| 1. |
- Mak, Jonathan K. L., et al.
(författare)
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Development of an Electronic Frailty Index for Hospitalized Older Adults in Sweden
- 2022
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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
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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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| 2. |
- Mak, Jonathan K. L., et al.
(författare)
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Two Years with COVID-19 : The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study
- 2023
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Ingår i: Gerontology. - : S. Karger. - 0304-324X .- 1423-0003. ; 69:4, s. 396-405
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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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| 3. |
- Mattsson, Malin, et al.
(författare)
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Personal factors in systemic sclerosis and their coverage by patient-reported outcome measures : A multicentre European qualitative study and literature review
- 2015
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - 1973-9087 .- 1973-9095. ; 51:4, s. 405-421
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Systemic sclerosis (SSc) is an autoimmune disease where thickening of the skin can lead to reduced body function and limitations in activities. Severe forms can also affect and seriously damage inner organs. Patient-centred rehabilitation emphasises considerations of patients’ background, experience and behavior which highlights the need to know if patient-reported outcome measures (PROMs) include such personal factors.AIM: To identify and describe personal factors in the experiences of functioning and health of persons with SSc and to examine if and to what extent PROMs in SSc research cover these factors.DESIGN: Data from a qualitative study with focus group interviews were analysed. PROMs in SSc research were identified in a literature review between 2008-2013.SETTING: Participants were recruited from outpatient clinics at rheumatology department.POPULATION: Sixty-three patients with SSc from four European countries participated.METHODS: Data from interviews were analysed using a structure of personal factors developed by Geyh et al. Identified PROMs were analysed and linked to main concepts, related to the personal factors, found in the interview data.RESULTS: Nineteen main concepts were related to the area “patterns of experience and behaviour” in the personal factor structure, 16 to “thoughts and beliefs”, nine to “feelings”, one to “motives” and one to “personal history and biography”, respectively. Among the 35 PROMs identified, 15 did not cover any of the identified concepts. Concepts within the area “feelings” were mostly covered by the PROMs. Five of the PROMs covered “patterns of experience and behaviour”, while “motives” and “personal history and biography” were not covered at all. Four of the identified PROMs covered concepts within the areas “feelings”, “thoughts and beliefs” and “patterns of experience and behaviour” in the same instrument. The Illness Cognition Questionnaire and Illness Behaviour Questionnaire were such PROMs.CONCLUSION: Patterns of experience and behaviour had the highest number of concepts related to personal factors, but few of the PROMs in SSc research covered these factors. Only a few PROMs covered several personal factors areas in the same instrument.CLINICAL REHABILITATION IMPACT: The results would be of value when developing core sets for outcome measurements in SSc.
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| 4. |
- Stamm, Tanja A., et al.
(författare)
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Concepts of functioning and health important to people with systemic sclerosis : a qualitative study in four European countries
- 2011
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 70:6, s. 1074-1079
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Tidskriftsartikel (refereegranskat)abstract
- Objective To describe the experiences of people with systemic sclerosis (SSc) in different European countries of functioning and health and to link these experiences to the WHO International Classification of Functioning, Disability and Health (ICF) to develop a common understanding from a bio-psycho-social perspective. Method A qualitative multicentre study with focus-group interviews was performed in four European countries: Austria, Romania, Sweden and Switzerland. The qualitative data analysis followed a modified form of 'meaning condensation' and the concepts that emerged in the analysis were linked to the ICF. Results 63 people with SSc participated in 13 focus groups. In total, 86 concepts were identified. 32 (37%) of these were linked to the ICF component body functions and structures, 21 (24%) to activities and participation, 26 (30%) to environmental factors, 6 (7%) to personal factors and 1 (1%) to the health condition itself. 19 concepts (22%) were identified in all four countries and included impaired hand function, household activities, paid work, drugs, climate and coldness, support from others and experiences with healthcare institutions, non-pharmacological treatment, social security and benefits. Conclusion Concepts identified in all four countries could be used for guiding clinical assessment, as well as interdisciplinary team care and rheumatological rehabilitation for patients with SSc. For a full understanding of the aspects of the disease that were most relevant to people with SSc, people with SSc from multiple countries needed to be involved.
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| 5. |
- Alwin, Jenny, 1978-, et al.
(författare)
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Health economic and process evaluation of AT interventions for persons with dementia and their relatives - A suggested assessment model
- 2007
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Ingår i: Technology and Disability. - 1055-4181. ; 19:2-3, s. 61-71
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Tidskriftsartikel (refereegranskat)abstract
- There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.
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| 6. |
- Bennett, Sarah E., et al.
(författare)
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Assessing acceptability and identifying barriers and facilitators to implementation of the EULAR recommendations for patient education in inflammatory arthritis : a mixed-methods study with rheumatology professionals in 23 European and Asian countries
- 2022
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 81:10, s. 1348-1357
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To disseminate and assess the level of acceptability and applicability of the European Alliance of Associations for Rheumatology (EULAR) recommendations for patient education among professionals in rheumatology across Europe and three Asian countries and identify potential barriers and facilitators to their application. Methods: A parallel convergent mixed-methods design with an inductive approach was used. A web-based survey, available in 20 different languages, was distributed to health professionals by non-probability sampling. The level of agreement and applicability of each recommendation was assessed by (0-10) rating scales. Barriers and facilitators to implementation were assessed using free-text responses. Quantitative data were analysed descriptively and qualitative data by content analysis and presented in 16 categories supported by quotes. Results: A total of 1159 completed the survey; 852 (73.5%) were women. Most of the professionals were nurses (n=487), rheumatologists (n=320), physiotherapists (n=158). For all recommendations, the level of agreement was high but applicability was lower. The four most common barriers to application were lack of time, lack of training in how to provide patient education, not having enough staff to perform this task and lack of evaluation tools. The most common facilitators were tailoring patient education to individual patients, using group education, linking patient education with diagnosis and treatment and inviting patients to provide feedback on patient education delivery.Conclusions: This project has disseminated the EULAR recommendations for patient education to health professionals across 23 countries. Potential barriers to their application were identified and some are amenable to change, namely training patient education providers and developing evaluation tools. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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| 7. |
- Björk, Mathilda, et al.
(författare)
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Inflammatory Arthritis and the Effect of Physical Activity on Quality of Life and Self-reported Function : A Systematic Review and Meta-analysis
- 2022
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Ingår i: Arthritis care & research. - : John Wiley & Sons. - 2151-464X .- 2151-4658. ; 74:1, s. 31-43
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE: Although physical activity (PA) is an evidence-based intervention that reduces disease-related symptoms and comorbidity in rheumatoid arthritis (RA), PA's effect on self-reported function and Quality of Life (QoL) has not been analyzed. This study synthesizes the evidence for the effectiveness of PA on QoL and self-reported function in adults with RA, spondyloarthritis (SpA), and psoriatic arthritis (PsA).METHODS: The databases PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify relevant randomized controlled trials (RCTs). Screening, risk of bias assessment (using RoB 2.0 tool), and data extraction were independently performed by two or more of the authors. The meta-analyses were conducted with a random-effects model.RESULTS: The systematic review included 55 RCTs and the meta-analysis included 37 RCTs. In 55 studies included, 76% investigated RA, 20% investigated SpA, and 4% investigated PsA. In RA effects were found on QoL and function compared to inactive controls, effects not sustained in comparison to active controls. In SpA the effects of PA on QoL were in favor of the control group. Effects on function were found compared to inactive controls and sustained in fatigue and pain when compared to active controls. In PsA no effects on QoL were found but on function compared to inactive controls. The effect size was below 0.30 in the majority of the comparisons.CONCLUSION: PA may improve QoL and self-reported function in RA, SpA, and PsA. However, larger trials are needed, especially in SpA and PsA.
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| 8. |
- Boström, Carina
(författare)
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Shoulder and upper extremity impairments, activity limitation and physiotherapeutic exercise in women with rheumatoid arthritis : a biopsychosocial approach
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to evaluate both specially-designed and commonly used instruments for measuring impairments, activity limitation and health-related quality of life (overall Sickness Impact Profile (SIP)). The focus was on shoulder and upper extremity. The relationships between concepts according to the International Classification of Impairments, Activity limitation and Participation (ICIDH) were studied. The instruments studied were also used in an evaluation of physiotherapeutic shoulder exercises. Ninety patients with mild or moderate RA were included in the studies. The results showed low clinical reliability and large day-to-day variations when measuring active motion range in the shoulder. A dynamic muscle function test for the shoulder also showed large day-to-day variations. A functional shoulder-arm movement impairment instrument showed satisfactory reliability though day-to-day variations. It correlated significantly (r=0.42-0.68) to pain during shoulder-arm movement, passive shoulder (except passive adduction) and elbow extension motion ranges, and active wrist motion range, isometric shoulder rotational muscle strength, a part of a specially-constructed shoulder-arm activity limitation questionnaire (SDQ), the Health Assessment Questionnaire, parts of the Functional Status Questionnaire, and the physical dimension and overall SIP. The shoulder-arm movement impairment instrument indicated construct and content validity and the SDQ indicated construct validity. The single variables as number of swollen joints in the upper extremity, passive shoulder (except adduction) and elbow motion range, isometric and isokinetic (concentric internal rotation) shoulder rotational strength did not indicate activity limitation or the overall SIP. However, the variables pain (including Ritchie index for upper-body half and shoulder tendalgia), shoulder-arm movement, passive shoulder adduction, and active elbow supination and wrist motion, and shoulder isokinetic eccentric internal rotational strength range did. In combining the variables, shoulder-arm movement, pain during movement and isokinetic eccentric shoulder internal rotation strength explained a rather large proportion (61.4 %) of the SDQ 1, covering predominantly personal hygiene activities. Still, the shoulder and upper-extremity variables indicated activity limitation and overall SIP to a rather small extent (11.330.2 %). Static and dynamic shoulder rotator endurance training in a group of women (n=37) were compared in a randomised study and measurements were taken at start, after 10 weeks training, and after a further 10 weeks. After the training both groups had fewer swollen joints (p=0.02) and less pain during movements (p=0.04) and during dynamic (p<0.002) and static (p=0.02) muscle function test of shoulder. The dynamic exercising group also improved according to the physical dimension (p=0.004) and overall SIP (p<0.002). The results of the studies showed that movement, pain and muscle strength are related to activity limitation and overall SIP but to a rather small extent although shoulder-arm activity limitation, disease-specific and more general activity limitation and health-related quality of life questionnaires were used in the analysis. Threshold levels, the severity of the disease, motivational, emotional and coping factors and impairments in other joints not studied in this thesis might explain the part of variation that our variables did not explain. Thus, it seems that all levels in the ICIDH-model have to be measured if all consequences of the disease are to be understood.
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| 9. |
- Brunnberg, Elinor, 1948-, et al.
(författare)
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Att höra eller nästan inte höra : Liv & hälsa ung 2005 och 2007 i Örebro län
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I linje med FN:s barnkonvention och Konventionen om rättigheter förpersoner med funktionshinder ska ungdomars röst göras hörd. Den härrapporten bygger helt på ungdomars uppgifter om sin verklighet.Studierna Liv & hälsa ung 2005 och 2007 visar att i den reguljära skolanupplever drygt fem procent av eleverna att de har ett funktionshinder närdet gäller hörseln och de rapporterar ofta en utsatt situation. Det finns även hörselskadade ungdomar på specialskolan/riksgymnasiet för döva och hörselskadade. De hörselskadade ungdomarna är en grupp som rapporterar en mängd hälsorelaterade problem, många känner sig mobbade av kamrater eller kränkta av vuxna i skolan. Det är också en grupp som förhållandevis ofta rapporterar bruk av alkohol, tobak och narkotika. De kan även ha andra funktionsnedsättningar eller tinnitus. De hörselskadade ungdomarna är en högriskgrupp som behöver uppmärksammas och få ett bättre anpassat stöd. Det behövs fördjupade studier hur stödet kan utformas på ett relevant sätt, speciellt gäller det dem med flera funktionshinder. För att göra detta är det viktigt att ungdomarna själva involveras i arbetet. Fördjupade studier behövs också om hur hörselskadade ungdomars delaktighet i den reguljära skolan kan förbättras samt om vad som skapar exempelvis stress, trötthet och olyckor. Det behövs åtgärder för att minska den mobbning som sker och inte minst minska det ungdomar rapporterar om kränkning från vuxna. Det behövs riktade insatser för att öka de hörselskadade ungdomarnas simkunnighet och fysiska aktivitet. Det är också av stor betydelse för de hörselskadade och döva ungdomarna att det finns kompetent tvåspråkig (svenska och teckenspråk) personal på ungdomsmottagningar och barnahus.
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| 10. |
- Brunnberg, Elinor, 1948-, et al.
(författare)
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Hard-of-hearing adolescents reporting some other disability or tinnitus : a replication study including an age-related analysis
- 2009
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In two previous studies based on the survey, Life & Health Young 2005 in Örebro county 15-16 years old Hard-of-hearing (HH) students with some other disability (HHDIS) and HH with tinnitus (HHTINN) reported considerably higher scores for mental symptoms and substance use than adolescents ‘just‘ HH or hearing adolescents. In order to replicate these findings we analysed the 2007 survey and included adolescents in grade 7, 9 and 2 in secondary school concerning substance use and depression. We also used reference data from the corresponding adult survey Life & Health 2008. In grade 9 HHDIS (2.0%) and HHTINN (2.0 %) both reported strongly increased rates of risky alcohol consumption (55/51% versus 13%), daily tobacco use (57/54% versus 10%) and depression (43/43% versus 14%) than hearing or ´just´ HH adolescents. Similar but less pronounced changes were present in grade 7 and grade 2. In HHDIS increased risk drinking was found until age 35, increased daily tobacco use until age 50 and increased depression until age 65. In HHTINN only rate of depression was increased in adult life. HHDIS and HHTINN thus are important targets for preventive measures. In addition tinnitus in young people can be a marker like disability of vulnerability.
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| 11. |
- Dür, Mona, et al.
(författare)
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Do patient-reported outcome measures cover personal factors important to people with rheumatoid arthritis? : A mixed methods design using the International Classification of Functioning, Disability and Health as frame of reference
- 2015
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPersonal factors (PFs) are internal factors that determine functioning and the individuals’ experience of disability. Their coverage by patient-reported outcome measures (PROMs) has not been examined in rheumatoid arthritis (RA) so far. The aims of this study were to identify PFs important in the life stories of people with RA and to determine their coverage by PROMs used in RA.MethodsThe qualitative data of people with RA was explored to identify PFs. Additionally a systematic literature search was conducted to find PROMs used in RA. PROMs items were linked to the components, domains and categories of the International Classification of Functioning, Disability and Health (ICF) to determine the coverage of important PFs by PROMs.ResultsTwelve PFs were found to be important in the life stories of people with RA. The PFs coping and reflecting about one’s life in an optimistic way were covered most frequently, each by 14 of the 42 explored PROMs, while job satisfaction was not covered at all. The London Coping with Rheumatoid Arthritis Questionnaire, General Self-Efficacy Scale, Arthritis Self-Efficacy Scale, Rheumatoid Arthritis Self-Efficacy Questionnaire and Revised Ways of Coping Inventory covered most PFs. Nineteen PROMs did not cover any of the PFs.ConclusionSeveral PFs were identified as important in the life stories of people with RA, but only 55% of the PROMS covered some of these PFs. When evaluating PFs important to people with RA, health professionals should be alert on which PROMs can be used to assess which PFs.
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| 12. |
- Dür, Mona, et al.
(författare)
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Personal Factors Important to People with Rheumatoid Arthritis and their Coverage by Patient-Reported Outcome Measures
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 73:Suppl. 2, s. 894-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background There is an increasing call to use patient reported outcome measures (PROMs) in health outcome research, because the perspective of patients is an essential part concerning the end results of health care. The coverage of patients' perspective by PROMs relevant in rheumatoid arthritis (RA) has been examined regarding all domains of the International Classification of Functioning, Disability and Health (ICF) except personal factors (PFs). Since the ICF did not classify PF, some researchers attempted to provide a classification of the PFs. Objectives We aimed to identify themes meaningful to people with RA, to determine which of these were attributed to PFs previously and to explore their coverage by PROMs. Methods We explored life stories to identify themes meaningful to people with RA and determined whether they have been previously attributed to PFs in the existing literature. Additionally we conducted a systematic literature search to identify PROMs relevant in RA. Finally, we explored whether the identified PROMs cover those themes which were attributed PFs previously. Results Twenty-two themes were found to be meaningful to 15 people with RA, of which 13 were attributed to PFs previously. Five themes were linked to activity and participation or environmental factors and four were not covered by the ICF. The systematic literature search resulted in the identification of 33 PROMs. Of these, the London Coping with Rheumatoid Arthritis Questionnaire and the Rheumatoid Arthritis Self-Efficacy Questionnaire covered most PFs. Examples of the coverage of themes attributed to PFs by PROMs are depicted at the Table 1.
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| 13. |
- Ekbäck, Gunnar, 1954-, et al.
(författare)
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What factors can be protective for both self-rated oral health and general health?
- 2015
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Ingår i: Swedish Dental Journal. - Stockholm : Swedish Dental Journal. - 0347-9994. ; 39:2, s. 99-107
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyze if the same protective factors are significant for both self-rated health and oral health. It was hypothesized that these factors should be the same.The material is based on a population sample of 17 113 women and men aged 18-84years in one county in central Sweden.The response rate was 61%.The data were collected through a postal questionnaire "Life and Health" in 2008.The questionnaire comprised of 149 questions and was divided into a number of areas, e.g. socioeconomic conditions, quality of life, social relations, lifestyle, and health. To analyze the strength of the protective factors whilst taking into account the relationships between the various independent variables, multivariate analyses were conducted using binary multiple logistic regression. The outcome measures with the strongest association to general health is belonging to the age group 18-34 years, positive faith in the future, good sleeping pattern and to be employed/ self-employed/retired.The outcomes with the strongest association to oral health are good finances, belonging to the age group 18-34years, to be born in Sweden and positive faith in the future.Conclusions.This study shows that, in.general, the same protective factors are significant for both self-rated health and self-rated oral health, making it possible to use the same approach to strengthen both general health and oral health. One important outcome, not often considered, is having positive faith in the future. It is a task for the health care system to strengthen people's faith in the future, partly through a very high quality care when needed, but also through active health promotion that increases the chances of a healthy life, both from a public health perspective as from an oral health perspective.
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| 14. |
- Erkenstam, Nina Hellström, 1976, et al.
(författare)
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Temporal Characterization of Microglia/Macrophage Phenotypes in a Mouse Model of Neonatal Hypoxic-Ischemic Brain Injury.
- 2016
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Ingår i: Frontiers in cellular neuroscience. - : Frontiers Media SA. - 1662-5102. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Immune cells display a high degree of phenotypic plasticity, which may facilitate their participation in both the progression and resolution of injury-induced inflammation. The purpose of this study was to investigate the temporal expression of genes associated with classical and alternative polarization phenotypes described for macrophages and to identify related cell populations in the brain following neonatal hypoxia-ischemia (HI). HI was induced in 9-day old mice and brain tissue was collected up to 7 days post-insult to investigate expression of genes associated with macrophage activation. Using cell-markers, CD86 (classic activation) and CD206 (alternative activation), we assessed temporal changes of CD11b(+) cell populations in the brain and studied the protein expression of the immunomodulatory factor galectin-3 in these cells. HI induced a rapid regulation (6 h) of genes associated with both classical and alternative polarization phenotypes in the injured hemisphere. FACS analysis showed a marked increase in the number of CD11b(+)CD86(+) cells at 24 h after HI (+3667%), which was coupled with a relative suppression of CD11b(+)CD206(+) cells and cells that did not express neither CD86 nor CD206. The CD11b(+)CD206(+) population was mixed with some cells also expressing CD86. Confocal microscopy confirmed that a subset of cells expressed both CD86 and CD206, particularly in injured gray and white matter. Protein concentration of galectin-3 was markedly increased mainly in the cell population lacking CD86 or CD206 in the injured hemisphere. These cells were predominantly resident microglia as very few galectin-3 positive cells co-localized with infiltrating myeloid cells in Lys-EGFP-ki mice after HI. In summary, HI was characterized by an early mixed gene response, but with a large expansion of mainly the CD86 positive population during the first day. However, the injured hemisphere also contained a subset of cells expressing both CD86 and CD206 and a large population that expressed neither activation marker CD86 nor CD206. Interestingly, these cells expressed the highest levels of galectin-3 and were found to be predominantly resident microglia. Galectin-3 is a protein involved in chemotaxis and macrophage polarization suggesting a novel role in cell infiltration and immunomodulation for this cell population after neonatal injury.
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| 15. |
- Erlandsson, Tina, et al.
(författare)
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Distributed and Collaborative Sensing for Providing Situation and Option Awareness
- 2016
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Ingår i: Proceedings of the Twenty-Ninth International Florida Artificial Intelligence Research Society Conference. - Palo Alto, California : AAAI Press. - 9781577357568 ; , s. 704-704
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Konferensbidrag (refereegranskat)abstract
- Teams of manned and unmanned aircraft have the opportunityto gather a huge amount of information regardingthe situation at hand. Together they can cover larger areasas well as sensing the same objects from different directionsenabling triangulation using combination of activeand/or passive sensors as well as image recognition. Combiningthis data with intelligence, maps and weather informationhas the potential of providing both the teams andthe commanders with situation awareness. This informationshould aid the decision makers to identify possibleoptions and anticipate their consequences, which is alsoknown as option awareness. A number of challenges needto be resolved in order to actualize this scenario. Thecommander who is interested in the entire battlespaceneeds to decide how to distribute the teams in air. Eachteam needs to collaborate to perform its tasks, taking intoaccount the members’ capabilities and resources, such assensor and communication ranges. The teams should alsorequest support from each other when needed. At all levels,there is a trade-off between gathering valuable informationand avoiding risk exposure. In this initial work, we elaborateon the opportunities and challenges with distributedand collaborative sensing with the aim of providing situationand option awareness for both commanders and pilots.
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| 16. |
- Flank, Peter, et al.
(författare)
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Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury
- 2014
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46:9, s. 886-890
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.Design:Descriptive, cross-sectional study.Subjects:A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.Methods:Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.Results:One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.Conclusion:Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.
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| 17. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Summarizing the effects of different exercise types in chronic low back pain : a systematic review of systematic reviews
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.METHODS: We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022-01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.RESULTS: Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.CONCLUSIONS: Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.TRIAL REGISTRATION: PROSPERO: Reg no 190409 Registration date 01AUG 2020.
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| 18. |
- Höglund, Jenny, et al.
(författare)
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Six-Minute Walking Test and 30 Seconds Chair-Stand-Test as Predictors of Mortality in COPD : A Cohort Study
- 2022
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Ingår i: The International Journal of Chronic Obstructive Pulmonary Disease. - : Dove Medical Press Ltd.. - 1176-9106 .- 1178-2005. ; 17, s. 2461-2469
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Tidskriftsartikel (refereegranskat)abstract
- Background: Physical inactivity is strongly associated with worse prognosis in Chronic Obstructive Pulmonary Disease (COPD), and assessment of physical function is very important. The six minute walking test (6MWT) is an established test known to predict mortality in COPD, and 30 seconds chair stand test (30sCST) is a potential alternative test. The study aimed to investigate and compare the associations of 6MWT and 30sCSTs with mortality.Methods: Data on patient demographics, established mortality predictors and results from 6MWT and 30sCST were collected from 2016 to 2019 from 97 consecutively included patients with COPD. In August 2021, mortality data were retrieved from patient records. Correlation analysis of 6MWT and 30sCST was performed. The predictive abilities of 6MWT and 30sCST, respectively, were analyzed using Kaplan Meyer-curves and Cox regression with adjustment for sex, age, body mass index below 22 and comorbid cardiovascular disease.Results: A positive correlation between 6MWT and 30sCST was shown (r = 0.61, p < 0.0001). Independent associations with mortality were found for 6MWD 250-349 (HR (95% CI) 3.19 (1.12 to 9.10), p = 0.030) and 6MWD <250 (4.27 (1.69 to10.8), p = 0.002) compared with 6MWD ≥350 meters, and for 30sCST <4 (3.31 (1.03 to 10.6), p = 0.045) compared with 30sCST≥11 risings. When both 6MWT and 30sCST were included in the multivariable model, 6MWD 250-349 (3.09 (1.02 to 9.37), p = 0.046) and 6MWD <250 (3.57 (1.26 to 10.1), p = 0.016) compared with 6MWD ≥350 meters predicted mortality.Conclusion: 30sCST and 6MWT correlates moderately and are independently associated with mortality in patients with COPD. Although 6MWT is the best predictor of mortality, 30sCST may be used as an alternative to identify patients at risk.
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| 19. |
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| 20. |
- Jones, Bethan, et al.
(författare)
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Disseminating and assessing implementation of the EULAR recommendations for patient education in inflammatory arthritis : a mixed-methods study with patients’ perspectives
- 2022
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Ingår i: RMD Open. - London : BMJ Publishing Group Ltd. - 2056-5933. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore patients’ agreement andreasons for agreement or disagreement with the EULAR recommendations for patient education (PE) for people with inflammatory arthritis (IA). Methods: This mixed-method survey collected data using snowball sampling. The survey had been translated into 20 languages by local healthcare professionals, researchers and patient research partners. It explored the degree towhich patients with IA agreed with each recommendationfor PE (0=do not agree at all and 10=agree completely)and their rationale for their agreement level in free text questions. Descriptive statistics summarised participants’ demographics and agreement levels. Qualitative contentanalysis was used to analyse the free text data. Sixteen subcategories were developed, describing the reasons foragreement or disagreement with the recommendations,which constituted the categories. Results: The sample comprised 2779 participants(79% female), with a mean (SD) age 55.1 (13.1) yearsand disease duration 17.1 (13.3) years. Participants strongly agreed with most recommendations (median10 (IQR: 9–10) for most recommendations). Reasonsfor agreement with the recommendations included thebenefit of using PE to facilitate collaborative care andshared decision making, the value of flexible and tailored PE, and the value of gaining support from other patients.Reasons for disagreement included lack of resources for PE, not wanting informa tion to be tailored by healthcare professionals and a reluctance to use telephone-basedPE. Conclusion: The EULAR recommendations for PE havebeen disseminated among patients with IA. Overall, agreement levels were very high, suggesting that they reflect patients’ preferences for engaging in collaborative clinical care and using PE to facilitate and supplement their own understanding of IA. Reasons for not completely agreeing with the recommendations can inform implementation strategies and education of healthcare professionals. © Author(s) (or their employer(s)) 2022.
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| 21. |
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| 22. |
- Lindén-Boström, Margareta, 1955-, et al.
(författare)
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Disparities in mental health among adolescents with and without impairments
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:7, s. 728-735
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To analyse whether there are differences in mental health among adolescents with and without various kinds of impairments, taking into account the number of impairments and gender.Methods: Data from the study Life & Health - Young People conducted in a Swedish county in 2011 was used. The survey included all students in grades 7 (13-14 years) and 9 (15-16 years) in compulsory school and grade 2 (17-18 years) in upper secondary school; there were 7793 respondents (81.0%). The students answered a questionnaire anonymously during school hours. Various measures of mental health were assessed in the groups: hard of hearing, visual impairment, motor impairment, difficulties in reading/writing/dyslexia, attention deficit hyperactive disorder/attention deficit disorder, other impairment, no impairment.Results: Of the studied impairments, difficulties in reading/writing/dyslexia are the most common (6.3%), followed by hard of hearing (5.4%). To have at least one impairment is more common among boys (18.2%) than girls (15.4%). In the impairment group, 21.5% have multiple impairments. Adolescents with impairments have worse mental health than those without, and those with multiple impairments have particularly higher odds ratio to have worse mental health. There are also differences in mental health between number and various kinds of impairments and between girls and boys.Conclusion: Adolescents with impairments, particularly girls and those with multiple impairments, have considerably worse mental health than others. These inequalities in health are an immense challenge, not only for those directly involved with the impaired: they affect everyone involved with the goal health equity for the whole population.
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| 23. |
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| 24. |
- Lindgren, Eva, et al.
(författare)
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Skrivande för delaktighet och demokrati
- 2022. - 1
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Ingår i: Skrivdidaktik i grundskolan. - Lund : Studentlitteratur AB. - 9789144144931 ; , s. 43-67
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 25. |
- Marklund, Sarah, et al.
(författare)
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Experiences and factors affecting usage of an ehealth tool for self-management among people with chronic obstructive pulmonary disease : qualitative study
- 2021
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Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications. - 1438-8871. ; 23:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.OBJECTIVE: This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.METHODS: The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months' access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.RESULTS: Three main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants' experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.CONCLUSIONS: Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.
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| 26. |
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| 27. |
- Mattsson, Malin, et al.
(författare)
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The validity and reliability of the Swedish version of the Satisfaction with appearance scale for individuals with systemic sclerosis
- 2023
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Ingår i: Journal of Scleroderma and Related Disorders. - : SAGE Publications. - 2397-1983 .- 2397-1991. ; 8:1, s. 53-63
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Tidskriftsartikel (refereegranskat)abstract
- Background: Systemic sclerosis (SSc) can lead to visible changes in appearance which could generate concerns among patients. Thus, valid questionnaires that capture these concerns are valuable to identify and communicate appearance concerns. Objective: To determine aspects of the validity and reliability of the Swedish version of the Satisfaction with Appearance scale for individuals with SSc (SWAP-Swe in SSc). Methods: Content validity was assessed by interviews. In a cross-sectional design, construct validity was evaluated by comparing the self-reported questionnaire SWAP-Swe in SSc to the Scleroderma Health Assessment Questionnaire (SSc HAQ), Patient Health Questionnaire-8 (PHQ-8), RAND-36, modified Rodnan skin score (mRSS), disease duration and age using Spearman’s rank correlations (rs). Internal consistency was evaluated by Cronbach’s alpha coefficient and corrected item-to-total correlations. Test–retest reliability was investigated using the intraclass correlation coefficient (ICC). Results: Eleven patients and 10 health professionals participated in the assessment of content validity. For the other aspects of validity and reliability 134 patients (median age 62 years, women 81%, limited cutaneous SSc 75%) participated. Overall, the content validity was satisfactory. The SWAP-Swe in SSc correlated with SSc HAQ (HAQ-DI rs = 0.50, visual analogue scales rs = 0.24–0.41), PHQ-8 (rs = 0.46), RAND-36 (rs = −0.21 to −0.47), mRSS (rs = 0.28), disease duration (rs = −0.01) and age (rs = −0.15). The Cronbach’s alpha coefficient was 0.92, corrected item-to-total correlations ⩾ 0.45 and the ICC 0.82. Conclusion: The SWAP-Swe in SSc showed satisfactory content validity, sufficient and good internal consistency and sufficient test–retest reliability. It was more strongly associated with self-reported questionnaires than with physician-assessed skin involvement and age, indicating that appearance concerns in SSc seem to be multidimensional as earlier reported. Our study contributes with a thorough investigation of validity and reliability including aspects that have not been investigated before. However, evaluation of more validity aspects of the SWAP-Swe in SSc is suggested.
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| 28. |
- Mattsson, Malin, et al.
(författare)
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Validity and reliability of the Patient Health Questionnaire-8 in Swedish for individuals with systemic sclerosis
- 2020
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Ingår i: Rheumatology International. - : Springer Science and Business Media LLC. - 0172-8172 .- 1437-160X. ; 40:10, s. 1675-1687
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depressive symptoms are common in rheumatic diseases and influence patients’ quality of life. The Patient Health Questionnaire-9 (PHQ-9), which assesses symptoms of depression, is valid in English in patients with systemic sclerosis (SSc). However, the measurement properties of the PHQ-8 (short version of the PHQ-9) have not been evaluated in Swedish patients with SSc. Objective: To investigate different aspects of validity and reliability of the PHQ-8 in Swedish (PHQ-8 Swe) for individuals with SSc. Methods: A total of 101 patients with SSc participated. Content validity was evaluated via interviews of 11 patients and 10 health professionals. Construct validity, internal consistency test–retest reliability, and floor/ceiling effects were evaluated in 90 patients. Results: Content validity was satisfactory, but some linguistic adjustments were made. Confirmatory factor analysis supported a better fit for a two-factor structure. Moderate-to-strong correlations were found between the PHQ-8 Swe and scleroderma HAQ including VAS (rs = 0.4–0.7); Multidimensional Assessment of Fatigue (rs = 0.7); RAND-36 subscales (rs = − 0.5 to − 0.8); and lung disease severity (Medsger scores) (rs = 0.4). There were weak correlations (rs = <0.4) between the PHQ-8 Swe and modified Rodnan skin score; and vascular, heart, and kidney disease severity. Cronbach’s alpha was 0.85, corrected item-to-total correlations were >0.40, and the ICC for the total score was 0.83. No floor/ceiling effects were found. Conclusion: The PHQ-8 Swe has satisfactory content validity and sufficient reliability in patients with in majority limited SSc. It is more strongly associated with self-reported disability, pain, disease interferences with daily activities, fatigue, and quality of life than with disease severity, except for a moderate association with lung severity.
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| 29. |
- Palmer, Nicholette D, et al.
(författare)
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A genome-wide association search for type 2 diabetes genes in African Americans.
- 2012
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Ingår i: PloS one. - San Francisco : Public Library of Science (PLoS). - 1932-6203. ; 7:1, s. e29202-
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Tidskriftsartikel (refereegranskat)abstract
- African Americans are disproportionately affected by type 2 diabetes (T2DM) yet few studies have examined T2DM using genome-wide association approaches in this ethnicity. The aim of this study was to identify genes associated with T2DM in the African American population. We performed a Genome Wide Association Study (GWAS) using the Affymetrix 6.0 array in 965 African-American cases with T2DM and end-stage renal disease (T2DM-ESRD) and 1029 population-based controls. The most significant SNPs (n = 550 independent loci) were genotyped in a replication cohort and 122 SNPs (n = 98 independent loci) were further tested through genotyping three additional validation cohorts followed by meta-analysis in all five cohorts totaling 3,132 cases and 3,317 controls. Twelve SNPs had evidence of association in the GWAS (P<0.0071), were directionally consistent in the Replication cohort and were associated with T2DM in subjects without nephropathy (P<0.05). Meta-analysis in all cases and controls revealed a single SNP reaching genome-wide significance (P<2.5×10(-8)). SNP rs7560163 (P = 7.0×10(-9), OR (95% CI) = 0.75 (0.67-0.84)) is located intergenically between RND3 and RBM43. Four additional loci (rs7542900, rs4659485, rs2722769 and rs7107217) were associated with T2DM (P<0.05) and reached more nominal levels of significance (P<2.5×10(-5)) in the overall analysis and may represent novel loci that contribute to T2DM. We have identified novel T2DM-susceptibility variants in the African-American population. Notably, T2DM risk was associated with the major allele and implies an interesting genetic architecture in this population. These results suggest that multiple loci underlie T2DM susceptibility in the African-American population and that these loci are distinct from those identified in other ethnic populations.
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| 30. |
- Parodis, Ioannis, 1981-, et al.
(författare)
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EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis
- 2024
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Ingår i: Annals of the Rheumatic Diseases. - : HighWire Press. - 0003-4967 .- 1468-2060. ; 83, s. 720-729
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To develop evidence-based recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc).METHODS: A task force comprising 7 rheumatologists, 15 other healthcare professionals and 3 patients was established. Following a systematic literature review performed to inform the recommendations, statements were formulated, discussed during online meetings and graded based on risk of bias assessment, level of evidence (LoE) and strength of recommendation (SoR; scale A-D, A comprising consistent LoE 1 studies, D comprising LoE 4 or inconsistent studies), following the European Alliance of Associations for Rheumatology standard operating procedure. Level of agreement (LoA; scale 0-10, 0 denoting complete disagreement, 10 denoting complete agreement) was determined for each statement through online voting.RESULTS: Four overarching principles and 12 recommendations were developed. These concerned common and disease-specific aspects of non-pharmacological management. SoR ranged from A to D. The mean LoA with the overarching principles and recommendations ranged from 8.4 to 9.7. Briefly, non-pharmacological management of SLE and SSc should be tailored, person-centred and participatory. It is not intended to preclude but rather complement pharmacotherapy. Patients should be offered education and support for physical exercise, smoking cessation and avoidance of cold exposure. Photoprotection and psychosocial interventions are important for SLE patients, while mouth and hand exercises are important in SSc.CONCLUSIONS: The recommendations will guide healthcare professionals and patients towards a holistic and personalised management of SLE and SSc. Research and educational agendas were developed to address needs towards a higher evidence level, enhancement of clinician-patient communication and improved outcomes.
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| 31. |
- Parodis, Ioannis, 1981-, et al.
(författare)
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Lifestyle interventions in the management of systemic sclerosis : a systematic review of the literature
- 2024
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Ingår i: Rheumatology. - : Oxford University Press. - 2514-1775. ; 8:2
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVES: We aimed to investigate the efficacy of lifestyle interventions for the management of SSc. METHODS: We searched the MEDLINE, Embase, Web of Science and CINAHL databases in June 2021. We included studies conducted on five or more patients with SSc published between 1 January 2000 and the search date evaluating lifestyle interventions, excluding systematic reviews without meta-analyses. Critical appraisal was conducted using critical appraisal tools from the Joanna Briggs Institute. Thirty-six studies were included for full-text evaluation.RESULTS: A total of 17 studies evaluated the effect of physical exercise alone, whereas 14 studies evaluated educational interventions for mental health management, often with physical exercise as a central component. At an aggregated level, these studies support patient education and physical exercise for the improvement of physical function, in particular hand and mouth function. Studies on diet and nutrition were few (n = 5) and pertained to gastrointestinal as well as anthropometric outcomes; these studies were insufficient to support any conclusions.CONCLUSION: Physical exercise and patient education should be considered for improving physical function in patients with SSc. These interventions can be provided alongside pharmacotherapy, but there is no evidence supporting that they can be a substitute. Further research should aim at assessing the effects of reductions of harmful exposures, including tobacco smoking and alcohol, improving sleep and enhancing social relations, three hitherto underexplored facets of lifestyle in the context of SSc.
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| 32. |
- Parodis, Ioannis, 1981-, et al.
(författare)
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Systematic literature review informing the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus and systemic sclerosis
- 2023
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Ingår i: RMD Open. - : BMJ Publishing Group Ltd. - 2056-5933. ; 9:3
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Forskningsöversikt (refereegranskat)abstract
- Through this systematic literature review, we assembled evidence to inform the EULAR recommendations for the non-pharmacological management of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). We screened articles published between January 2000 and June 2021. Studies selected for data extraction (118 for SLE and 92 for SSc) were thematically categorised by the character of their intervention. Of 208 articles included, 51 were classified as robust in critical appraisal. Physical activity was the most studied management strategy and was found to be efficacious in both diseases. Patient education and self-management also constituted widely studied topics. Many studies on SLE found psychological interventions to improve quality of life. Studies on SSc found phototherapy and laser treatment to improve cutaneous disease manifestations. In summary, non-pharmacological management of SLE and SSc encompasses a wide range of interventions, which can be combined and provided either with or without adjunct pharmacological treatment but should not aim to substitute the latter when this is deemed required. While some management strategies i.e., physical exercise and patient education, are already established in current clinical practice in several centres, others e.g., phototherapy and laser treatment, show both feasibility and efficacy, yet require testing in more rigorous trials than those hitherto conducted.
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| 33. |
- Pettersson, Susanne, et al.
(författare)
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Lifestyle habits and fatigue among people with systemic lupus erythematosus and matched population controls
- 2015
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Ingår i: Lupus. - : Sage Publications. - 0961-2033 .- 1477-0962. ; 24:9, s. 955-965
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The objective of this paper is to identify clusters of fatigue in patients with systemic lupus erythematosus (SLE) and matched controls, and to analyze these clusters with respect to lifestyle habits, health-related quality of life (HRQoL), anxiety and depression.METHODS: Patients with SLE (n = 305) and age- and gender-matched population controls (n = 311) were included. Three measurements of fatigue (Fatigue Severity Scale (FSS), Vitality (VT, from SF-36) and Multidimensional Assessment of Fatigue scale (MAF) and hierarchic cluster analysis were used to define clusters with different degrees of fatigue. Lifestyle habits were investigated through questionnaires. HRQoL was assessed with the SF-36 and anxiety/depression with the Hospital Anxiety and Depression Scale.RESULTS: Three clusters, denominated "High," "Intermediate" and "Low" fatigue clusters, were identified. The "High" contained 80% patients, and 20% controls (median; VT 25, FSS 5.8, MAF 37.4). These had the most symptoms of depression (51%) and anxiety (34%), lowest HRQoL (p < 0.001) and they exercised least frequently. The "Intermediate" (48% patients and 52% controls) (median; VT 55, FSS 4.1, MAF 23.5) had similarities with the "Low" regarding sleep/rest whereas social status and smoking were closer to the "High." The"Low" contained 22% patients and 78% controls (median; VT 80, FSS 2.3, MAF 10.9). They had the highest perceived HRQoL (p < 0.001), least symptoms of anxiety (10%), no depression, smoked least (13%) and reported the highest percentage (24%) of exercising ≥ 3 times/week.CONCLUSION: Fatigue is common, but not a general feature of SLE. It is associated with depression, anxiety, low HRQoL and less physical exercise. Patients with SLE and population controls with a healthy lifestyle reported lower levels of fatigue. Whether lifestyle changes can reduce fatigue, which is a major problem for a majority of SLE patients, needs to be further explored.
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| 34. |
- Rasmussen-Barr, Eva, et al.
(författare)
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Summarizing the effects of different exercise types in chronic neck pain - a systematic review and meta-analysis of systematic reviews
- 2023
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Ingår i: BMC Musculoskeletal Disorders. - 1471-2474. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence.METHODS: We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible.RESULTS: Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low (n = 13) to moderate to high (n = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available.CONCLUSION: Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality.TRIAL REGISTRATION: Prospero CRD42022336014.
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| 35. |
- Ström, Peter, 1984-, et al.
(författare)
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Discourse of influence : participation and opinions in digital and print media
- 2024
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Ingår i: Sakprosa. - Oslo : Universitetet i Oslo. - 1502-6000 .- 1891-5108. ; 16:1, s. 1-34
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Tidskriftsartikel (refereegranskat)abstract
- In democratic societies, exchange of written opinion is fundamental, but since the 1990s, public debate has gradually moved away from print media platforms to digital media platforms. In order to understand how a shift from print to digital media in opinion-oriented writing may have consequences for interaction and participation, it is relevant to investigate interpersonal aspects of opinion-oriented texts situated in digital and print media. The aim of the study is to explore and compare writers’ attitudes and the construction of the writer-reader-relationship in digital media (represented by Twitter) and (traditionally) print media (represented by letters to the editor, LEs). Bakhtinian dialogism and appraisal theory form the theoretical backdrop of the study. Results show that in the LEs, writers tend to take a negative general value position, but in the tweets, the writers’ attitude is more often either positive or negative, making Twitter a more diverse platform. Furthermore, attitudinal meaning is more transparent in the LEs, indicating that tweets are more often specialized, and readers who are not familiar with the context and interactional style of specific writers may be excluded from the communication. Another result is that a shift from print to digital media platforms seems to turn the focus of discussion more towards attitudes and perspectives in general, and less towards writers’ own attitudes. Therefore, digital media opinion exchange can be understood as a meta-discussion of attitudes, while print media rather transmit writers’ personal attitudes.
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| 36. |
- Säfström, Anna Ida, 1984-, et al.
(författare)
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Developing a diagnostic framework for primary and secondary students’ reasoning difficulties during mathematical problem solving
- 2024
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Ingår i: Educational Studies in Mathematics. - : Springer Nature. - 0013-1954 .- 1573-0816. ; 115:2, s. 125-149
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Tidskriftsartikel (refereegranskat)abstract
- It is well-known that a key to promoting students’ mathematics learning is to provide opportunities for problem solving and reasoning, but also that maintaining such opportunities in student–teacher interaction is challenging for teachers. In particular, teachers need support for identifying students’ specific difficulties, in order to select appropriate feedback that supports students’ mathematically founded reasoning without reducing students’ responsibility for solving the task. The aim of this study was to develop a diagnostic framework that is functional for identifying, characterising, and communicating about the difficulties students encounter when trying to solve a problem and needing help from the teacher to continue the construction of mathematically founded reasoning. We describe how we reached this aim by devising iterations of design experiments, including 285 examples of students’ difficulties from grades 1–12, related to 110 tasks, successively increasing the empirical grounding and theoretical refinement of the framework. The resulting framework includes diagnostic questions, definitions, and indicators for each diagnosis and structures the diagnostic process in two simpler steps with guidelines for difficult cases. The framework therefore has the potential to support teachers both in eliciting evidence about students’ reasoning during problem solving and in interpreting this evidence.
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| 37. |
- Tsoi, Alexander, et al.
(författare)
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Efficacy of lifestyle interventions in the management of systemic lupus erythematosus : a systematic review of the literature
- 2024
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Ingår i: Rheumatology International. - : Springer. - 0172-8172 .- 1437-160X. ; 44:5, s. 765-778
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Forskningsöversikt (refereegranskat)abstract
- We performed a systematic review to explore existing evidence regarding the efficacy of lifestyle interventions for the management of systemic lupus erythematosus (SLE). The search was conducted on the 22nd of June 2021 for publications between 1st of January 2000 and the date of search. Additional articles within the aforementioned timeframe and until December 2023 were added by hand searching. Databases utilized were Medline, Embase, Web of Science, and Cinahl. Lifestyle interventions were defined as any intervention encompassing one or more of the following: physical exercise, diet and nutrition, mental health, harmful exposures, sleep, and social relations. The Joanna Briggs Institute critical appraisal tools were used for risk of bias assessment. The search yielded 11,274 unique records, we assessed the full text of 199 records, and finally included 102 studies. Overall, the quality of the evidence is limited, and there were multiple sources of heterogeneity. The two domains most extensively researched were mental health (40 records) and physical exercise (39 records). Psychological interventions had a positive effect on depressive symptoms, anxiety, and health-related quality of life (HRQoL), whereas physical exercise improved fatigue, depressive symptoms, aerobic capacity, and physical functioning. Studies on diet and nutrition (15 records) support that low fat intake and Mediterranean diet may be beneficial for reducing cardiovascular risk, but large interventional studies are lacking. Studies on harmful exposures (7 records) support photoprotection and use of sunscreen. While studies imply benefits regarding disease burden and drug efficacy in non-smokers and regarding HRQoL in normal-weight patients, more survey is needed on tobacco smoking and alcohol consumption, as well as weight control strategies. Studies on social relations (1 record) and sleep (no records) were sparse or non-existent. In conclusion, psychosocial interventions are viable for managing depressive symptoms, and exercise appears essential for reducing fatigue and improving aerobic capacity and physical function. Photoprotection should be recommended to all patients. Lifestyle interventions should be considered a complement, not a substitute, to pharmacotherapy.
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| 38. |
- Wamala, Sarah, et al.
(författare)
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Does socioeconomic disadvantage explain why immigrants in Sweden refrain from seeking the needed medical treatment?
- 2007
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Ingår i: Italian Journal of Public Health. - : Prex SpA. - 1723-7807 .- 1723-7815. ; 4:3, s. 227-233
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Tidskriftsartikel (refereegranskat)abstract
- Background: For the last 20 years, Sweden has changed from a homogeneous to multicultural society with about 20% of immigrants born in other countries. The existing Swedish studies have not shown coherent results on how access to health care services varies by ethnicity. The aim of this paper was to analyze the association between country of birth and refraining from seeking medical treatment and whether socioeconomic disadvantage modifies this association.Methods: Cross-sectional Swedish National Survey of Public Health 2004. A population-based sample comprising of 14,732 men (1,382 immigrants) and 17,115 women (1,717 immigrants) aged 21 to 84 years. Country of birth was categorised as being born in Sweden, other OECD countries or other countries (non-OECD). The main outcome was the self-reporting of refraining from seeking medical treatment during the past three months. Data was collected within a three-month period during the spring of 2004 and was based on a postal self-administered questionnaire linked to registry data from Statistics Sweden. The nonresponse rate was 37%.Main results: In spite of the fact that immigrants reported poorer health status, they were more likely to refrain from seeking medical treatment as compared to Swedish-born residents (odds for immigrants from other OECD countries were ORmen = 2.2, 95% CI 1.8-2.6 and ORwomen = 1.8, 95% CI 1.5-2.1 and forimmigrants from other countries (ORmen = 3.1, 95% CI 2.4-3.4 and ORwomen = 2.3, 95% CI 1.8-2.9). Socioeconomic disadvantage (SDI) did not explain why immigrants fromother OECD countries had increased odds for refraining fromseekingmedical treatment. However SDI explained about 20%of the increased odds for refraining from seeking medical treatment among immigrants from other (non-OECD) countries.Conclusions: Socioeconomic disadvantage does not fully explain why immigrants refrain from seeking medical treatment. Public health strategies towards the goal “care on equal terms” cannot be achieved without addressing wider socioeconomic determinants including interactions between class and ethnicity.
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| 39. |
- Widerström, Birgitta, et al.
(författare)
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“How does physical examination findings influence physiotherapists’ decision-making when matching treatment to patients with low back pain?”
- 2021
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Ingår i: Musculoskeletal Science and Practice. - : Elsevier. - 2468-8630 .- 2468-7812. ; 53
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Tidskriftsartikel (refereegranskat)abstract
- Further clinical data how low-back pain (LBP) symptoms and signs manifests in physiotherapy clinical reasoning and treatment decision-making is needed. Objective: The aim was to explore and describe how symptoms and signs portrayed in three case descriptions of LBP influences physiotherapy treatment decision-making. Design: This was an exploratory interview study using inductive content analysis. Method: Fifteen semi-structured individual interviews were used to collect data of physiotherapists’ treatment decision-making regrading three diverse LBP case descriptions. The participants were men, women, experienced and novice, working in primary healthcare settings in one sparsely populated region and in one larger city in Sweden. Findings: Two overarching themes were identified influencing decision-making for the treatment of LBP:1) Explicit assessment features distinguish treatment approaches; with categories describing how symptoms and signs were used to target treatment (nature of pain induce reflections on plausible cause; narrative details trigger attention and establishes knowledge-enhancing foci; pain-movement-relationship is essential; diverse emphasis of pain modulation and targeted treatment approaches): and 2) Preconceived notion of treatment, with categories describing personal treatment rationales, unrelated to the presented symptoms and signs (passive treatment avoidance and motor control exercise ambiguity). Conclusion: This study identifies how assessment details lead to decisions on diverse treatment approaches for LBP, but also that treatment decisions can be based on preconceived beliefs unrelated to the clinical presentation. The results underpin the mix of knowledge sources that clinicians need to balance and the necessity of self-awareness of preconceptions for informed and meaningful clinical decision-making.
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