| 1. |
- Bergström, Maria, 1983-
(author)
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Participation and support in everyday life over a decade : perspectives of persons with rheumatoid arthritis and their significant others
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Introduction: The treatment of rheumatoid arthritis (RA) has evolved over recent decades. Today, many previous limitations related to, for example, joint damage have become rare, and persons with RA can often continue to work and engage in different aspects of everyday life. Nonetheless, persons with RA still report restrictions in everyday life, as they can be negatively impacted by symptoms like pain, stiffness and fatigue. As these symptoms might be invisible to others, the significant others of persons with RA can find it difficult to comprehend the effect of the disease. As a consequence, both the person with RA and the significant other may be affected, despite today’s effective treatment.As participation is a central concept within healthcare, it is also a prominent factor within rehabilitation and its goals. Despite access to contemporary treatment during the whole disease course, persons with RA still report participation restrictions. Since RA is a chronic disease, these remaining restrictions are of particular interest from a longitudinal perspective. However, support from the social environment, such as significant others, has the possibility to positively influence participation in everyday life. Therefore, it is essential to explore the influence of significant others and their support with the goal of enhanced participation in the everyday life of persons with RA, from a longitudinal perspective.Aim: The general aim of this thesis is to explore participation in the everyday life of persons with RA over a decade, and in relation to this investigate the influence of significant others and their support.Methods: This thesis consists of four studies that used different methodological approaches: qualitative, quantitative and mixed methods.Study I was a qualitative study where 59 persons with RA participated in semi-structured interviews approximately three years after diagnosis. Questions covered experiences in everyday life and participation. The material was analysed through content analysis.In Study II, longitudinal data from 274 persons with RA were analysed regarding disease activity (assessed by DAS28), grip force (assessed by Grippit), pain intensity (VAS mm) and activity limitations (assessed by HAQ). The data were collected at inclusion, year one and year two after diagnosis. Data related to sickness absence were also obtained, as well as self-assessed perceptions of experienced support. Through regression analyses, associations between disease-related variables and sickness absence were investigated, with support as a moderator.The data in Study III comprise semi-structured individual interviews with 16 persons with RA and their significant others, conducted approximately a decade after diagnosis. The interview guide was developed with Study I in mind and included similar topics, with the addition of support. This material was analysed using dyadic analysis, where a person with RA and the significant other comprised a dyad.Finally, in Study IV, a convergent mixed methods approach was used. Longitudinal data regarding disease-related variables (same as Study II) were collected during the first decade after diagnosis and analysed through linear mixed models. The qualitative material consisted of individual interviews conducted three and ten years after diagnosis and analysed by directed content analysis. The quantitative and qualitative results were integrated in accordance with the chosen method.Results: Significant others of persons with RA could encompass both facilitators and hinders to participation in the everyday life of persons with RA. Through the provision of support and helpful attitudes towards needed adaptations, they had a positive influence on participation in the everyday life of persons with RA. This was a continuous process since the persons with RA were still affected by the disease a decade after diagnosis, and adaptations by the significant others might also still be needed.Experiences of RA were found to differ between men and women over the first decade after diagnosis. Moreover, through a mixed methods design, discrepancies were found between the persons’ own descriptions in interviews and the quantitative results. For instance, women expressed issues related to grip force and disease activity in the interviews, but these issues were not detected in the same way in the quantitative results. These discrepancies were additionally not seen in men; however, both men and women still showed signs of disability a decade after RA diagnosis. Nevertheless, over time, the persons with RA and their significant others had learned to live with the disease and there was a sense of togetherness in everyday life with RA. Namely, they approached the disease together as a unit.Support was identified as a positive aspect that facilitated everyday life. It entailed both the support between the person with RA and the significant other, as well as the support from others outside of the dyad. Support could also come in different forms. For example, the person with RA could receive emotional support from a significant other, or healthcare professionals (HCPs) could provide informational support to either or both of the parties. In connection to the latter, a continuous need for knowledge was identified in both the persons with RA and the significant others. Support from significant others also proved to have an impact on work life specifically, as more perceived support was associated with an increased risk of sickness absence.Conclusively, significant others and their support can influence participation in the everyday life of persons with RA, and this influence can be facilitated through positive attitudes and different types of support during the first decade after diagnosis.Conclusions: Significant others are essential providers of support as facilitators for participation in the everyday life of persons with RA, including many years after diagnosis. However, they must also be attentive towards the further need for adaptations and possible emotional burden in the persons with RA. It is also important for significant others to find a balance between overprotecting and contributing to independence.The significant others in their turn might need support in understanding the impact of the disease. In this case, HCPs should be providers of support to both persons with RA and their significant others and consult with both of them as a unit in the rehabilitation process. This also exemplifies the need for support from outside the dyads of persons with RA and their significant others.Support is requested both at an early stage and throughout the disease course. Different types of support from significant others can therefore preferably be part of the rehabilitation process as a way to enhance participation in the everyday life of persons with RA.
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| 2. |
- Söderström Malmborg, Julia, 1988-
(author)
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Pain and health in adolescents and young adults – pieces of a puzzle
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Background: Musculoskeletal pain is a burden for the individual and for society, and it has a negative impact on overall health. The biological, psychological, and social factors that govern pain and health form a complex puzzle to put together. Musculoskeletal pain conditions may be alleviated by physical activity, but a too high level of physical activity may also increase the risk of pain. Youth athletes may be especially vulnerable to developing pain due to factors related to training load and physical maturity. Being physically active and maintaining a healthy diet is associated with better health, but if carried out to excess these health behaviours may become unhealthy. Our understanding of musculoskeletal pain and health in adolescents and young adults needs to be developed, both in individuals involved in sports and exercise and in the general population.Aim: The overall aim was to study musculoskeletal pain and its relationship to various health-related factors in adolescents and young adults enrolled in sport or general education programmes.Methods: Study I was a cross-sectional study on university students (aged 19–29) from an exercise science programme (n = 118) and a business programme (n = 89), assessing health status, physical activity, and orthorexia nervosa (an exaggerated fixation on healthy food). Study II was a cross-sectional study (n = 178), and Study III a 2-year longitudinal (n = 131) study on sport school students (aged 14 at baseline), assessing musculoskeletal pain, health status, physical maturity, and sports performance. Study IV was a 3-year longitudinal study on students from a general upper secondary school (n = 256, aged 16 at baseline), assessing chronic musculoskeletal pain, health status, physical activity, sleep, stress, anxiety, and depression.Results: In Study I, compared to business students, exercise science students reported more pain, but better general health. A high level of physical activity in combination with orthorexia nervosa was most prevalent in men from the exercise science programme. In Studies II and III, pain was common in sport school students. At baseline, boys with constant pain were not as physically mature as boys with infrequent pain. Students with constant pain reported a worse health status than students with infrequent pain. At follow-up, frequent pain, frequent pain in two or more body regions, and a worse health status at baseline were identified as risk factors for having frequent pain at follow-up in girls. For boys, late physical maturation at baseline was a risk factor. Involvement in non-contact sports was also an identified risk factor over time in both sexes. Pain was associated with a worse sports performance in boys at both baseline and follow-up. In Study IV, chronic musculoskeletal pain was common in students from a general upper secondary school. A worse health status, severe sleeping problems, anxiety, and chronic musculoskeletal pain at baseline were associated with reporting chronic musculoskeletal pain at follow-up.Conclusions: Pain was prevalent, and also persistent, in adolescents and young adults, irrespective of attending sport or general education programmes. Pain is a biopsychosocial phenomenon and must be treated as such. Pain should be frequently monitored, and treatment should be introduced early on to prevent pain from becoming persistent.
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| 3. |
- Arvidsson, Susann
(author)
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Health promoting factors in people with chronic musculoskeletal pain or with rheumatic diseases: a descriptive and interventional study
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim of this thesis with a salutogenic approach was to describe health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, and to evaluate the effects of an intervention study with a self-care promoting PBL-program for people with rheumatic diseases having chronic musculoskeletal pain, sleep disturbances and/or fatigue. Methods: This thesis is comprised of four samples: a randomly selected sample from a Swedish general population (study I) and three different samples containing people with rheumatic diseases registered at a hospital for rheumatic diseases in the southwest of Sweden (studies II, III and IV). Study I had a longitudinal cohort design with an eight-year follow-up in a general population. There were 1109 participants without chronic pain and 700 participants with chronic musculoskeletal pain. Study II had a longitudinal cohort design with participants with rheumatic diseases (n=185) 12 months after rehabilitation at a hospital for rheumatic diseases. Study III had a descriptive qualitative design with a phenomenological approach based on a reflective life-world perspective. Twelve participants were interviewed about their experiences about health-promoting self-care. Study IV had a randomised controlled design with post-test six months after the one-year self-care promoting problem-based learning (PBL) program for people with rheumatic diseases. The participants were randomly assigned to the experimental group, 54 participants, or to the control group, 148 participants. Data in studies I, II and IV were analysed with statistics. In study III a Husserlian phenomenological approach based on a reflective life-world perspective was used in the data collection and analysis. Results: Study I: Although participants without chronic musculoskeletal pain reported better health-related quality of life (HRQL) than participants with chronic musculoskeletal pain, similar health factors were found to promote a better HRQL in the eight-year follow-up. The most important factors were feeling rested after sleep and having good sleep structure. Study II: The most important factors promoting better outcome in HRQL 12 months after rehabilitation in participants with rheumatic diseases were having a strong sense of coherence (SOC), feeling rested after sleep, having work capacity, and having good sleep structure. Study III: The meaning of health-promoting self-care as experienced by people with rheumatic diseases was that self-care takes place against a background of continual hope and belief to be able to influence health in positive ways. Self-care was a way of life and implied being ready to understand and respond to signals from the body. Three interrelated constituents elucidated the experiences: dialogue, power struggle and choice. Study IV: At the six month follow-up the participants in the experimental group had stronger empowerment after participation in the self-care promoting PBL-program compared with the control group which only got standard care for people with rheumatic diseases. There were no differences in HRQL, self-care ability, SOC, pain, quality of sleep or fatigue between the experimental group and the control group. The participants in the experimental group also stated that they had implemented lifestyle changes which they had not done without the PBL-program. Conclusion: The results of this thesis provide a valuable and useful insight in health promoting factors in people with chronic musculoskeletal pain and in people with rheumatic diseases, but also in that people with rheumatic diseases have benefit from taking part in patient education with a self-care promoting PBL-program. These results contribute to evidence supporting the introduction of a more salutogenic approach in rheumatology care and research.
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| 4. |
- Bergman, Filip, 1992-
(author)
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Sustainability performance of multi-utility tunnels : Sustainability assessments for furthering knowledge and understanding
- 2022
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Licentiate thesis (other academic/artistic)abstract
- The multi-utility tunnel has received increased attention as an alternative method for the installation of subsurface infrastructure for the distribution of electricity, water, sewage and district heating. In previous research, the multi-utility tunnel (MUT) has been described as a more sustainable technology compared to the conventionally used technique where the cables and pipes are placed with open-cut excavation (OCE), especially when the entire life cycle is taken into account. This thesis aims to contribute to an improved understanding of MUT's sustainability performance in relation to conventional installation using open-cut excavation. This is done by using literature study, interview study and quantitative sustainability assessments to gain an understanding of the current state of knowledge. Furthermore, this thesis also focuses on how knowledge can be deepened with the help of quantitative sustainability assessments and the challenges of conducting this type of assessment. This thesis shows that the state of knowledge regarding MUT's sustainability performance is low and scattered, with a lack of a holistic approach. Direct economic performance has gained the most attention, followed by indirect and social impact, and the environmental impact has so far barely been assessed. The sustainability performance depends to a large extent on the conditions of the specific case, and these should be considered when assessing the technology. Quantitative assessments have the potential to help deepen the knowledge of the sustainability implications of using MUT. The characteristics of MUT have some similarities with other types of physical infrastructure. Similarities are that the systems are long-lived, have project conditions that affect sustainability performance, and impact a broad spectrum of actors. One difference to typical infrastructure systems is that the owner and management structure of MUT is, by design, more complex as several types of utility systems are in use. The characteristics of MUT give some practical considerations that need to be addressed: data availability, including practitioners; detailed data; transparency; and flexibility. This thesis highlights the complexity of assessing MUT´s sustainability performance and advocates that future studies should have a learning-oriented approach so that the knowledge level can collectively and gradually improve over time rather than focusing on decision-oriented studies.
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| 5. |
- Bergman, Niclas
(author)
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Aspects of probabalistic serviceability limit state design of dry deep mixing
- 2015
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Doctoral thesis (other academic/artistic)abstract
- An expanding population and increased need for infrastructure increasingly necessitate construction on surfaces with poor soil conditions. To facilitate the construction of buildings, roads and railroads in areas with poor soil conditions, these areas are often improved by means of foundation engineering. Constructions that are fairly limited in scope are often founded on shallow or deep foundations. However, these methods are relatively expensive and thus not applicable for large-scale constructions like roads and railroads. A cost-effective way to deal with poor soil conditions is to use ground improvement. This thesis deals with a ground improvement method called deep mixing (DD)using lime-cement columns.Lime-cement columns are manufactured by pushing a mechanical mixing tool to the desired depth, with the tool then rotated and retracted while a lime-cement binder is distributed into soil, forming lime-cement columns. Because of the complex mixing process and inherent soil variability, soil improved by DD shows high variability with respect to strength and deformation properties. Due to this high variability, it is difficult to predict the properties in advance; it is therefore important to verify the properties after installation. In Sweden, this is normally done using the column penetration test (KKK) method.Current design praxis considers evaluated mean values in the design, and the effect of variability and uncertainties is dealt with by using a sufficiently high total factor of safety. A more rational approach for dealing with the effect of variability and uncertainties on the reliability of a mechanical system is to include them as parameters in the design model. This can be done by using reliability-based design (RRR). A major incentive for using ??? is that lower variability in design properties produces higher design values. This is important since it encourages contractors to improve their manufacturing methodologies because ??? allows more homogenous columns to be assigned higher design values. Reliability-based design is also in line with Eurocode 7, which states that the selection of the characteristic values for geotechnical parameters shall take the variability of the measured property values into account.The first part of this doctoral thesis deals with test methods and quantification of the strength variability of soil improved by lime-cement columns. Tip resistances from three different test sites using three different penetration test methods – the cone penetration test, the column penetration test and the total-sounding test – are analysed and quantified in terms of means, variances and scale of fluctuations. The second part introduces RRR in serviceability limit state (SSS) design, using First Order Reliability Methods (FFFF) and Monte-Carlo simulations.Summarizing the most important findings and conclusions from this study: The scale of fluctuation was estimated to be 0.2-0.7 m and 0-3 m in the vertical and horizontal direction, respectively. The relation between cone tip resistances measured using the cone penetration test and column penetration test does not correspond to the cone factors proposed in previous studies and in the Swedish Design Guidelines. The agreement between the column penetration test and total-sounding test was found to be “good enough”. It is therefore suggested that the total-sounding test be used as a complement to the column penetration test in evaluating the average strength properties of a group of medium- and high-strength lime-cement columns.Reliability-based design is a rational approach to incorporate strength and deformation parameter variability with an SSS design.
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| 6. |
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| 7. |
- Bergsten, Ulrika, 1966-
(author)
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Patients' and healthcare providers' experiences of the cause, management and interaction in the care of rheumatoid arthritis
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim of this thesis was to explore and describe patients’ and healthcare providers’ experiences of the causes, management and interaction in the care of rheumatoid arthritis (RA). Method: The thesis is based on four studies. Studies I and II contain data from an epidemiologic project involving patients who were recently diagnosed with RA. The patients answered an open-ended question about their conception of the cause of their RA (Study I). Qualitative data from 38 patients were analysed using the phenomenographic approach in order to identify variation in conceptions. The results of Study I formed the basis for categorizing the conceptions of 785 patients in the search for patterns of background factors (Study II). Study III aimed to explore how patients experienced their management of RA in everyday life. Data were collected by interviews with 16 patients and analysed according to Grounded Theory (GT). In study IV, the aim was to explore healthcare providers’ experiences of their interaction with patients’ management of RA. Data were collected by interviews with 18 providers representing different professions and analysed using GT. Findings: Patients’ conceptions of the cause of their RA revealed new aspects from the patient perspective that can complement pathogenetic models. Two descriptive categories emerged: consequences beyond personal control and overloaded circumstances, which included six categories of conceptions (Study I). The most common conceptions of the cause of RA were unexpected effects of events followed by work and family-related stress (Study II). Background factors that influenced the conceptions of the cause were age, sex and educational level. Patient management of RA involved using personal resources together with grasping for support from others in their striving for a good life. When linking these aspects together, four ways of management emerged: mastering, struggling, relying and being resigned (Study III). Healthcare providers’ experiences of their interaction with patients’ management shed light upon the important issue of delivering knowledge and advice. The providers’ attitudes constituted one cornerstone and patients’ responses the other. The providers reported that the interaction led to different outcomes: completed delivery, adjusted delivery and failed delivery. Conclusions: The findings contribute new knowledge from both patients’ and healthcare providers’ perspectives, which could be used to develop a more person-centred approach in rheumatology care. Person-centred care involves taking patients’ beliefs and values into account in addition to creating a trusting relationship between patient and provider. A successful person-centred approach requires an organisation that supports the person-centred framework.
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| 8. |
- Emilson, Christina, 1969-
(author)
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Long-term perspectives on musculoskeletal pain : Health care utilization and integration of behavioral medicine treatment into physical therapy
- 2017
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Doctoral thesis (other academic/artistic)abstract
- There are currently no effective methods for treating and preventing chronic pain. The aim of this thesis was to study prognostic factors for health care utilization, and the long-term outcomes of tailored behavioral medicine treatment for patients with musculoskeletal pain. Another aim was to increase knowledge about physical therapists’ assessment and analysis of patients’ pain conditions and to investigate the potential of subgrouping patients based on prognostic factors.Methods: In Study I, a prospective population-based cohort was followed over 21 years. Data from three measure points were analyzed: 1995 (n=2425), 2007 (n=1582) and 2016 (n=1184). Study II was a 10-year follow-up of randomized controlled trial (n=97), comparing tailored behavioral medicine treatment and exercise-based physical therapy. In Study III, a descriptive and explorative design was applied, using data from video-recordings of 12 physical therapists. In study IV, assignment to three subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire was validated against reference instruments, and the stability between two points of measurement was investigated in patients (n=40) who were seeking primary health care due to musculoskeletal pain.Results: Chronic pain, female gender and high age predict high health care utilization over 21 years, and a trajectory of stable high health care utilization over the entire period. The differences between groups in favor for tailored behavioral medicine treatment reported at post-treatment and after two years, were not maintained at the 10-year follow-up. A majority of the physical therapists assessed factors for poor prognosis. The analyses were mainly based on biomedical assessments and none of the physical therapists included behavioral factors. Subgroup assignment according to the Örebro Musculoskeletal Pain Screening Questionnaire appears to be valid and stable over time.Conclusion: Prognostic factors such as chronic pain and female gender need to be considered when allocating health care resources and planning treatment to improve long-term outcomes. The treatment should also be tailored based on individual functional behavioral analyses of key behaviors and on patient´s biomedical and psychosocial condition, including strategies for maintenance of behavioral changes. Evidence-based methods for integrating behavioral medicine treatment into physical therapy need to be further evaluated and improved.
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| 9. |
- Filipsson, Karl, 1991-
(author)
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From behaviour to genes: anti-predator responses of brown trout (Salmo trutta) under winter conditions
- 2020
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Licentiate thesis (other academic/artistic)abstract
- Temperature has major effects on the performance of poikilotherms. In encounters with predators, low winter temperatures constrain predator detection and escape capabilities in prey fishes. Most studies of the anti-predator responses of fish under winter conditions focus on endothermic terrestrial predators, whereas effects of piscivorous fish are generally overlooked. The studies presented in this thesis explore behavioural and physiological responses of juvenile brown trout (Salmo trutta) at winter temperatures of 3 and 8 °C in the presence and absence of a winter-active piscivorous fish (burbot, Lota lota). In Paper I, I report behavioural responses of trout in relation to the time of day. At the lower temperature and in the presence of burbot, trout reduced their activity. Trout used overhead shelter the most during the day and in the presence of burbot. Trout also spatially avoided burbot at night and at dawn but not during the day. In Paper II, I examined plasma cortisol and mRNA expression of stress-related genes. A redundancy analysis showed that both temperature and the presence of burbot explained a significant amount of the observed variation. Trout had higher cortisol levels when exposed to the burbot. Analyses of individual gene expressions revealed that trout had higher mRNA expression at 3 than at 8 °C for 11 of the 16 examined genes. Only one gene, RBP1, was expressed to a higher degree in the presence of burbot, but there were also interaction effects between temperature and burbot presence for two genes coding for serotonin and glucocorticoid receptors. My studies show that piscivorous fish shape anti-predator responses of juvenile brown trout, both behaviourally and at the gene level, under winter conditions. The observed thermal effects on mRNA levels underscore the importance of temperature in fish stress responses, with implications for stream salmonids in a warmer climate.
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| 10. |
- Holmström, Stefan, 1970-
(author)
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Workplace stress measured by Job Stress Survey and relationships to musculoskeletal complaints
- 2008
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Doctoral thesis (other academic/artistic)abstract
- The main purpose of this thesis was to evaluate and test the Job Stress Survey (JSS, Spielberger, 1991; Spielberger & Vagg, 1999), a self-report instrument which assesses workplace stress. In the thesis a thorough evaluation is made of JSS scales and items, and the relations to health, particularly musculoskeletal complaints. The aim of Study I was to evaluate the factor structure and the psychometric properties of a Swedish version of the JSS. The instrument was distributed to medical service personal and metal industry workers (n=1186). Factor analyses demonstrated a good resemblance between the present version and the American original version. The results also showed that the internal consistencies, as well as the test-retest reliabilities of the scales are high, and the concurrent validity are good. Study II examined work-related stress measured by JSS for the subgroups of gender, industry workers and medical service personnel, and special attention was given to the problem of differential item functioning (DIF) on these subgroups. The main findings were that both gender and occupation has a substantial impact on specific sources of work-related stress assessed by JSS scales and individual items. The result of the DIF analyses showed no item bias in the gender subgroup, but for the occupational subgroups there where items showing DIF in two of the scales. These items do not jeopardize the conclusions made on scale level since the number of items showing DIF are too few to make an impact on the overall result on the different scales. In Study III the relation between self-reported stress and health, particularly musculoskeletal problems were examined longitudinally in two metal industry factories. Results showed high levels of stress and musculoskeletal complaints in these factories and significant and strong relationships between the JSS scales and musculoskeletal, as well as psychosocial ratings. Lack of Organizational Support was found to be more related to musculoskeletal pain than Job Pressure. Longitudinal differences were found between the factories and between different types of musculoskeletal complaints. The general conclusions from the studies are that the present version of JSS shows a good resemblance with the American original, and that JSS is a useful instrument for studying relationships between stress and health.
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| 11. |
- Lindholm, Annelie, 1975-
(author)
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Overweight and Obesity in Preschool Children : Early Risk Factors and Early Identification
- 2019
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Doctoral thesis (other academic/artistic)abstract
- BACKGROUND: Overweight and obesity in children has reached epidemic proportions in recent decades, and even the youngest age groups are affected. Excess weight during childhood often follows the child into adulthood and is associated with diseases such as cardiovascular diseases and type 2 diabetes mellitus. In addition, excess weight often leads to health problems already during childhood. Childhood obesity is therefore one of the greatest public health challenges of the 21st century.AIM: The overall aim was to study growth patterns and early risk factors for overweight, obesity and an elevated waist-to-height ratio (WHtR) in preschool children. The specific aims were to: examine early body mass index (BMI) and WHtR growth patterns and their ability to predict overweight or obesity in children at 5 years of age (Paper I); examine if BMI and WHtR growth patterns from an early age could identify children with an elevated WHtR at 5 years of age by using standard deviation score(s) (SDS) in children classified according to WHtRSDS at 5 years of age. Another aim was to study the association between BMISDS and WHtRSDS at 5 years of age (Paper II); examine nutrition- and feeding practice-related risk factors for rapid weight gain during the first 0–6 months and the following 6–12 months (Paper III); examine the association between potential early risk factors and an elevated WHtR, defined as WHtRSDS ≥ 1 at 5 years of age, and examine whether similar associations also were found for overweight or obesity at the same age (Paper IV).METHODS: This project was part of the population-based birth cohort study the Halland Health and Growth Study, including 2,666 children born in the county of Halland in the southwestern part of Sweden between October 2007 and December 2008. Weight, height and waist circumference were measured at nine time points starting at birth. At every measurement point the parents filled in questionnaires regarding their child’s nutrition, health and lifestyle and also background information about the family.RESULTS: We found that children with overweight or obesity at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with normal weight or underweight. BMI was sufficient for predicting overweight or obesity at 5 years of age and WHtR did not add any further information in this prediction.Children with a WHtRSDS ≥ 1 at 5 years of age could be identified already from an early age by significantly higher mean BMISDS and WHtRSDS than corresponding values in children with a WHtRSDS < 1. When comparing WHtRSDS and BMISDS at 5 years of age, 55% of the children with an elevated WHtRSDS had normal BMISDS.Rapid weight gain was more common during the first 6 months of the first year than during the next 6 months. Bottle-feeding and nighttime meals containing formula milk were associated with rapid weight gain between 0 and 6 months. Breastfeeding was negatively associated with rapid weight gain during the same period.Rapid weight gain during 0–6 months and also maternal pre-pregnancy BMI and paternal BMI were associated with a WHtRSDS ≥ 1 at 5 years of age. Rapid weight gain during both 0–6 and 6–12 months and also maternal pre-pregnancy BMI, were associated with overweight or obesity at 5 years of age.CONCLUSION: This thesis showed that BMI was sufficient for predicting overweight or obesity at 5 years of age, and WHtR did not add any further information to this prediction. For identification of children with an elevated WHtR, BMI classification missed every second child, indicating that WHtR adds value in children who may need further investigation regarding cardiometabolic risk factors. Risk factors operating before pregnancy and early in life increase the risk of early rapid weight gain, an elevated WHtR and overweight or obesity at 5 years of age and bottle feeding, nighttime meals, early rapid weight gain as well as parental overweight are potential modifiable risk factors in this development.
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| 12. |
- Pietilä Holmner, Elisabeth, 1953-
(author)
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Multimodal rehabilitation of patients with chronic musculoskeletal pain, focusing on primary care
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background: Chronic pain is a complex condition that has consequences both for individual people and for society. The individual often experiences impact on function, activity and participation. Society is affected by high healthcare and sick leave costs and a loss of workforce. Multimodal rehabilitation programmes (MMRP) have mainly been provided through specialist care but it is now also available through primary care. The overall aim of this thesis was to evaluate the effects of MMRP in patients with chronic musculoskeletal pain and to explore patients’ and healthcare professionals’ experiences of MMRP.Study I: Aim: To evaluate the effects of an interdisciplinary team assessment and MMRP for patients with chronic pain in a specialist care setting. Design: Longitudinal cohort study. Method: Pain intensity, pain dimensions, anxiety and depression were measured at assessment and at the start and end of MMRP. A total of 93 women were evaluated. Result: Pain and pain-related measures were significantly improved both after the interdisciplinary assessment and after MMRP.Study II: Aim: To explore healthcare professionals’ experiences of MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Fourteen healthcare professionals (11 women, 3 men) were interviewed about their work with MMRP. Result: Healthcare professionals considered that MMRP was useful but also challenging. It was difficult to select appropriate patients, and health care professionals felt they were torn between following healthcare legislation and the goals of MMRP. They had to deal with ethical dilemmas as well as decide what constitutes good results.Study III: Aim: To explore patients’ experiences of participating in MMRP in primary care. Design: Individual interviews, analysed with qualitative content analysis. Method: Twelve former patients (7 women and 5 men) were interviewed about their experiences of MMRP in primary care. Result: Patients in primary care experienced a complex, ongoing process of accepting chronic pain. Obtaining redress, learning about chronic pain, and experiencing fellowship with others with the same condition contributed to the acceptance process.Study IV: Aim: To evaluate the effects of MMRP in primary care at one-year follow-up for all patients together and for men and women separately and to identify predictive factors for being employable at follow-up. Design: Prospective longitudinal cohort study. Method: Pain, physical and emotional functioning, coping, health-related quality of life, work-related factors, sick leave extent and sickness compensation were evaluated prior to and one year after MMRP in 234 patients, 34 men and 200 women. Result: All patients improved significantly in most measures at one-year follow-up, and the effect was larger in women. Sick leave decreased while no significant difference was found for total sickness compensation. Patients’ self-reported rating of current work ability before MMRP was significantly associated with being employable at follow-up.General conclusions and implications: MMRP seems to be effective for patients with chronic musculoskeletal pain, both in specialist care and in primary care. MMRP was more effective for women than for men, and the reasons for this need to be investigated further. An interdisciplinary team assessment could also be beneficial for decreasing pain and pain-related measures. Patients in primary care experience a complex, ongoing process of accepting chronic pain. Healthcare professionals have to deal with conflicting emotions with regard to different commitments from healthcare legislation and the goals of MMRP.
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| 13. |
- Schlager, Angela
(author)
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Defining generalised joint hypermobility : Aspects of reliability, validity and the association to pregnancy induced pain
- 2024
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to evaluate the definition of joint hypermobility and generalised joint hypermobility with aspects of reliability, validity and the association between generalised joint hypermobility and pregnancy-induced pain. Generalised joint hypermobility is used to reflect hereditary systematic connective tissue fragility. In study I, the inter-rater and intra-rater reliability, were evaluated in 49 women and men through 12 joint mobility tests included in three instruments for defining generalised joint hypermobility. In study II, the criterion validity was evaluated in 339 women in early pregnancy between the self-reported five-part questionnaire to identify generalised joint hypermobility, with the Beighton score. In study III, 255 women in early pregnancy were included to evaluate if a subset of joint mobility tests could define generalised joint hypermobility and establish limits for joint hypermobility. In study IV, 99 women pain-free before pregnancy were included to investigate the first onset of self-reported pain during pregnancy comparing women with and without generalised joint hypermobility, by parity and pain location. The reliability was good-to-excellent for both inter- and intra-rater reliability, for the majority of the joint mobility tests. The five-part questionnaire to identify generalised joint hypermobility with a cut-off level of ≥ 2 entailed the highest clinimetric values. However, the odds of having generalised joint hypermobility with a positive self-reported five-part questionnaire were low and yielding a false positive rate of 38%. No subset of joint mobility tests could define generalised joint hypermobility. Different combinations of joint mobility tests in upper- and lower limbs and the axial skeleton were compiled and evaluated for different standard deviation levels, where plus two standard deviations were most difficult to achieve. Women with generalised joint hypermobility and multiparous women experienced substantial earlier onset of self-reported pain during pregnancy, mainly in the lower back region. Thoroughly measured joint mobility and defining generalised joint hypermobility through different combinations of joint mobility tests, probably increased the precision of defining generalised joint hypermobility. Generalised joint hypermobility seems to be important for early development of pain during pregnancy. To identify women with generalised joint hypermobility in early pregnancy might be important in order to offer proper information, advice and rehabilitation.
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| 14. |
- Spinord, Linda, 1973-
(author)
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Multimodal rehabilitation for patients with chronic pain in northern Sweden, focusing on gender and age
- 2021
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Doctoral thesis (other academic/artistic)abstract
- The overall aim of this thesis was to study outcomes and experiences of multimodal rehabilitation programmes (MMRP) for patients with chronic pain in northern Sweden, focusing on gender and age. This thesis is based on four studies that used both quantitative and qualitative methods. The quantitative studies (I-III) investigated patient-reported outcome measures (PROM) from the Swedish Quality Registry for Pain Rehabilitation (SQRP) collected during 2011-2016 at two specialist clinics in northern Sweden. Adults aged 18-65 years were included, n=436 (356 women and 83 men), divided into three age groups (18-30, 31-45 and 46-65 years of age). Data from the two programmes at three measurement occasions were used, at the start of MMRP, immediately after MMRP and at one-year follow-up. Descriptive and multivariate statistics were used in Studies I-III.The analyses were performed separately for women, men and three different age groups. In Study I, the analysis was performed in two steps: in the first step the two patient populations in the two MMRPs were analysed separately and in the next step, the patients in the two programmes were analysed together. In Studies (II-III), the patient in the programmes were analysed together. In Study IV, a qualitative design was used to explore how patients with chronic pain experienced staying at a residency during participation in MMRP. In Study IV, a grounded theory method with emergent design was used for data collection and analysis. Individual semi-structured interviews with 12 patients (8 women and 4 men) with experiences of MMRP were conducted.In Study I, patients improved regardless of the design of the MMRP in terms of pain intensity, emotional functioning, activity and physical functioning at the one-year follow-up. For both programmes, the women were found to improve in more variables than the men did.In Study II, all subgroups (men, women and age groups) improved in terms of pain intensity and emotional functioning immediately after MMRP. The results revealed that the men showed greater short-term improvements than the women did. The women improved in more variables at one-year follow-up than the men did. The youngest age group was found to have greater positive effects of MMRP in terms of pain intensity and emotional functioning, immediately after MMRP and at one-year follow-up, than the other two age groups.In Study III, a number of interacting factors influenced whether patients participating in MMRP ended up on full-time sick leave at one-year follow-up, or not. Sick leave at start was an important factor for all subgroups. For women at start, low physical functioning, low health-related quality of life, low work importance and low affective distress were related to full-time sick leave at one-year follow-up. The results showed that unemployed men who reported widespread pain were related to full-time sick leave at one-year follow-up. The 31-45 years age group, which reported high pain intensity, low emotional functioning and low activity and physical functioning, was related to full-time sick leave at one-year follow-up. Those in the 46-65 years age group with low education, low work importance, low belief in recovery and long duration of pain were found to be related to full-time sick leave at one-year follow-up.In Study IV, the analysis resulted in a core category “Finding my self-worth”, consisting of the four categories: “Space for myself”, “Mirroring myself”, “I am of value” and “Dealing with returning to everyday life”. The results showed that the patients who stayed at a residency during MMRP were more likely to be released from the obligations of chores in their everyday life at home. This created space and time for reflection and interaction with others. The patients’ participation in MMRP while staying at a residency contributed to experiences of awareness of their own value and the significance of taking care of themselves and changing their behaviour after returning home.In conclusion, the results showed that MMRP seems to be an effective method of treating patients with chronic pain, in terms of reduced pain, improved emotional functioning, activity and physical functioning and health. The results also revealed that men seemed to need more support after MMRP to sustain the effects of MMRP while woman were more likely to sustain the positive effects at one-year follow-up. Full-time sick leave for patients with chronic pain at one-year follow-up can be affected by a number of interacting factors and these factors differ for women, men and different age groups. The opportunity to be released from everyday obligations, enjoy time for reflection and interaction with others can contribute to personal awareness which facilitates the implementation of changes at home following MMRP.
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| 15. |
- Williamson, Alice, et al.
(author)
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Genome-wide association study and functional characterization identifies candidate genes for insulin-stimulated glucose uptake
- 2023
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In: Nature Genetics. - : Springer Nature. - 1061-4036 .- 1546-1718. ; 55:6, s. 973-983
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Journal article (peer-reviewed)abstract
- Distinct tissue-specific mechanisms mediate insulin action in fasting and postprandial states. Previous genetic studies have largely focused on insulin resistance in the fasting state, where hepatic insulin action dominates. Here we studied genetic variants influencing insulin levels measured 2 h after a glucose challenge in >55,000 participants from three ancestry groups. We identified ten new loci (P < 5 × 10-8) not previously associated with postchallenge insulin resistance, eight of which were shown to share their genetic architecture with type 2 diabetes in colocalization analyses. We investigated candidate genes at a subset of associated loci in cultured cells and identified nine candidate genes newly implicated in the expression or trafficking of GLUT4, the key glucose transporter in postprandial glucose uptake in muscle and fat. By focusing on postprandial insulin resistance, we highlighted the mechanisms of action at type 2 diabetes loci that are not adequately captured by studies of fasting glycemic traits.
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| 16. |
- Lagrosen, Stefan, 1960-
(author)
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Kvalitetsstyrning i skolan? : en analys av TQM:s tillämpbarhet inom den svenska grundskolan sett från en företagsekonomisk utgångspunkt
- 1997
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Doctoral thesis (other academic/artistic)abstract
- This is a study of the application of the theoretical framework, total quality management (TQM) which has been developed in the private manufacturing sector, in the Swedish school system. The purpose is to highlight the effects of the use of TQM in schools and thereby to see whether it is advisable to promote this use and to study ways of refining the framework in order to make it more applicable to organisations such as schools. The study is done from a business management perspective. It is based on qualitative research methods and has its theoretical foundation in TQM and service management.The empirical basis of the study is a quality project which took place in four schools in the municipality of Täby, north of Stockholm, during the years 1992-94. The data has been generated through observation, in-depth interviews and focus group interviews. Quality dimensions for the different participant groups have been defined in order to clarify what quality in schools mean. These dimensions have been compared with the set of values that permeates TQM as well as with the substance of the specific quality model that has been used, the model for the Swedish Quality Award, (USK). On this ground the relevance of TQM for use in schools has been assessed. A summary of the effects of the studied quality project is also done.The result of this comparison is that TQM is substantially relevant and suitable for use in schools. Certain parts of the theory suffers, however, from a limited view of knowledge which is insufficient for the school-sector whose activities consist of human interaction. The effects of the specific quality project that has been studied has been found to be highly positive.The conclusion that is drawn is that it is advisable to use TQM in schools providing that one is aware of the above-mentioned limitation and that the transfer of methods is done with a certain discrimination. The Service Management theories are also recommended as a theoretical starting-point for quality improvement in schools. Finally examples are given as to how these methods can be put to practical use in schools in a suitable manner.
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| 17. |
- Larsson, Ingrid
(author)
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Person-centred care in rheumatology nursing in patients undergoing biological therapy : An explorative and interventional study
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Aim: The overall aim was to explore and evaluate rheumatology nursing from a person-centred care perspective in patients undergoing biological therapy.Methods: This thesis focuses on patients with chronic inflammatory arthritis (CIA) who were undergoing biological therapy at a rheumatology clinic in Sweden. Papers I and II had an explorative descriptive design with a phenomenographic approach. The 40 participants were interviewed about their dependence on or independence of a nurse for the administration of their infusions or injections. Paper III had a randomized controlled design involving 107 patients in the trial. The objective of the intervention was to replace every second monitoring visit at a rheumatologist-led clinic by a visit to a nurse-led rheumatology clinic, based on person-centred care. Paper IV had an explorative descriptive design with a qualitative content analysis approach. Interviews were conducted with 20 participants who attended the nurse-led rheumatology clinic.Findings: Dependence on a rheumatology nurse for administration of intravenous infusions was described as invigorating due to the regular contact with the nurse, which provided security and involvement (paper I). Independence of a nurse for subcutaneous injections was understood by the patients in different ways and was achieved by struggling to cope with injecting themselves, learning about and participating in drug treatment (paper II). Patients with stable CIA receiving biological therapy were monitored by a nurse-led rheumatology clinic without any difference in outcome when compared to monitoring carried out at a rheumatologist-led clinic, as measured by the Disease Activity Score 28. Replacing one of the two annual rheumatologist outpatient follow-up visits by a visit to a nurse-led clinic for the monitoring of biological therapy was found to be safe and effective (paper III). A nurse-led rheumatology clinic, based on person-centred care, added value to the follow-up care of patients with stable CIA undergoing biological therapy by providing a sense of security, familiarity and participation (paper IV).Conclusions: This thesis contributes a valuable insight into person-centred care as the core of rheumatology nursing in the area of biological therapy. The rheumatology nurse adds value to patient care when she/he gives patients an opportunity to talk about themselves as a person and allow their illness narrative to constitute a starting point for building collaboration, which encourages and empowers patients to be an active part in their biological therapy and become autonomous. A nurse who provides person-centred care and keeps the patients’ resources and needs in focus serves as an important guide during their healthcare journey.
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| 18. |
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NORLIT 2009, Codex and Code: Aestethcis, Language and Politics in an Age of Digital Media : Stockholm, August 6-9, 2009
- 2010
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Editorial proceedings (peer-reviewed)abstract
- The aim of the conference was to develop the study of Comparative Literature through Nordic collaboration both in its own discipline and in Modern Language and Cultural studies. As the title for the conference suggests, the principal question for the conference was the challenge that the study of literature encounters in an age of digitalization and globalization. It was our aim to encourage discussion of how literary studies respond to the ongoing changes in media and technology, politics and economy. Many have argued that the Humanities currently are in a state of crisis. We believe that the discipline seldom has found itself in such an interesting and fruitful historical moment. Several of these questions have surfaced duringearlier media system changes, in particular during Romanticism and Modernism, which provided the conference with an historical frame. The conference Codex and Code also addressed questions of authenticity and originality, identity and gender, literary genres and reading practices, media and materiality, culture and popular culture, language and history, world literature, work aesthetics, translations, and canon formation.
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| 19. |
- Sundström, Maria, 1980-
(author)
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Radiosynthesis of Perfluoroalkyl Substances : Chemical analysis, uptake, distribution, and partitioning studies
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Perfluoroalkyl substances (PFASs) are widely utilized manmade chemicals. Their properties have made them highly appreciated in a variety of industrial and consumer product applications, including fire-fighting foams, hydraulic fluids, as well as in cookware and food contact papers.However, some of the PFASs are highly persistent in the environment and their toxicological profiles are of concern. Voluntary and regulatory efforts have been taken to reduce the environmental levels of PFASs. These actions have resulted in a reduction of PFASs in human milk from Stockholm as presented in this thesis.The radiosyntheses of 35S-PFOS, 35S-PFBS, and 14C-PFOA presented herein were applied for distribution studies in mice but also for solubility and adhesion experiments of common laboratory solvents and buffers. The radiosynthesis employed reactive Grignard reagents, perfluoroalkyliodides, and 35S-sulfur dioxide or 14C-carbon dioxide. The distribution studies were performed with 35S-PFOS on both pregnant mice and their offspring as well as on male mice. The mice were subjected to whole-body autoradiography and the tissues were analyzed by liquid scintillation counting. Liver and lungs were the target organs for 35S-PFOS in the dams. The fetuses and pups had remarkable high levels of 35S-PFOS in their lungs as well as in the brain. The male mice were given a high dose and a more environmental relevant dose of 35S-PFOS. PFOS was transferred from the blood to the tissues as the dose increased.In another study the distribution pattern of the shorter homologue PFBS was compared to PFOS. 35S-PFBS was utilized and demonstrated a 5-40 fold lower tissue levels in comparison to PFOS.The pharmacokinetic parameters determined for PFHxS in mice, rats, and monkeys will provide valuable insight in establishing a proper risk assessment for this compound. The study confirms the common species differences in serum elimination half-life that are associated with PFASs.
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