsborg: Stiftelsen Invandrare & minoriteter. - 0346-6566. ; 2, s. 1-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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