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1.
  • Artaxo, Paulo, et al. (författare)
  • Tropical and Boreal Forest – Atmosphere Interactions : A Review
  • 2022
  • Ingår i: Tellus. Series B, Chemical and physical meteorology. - : Stockholm University Press. - 0280-6509 .- 1600-0889. ; 74:1, s. 24-163
  • Forskningsöversikt (refereegranskat)abstract
    • This review presents how the boreal and the tropical forests affect the atmosphere, its chemical composition, its function, and further how that affects the climate and, in return, the ecosystems through feedback processes. Observations from key tower sites standing out due to their long-term comprehensive observations: The Amazon Tall Tower Observatory in Central Amazonia, the Zotino Tall Tower Observatory in Siberia, and the Station to Measure Ecosystem-Atmosphere Relations at Hyytiäla in Finland. The review is complemented by short-term observations from networks and large experiments.The review discusses atmospheric chemistry observations, aerosol formation and processing, physiochemical aerosol, and cloud condensation nuclei properties and finds surprising similarities and important differences in the two ecosystems. The aerosol concentrations and chemistry are similar, particularly concerning the main chemical components, both dominated by an organic fraction, while the boreal ecosystem has generally higher concentrations of inorganics, due to higher influence of long-range transported air pollution. The emissions of biogenic volatile organic compounds are dominated by isoprene and monoterpene in the tropical and boreal regions, respectively, being the main precursors of the organic aerosol fraction.Observations and modeling studies show that climate change and deforestation affect the ecosystems such that the carbon and hydrological cycles in Amazonia are changing to carbon neutrality and affect precipitation downwind. In Africa, the tropical forests are so far maintaining their carbon sink.It is urgent to better understand the interaction between these major ecosystems, the atmosphere, and climate, which calls for more observation sites, providing long-term data on water, carbon, and other biogeochemical cycles. This is essential in finding a sustainable balance between forest preservation and reforestation versus a potential increase in food production and biofuels, which are critical in maintaining ecosystem services and global climate stability. Reducing global warming and deforestation is vital for tropical forests.
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2.
  • Lindegren, Sture, 1960, et al. (författare)
  • Binding Affinity, Specificity and Comparative Biodistribution of the Parental Murine Monoclonal Antibody MX35 (Anti-NaPi2b) and Its Humanized Version Rebmab200.
  • 2015
  • Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 10:5
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this preclinical study was to evaluate the characteristics of the monoclonal antibody Rebmab200, which is a humanized version of the ovarian-specific murine antibody MX35. This investigation contributes to the foundation for future clinical α-radioimmunotherapy of minimal residual ovarian cancer with 211At-Rebmab200. Here, the biodistribution of 211At-Rebmab200 was evaluated, as was the utility of 99mTc-Rebmab200 for bioimaging. Rebmab200 was directly compared with its murine counterpart MX35 in terms of its in-vitro capacity for binding the immobilized NaPi2B epitope and live cells; we also assessed its biodistribution in nude mice carrying subcutaneous OVCAR-3 tumors. Tumor antigen and cell binding were similar between Rebmab200 and murine MX35, as was biodistribution, including normal tissue uptake and in-vivo tumor binding. We also demonstrated that 99mTc-Rebmab200 can be used for single-photon emission computed tomography of subcutaneous ovarian carcinomas in tumor-bearing mice. Taken together, our data support the further development of Rebmab200 for radioimmunotherapy and diagnostics.
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3.
  • Bargholtz, Marcus, et al. (författare)
  • Test–Retest Reliability, Agreement and Criterion Validity of Three Questionnaires for the Assessment of Physical Activity and Sedentary Time in Patients with Myocardial Infarction
  • 2023
  • Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 20:16
  • Tidskriftsartikel (refereegranskat)abstract
    • Regular physical activity (PA) and limited sedentary time (SED) are highly recommended in international guidelines for patients after a myocardial infarction (MI). Data on PA and SED are often self-reported in clinical practice and, hence, reliable and valid questionnaires are crucial. This study aimed to assess the test–retest reliability, criterion validity and agreement of two PA and one SED questionnaire commonly used in clinical practice, developed by the Swedish National Board of Health and Welfare (BHW) and the Swedish national quality register SWEDEHEART. Data from 57 patients (mean age 66 ± 9.2 years, 42 males) was included in this multi-centre study. The patients answered three questionnaires on PA and SED at seven-day intervals and wore an accelerometer for seven days. Test–retest reliability, criterion validity and agreement were assessed using Spearman’s rho and linearly weighted kappa. Test–retest reliability was moderate for three of the six-sub questions (k = 0.43–0.54) within the PA questionnaires. For criterion validity, the correlation was fair within three of the six sub-questions (r = 0.41–0.50) within the PA questionnaires. The SED questionnaire had low agreement (k = 0.12) and criterion validity (r = 0.30). The studied questionnaires for PA could be used in clinical practice as a screening tool and/or to evaluate the level of PA in patients with an MI. Future research is recommended to develop and/or evaluate SED questionnaires in patients with an MI.
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5.
  • Christopoulos, Arthur, et al. (författare)
  • THE CONCISE GUIDE TO PHARMACOLOGY 2021/22: G protein-coupled receptors.
  • 2021
  • Ingår i: British journal of pharmacology. - : Wiley. - 1476-5381 .- 0007-1188. ; 178 Suppl 1
  • Forskningsöversikt (refereegranskat)abstract
    • The Concise Guide to PHARMACOLOGY 2021/22 is the fifth in this series of biennial publications. The Concise Guide provides concise overviews, mostly in tabular format, of the key properties of nearly 1900 human drug targets with an emphasis on selective pharmacology (where available), plus links to the open access knowledgebase source of drug targets and their ligands (www.guidetopharmacology.org), which provides more detailed views of target and ligand properties. Although the Concise Guide constitutes over 500 pages, the material presented is substantially reduced compared to information and links presented on the website. It provides a permanent, citable, point-in-time record that will survive database updates. The full contents of this section can be found at http://onlinelibrary.wiley.com/doi/bph.15538. G protein-coupled receptors are one of the six major pharmacological targets into which the Guide is divided, with the others being: ion channels, nuclear hormone receptors, catalytic receptors, enzymes and transporters. These are presented with nomenclature guidance and summary information on the best available pharmacological tools, alongside key references and suggestions for further reading. The landscape format of the Concise Guide is designed to facilitate comparison of related targets from material contemporary to mid-2021, and supersedes data presented in the 2019/20, 2017/18, 2015/16 and 2013/14 Concise Guides and previous Guides to Receptors and Channels. It is produced in close conjunction with the Nomenclature and Standards Committee of the International Union of Basic and Clinical Pharmacology (NC-IUPHAR), therefore, providing official IUPHAR classification and nomenclature for human drug targets, where appropriate.
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6.
  • Li, Hongjie, et al. (författare)
  • First identification of rotational band structures in Re-166(75)91
  • 2015
  • Ingår i: Physical Review C. Nuclear Physics. - 0556-2813 .- 1089-490X. ; 92:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Excited states in the odd-odd, highly neutron-deficient nucleus Re-166 have been investigated via the Mo-92(Kr-78, 3p1n)Re-166 reaction. Prompt gamma rays were detected by the JUROGAM II. gamma-ray spectrometer, and the recoiling fusion-evaporation products were separated by the recoil ion transport unit (RITU) gas-filled recoil separator and implanted into the Gamma Recoil Electron Alpha Tagging spectrometer located at the RITU focal plane. The tagging and coincidence techniques were applied to identify the gamma-ray transitions in Re-166, revealing two collective, strongly coupled rotational structures, for the first time. The more strongly populated band structure is assigned to the pi h(11/2)[514]9/2(-) circle times vi(13/2)[660]1/2(+) Nilsson configuration, while the weaker structure is assigned to be built on a two-quasiparticle state of mixed pi h(11/2)[514]9/2(-) circle times v[h(9/2)f(7/2)]3/2(-) character. The configuration assignments are based on the electromagnetic characteristics and rotational properties, in comparison with predictions from total Routhian surface and particle-rotor model calculations.
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7.
  • Mak, Jonathan K. L., et al. (författare)
  • Development of an Electronic Frailty Index for Hospitalized Older Adults in Sweden
  • 2022
  • Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences. - : Oxford University Press. - 1079-5006 .- 1758-535X. ; 77:11, s. 2311-2319
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcomes in hospitalized older adults. Methods EHRs were extracted for 18 225 patients with unplanned admissions between 1 March 2020 and 17 June 2021 from 9 geriatric clinics in Stockholm, Sweden. A 48-item eFI was constructed using diagnostic codes, functioning and other health indicators, and laboratory data. The CFS, Hospital Frailty Risk Score, and Charlson Comorbidity Index were used for comparative assessment of the eFI. We modeled in-hospital mortality and 30-day readmission using logistic regression; 30-day and 6-month mortality using Cox regression; and length of stay using linear regression. Results Thirteen thousand one hundred and eighty-eight patients were included in analyses (mean age 83.1 years). A 0.03 increment in the eFI was associated with higher risks of in-hospital (odds ratio: 1.65; 95% confidence interval: 1.54-1.78), 30-day (hazard ratio [HR]: 1.43; 1.38-1.48), and 6-month mortality (HR: 1.34; 1.31-1.37) adjusted for age and sex. Of the frailty and comorbidity measures, the eFI had the highest area under receiver operating characteristic curve for in-hospital mortality of 0.813. Higher eFI was associated with longer length of stay, but had a rather poor discrimination for 30-day readmission. Conclusions An EHR-based eFI has robust associations with adverse outcomes, suggesting that it can be used in risk stratification in hospitalized older adults.
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  • Mak, Jonathan K. L., et al. (författare)
  • Two Years with COVID-19 : The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study
  • 2023
  • Ingår i: Gerontology. - : S. Karger. - 0304-324X .- 1423-0003. ; 69:4, s. 396-405
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-19 patients. Objectives: The aim of the study was to examine the association of frailty with mortality, readmission, and length of stay in older COVID-19 patients and to compare the predictive accuracy of the eFI to other frailty and comorbidity measures. Methods: This was a retrospective cohort study using electronic health records (EHRs) from nine geriatric clinics in Stockholm, Sweden, comprising 3,980 COVID-19 patients (mean age 81.6 years) admitted between March 2020 and March 2022. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the Clinical Frailty Scale, and the Hospital Frailty Risk Score. Comorbidity was measured using the Charlson Comorbidity Index. We analyzed in-hospital mortality and 30-day readmission using logistic regression, 30-day and 6-month mortality using Cox regression, and the length of stay using linear regression. Predictive accuracy of the logistic regression and Cox models was evaluated by area under the receiver operating characteristic curve (AUC) and Harrell's C-statistic, respectively. Results: Across the study period, the in-hospital mortality rate decreased from 13.9% in the first wave to 3.6% in the latest (Omicron) wave. Controlling for age and sex, a 10% increment in the eFI was significantly associated with higher risks of in-hospital mortality (odds ratio = 2.95; 95% confidence interval = 2.42-3.62), 30-day mortality (hazard ratio [HR] = 2.39; 2.08-2.74), 6-month mortality (HR = 2.29; 2.04-2.56), and a longer length of stay (beta-coefficient = 2.00; 1.65-2.34) but not with 30-day readmission. The association between the eFI and in-hospital mortality remained robust across the waves, even after the vaccination rollout. Among all measures, the eFI had the best discrimination for in-hospital (AUC = 0.780), 30-day (Harrell's C = 0.733), and 6-month mortality (Harrell's C = 0.719). Conclusion: An eFI based on routinely collected EHRs can be applied in identifying high-risk older COVID-19 patients during the continuing pandemic.
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9.
  • Matheu, Victor, et al. (författare)
  • Impact on allergic immune response after treatment with vitamin A
  • 2009
  • Ingår i: Nutrition & Metabolism. - : Springer Science and Business Media LLC. - 1743-7075. ; 6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Vitamin A may have some influence on the immune system, but the role in allergy modulation is still unclear. Objective: To clarify whether high levels of retinoic acid (RA) affects allergic response in vivo, we used a murine experimental model of airway allergic disease. Methods: Ovalbumin (OVA)-immunization/OVA-challenge (OVA/OVA) and house dust mite (HDM)-immunization/HDM-challenge (HDM/HDM) experimental murine models of allergic airway disease, using C57Bl.10/Q groups of mice (n = 10) treated subcutaneously with different concentrations of all-trans RA (0, 50, 500 and 2,500 ug) every 2-days were used to assess the allergic immune response. Results: Levels of total and specific-IgE in sera were increased in all groups of RA treated OVA/OVA and HDM/HDM mice. Percentage and total amount of recruited eosinophil in airways by bronchoalveolar lavage fluid (BALF) were significantly enhanced in groups treated with 50, 500 and 2,500 ug of RA compared to non-treated mice. However, the group of mice treated with 2,500 ug had less eosinophil recruitment than the other two groups (50 and 500 ug). In parallel, levels of IL-5 and total IgE in BALF were also significantly diminished in the group treated with 2,500 ug compared to the other 2 groups (50 and 500 ug). Finally, total lung resistance was decreased in group treated with 2,500 ug compared to non-treated mice. Conclusion: Our results suggest that retinoic acid directly enhances allergic response in vivo, but in higher doses may produce of immune suppression.
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10.
  • Sandberg, Anna, et al. (författare)
  • The Impact of Nordic Pole Walk Advice Alone or in Combination With Exercise Strategies on Daily Physical Activity in Patients With Intermittent Claudication: A Randomized Clinical Trial.
  • 2023
  • Ingår i: Physical therapy. - 1538-6724. ; 103:11
  • Tidskriftsartikel (refereegranskat)abstract
    • The impact of exercise interventions on physical activity (PA) remains undetermined in intermittent claudication, which is why it is important to include objectively measured PA as an additional endpoint. The aim of this prespecified secondary analysis of a randomized clinical trial was to investigate the impact of unsupervised Nordic pole walk advice (WA) alone or in combination with hospital-based supervised exercise (SEP) or home-based structured exercise (HSEP) on PA in patients with intermittent claudication.In total, 166 patients with intermittent claudication (mean age=72 [SD=7.4] y; 41% women) were randomized to 3 intermittent claudication-treatment strategies: WA, WA+SEP, or WA+HSEP. All patients received Nordic poles and standardized WA (≥30min, 3 times weekly). Patients randomized to HSEP and SEP accepted participation in an additional 6-months exercise program. PA was measured with an accelerometer-based activPAL3 monitor for 7days at baseline and at 3, 6, and 12months. PA outcomes were steps per day, time spent within a stepping cadence ≥100 steps per minute, time spent upright, number of body transitions from sitting to standing, and number of sitting bouts of >30minutes and>60minutes.At 1year, no intergroup differences were observed in any of the PA variables, whereas significant intergroup differences were observed at 3months regarding time spent within a stepping time cadence ≥100 steps per minute. The mean change for HSEP (2.47 [SD=10.85] min) was significantly different from the mean change for WA (-3.20 [SD=6.24] min). At 6months, the number of sitting bouts (>60min) for SEP was significantly different from WA (mean change=0.24 [SD=0.69] vs -0.23 [SD=0.81]).This study indicates that the addition of 6months of HSEP or SEP does not improve PA at 1year, as compared to unsupervised WA alone. Factors of importance for increasing PA in patients with intermittent claudication require further investigation.At the 1-year follow-up, the addition of intermittent claudication-tailored additional exercise strategies did not improve daily PA in patients with intermittent claudication compared with unsupervised Nordic pole WA alone. Future studies may explore the role of behavior change techniques to increase PA in this patient group.
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11.
  • Strauch, Stefanie, et al. (författare)
  • Objectively Assessed Physical Activity in the Oldest Old Persons With Coronary Artery Disease
  • 2019
  • Ingår i: Journal of Geriatric Physical Therapy. - : LIPPINCOTT WILLIAMS & WILKINS. - 1539-8412 .- 2152-0895. ; 42:4, s. E69-E76
  • Tidskriftsartikel (refereegranskat)abstract
    • Background and Purpose: Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for Acti-Graph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons. Methods: In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity. Results and Discussion: The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation. Conclusions: The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.
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  • Voutilainen, Liina, et al. (författare)
  • Life-long shedding of Puumala hantavirus in wild bank voles (Myodes glareolus)
  • 2015
  • Ingår i: Journal of General Virology. - : Society for General Microbiology. - 0022-1317 .- 1465-2099. ; 96:6, s. 1238-1247
  • Tidskriftsartikel (refereegranskat)abstract
    • The knowledge of viral shedding patterns and viraemia in the reservoir host species is a key factorin assessing the human risk of zoonotic viruses. The shedding of hantaviruses (familyBunyaviridae) by their host rodents has widely been studied experimentally, but rarely in naturalsettings. Here we present the dynamics of Puumala hantavirus (PUUV) shedding and viraemia innaturally infected wild bank voles (Myodes glareolus). In a monthly capture–mark–recapturestudy, we analysed 18 bank voles for the presence and relative quantity of PUUV RNA in theexcreta and blood from 2 months before up to 8 months after seroconversion. The proportion ofanimals shedding PUUV RNA in saliva, urine and faeces peaked during the first month afterseroconversion, but continued throughout the study period with only a slight decline. The quantityof shed PUUV in reverse transcription quantitative PCR (RT-qPCR) positive excreta was constantover time. In blood, PUUV RNA was present for up to 7 months but both the probability of viraemiaand the virus load declined with time. Our findings contradict the current view of a decline in virusshedding after the acute phase and a short viraemic period in hantavirus infection – anassumption widely adopted in current epidemiological models. We suggest the life-long sheddingas a means of hantaviruses to survive over host population bottlenecks, and to disperse infragmented habitats where local host and/or virus populations face temporary extinctions. Ourresults indicate that the kinetics of pathogens in wild hosts may differ considerably from thoseobserved in laboratory settings.
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  • Ögmundsdóttir Michelsen, Halldóra, et al. (författare)
  • The effect of audit and feedback and implementation support on guideline adherence and patient outcomes in cardiac rehabilitation : a study protocol for an open-label cluster-randomized effectiveness-implementation hybrid trial
  • 2024
  • Ingår i: Implementation Science. - : BioMed Central (BMC). - 1748-5908. ; 19:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundProviding secondary prevention through structured and comprehensive cardiac rehabilitation programmes to patients after a myocardial infarction (MI) reduces mortality and morbidity and improves health-related quality of life. Cardiac rehabilitation has the highest recommendation in current guidelines. While treatment target attainment rates at Swedish cardiac rehabilitation centres is among the highest in Europe, there are considerable differences in service delivery and variations in patient-level outcomes between centres. In this trial, we aim to study whether centre-level guideline adherence and patient-level outcomes across Swedish cardiac rehabilitation centres can be improved through a) regular audit and feedback of cardiac rehabilitation structure and processes through a national quality registry and b) supporting cardiac rehabilitation centres in implementing guidelines on secondary prevention. Furthermore, we aim to evaluate the implementation process and costs.MethodsThe study is an open-label cluster-randomized effectiveness-implementation hybrid trial including all 78 cardiac rehabilitation centres (attending to approximately 10 000 MI patients/year) that report to the SWEDEHEART registry. The centres will be randomized 1:1:1 to three clusters: 1) reporting cardiac rehabilitation structure and process variables to SWEDEHEART every six months (audit intervention) and being offered implementation support to implement guidelines on secondary prevention (implementation support intervention); 2) audit intervention only; or 3) no intervention offered. Baseline cardiac rehabilitation structure and process variables will be collected. The primary outcome is an adherence score measuring centre-level adherence to secondary prevention guidelines. Secondary outcomes include patient-level secondary prevention risk factor goal attainment at one-year after MI and major adverse coronary outcomes for up to five-years post-MI. Implementation outcomes include barriers and facilitators to guideline adherence evaluated using semi-structured focus-group interviews and relevant questionnaires, as well as costs and cost-effectiveness assessed by a comparative health economic evaluation.DiscussionOptimizing cardiac rehabilitation centres’ delivery of services to meet standards set in guidelines may lead to improvement in cardiovascular risk factors, including lifestyle factors, and ultimately a decrease in morbidity and mortality after MI.
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  • Ahlgren Cederlöf, Ebba, et al. (författare)
  • Lifetime measurement of the yrast 2+ state in 118Te
  • 2023
  • Ingår i: European Physical Journal A. - : Springer. - 1434-6001 .- 1434-601X. ; 59:12
  • Tidskriftsartikel (refereegranskat)abstract
    • The electromagnetic transition probabilities of the yrast 2+ states in the midshell Te isotopes, two protons above the closed shell at Sn, are of great importance for the understanding of nuclear collectivity in these isotopes and the role played by the neutron-proton interactions and cross-shell excitations. However, the large uncertainty of the experimental data for the midshell nucleus 118Te and the missing data for 116Te make it difficult to pin down the general trend of the evolution of transition probabilities as a function of the neutron number. In this work, the lifetime of the yrast 2+ state in 118Te was measured, with the aim of reducing the uncertainty of the previous measurement. The result is τ2+ = 7.46(19) ps. In addition, the lifetime of the 4+ state was measured to be τ4+ = 4.25(23) ps. The experimental transition rates are extracted from the measured lifetimes and compared with systematic large-scale shell-model calculations. The trend of the B(E2; 0+ → 2+) values in the midshell area is in good agreement with the calculations and the calculated B4/2 ratio provide evidence for 118Te as a near perfect harmonic vibrator.
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15.
  • Aktaa, Suleman, et al. (författare)
  • European Society of Cardiology Quality Indicators for Cardiovascular Disease Prevention: developed by the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with the European Association for Preventive Cardiology of the European Society of Cardiology
  • 2022
  • Ingår i: European Journal of Preventive Cardiology. - : OXFORD UNIV PRESS. - 2047-4873 .- 2047-4881. ; 23:7, s. 1060-1071
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. Methods and results The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collaboration with Task Force members of the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice and the European Association of Preventive Cardiology (EAPC). We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care for ASCVD prevention by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. In total, 17 main and 14 secondary QIs were selected across six domains of care for ASCVD prevention: (i) structural framework, (ii) risk assessment, (iii) care for people at risk for ASCVD, (iv) care for patients with established ASCVD, (v) patient education and experience, and (vi) outcomes. Conclusion We present the 2021 ESC QIs for Cardiovascular Disease Prevention, which have been co-constructed with EAPC using the ESC methodology for QI development. These indicators are supported by evidence from the literature, underpinned by expert consensus and aligned with the 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice to offer a mechanism for the evaluation of ASCVD prevention care and outcomes.
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17.
  • Blomqvist, Andreas, et al. (författare)
  • Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure
  • 2024
  • Ingår i: BMC Medical Informatics and Decision Making. - : BMC. - 1472-6947. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPhysical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.MethodsA mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.ResultsTen people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.ConclusionsIt was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.Trial registrationClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.
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  • Blomqvist, Andreas, et al. (författare)
  • Utility of single-item questions to assess physical inactivity in patients with chronic heart failure
  • 2020
  • Ingår i: ESC Heart Failure. - : WILEY PERIODICALS, INC. - 2055-5822. ; 7:4, s. 1467-1476
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim The purpose of this study was to explore the utility of two single-item self-report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross-sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self-reported physical activity or low self-reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: rho = 0.24, P = 0.016 for SR1 and rho = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self-reported physical activity group (P < 0.001). Conclusions There might be utility in the single SR question for high-specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.
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20.
  • Borg, Sabina, et al. (författare)
  • Effectiveness of a behavioral medicine intervention in physical therapy on secondary psychological outcomes and health-related quality of life in exercise-based cardiac rehabilitation : a randomized, controlled trial
  • 2023
  • Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central Ltd. - 2052-1847. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Interventions promoting adherence to exercise-based cardiac rehabilitation (exCR) are important to achieve positive physical and psychological outcomes, but knowledge of the added value of behavioral medicine interventions for these measures is limited. The aim of the study was to investigate the added value of a behavioral medicine intervention in physical therapy (BMIP) in routine exCR on psychological outcomes and health-related quality of life (HRQoL) versus routine exCR alone (RC). Methods: A total of 170 patients with coronary artery disease (136 men), mean age 62.3 ± 7.9 years, were randomized at a Swedish university hospital to a BMIP plus routine exCR or to RC for four months. The outcome assessments included HRQoL (SF-36, EQ-5D), anxiety and depression (HADS), patient enablement and self-efficacy and was performed at baseline, four and 12 months. Between-group differences were tested with an independent samples t-test and, for comparisons within groups, a paired t-test was used. An intention-to-treat and a per-protocol analysis were performed. Results: No significant differences in outcomes between the groups were shown between baseline and four months or between four and 12 months. Both groups improved in most SF-36 domains, EQ-VAS and HADS anxiety at the four-month follow-up and sufficient enablement remained at the 12-months follow-up. Conclusion: A BMIP added to routine exCR care had no significant effect on psychological outcomes and HRQoL compared with RC, but significant improvements in several measures were shown in both groups at the four-month follow-up. Since recruited participants showed a better psychological profile than the general coronary artery disease population, further studies on BMIP in exCR, tailored to meet individual needs in broader patient groups, are needed. Trial registration number NCT02895451, 09/09/2016, retrospectively registered.
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21.
  • Borg, Sabina, 1982- (författare)
  • Exercise-Based Cardiac Rehabilitation in Patients with Coronary Artery Disease : Attendance, Adherence and the Added Value of a Behavioural Medicine Intervention
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Coronary artery disease (CAD) is the leading global cause of death. After an index event related to CAD, exercise-based cardiac rehabilitation (exCR) is strongly recommended as part of the secondary prevention. Despite the well-established beneficial effects of exCR in patients with CAD, attendance at and adherence to the programme are low, and remain a matter of major concern. One strategy that may increase adherence and rehabilitation outcomes in patients with CAD is to add a behavioural medicine intervention to routine exCR care. The added value of such interventions needs to be further explored. Although several factors associated with non-attendance at exCR appear to be similar between different countries, patterns of attendance may differ due to differences in contextual aspects. The factors that affect attendance at exCR in a Swedish context remain to be explored.Overall aim: To investigate barriers for exCR attendance and to evaluate the added value of a behavioural medicine intervention in physiotherapy on exercise adherence and rehabilitation outcomes in patients with CAD.Methods: The three papers in this thesis are based on two studies of patients with CAD, one registrybased cohort study of 31,297 patients included from the SWEDEHEART registry (Paper I), and one randomised controlled trial of 170 patients included at a Swedish university hospital (Papers II and III). In the first paper, several individual and structural variables were compared for attenders and nonattenders, using multivariable analysis in a logistic regression model. In Papers II and III, patients were randomised 1:1 either to a behavioural medicine intervention in physiotherapy in addition to routine exCR care or to routine exCR care alone for four months. The behaviour change techniques used in the behavioural medicine intervention – specific goal-setting, re-evaluation of the goals, and selfmonitoring and feedback – were based on control theory. Outcome assessment took place at baseline, four and 12 months, and included physical fitness, psychological outcomes and health-related quality of life. Exercise adherence was evaluated at the end of the four-month intervention. An intention-to-treat and a per-protocol analysis were performed.Results: Individual and structural factors associated with non-attendance at exCR in a Swedish context were identified as having a distance greater than 16 km to the hospital, belonging to a county hospital, having a higher burden of comorbidities, being male, and being retired. Exercise adherence was higher for patients who received the behavioural medicine intervention in physiotherapy together with routine exCR (31%) than it was for those who received routine exCR care alone (19%). Rehabilitation outcomes did not differ significantly between the two groups, either between baseline and four months or between four and 12 months. Both groups improved significantly in all measures of physical fitness, and in several measures of health-related quality of life and anxiety at the four-month follow-up. Sufficient enablement remained for patients in both groups at the 12-months follow-up.Conclusions: Distance to the hospital was the strongest predictor for non-attendance at exCR in a Swedish context. The individual factors associated with non-attendance at exCR identified in this thesis confirm previous results, with the exception that female gender was associated with a higher attendance at exCR. The results of this thesis confirm what others have pointed out: it is challenging to achieve behavioural change in patients with the aim to improve rehabilitation outcomes. Even though adherence was higher when a behavioural medicine intervention was added, it was low in both groups. The current behavioural medicine intervention in physiotherapy did not give any improvements over routine exCR care alone in physical fitness, psychological outcomes or health-related quality of life. As such, there is still room for further development and evaluation of behavioural medicine interventions within the context of exCR. A greater tailoring of these interventions to individual needs in a broader population of patients with CAD is suggested.
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22.
  • Borg, Sabina, et al. (författare)
  • Factors associated with non-attendance at exercise-based cardiac rehabilitation
  • 2019
  • Ingår i: BMC Sports Science, Medicine and Rehabilitation. - : BMC. - 2052-1847. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundDespite its well-established positive effects, exercise-based cardiac rehabilitation (exCR) is underused in patients following an acute myocardial infarction (AMI). The aim of the study was to identify factors associated with non-attendance at exCR in patients post-AMI in a large Swedish cohort.MethodsA total of 31,297 patients who have suffered an AMI, mean age 62.4 ± 4 years, were included from the SWEDEHEART registry during the years 2010–2016. Comparisons between attenders and non-attenders at exCR were done at baseline for the following variables: age, sex, body mass index, occupational status, smoking, previous diseases, type of index cardiac event and intervention, and left ventricular function. Distance of residence from the hospital and type of hospital were added as structural variables in logistic regression analyses, with non-attendance at exCR at one-year follow-up as dependent, and with individual and structural variables as independent variables.ResultsIn total, 16,214 (52%) of the patients did not attend exCR. The strongest predictor for non-attendance was distance to the exCR centre (OR 1.75 [95% CI: 1.64–1.86]). Other predictors for non-attendance included smoking, history of stroke, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), AMI or diabetes, male sex, being retired vs. being employed, and being followed-up at a county hospital. Patients with ST-elevation myocardial infarction (STEMI) and those intervened with PCI or CABG were more likely to attend exCR.ConclusionsA distance greater than 16 km was associated with increased probability of non-attendance at exCR, as were smoking, a higher burden of comorbidities, and male sex. A better understanding of individual and structural factors can support the development of future rehabilitation services.
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23.
  • Borg, Sabina, et al. (författare)
  • The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial
  • 2020
  • Ingår i: Patient Preference and Adherence. - : DOVE MEDICAL PRESS LTD. - 1177-889X. ; 14, s. 2517-2529
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Despite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMW) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care. Patients and Methods: In a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity. Results: The four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate. Conclusion: Both groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.
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24.
  • Borg, Sabina, et al. (författare)
  • The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial
  • 2017
  • Ingår i: BMC Cardiovascular Disorders. - : BIOMED CENTRAL LTD. - 1471-2261 .- 1471-2261. ; 17
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: To help patients with coronary artery disease (CAD) benefit from the positive health effects attained by exercise-based cardiac rehabilitation (CR), adherence to these programmes according to international guidelines is important. Strategies to increase adherence to exercise-based CR are mainly an unexplored area. The objective of this study is to investigate the effects of a behavioural medicine intervention in physiotherapy, containing goal-setting, self-monitoring and feedback, with the aim of improving rehabilitation outcomes for exercise-based CR, compared with usual care. Methods: This is a randomised, controlled trial. A total of 160 patients with CAD will be included consecutively at the Coronary Care Unit at a university hospital in Sweden. Patients are randomised 1:1 using sealed envelopes to usual care or a behavioural medicine intervention in physiotherapy, in addition to usual care for 4 months. Outcome assessment at baseline, 4 and 12 months includes submaximal aerobic capacity (primary outcome), exercise adherence, muscle endurance, level of physical activity, biomarkers, anxiety and depression, health-related quality of life, patient enablement and self-efficacy (secondary outcomes). Discussion: This is the first study to evaluate the role of an integrated behavioural medicine intervention in exercise-based CR in the effects of rehabilitation outcomes. The results of this study will provide valuable information about the effect of these interventions in exercise-based CR and it has the potential to inform and assist in further treatment in secondary prevention for patients with CAD.
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25.
  • Brosved, Madeleine, et al. (författare)
  • Effects of Cardiac Rehabilitation on Physical Fitness, Physical Function, and Self-reported Outcomes in Patients ≥80 yr: A RANDOMIZED CONTROLLED TRIAL.
  • 2022
  • Ingår i: Journal of cardiopulmonary rehabilitation and prevention. - 1932-751X. ; 42:5, s. 331-337
  • Tidskriftsartikel (refereegranskat)abstract
    • The beneficial effects of exercise-based cardiac rehabilitation (CR) after an acute coronary syndrome (ACS) are well known, but patients ≥80 yr have been less studied. The aim was to evaluate the effects of CR on patients with ACS ≥80 yr on peak cardiorespiratory fitness (CRF), physical function, and patient-reported outcome measures (PROMs) compared with a control group.A total of 26 patients with ACS, median age 82 (81, 84) yr, were randomized to hospital-based CR combined with a home-based exercise program (CR group) or to a control group (C) for 4 mo. Outcomes were assessed at baseline and 4 mo and included the peak CRF (primary outcome), 6-min walk test (6MWT), muscle endurance, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), one-leg stand test, and PROMs.There were no significant differences between the groups in peak CRF. The CR group improved significantly in terms of the 6MWT ( P = .04), isotonic muscle endurance ( P < .001), one-leg stand test ( P = .001), SPPB total score ( P =.03), Activities-specific Balance Confidence ( P =.01), and anxiety ( P =.03), as compared with C. There were no significant intergroup differences in the TUG, the self-reported health question or depression.Patients with ACS ≥80 yr improved in walking distance, muscle endurance, physical function, and PROMs, but not in peak CRF, by participating in a CR program. These results suggest an increased referral to CR for this growing group of patients to enable preserved mobility and independence in daily living, but this needs to be confirmed in larger studies.
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26.
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27.
  • Bäck, Maria, 1978, et al. (författare)
  • Effects of high frequency exercise in patients before and after percutaneous coronary intervention
  • 2008
  • Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7, s. 307-313
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to evaluate the effects of high frequency exercise for patients before and after an elective percutaneous coronary intervention (PCI), with special reference to maximal aerobic capacity, muscle function, health related quality of life (HRQoL), waist–hip ratio (WHR) and restenosis. Methods: A randomised, controlled study was performed in Sweden between 2004 and 2006 in thirty-seven patients (five women) with stable coronary artery disease (CAD), age 63.6±6.9 years, randomised to either high frequency exercise or control group. The patients in the training group performed three endurance resistance exercises and trained on a cycle ergometer 30 min, 5 times a week for 8 months at 70% of VO2max. Results: Patients in the training group significantly improved their maximal aerobic capacity (15 (9–46) vs. 8 (0–18)% p≤0.05), shoulder flexion (p≤0.01), shoulder abduction (p≤0.01) and heel-lift (p≤0.05) compared to the control group. There were no significant differences between the groups in HRQoL, WHR and restenosis. Conclusion: High frequency exercise in patients treated with PCI seems to improve maximal aerobic capacity and muscle function, which may reduce the risks of further progression of atherosclerosis. However, further larger studies are needed to fully investigate the effects of exercise in patients with PCI.
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28.
  • Bäck, Maria, 1978 (författare)
  • Exercise and physical activity in relation to kinesiophobia and cardiac risk markers in coronary artery disease
  • 2012
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Coronary artery disease (CAD) is the leading cause of death worldwide. Patients who have survived a coronary event are the highest priority for secondary prevention. In the secondary prevention of CAD, strong evidence of the beneficial effects of exercise-based cardiac rehabilitation is confirmed. The positive effects of physical activity are well established in primary prevention, but the question of whether these effects also relate to patients with CAD still remains to be explored. It is theoretically possible that kinesiophobia, fear of movement, may prevent successful cardiac rehabilitation. The impact on kinesiophobia by rehabilitation outcomes in patients with CAD has not previously been investigated. The overall aim of this thesis was to study the impact of exercise and physical activity in relation to kinesiophobia and cardiac risk markers in patients with CAD. Study I evaluated the effects of high-frequency exercise before and after an elective percutaneous coronary intervention (PCI). Study II examined the level of physical activity in patients with CAD and investigated the association between physical activity and cardiac risk markers. Study III investigated the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia, in patients with CAD. Study IV described the occurrence of kinesiophobia in patients with CAD and investigated the impact on kinesiophobia by clinical variables with an influence on rehabilitation outcomes. The main findings were that high-frequency exercise improved the maximum aerobic capacity and muscle function in patients treated with PCI, which may have clear advantages when it comes to preventing the progress of CAD. A relatively high level of physical activity was found among patients with CAD, six months after the cardiac event. After adjustment for confounders, statistically significant, yet weak, associations were found between physical activity and several cardiac risk markers. Support was found for the TSK-SV Heart as a reliable, valid questionnaire for measuring kinesiophobia in patients with CAD. A high level of kinesiophobia was found in 20% of patients with CAD, six months after the cardiac event. In addition, an impact on kinesiophobia was identified by clinical variables with an influence on rehabilitation outcomes in patients with CAD, representing medical variables, all components of the International Classification of Functioning, Disability and Health (ICF) and health-related quality of life. In conclusion, high-frequency exercise in patients treated with PCI improved their maximum aerobic capacity and muscle function. Significant, yet weak, associations were identified between physical activity and cardiac risk markers in patients with CAD. Several important clinical findings with an impact on rehabilitation outcomes were found to be associated with a high level of kinesiophobia. Kinesiophobia therefore needs to be considered in cardiac rehabilitation and would benefit from future research.
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29.
  • Bäck, Maria, et al. (författare)
  • Finland: A Country of High Political Trust and Weak Political Self-efficacy
  • 2024. - 1
  • Ingår i: Political Behaviour in Contemporary Finland. - New York : Routledge. - 9781003452287 ; , s. 30-42
  • Bokkapitel (refereegranskat)abstract
    • This chapter discusses the association between political trust and political self-efficacy in Finland. Finland has among the highest levels of political trust in the world, but simultaneously the levels of political self-efficacy are comparatively on a much weaker level. As previous research has shown higher political trust and higher political self-efficacy to be associated at the individual level, this is somewhat unexpected. The findings in this chapter show that in the Finnish context a higher political self-efficacy, indeed, predicts lower political trust, adding support to the notion of well-informed citizens withdrawing their trust if they feel that the system is not acting according to their normative expectations. This chapter ends with a discussion about what the findings imply for the status of Finnish democracy, concluding that the findings should not necessarily be seen only in a negative light.
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30.
  • Bäck, Maria, et al. (författare)
  • Home-based supervised exercise versus hospital-based supervised exercise or unsupervised walk advice as treatment for intermittent claudication : a systematic review.
  • 2015
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 47:9, s. 801-808
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To evaluate the effects of home-based supervised exercise vs hospital-based supervised exercise, and the effects of home-based supervised exercise vs unsupervised "go home and walk advice" on daily life and corridor-walking capacity, health-related quality of life and patient-reported functional walking capacity in patients with intermittent claudication.DATA SOURCES: Systematic literature searches were conducted in PubMed, EMBASE, ProQuest, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), the Cochrane Library, and a number of Health Technology Assessment (HTA)-databases in October 2014.STUDY SELECTION: Randomized controlled trials and non-randomized controlled trials (> 100 patients) were considered for inclusion.DATA EXTRACTION: Data extraction and risk of bias assessment was performed independently and discussed in meetings.DATA SYNTHESIS: Seven randomized controlled trials and 2 non-randomized controlled studies fulfilled the inclusion criteria. The included studies had some, or major, limitations.CONCLUSION: Based on a low quality of evidence, home-based supervised exercise may lead to less improvement in maximum and pain-free walking distance, and in more improvement in daily life walking capacity, compared with hospital-based supervised exercise. Home-based supervised exercise may improve maximum and pain-free walking distance compared with "go home and walk advice" and result in little or no difference in health-related quality of life and functional walking capacity compared with hospital-based supervised exercise or "go home and walk advice". Further research is needed to establish the optimal exercise modality for these patients.
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31.
  • Bäck, Maria, 1978, et al. (författare)
  • Home-based versus hospital-based supervised exercise or walk advice as treatment for intermittent claudication : Hembaserad jämfört med sjukhusbaserad handledd fysisk träning eller träningsråd som behandling vid claudicatio intermittens
  • 2014
  • Rapport (övrigt vetenskapligt/konstnärligt)abstract
    • Method and patient group Intermittent claudication, the most common symptomatic presentation of peripheral arterial disease, is present in 7% of Swedish people aged 60 years or older. The progressive atherosclerotic process involves the development of stenoses and/or occlusions in the arteries propagating blood to the lower limbs. This causes effort-induced pain in the affected limb(s). Treatment is usually conservative and includes exercise therapy. Today, current practice in Sweden for patients with IC usually does not include hospital-based supervised exercise programs. A home-based supervised exercise program in a self-chosen environment might bridge the gap between the highly structured and costly hospital-based supervised exercise programs and ’go home and walk advice’. Question at issue Is home-based supervised exercise more effective than either unsupervised ‘go home and walk advice’, or hospital-based supervised exercise, for patients with intermittent claudication, in terms of walking distance, health related quality of life, symptoms, and risks associated with exercise? Studied risks and benefits for patients Ten articles were identified: two systematic reviews, six randomized controlled trials (RCT) and two cohort studies. The systematic reviews were only commented on. The quality of evidence (GRADE ⊕⊕) was low for all conclusions. Concluding remark Home-based supervised exercise for patients with intermittent claudication was compared with hospitalbased supervised exercise, or ‘go home and walk advice’. Six RCTs and two cohort studies were identified. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise, as compared with ‘go home and walk advice’, may slightly improve maximum and pain-free walking distance and result in little or no difference in health-related quality of life, and functional walking ability. There is low quality of evidence (GRADE ⊕⊕) that home-based supervised exercise may lead to less improvement in both maximum and pain-free walking distance than supervised hospital-based exercise, and result in little or no difference in health-related quality of life, and functional walking ability. There are no major ethical issues, and a reliable estimate of the total cost change is not possible, due to a total lack of reliable long-term data.
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32.
  • Bäck, Maria, 1978, et al. (författare)
  • How does kinesiophobia change over time in patients with acute coronary artery disease?
  • 2015
  • Ingår i: Physiotherapy, Oral presentation, World Confederation for Physical Therapy (WCPT), 1-4 May 2015Singapore. - : Elsevier BV. ; 101:Suppl. 1
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • The occurrence of kinesiophobia and the impact on kinesiophobia by clinical variables with influence on rehabilitation outcomes in exercise-based cardiac rehabilitation (CR) has by us been identified six months after acute coronary artery disease (CAD). However, the occurrence of kinesiophobia in the acute phase of CAD and how it changes over time has not previously been studied. Moreover, the gender perspective has not been highlighted. The primary purpose was to identify levels of kinesiophobia in the acute phase of CAD and to study changes over time and in relation to gender. Participants: In total, 105 patients with CAD (25 women), mean age 63.1±11.5 were included in the study at the cardiac intensive care, Sahlgrenska University Hospital, Sweden between October 2013 and June 2014. Design and statistics: The patients were asked to fill in a set of questionnaires including the Tampascale for Kinesiophobia Heart (TSK-SV Heart), the Hospital Anxiety and Depression Scale (HADS), Harm Avoidance (HA) and the Positive and Negative Affect Schedule (PANAS). The patients filled in the questionnaires at three different time points: At the cardiac intensive care (T1), after 2 weeks (T2) and after 4 months (T3). A linear mixed model (LMM) procedure was used to compare kinesiophobia across time points. The within-subjects-design factor was data collection time (T1-T3), and the between-subjects-design factor was gender. The dependent variable was kinesiophobia. The questionnaires reflecting personality traits and affective states (HADS, PANAS, HA) were used as covariates in order to discover any effects these might have on differences across groupings. Covariates were included in two steps: first all five, then only those that contributed significantly at p-level < 0.05. Thirty-five patients were excluded due to loss of follow-up or missing data. The mean value on the TSK-SV Heart was 32.1 at T1, 30.3 at T2 and 29.2 at T3. The presence of a high level of kinesiophobia was 24% at T1 and 19% at T2 and T3. Without covariates, there was an effect of gender (p=0.011), with a higher TSK-SV Heart mean score for women, and over time points (p=0.013), with lower TSK-SV Heart mean score at T3. No interaction effect was found. Inclusion of the covariates showed that the HADS variables had no impact on kinesiophobia. Although negative affect (p=0.016), positive affect (p=0.002), and HA (p=0.057) had impact on kinesiophobia, this did not influence the significane of gender (p=0.042) and over time points (p=0.004). Kinesiophobia decreased over time after acute CAD, independent of patients´ personality traits and affective states. Female gender had a significant influence on kinesiohobia. Still 19% of the patients were identified with a high level of kinesiophobia at T3. The further establishment of the impact of kinesiophobia in CR and the design of a treatment intervention should be prioritized in future studies. The results of this study suggest that it is desirable to screen for kinesiophobia in the acute phase of CAD, as recognition may facilitate the appropriate treatment for these patients with the overall target of enhancing attendance at CR.
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33.
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34.
  • Bäck, Maria, et al. (författare)
  • Important aspects in relation to patients attendance at exercise-based cardiac rehabilitation - facilitators, barriers and physiotherapists role: a qualitative study
  • 2017
  • Ingår i: BMC Cardiovascular Disorders. - : BIOMED CENTRAL LTD. - 1471-2261 .- 1471-2261. ; 17
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In order to improve attendance at exercise-based cardiac rehabilitation (CR), a greater insight into patients perspectives is necessary. The aim of the study was to explore aspects that influence patients attendance at exercise-based CR after acute coronary artery disease (CAD) and the role of the physiotherapist in patients attendance at exercise-based CR. Methods: A total of 16 informants, (5 women; median age 64.5, range 47-79 years), diagnosed with CAD, were included in the study at the Cardiology Department, Linkping University Hospital, Sweden. Qualitative interviews were conducted and analysed according to inductive content analysis. Results: Four main categories were identified: (i) previous experience of exercise, (ii) needs in the acute phase, (iii) important prerequisites for attending exercise-based CR and (iv) future ambitions. The categories demonstrate that there are connections between the past, the present and the future, in terms of attitudes to facilitators, barriers and the use of strategies for managing exercise. An overall theme, defined as existential thoughts, had a major impact on the patients attitudes to attending exercise-based CR. The interaction and meetings with the physiotherapists in the acute phase were described as important factors for attending exercise-based CR. Moreover, informants could feel that the physiotherapists supported them in learning the right level of effort during exercise and reducing the fear of exercise. Conclusions: This study adds to previous knowledge of barriers and facilitators for exercise-based CR that patients with CAD get existential thoughts both related to exercise during the rehabilitation process and for future attitudes to exercise. This knowledge might necessitate greater attention to the physiotherapist-patient interaction. To be able to tailor exercise-based CR for patients, physiotherapists need to be aware of patients past experiences of exercise and previous phases of the rehabilitation process as these are important for how patients perceive their need and ability of exercise.
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35.
  • Bäck, Maria, 1978, et al. (författare)
  • Kinesiofobi (rörelserädsla) hos patienter med kranskärlssjukdom
  • 2011
  • Ingår i: Abstraktbok Sjukgymnastdagarna 14-16 sept 2011, Stockholm.
  • Konferensbidrag (refereegranskat)abstract
    • Bakgrund och syfte Att patienter med kranskärlssjukdom är rörelserädda är ett känt kliniskt fenomen, som dock inte finns vetenskapligt studerat. Studiens syfte var tvådelat: 1). Reliabilitets- och validitetstesta Tampaskalan för kinesiofobi – Heart (TSK-SV Heart). 2). Undersöka förekomsten av kinesiofobi bland patienter med kranskärlssjukdom. Metoder Studien bestod av 332 patienter (75 kvinnor) med kranskärlssjukdom som vårdats vid Sahlgrenska Universitetssjukhuset/Sahlgrenska mellan 2007-2009. Patienterna inkluderades 6 månader efter vårdtillfället. Kinesiofobi utvärderades med TSK-SV Heart, ett frågeformulär som subjektivt mäter patientens grad av kinesiofobi. Ett värde >37 poäng indikerar kinesiofobi. För test av reliabilitet av TSK-SV Heart mättes stabilitet över tid, inre konsistens samt homogenitet. Validitetstesterna inkluderade ytvaliditet, innehållsvaliditet samt begreppsvaliditet. Resultat Reliabilitetstesterna visade på en god stabilitet över tid (Intraclass Correlation Coefficient=0.84) och en god inre konsistens (Cronbach’s alpha=0.79). Validitetstesterna resulterade i en god yt- och innehållsvaliditet. Begreppsvaliditeten utvärderades genom en konfirmatorisk faktoranalys som visade på acceptabla modellanpassningmått för en fyra faktor modell. Tjugo procent av patienterna hade en förhöjd grad av kinesiofobi (>37 poäng på TSK-SV Heart). Konklusion Att med ett reliabelt och valitt instrument kunna identifiera de patienter med kranskärlssjukdom som har en hög grad av kinesiofobi kan vara ett första steg mot att utforma en behandling för att öka dessa patienters följsamhet till fysisk aktivitet och träning, som har väl vedertagna positiva effekter.
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36.
  • Bäck, Maria, et al. (författare)
  • Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.
  • 2016
  • Ingår i: Physiotherapy Theory and Practice. - : Informa UK Limited. - 0959-3985 .- 1532-5040. ; 32:8, s. 571-580
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).PATIENTS: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.METHODS: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.RESULTS: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.CONCLUSIONS: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.
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37.
  • Bäck, Maria, et al. (författare)
  • Mellanmänskligt förtroende och åsikter om finlandssvenskar och det svenska språkets ställning i Finland
  • 2020
  • Ingår i: Ur majoritetens perspektiv. - Helsingfors : Svenska litteratursällskapet i Finland. - 9789515835161 ; , s. 66-82
  • Bokkapitel (refereegranskat)abstract
    • I detta kapitel fokuserar vi på sambandet mellan mellanmänskligtförtroende och attityder gentemot finlandssvenskar och det svenskaspråkets ställning i Finland. En stor del av den tidigare forskningenom förtroende tyder på att individer som uppvisar högt mellanmänskligt förtroende samtidigt också uppvisar andra nära relateradesamhällspositiva attityder (Rothstein & Uslaner 2015; Welch m.fl.2005). Det mellanmänskliga förtroendet förenar oss med människorsom är olika oss själva (Rothstein & Uslaner 2015, 155) och det ansesäven vara starkt kopplat till andra positiva personlighetsattribut påindividnivån, såsom en allmänt hög livstillfredsställelse, samarbetsvilja och respekt för andra människors rättigheter (Rotter 1971). Påmotsvarande sätt tenderar individer vars mellanmänskliga förtroende är lågt vara mer cyniska och ha en i allmänhet mer pessimistisk inställning till livet (Delhey & Newton 2003, 95). Det mellanmänskliga förtroendet innebär att man anser att de flesta människorgår att lita på, och det är en form av socialt förtroende som i litteraturen ofta också förknippas med begreppet socialt kapital (Putnam1993).
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38.
  • Bäck, Maria, et al. (författare)
  • Perceptions of Kinesiophobia in Relation to Physical Activity and Exercise After Myocardial Infarction: A Qualitative Study
  • 2020
  • Ingår i: Physical therapy. - : Oxford University Press (OUP). - 1538-6724 .- 0031-9023. ; 100:12, s. 2110-2119
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: Physical activity and exercise are central components in rehabilitation after a myocardial infarction. Kinesiophobia (fear of movement) is a well-known barrier for a good rehabilitation outcome in these patients; however, there is a lack of studies focusing on the patient perspective. The aim of this study was to explore patients' perceptions of kinesiophobia in relation to physical activity and exercise 2 to 3months after an acute myocardial infarction. METHODS: This qualitative study design used individual semi-structured interviews. Face-to-face interviews were conducted with 21 patients post-myocardial infarction who were screened for kinesiophobia (≥32 on the Tampa Scale for Kinesiophobia Heart). The interviews were transcribed and analyzed according to an inductive content analysis. RESULTS: An overarching theme was defined as "coping with fear of movement after a myocardial infarction-a dynamic process over time" comprising 2 subthemes and explaining how coping with kinesiophobia runs in parallel processes integrating the patient's internal process and a contextual external process. The 2 processes are described in a total of 8 categories. The internal process was an iterative process governed by a combination of factors: ambivalence, hypervigilance, insecurity about progression, and avoidance behavior. The external process contains the categories of relatives' anxiety, prerequisites for feeling safe, information, and the exercise-based cardiac rehabilitation program. CONCLUSION: Coping with fear of movement after a myocardial infarction is a dynamic process that requires internal and external support. To further improve cardiac rehabilitation programs, person-centered strategies that support the process of each person-as well as new treatment strategies to reduce kinesiophobia-need to be elaborated. IMPACT: Patients with a myocardial infarction were found to be ambivalent about how they expressed their fear of movement; therefore, it is crucial for physical therapists to acknowledge signs of fear by listening carefully to the patient's full story in addition to using adequate self-reports and tests of physical fitness. These results will inform the design, development, and evaluation of new treatment strategies, with the overall aim of reducing kinesiophobia and increasing physical activity and participation in exercise-based cardiac rehabilitation. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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39.
  •  
40.
  • Bäck, Maria, 1978, et al. (författare)
  • Physical activity in relation to cardiac risk markers in secondary prevention for patients with coronary artery disease
  • 2012
  • Ingår i: European Society of Cardiology (ESC), Münich, Germany.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Purpose: The strong evidence of the benefits of exercise-based cardiac rehabilitation can not be questioned. However, the relationship between level of habitual physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) has yet to be quantified. The aims of the study were to describe the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. Methods: In total, 332 patients, mean age 65±9.1 years, diagnosed with CAD at a university hospital were included in the study, six months after the cardiac event. Physical activity was measured with a pedometer (steps/day). Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index, waist-hip ratio, and muscle endurance. Correlations with cardiac risk indicators were assessed using Spearman's rank order correlation, where adjustments were made for characteristics univariately associated (p<0.05) with both pedometer steps/day and the variable in question. Results: The patients performed in median 7027 (inter-quartile range 4553-9356) steps/day. The significant adjusted correlations between pedometer steps/day and cardiac risk markers were in general small. Pedometer steps/day was positively correlated with high-density lipoprotein cholesterol (HDL) (0.19, p<0.001), muscle endurance tests (0.19-0.25, p<0.001) and inversely associated with triglycerides (-0.20, p<0.001), glucose-tolerance (-0.23, p<0.001), twenty-four hour heart rate recording during night (-0.17, p=0.004), and total heart rate over 24h (-0.13, p=0.02). Conclusions: There were small, but significant, associations between habitual physical activity and HDL, muscle endurance, triglycerides, glucose-tolerance, and 24-h heart rate, indicating the possibility of positive effects of physical activity on these parameters. However, before more confirmatory data are available, we recommend that patients with CAD are routinely referred to exercise-based cardiac rehabilitation, due to the principle of evidence-based medicine.
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41.
  • Bäck, Maria, 1978, et al. (författare)
  • Physical activity in relation to cardiac risk markers in secondary prevention of coronary artery disease.
  • 2013
  • Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 168:1, s. 478-483
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The relationship between physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) is uncertain. The aims of the study were therefore to examine the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. METHODS: In total, 332 patients, mean age, 65±9.1years, diagnosed with CAD at a university hospital were included in the study 6months after their cardiac event. Physical activity was measured with a pedometer (steps/day) and two questionnaires. Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index (BMI), waist-hip ratio, and muscle endurance. The study had a cross-sectional design. RESULTS: The patients performed a median of 7027steps/day. After adjustment for confounders, statistically significant correlations between steps/day and risk markers were found with regard to; high-density lipoprotein cholesterol (HDL-C) (r=0.19, p<0.001), muscle endurance measures (r ranging from 0.19 to 0.25, p=0.001 or less) triglycerides (r=-0.19, p<0.001), glucose-tolerance (r=-0.23, p<0.001), BMI (r=-0.21, p<0.001), 24-h heart rate recording during night (r=-0.17, p=0.004), and average 24-h heart rate (r=-0.13, p=0.02). CONCLUSIONS: A relatively high level of physical activity was found among patients with CAD. There was a weak, but significant, association between pedometer steps/day and HDL-C, muscle endurance, triglycerides, glucose-tolerance, BMI and 24-h heart rate, indicating potential positive effects of physical activity on these parameters. However, before clinical implications can be formed, more confirmatory data are needed.
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42.
  • Bäck, Maria, et al. (författare)
  • Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event
  • 2018
  • Ingår i: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION. - : LIPPINCOTT WILLIAMS & WILKINS. - 1932-7501 .- 1932-751X. ; 38:4, s. 224-230
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.
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43.
  • Bäck, Maria, 1978, et al. (författare)
  • Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event
  • 2018
  • Ingår i: Journal of Cardiopulmonary Rehabilitation and Prevention. - : Ovid Technologies (Wolters Kluwer Health). - 1932-7501. ; 38:4, s. 224-230
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits. Methods: In all, 106 patients with CAD (25 women), mean age 63.1 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates. Results: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant. Conclusions: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.
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44.
  • Bäck, Maria, 1978, et al. (författare)
  • The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease
  • 2013
  • Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 167:2, s. 391-397
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The impact on kinesiophobia (fear of movement) for patients with coronary artery disease (CAD) is not known. The aims were to describe the occurrence of kinesiophobia in patients with CAD, and to investigate the influence on kinesiophobia by clinical variables. Material and methods: In total, 332 patients, mean age, 65±9.1 years diagnosed with CAD at a university hospital were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to assess kinesiophobia. Comparisons between high versus low levels of kinesiophobia were measured for each variable. Binary logistic regression analyses were performed with a high level of kinesiophobia (TSK-SV Heart >37) as dependent variable, and with the observed variables as independent. The study had an exploratory, cross-sectional design. Results: A high level of kinesiophobia was found in 20% of the patients. The following variables decreased the odds ratio (OR) for a high level of kinesiophobia: Attending cardiac rehabilitation (yes vs no; -56.7%), level of physical activity (medium vs high; -80.2%), Short Form-36: general health (-4,3%), physical functioning (-1.8%). Two variables increased the OR for a high level of kinesiophobia: heart failure as complication at hospital (yes vs no; 418.7%), anxiety (19.2%). Previous heart failure (yes vs no) was unexpectedly found to reduce kinesiophobia (-88.3%) due to suppression. Conclusions: Several important clinical findings with impact on rehabilitation and prognosis for patients with CAD were found to be associated with a high level of kinesiophobia. Therefore, kinesiophobia needs to be considered in secondary prevention for patients with CAD.
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45.
  • Bäck, Maria, et al. (författare)
  • The remote exercise SWEDEHEART study-Rationale and design of a multicenter registry-based cluster randomized crossover clinical trial (RRCT)
  • 2023
  • Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 262, s. 110-118
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite proven benefits of exercise-based cardiac rehabilitation (EBCR), few patients with myocardial infarction (MI) participate in and complete these programs.Study design and objectives: The Remote Exercise SWEDEHEART study is a large multicenter registry-based cluster randomized crossover clinical trial with a planned enrollment of 1500 patients with a recent MI. Patients at intervention centers will be offered supervised EBCR, either delivered remotely, center-based or as a combination of both modes, as self -preferred choice. At control centers, patients will be offered supervised center-based EBCR, only. The duration of each time period (intervention/control) for each center will be 15 months and then cross-over occurs. The primary aim is to evaluate if remotely delivered EBCR, offered as an alternative to center-based EBCR, can increase participation in EBCR sessions. The proportion completers in each group will be presented in a supportive responder analysis. The key secondary aim is to investigate if remote EBCR is as least as effective as center-based EBCR, in terms of physical fitness and patient-reported outcome measures. Follow-up of major adverse cardiovascular events (cardiovascular-and all-cause mortality, recurrent hospitalization for acute coronary syndrome, heart failure hospitalization, stroke, and coronary revascularization) will be performed at 1 and 3 years. Safety monitoring of serious adverse events will be registered, and a cost-effectiveness analysis will be conducted to estimate the cost per quality-adjusted life-year (QALY) associated with the intervention compared with control.Conclusions: The cluster randomized crossover clinical trial Remote Exercise SWEDEHEART study is evaluating if par-ticipation in EBCR sessions can be increased, which may contribute to health benefits both on a group level and for individual patients including a more equal access to health care.Trial registration The study is registered atClinicalTrials.gov (Identifier: NCT04260958) (Am Heart J 2023;262:110-118.)
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46.
  • Bäck, Maria, 1978, et al. (författare)
  • The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)
  • 2021
  • Ingår i: European Heart Journal-Quality of Care and Clinical Outcomes. - : Oxford University Press (OUP). - 2058-5225 .- 2058-1742. ; 7:5, s. 431-437
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed. Methods and results The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020. Conclusion The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.
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47.
  • Bäck, Maria, 1978, et al. (författare)
  • Validation of a queationnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease
  • 2011
  • Ingår i: World Physical Therapy 16th International WCPT Congress 20-23 June 2011, Amsterdam.
  • Konferensbidrag (refereegranskat)abstract
    • Purpose The aim of the study was twofold; firstly to examine the reliability and validity of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), and secondly to investigate the occurrence of kinesiophobia among patients with coronary artery disease (CAD). Relevance Kinesiophobia, i.e. debilitating fear of movement, in relation to cardiac disease is a well-known clinical phenomenon. So far, however, there is not known which role kinesiophobia, plays for the level of physical activity in patients with CAD. Participants The study consisted of 331 patients (75 women), age 65±9.1 years, with CAD who attended the medical department at Sahlgrenska University Hospital between year 2007–2009. Exclusion criteria were death during the hospital period, serious diseases interfering participation in the study and inability to understand the Swedish language. Methods The patients were asked to fill in the TSK-SV Heart, which comprises of 17 items that assess the patient’s subjective rating of kinesiophobia. An operational definition of kinesiophobia was defined as TSK-SV Heart >37 points. The reliability test included stability over time, internal consistency and homogeneity. The test of validity comprised face validity, content validity and construct validity. Results In terms of reliability the TSK-SV Heart was found to be stable over time (Intraclass Correlation Coefficient 0.84) and internal consistency measured with Cronbach’s alpha was 0.84. The TSK-SV Heart was considered to have face, content and construct validity. Twenty percentage of the patients had kinesiophobia (TSK-SV Heart >37 points). Conclusion: TSK-SV Heart seems to be a reliable and valid and could be used to detect kinesiophobia in patients with CAD. Impact: One third of a sample of patients with CAD suffered from kinesiophobia, which might negatively impact the patients’ future level of physical activity.
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48.
  • Bäck, Maria, 1978, et al. (författare)
  • Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease
  • 2012
  • Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081 .- 1650-1977. ; 44:4, s. 363-369
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), which is a brief questionnaire to detect kinesiophobia (fear of movement), in patients with coronary artery disease (CAD). Design: Methodological research (cross-sectional study). Subjects: A total of 332 patients, mean age, 65±9.1 years diagnosed with CAD at a university hospital were included in the study. Methods: The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face validity, content validity, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. Results: In terms of reliability, the TSK-SV Heart was found to be stable over time (Intra Class Correlation coefficient = 0.83), and internally consistent (Cronbach’s alpha = 0.78). A confirmatory factor analysis provided acceptable fit for a hypothesized four-factor model with inclusion of a method factor. Conclusions: These results provide support showing the TSK-SV Heart to be reliable and the questionnaire seems to be valid for use in patients with CAD. However, some items need further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future studies concerning their implications for the target group.
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49.
  • Bäck, Maria, 1978, et al. (författare)
  • What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?
  • 2014
  • Ingår i: European Heart Journal. European Society of Cardiology, 30 August - 3 September 2014, Barcelona. ; 35:Suppl 1
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Purpose Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusions Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.
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50.
  • Bäck-Wiklund, Margareta, 1944, et al. (författare)
  • Are Health Care Organizations Healthy? Quality of Work and Private Life in Northern and Southern Europe
  • 2012
  • Ingår i: Work and Family Researchers Network Inaugural Conference, June 14-16, 2012, New York City.
  • Konferensbidrag (refereegranskat)abstract
    • In this paper we study healthy organization and gender through exploring the dual agenda from the perspective of the human service organization. Looking at employee survey data from public hospitals in eight countries across the Europe (Bulgaria, Finland, Germany, Hungary, Netherlands, Portugal, Sweden and the UK), we analyze the empirical support for concept of the healthy organization. Quantitative and qualitative methods have been used in a mixed methods approach, collected across four types of service sector organizations in each participating country (public hospitals, ITC, retail, and bank/insurance), within the framework of the EU project Quality of Life in a Changing Europe (QUALITY). Two case studies of hospitals are selected: one gender equal in average self-reported health status (Sweden) and one where women share a much lower average (Portugal). We explore the dual agenda from two perspectives – the work-household duality (engagement/work-life balance) and workforce-organization duality (social support/life satisfaction). Three hypotheses are advanced: (1) that human service organizations, and the hospital employee in particular, harbour a latent healthy organizations perception, indicated by an individual consistency of social support, life satisfaction engagement, work-life balance; (2) that due to gendered differences, women in medicine share a stronger such healthy organizations perception, and; (3) gender matters for the healthy organizations perception because of work organizational policy, career paths and home related resources. The findings in large verify these hypotheses. Among employees at the eight hospitals across Europe, there is a significant latent dimension of perceiving the healthy organization measure, based on social support, engagement, satisfaction with life and work-life balance, and this construct is significantly higher among women, mainly because of formal work time flex policies, formal supervisory position combined with low education level, and domestic resources that includes the availability of child care and a stronger social network. These findings are further verified/ explored by in depth analysis of our two case studies.
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