| 1. |
- Barazanji, Nawroz, et al.
(author)
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Irritable bowel syndrome in women: Association between decreased insular subregion volumes and gastrointestinal symptoms
- 2022
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In: NeuroImage. - : Elsevier. - 2213-1582. ; 35
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Journal article (peer-reviewed)abstract
- Irritable bowel syndrome (IBS) is a chronic pain disorder characterized by disturbed interactions between the gut and the brain with depression as a common comorbidity. In both IBS and depression, structural brain alterations of the insular cortices, key structures for pain processing and interoception, have been demonstrated but the specificity of these findings remains unclear. We compared the gray matter volume (GMV) of insular cortex (IC) subregions in IBS women and healthy controls (HC) and examined relations to gastrointestinal (GI) symptoms and glutamate + glutamine (Glx) concentrations. We further analyzed GMV of IC subregions in women with major depression (MDD) compared to HC and addressed possible differences between depression, IBS, IBS with depression and HC.
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| 2. |
- Bednarska, Olga, 1973-, et al.
(author)
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Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome
- 2019
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In: Pain. - : Lippincott Williams & Wilkins. - 0304-3959 .- 1872-6623. ; 160:9, s. 2004-2012
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Journal article (peer-reviewed)abstract
- Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstratealtered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However,alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changesremain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthycontrols [HC]) with respect to aINS glutamate 1 glutamine (Glx) and g-aminobutyric acid (GABA1) concentrations and addressedpossible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonancespectroscopy of bilateral aINS to assess Glx and GABA1 concentrations. Questionnaire data from all participants and prospectivesymptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with IBS-related andpsychological parameters. Concentrations of Glx were lower in IBS compared with HC (left aINS P , 0.05, right aINS P , 0.001),whereas no group differences were detected for GABA1concentrations. Lower right-lateralized Glx concentrations in patients weresubstantially predicted by longer pain duration, while less frequent use of adaptive pain‐coping predicted lower Glx in left aINS. Ourfindings provide first evidence for reduced excitatory but unaltered inhibitory neurotransmitter levels in aINS in IBS. The results alsoindicate a functional lateralization of aINS with a stronger involvement of the right hemisphere in perception of abdominal pain and ofthe left aINS in cognitive pain regulation. Our findings suggest that glutaminergic deficiency may play a role in pain processing in IBS.
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| 5. |
- Engström, Maria, 1958-, et al.
(author)
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Paradigm design of sensory–motor and language tests in clinical fMRI
- 2004
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In: Neurophysiologie clinique. - : Elsevier BV. - 0987-7053 .- 1769-7131. ; 34:6, s. 267-277
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Journal article (peer-reviewed)abstract
- Functional magnetic resonance imaging (fMRI) paradigms on sensory–motor and language functions are reviewed from a clinical user’s perspective. The objective was to identify special requirements regarding the design of fMRI paradigms for clinical applications. A wide range of methods for setting up fMRI examinations were found in the literature. It was concluded that there is a need for standardised procedures adapted for clinical settings. Sensory–motor activation patterns do not vary much at different hand motion tasks. Nevertheless it is one of the most important clinical tests. In contrast, the language system is much more complex. In several studies it has been observed that word production tasks are preferable in determination of language lateralisation. Broca’s area is activated by most tasks, whereas sentence processing and semantic decision also involve activation in temporoparietal and frontal areas. However, combined task analysis (CTA) of several different tasks has been found to be more robust and reliable for clinical fMRI compared to separate task analysis.
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| 6. |
- Gustafsson, Håkan, 1976-, et al.
(author)
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Magnetic and Electron Spin Relaxation Properties of (GdxY1-x)2O3 (0 ≤ x ≤ 1) Nanoparticles Synthesized by the Combustion Method. Increased Electron Spin Relaxation Times with Increasing Yttrium Content
- 2011
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In: The Journal of Physical Chemistry C. - United States : American Chemical Society. - 1932-7447 .- 1932-7455. ; 115:13, s. 5469-5477
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Journal article (peer-reviewed)abstract
- The performance of a magnetic resonance imaging contrast agent (CA) depends on several factors, including the relaxation times of the unpaired electrons in the CA. The electron spin relaxation time may be a key factor for the performance of new CAs, such as nanosized Gd2O3 particles. The aim of this work is, therefore, to study changes in the magnetic susceptibility and the electron spin relaxation time of paramagnetic Gd2O3 nanoparticles diluted with increasing amounts of diamagnetic Y2O3. Nanoparticles of (GdxY1-x)2O3 (0 e x e 1) were prepared by the combustion method and thoroughly characterized (by X-ray di.raction, transmission electron microscopy, thermogravimetry coupled with mass spectroscopy, photoelectron spectroscopy, Fourier transform infrared spectroscopy, and magnetic susceptibility measurements). Changes in the electron spin relaxation time were estimated by observations of the signal line width in electron paramagnetic resonance spectroscopy, and it was found that the line width was dependent on the concentration of yttrium, indicating that diamagnetic Y2O3 may increase the electron spin relaxation time of Gd2O3 nanoparticles.
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| 7. |
- Hedlund, Anna, et al.
(author)
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Gd2O3 nanoparticles in hematopoietic cells for MRI contrast enhancement
- 2011
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In: International journal of nano medicine. - Manchester, UK : Dove Medical Press Ltd. - 1178-2013. ; 6, s. 3233-3240
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Journal article (peer-reviewed)abstract
- As the utility of magnetic resonance imaging (MRI) broadens, the importance of having specific and efficient contrast agents increases and in recent time there has been a huge development in the fields of molecular imaging and intracellular markers. Previous studies have shown that gadolinium oxide (Gd2O3) nanoparticles generate higher relaxivity than currently available Gd chelates: In addition, the Gd2O3 nanoparticles have promising properties for MRI cell tracking. The aim of the present work was to study cell labeling with Gd2O3 nanoparticles in hematopoietic cells and to improve techniques for monitoring hematopoietic stem cell migration by MRI. Particle uptake was studied in two cell lines: the hematopoietic progenitor cell line Ba/F3 and the monocytic cell line THP-1. Cells were incubated with Gd2O3 nanoparticles and it was investigated whether the transfection agent protamine sulfate increased the particle uptake. Treated cells were examined by electron microscopy and MRI, and analyzed for particle content by inductively coupled plasma sector field mass spectrometry. Results showed that particles were intracellular, however, sparsely in Ba/F3. The relaxation times were shortened with increasing particle concentration. Relaxivities, r1 and r2 at 1.5 T and 21°C, for Gd2O3 nanoparticles in different cell samples were 3.6–5.3 s-1 mM-1 and 9.6–17.2 s-1 mM-1, respectively. Protamine sulfate treatment increased the uptake in both Ba/F3 cells and THP-1 cells. However, the increased uptake did not increase the relaxation rate for THP-1 as for Ba/F3, probably due to aggregation and/or saturation effects. Viability of treated cells was not significantly decreased and thus, it was concluded that the use of Gd2O3 nanoparticles is suitable for this type of cell labeling by means of detecting and monitoring hematopoietic cells. In conclusion, Gd2O3 nanoparticles are a promising material to achieve positive intracellular MRI contrast; however, further particle development needs to be performed.
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| 8. |
- Larsson, Mats, et al.
(author)
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Brain Responses to Visceral Stimuli Reflect Visceral Sensitivity Thresholds in Patients With Irritable Bowel Syndrome
- 2012
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In: Gastroenterology. - : Elsevier. - 0016-5085 .- 1528-0012. ; 142:3, s. 463-472
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Journal article (peer-reviewed)abstract
- BACKGROUND & AIMS:Only a fraction of patients with irritable bowel syndrome (IBS) have increased perceptual sensitivity to rectal distension, indicating differences in processing and/or modulation of visceral afferent signals. We investigated the brain mechanisms of these perceptual differences.METHODS:We analyzed data from 44 women with IBS and 20 female healthy subjects (controls). IBS symptom severity was determined by a severity scoring system. Anxiety and depression symptoms were assessed using the hospital anxiety and depression score. Blood oxygen level-dependent signals were measured by functional magnetic resonance imaging during expectation and delivery of high (45 mmHg) and low (15 mmHg) intensity rectal distensions. Perception thresholds to rectal distension were determined in the scanner. Brain imaging data were compared among 18 normosensitive and 15 hypersensitive patients with IBS and 18 controls. Results were reported significant if peak P-values were ≤.05, with family-wise error correction in regions of interest.RESULTS:The subgroups of patients with IBS were similar in age, symptom duration, psychological symptoms, and IBS symptom severity. Although brain responses to distension were similar between normosensitive patients and controls, hypersensitive patients with IBS had greater activation of insula and reduced deactivation in pregenual anterior cingulate cortex during noxious rectal distensions, compared to controls and normosensitive patients with IBS. During expectation of rectal distension, normosensitive patients with IBS had more activation in right hippocampus than controls.CONCLUSIONS:Despite similarities in symptoms, hyper- and normosensitive patients with IBS differ in cerebral responses to standardized rectal distensions and their expectation, consistent with differences in ascending visceral afferent input.
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| 9. |
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| 10. |
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| 11. |
- Randmaa, Maria, 1957-, et al.
(author)
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Psychometric properties of an instrument measuring communication within and between the professional groups licensed practical nurses and registered nurses in anaesthetic clinics.
- 2019
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 19:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: The most common cause of clinical incidents and adverse events in relation to surgery is communication error. There is a shortage of studies on communication between registered nurses and licenced practical nurses as well as of instruments to measure their perception of communication within and between the professional groups. The aim of the present study was to evaluate the psychometric properties of the Swedish version of the adapted ICU Nurse-Physician Questionnaire, designed to also measure communication within and between two professional groups: licensed practical nurses and registered nurses. Specifically, the aim was to examine the instrument's construct validity using confirmatory factor analysis and its internal consistency using Cronbach's Alpha.METHODS: A cross-sectional and correlational design was used. The setting was anaesthetic clinics in two Swedish hospitals. A total of 316 questionnaires were delivered during spring 2011, of which 195 were analysed to evaluate the psychometric properties of the questionnaire. Construct validity was assessed using confirmatory factor analysis and internal consistency using Cronbach's Alpha. To assess items with missing values, we conducted a sensitivity analysis of two sets of data, and to assess the assumption of normally distributed data, we used Bayesian estimation.RESULTS: The results support the construct validity and internal consistency of the adapted ICU Nurse-Physician Questionnaire. Model fit indices for the confirmative factor analysis were acceptable, and estimated factor loadings were reasonable. There were no large differences between the estimated factor loadings when comparing the two samples, suggesting that items with missing values did not alter the findings. The estimated factor loadings from Bayesian estimation were very similar to the maximum likelihood results. This indicates that confirmative factor analysis using maximum likelihood produced reliable factor loadings. Regarding internal consistency, alpha values ranged from 0.72 to 0.82.CONCLUSIONS: The tests of the adapted ICU Nurse-Physician Questionnaire indicate acceptable construct validity and internal consistency, both of which need to be further tested in new settings and samples.TRIAL REGISTRATION: Current controlled trials http://www.controlled-trials.com Communication and patient safety in anaesthesia and intensive care. Does implementation of SBAR make any differences? Identifier: ISRCTN37251313, retrospectively registered (assigned 08/11/2012).
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| 12. |
- Randmaa, Maria, 1957-, et al.
(author)
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The postoperative handover : a focus group interview study with nurse anaesthetists, anaesthesiologists, and PACU nurses
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:8
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Journal article (peer-reviewed)abstract
- OBJECTIVES To investigate different professionals’ (nurse anaesthetists’, anaesthesiologists’, and postanaesthesia care unit nurses’) descriptions of and reflections on the postoperative handover.DESIGN A focus group interview study with a descriptive design using qualitative content analysis of transcripts.SETTING One anaesthetic clinic at two hospitals in Sweden.PARTICIPANTS Six focus groups with 23 healthcare professionals involved in postoperative handovers. Each group was homogeneous regarding participant profession, resulting in two groups per profession: nurse anaesthetists (n=8), anaesthesiologists (n=7) and postanaesthesia care unit nurses (n=8).RESULTS Patterns and five categories emerged: 1) Having different temporal foci during handover, 2) Insecurity when information is transferred from one team to another, 3) Striving to ensure quality of the handover, 4) Weighing the advantages and disadvantages of the bedside handover, and 5) Having different perspectives on the transfer of responsibility. The professionals’ perceptions of the postoperative handover differed with regard to temporal foci and transfer of responsibility. All professional groups were insecure about having all information needed to ensure the quality of care. They strived to ensure quality of the handover by: focusing on matters that deviated from the normal course of events, aiding memory through structure and written information, and cooperating within and between teams. They reported that the bedside handover enhances their control of the patient, but also that it could threaten the patient’s privacy and that frequent interruptions could be disturbing.CONCLUSIONS The present findings revealed variations in different professionals’ views on the postoperative handover. Healthcare interventions are needed to minimize the gap between professionals’ perceptions and practices and to achieve a shared understanding of postoperative handover. Furthermore, to ensure high-quality and safe care, stakeholders/decision-makers need to pay attention to the environment and infrastructure in postanaesthesia care.
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| 13. |
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- van Ettinger-Veenstra, Helene, 1982-, et al.
(author)
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Language deficits in Epilepsy, an fMRI study
- 2012
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Conference paper (other academic/artistic)abstract
- Cognitive functions in people with epilepsy are affected by focality, number of generalized seizures, side effects of antiepileptic drugs (AEDs) or the underlying disease (Kwan, 2001). Newly diagnosed patients have cognitive deficits even before starting on AEDs. Performance declines already in the first year after diagnosis and the impairment continues in the following years (Taylor, 2010; Baker, 2011). In mesial temporal lobe epilepsy (TLE) the hippocampal damage seems to be progressive and accompanied by thinning of neocortex (Briellmann, 2002; Bernhardt, 2009). Widespread structural and functional abnormalities in left TLE can affect more distant networks (Bonilha, 2009); a damage pattern also seen in right TLE (Karunanayaka, 2011).
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| 19. |
- van Ettinger-Veenstra, Helene, 1982-, et al.
(author)
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Right-hemispheric cortical contributions to language ability in healthy adults
- 2012
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In: Brain and Language. - : Elsevier. - 0093-934X .- 1090-2155. ; 120:3, s. 395-400
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Journal article (peer-reviewed)abstract
- In this study we investigated the correlation between individual linguistic ability based on performance levels and their engagement of typical and atypical language areas in the brain. Eighteen healthy subjects between 21 and 64 years participated in language ability tests, and subsequent functional MRI scans measuring brain activity in response to a sentence completion and a word fluency task. Performance in both reading and high-level language tests correlated positively with increased right-hemispheric activation in the inferior frontal gyrus (specifically Brodmann area 47), the dorsolateral prefrontal cortex (DLPFC), and the medial temporal gyrus (Brodmann area 21). In contrast, we found a negative correlation between performance and left-hemispheric DLPFC activation. Our findings indicate that the right lateral frontal and right temporal regions positively modulate aspects of language ability.
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| 20. |
- Warntjes, Marcel Jan Bertus, et al.
(author)
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Brain Characterization Using Normalized Quantitative Magnetic Resonance Imaging
- 2013
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In: PLOS ONE. - United States : Public Library of Science. - 1932-6203. ; 8:8
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Journal article (peer-reviewed)abstract
- ObjectivesTo present a method for generating reference maps of typical brain characteristics of groups of subjects using a novel combination of rapid quantitative Magnetic Resonance Imaging (qMRI) and brain normalization. The reference maps can be used to detect significant tissue differences in patients, both locally and globally.Materials and MethodsA rapid qMRI method was used to obtain the longitudinal relaxation rate (R1), the transverse relaxation rate (R2) and the proton density (PD). These three tissue properties were measured in the brains of 32 healthy subjects and in one patient diagnosed with Multiple Sclerosis (MS). The maps were normalized to a standard brain template using a linear affine registration. The differences of the mean value ofR1, R2 and PD of 31 healthy subjects in comparison to the oldest healthy subject and in comparison to an MS patient were calculated. Larger anatomical structures were characterized using a standard atlas. The vector sum of the normalized differences was used to show significant tissue differences.ResultsThe coefficient of variation of the reference maps was high at the edges of the brain and the ventricles, moderate in the cortical grey matter and low in white matter and the deep grey matter structures. The elderly subject mainly showed significantly lower R1 and R2 and higher PD values along all sulci. The MS patient showed significantly lower R1 and R2 and higher PD values at the edges of the ventricular system as well as throughout the periventricular white matter, at the internal and external capsules and at each of the MS lesions.ConclusionBrain normalization of rapid qMRI is a promising new method to generate reference maps of typical brain characteristics and to automatically detect deviating tissue properties in the brain.
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| 21. |
- West, Janne, 1982-, et al.
(author)
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Application of Quantitative MRI for Brain Tissue Segmentation at 1.5 T and 3.0 T Field Strengths
- 2013
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In: PLOS ONE. - United States : Public Library of Science. - 1932-6203. ; 8:9
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Journal article (peer-reviewed)abstract
- BackgroundBrain tissue segmentation of white matter (WM), grey matter (GM), and cerebrospinal fluid (CSF) are important in neuroradiological applications. Quantitative Mri (qMRI) allows segmentation based on physical tissue properties, and the dependencies on MR scanner settings are removed. Brain tissue groups into clusters in the three dimensional space formed by the qMRI parameters R1, R2 and PD, and partial volume voxels are intermediate in this space. The qMRI parameters, however, depend on the main magnetic field strength. Therefore, longitudinal studies can be seriously limited by system upgrades. The aim of this work was to apply one recently described brain tissue segmentation method, based on qMRI, at both 1.5 T and 3.0 T field strengths, and to investigate similarities and differences.MethodsIn vivo qMRI measurements were performed on 10 healthy subjects using both 1.5 T and 3.0 T MR scanners. The brain tissue segmentation method was applied for both 1.5 T and 3.0 T and volumes of WM, GM, CSF and brain parenchymal fraction (BPF) were calculated on both field strengths. Repeatability was calculated for each scanner and a General Linear Model was used to examine the effect of field strength. Voxel-wise t-tests were also performed to evaluate regional differences.ResultsStatistically significant differences were found between 1.5 T and 3.0 T for WM, GM, CSF and BPF (p<0.001). Analyses of main effects showed that WM was underestimated, while GM and CSF were overestimated on 1.5 T compared to 3.0 T. The mean differences between 1.5 T and 3.0 T were -66 mL WM, 40 mL GM, 29 mL CSF and -1.99% BPF. Voxel-wise t-tests revealed regional differences of WM and GM in deep brain structures, cerebellum and brain stem.ConclusionsMost of the brain was identically classified at the two field strengths, although some regional differences were observed.
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| 22. |
- Witt, Suzanne T., et al.
(author)
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Evidence for cognitive resource imbalance in adolescents with narcolepsy
- 2018
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In: Brain Imaging and Behavior. - : Springer Science and Business Media LLC. - 1931-7557 .- 1931-7565. ; 12:2, s. 411-424
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Journal article (peer-reviewed)abstract
- The study investigated brain activity changes during performance of a verbal working memory task in a population of adolescents with narcolepsy. Seventeen narcolepsy patients and twenty healthy controls performed a verbal working memory task during simultaneous fMRI and EEG acquisition. All subjects also underwent MRS to measure GABA and Glutamate concentrations in the medial prefrontal cortex. Activation levels in the default mode network and left middle frontal gyrus were examined to investigate whether narcolepsy is characterized by an imbalance in cognitive resources. Significantly increased deactivation within the default mode network during task performance was observed for the narcolepsy patients for both the encoding and recognition phases of the task. No evidence for task performance deficits or reduced activation within the left middle frontal gyrus was noted for the narcolepsy patients. Correlation analyses between the spectroscopy and fMRI data indicated that deactivation of the anterior aspect of the default mode in narcolepsy patients correlated more with increased concentrations of Glutamate and decreased concentrations of GABA. In contrast, deactivation in the default mode was correlated with increased concentrations of GABA and decreased concentrations of Glutamate in controls. The results suggested that narcolepsy is not characterized by a deficit in working memory but rather an imbalance of cognitive resources in favor of monitoring and maintaining attention over actual task performance. This points towards dysregulation within the sustained attention system being the origin behind self-reported cognitive difficulties in narcolepsy.
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| 23. |
- Aryuwat, Pimwalunn, et al.
(author)
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Factors Associated with Resilience among Thai Nursing Students in the Context of Clinical Education : A Cross-sectional Study
- 2024
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In: Education Sciences. - 2227-7102. ; 14:1
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Journal article (peer-reviewed)abstract
- Resilience aids nursing students in dealing with adversities during their nursing education. This study examined the relationship between nursing students’ resilience and relevant variables in the context of clinical education. Methods: A cross-sectional study was conducted to collect data from 319 undergraduate nursing students in Northeast Thailand. The Connor–Davidson Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Learning Experience Scale or the Personal Responsibility Orientation to Self-Direction in Learning Scale, and the Stressors in Nursing Students scale were administered. A multiple regression analysis was performed for factors presumed to be associated with resilience. Results reported that Thai nursing students’ average resilience score was 71.79 ± 16.33. Multiple regression analysis indicated factors associated with resilience, in which social support (β = 0.354, p < 0.001, 95%CI: 0.240 to 0.469) and self-directed learning (β = 0.787, p < 0.001, 95%CI: 0.606 to 0.968) showed a positive association, while stress (β = −0.083, p = 0.025, 95%CI: −0.083 to −0.006) had a negative association. The final model accounted for 43.4% of the variance in the resilience score. In conclusion, self-directed learning, social support, and perceived stress among nursing students during clinical education are associated with their resilience.
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| 24. |
- Bednarska, Olga, 1973-
(author)
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Peripheral and Central Mechanisms in Irritable Bowel Syndrome : in search of links
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Irritable bowel syndrome (IBS) is a chronic visceral pain disorder with female predominance, characterized by recurrent abdominal pain and disturbed bowel habits in the absence of an identifiable organic cause. This prevalent and debilitating disease, which accounts for a substantial economic and individual burden, lacks exact diagnostic tools and effective treatment, since its pathophysiology remains uncertain. The bidirectional and multilayered brain-gut axis is a well-established disease model, however, the interactions between central and peripheral mechanisms along the brain-gut axis remain incompletely understood. One of the welldescribed triggering factors, yet accounting for only a fraction of IBS prevalence, is bacterial gastroenteritis that affects mucosal barrier function. Altered gut microbiota composition as well as disturbed intestinal mucosal barrier function and its neuroimmune regulation have been reported in IBS, however, the impact of live bacteria, neither commensal nor pathogenic, on intestinal barrier has not been studied yet. Furthermore, abnormal central processing of visceral sensations and psychological factors such as maladaptive coping have previously been suggested as centrally-mediated pathophysiological mechanisms of importance in IBS. Brain imaging studies have demonstrated an imbalance in descending pain modulatory networks and alterations in brain regions associated with interoceptive awareness and pain processing and modulation, particularly in anterior insula (aINS), although biochemical changes putatively underlying these central alterations remain poorly understood. Most importantly, however, possible associations between these documented changes on central and peripheral levels, which may as complex interactions contribute to disease onset and chronification of symptoms, are widely unknown.This thesis aimed to investigate the peripheral and central mechanisms in women with IBS compared to female healthy controls (HC) and to explore possible mutual associations between these mechanisms.In Paper I, we studied paracellular permeability and passage of live bacteria, both commensal and pathogenic through colonic biopsies mounted in Ussing chambers. We explored the regulation of the mucosal barrier function by mast cells and the neuropeptide vasoactive intestinal polypeptide (VIP) as well as a correlation between mucosal permeability and gastrointestinal and psychological symptoms. We observed increased paracellular permeability and the passage of commensal and pathogenic live bacteria in patients with IBS compared with HC, which was diminished by blocking the VIP receptors as well as after stabilizing mast cells in both groups. Moreover, higher paracellular permeability was associated with less somatic and psychological symptoms in patients.In Paper II, we aimed to determine the association between colonic mucosa paracellular permeability and structural and resting state functional brain connectivity. We demonstrated different patterns of associations between mucosa permeability and functional and structural brain connectivity in IBS patients compared to HC. Specifically, lower paracellular permeability in IBS, similar to the levels detected in HC, was associated with more severe IBS symptoms and increased functional and structural connectivity between intrinsic brain resting state network and descending pain modulation brain regions. Our findings further suggested that this association between mucosa permeability and functional brain connectivity was mainly mediated by coping strategies.In Paper III, we investigated putative alterations in excitatory and inhibitory neurotransmission of aINS, as the brain’s key node of the salience network crucially involved in cognitive control, in IBS patients relative to HC and addressed possible connections with both symptoms and psychological factors. We found decreased concentrations of the excitatory neurotransmitter Glx in bilateral aINS in IBS patients compared to HC, while inhibitory neurotransmitter GABA+ levels were comparable. Further, we demonstrated hemisphere-specific associations between abdominal pain, coping and aINS excitatory neurotransmitter concentration.In conclusion, this thesis broadens the knowledge on peripheral and central mechanisms in IBS and presents novel findings that bring together the ends of brain-gut axis. Our results depict association between mucosal permeability, IBS symptoms and functional and structural connectivity engaging brain regions involved in emotion and pain modulation as well as underlying neurotransmitter alterations.
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| 25. |
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| 26. |
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| 27. |
- Bjuhr, Marie, et al.
(author)
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Health and work-related factors as predictors of still being active in working life at age 66 and 72 in a Swedish population: A longitudinal study
- 2023
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In: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 76:4, s. 1481-1492
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Journal article (peer-reviewed)abstract
- BACKGROUND: Health and work environment are known factors in being active in working life beyond legal retirement.OBJECTIVE: To investigate sociodemographic, health and work environment factors as possible predictors of being active in working life at ages 66 and 72. Secondly, investigate eventual changes over time, shortly after a major reform in the Swedish pension system, and predictors of still being active in working life at age 66.METHODS: We used a longitudinal design with two separate cohorts of people at age 60. One baseline assessment was made in 2001–2003 with two 6 years follow-ups, and one in 200–2009 with one 6 years follow-up. Data were accessed through a Swedish national population-based study and analysed using logistic regression. To examine possible differences between the two cohorts, interaction terms with each independent variable were analysed.RESULTS: Being a man and working in a profession that requires at least three years of university education predicted that the person would still be active in working life at age 66 and 72. Additionally, having a light level of physical activity at work and being diagnosed with fewer than two diseases, also predicted still being active in working life at age 66. Only physical activity at work showed significant changes over time.CONCLUSION: Shortly after a major reform of the public pension system, there was an increase in participation in working life after age 66 and 72. However, gender, profession, and health factors are still important considerations regarding older people’s participation in working life.
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| 28. |
- Bjuhr, Marie, et al.
(author)
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Incentives behind and Experiences of Being Active in Working Life after Age 65 in Sweden
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:23
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Journal article (peer-reviewed)abstract
- Since individual and societal expectations regarding the possibility of an extended working life after the expected retirement age are increasing, research on sustainable working life combined with healthy ageing is needed. This study explores the incentives behind and experiences of an extended working life after the expected retirement age of 65 among Swedish people. The inductive qualitative content analyses are based on 18 individual semi-structured interviews among persons 67–90 years old with varying characteristics and varying experiences of extended working lives. The analyses revealed that working contributed to (1) sustained internal resources, i.e., cognitive function, physical ability and increased vigor; (2) sustained external resources, i.e., social enrichment, better daily routines and economic benefits; (3) added meaningfulness to life, i.e., being needed, capability and satisfaction with working tasks. Meanwhile, having flexible working conditions enabled a satisfying balance between work and leisure. Altogether, these different aspects of overall health and working life were interpreted as contributing to increased feelings of vitality, the innermost dimension of health. Conclusions: regardless of biological age, our results indicate that being able to remain active in working life can be beneficial to vitality and could make these results valuable for both health-care personnel and employers.
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| 29. |
- Bjuhr, Marie, et al.
(author)
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Sustained health in working life among an aging population and an aging working force
- 2023
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Conference paper (peer-reviewed)abstract
- Background. A crucial factor for social sustainability is equal health and social justice. With an aging population andincreased expectations on senior workers to prolong their working life, research focusing on sustainable working life incombination with healthy aging is needed.Purpose. To explore factors related to and experiences of prolonging working life after the expected retirement age of65 among Swedish people.Methods. Cross-sectional and longitudinal data were used to assess associations with participation in working life atages 66 and 72. Additionally, qualitative data, based on 18 individual semi-structured interviews with workers 67–90years were used to gain an extended understanding of incentives for prolonged working life.Findings. Male gender and profession were associated with participating in working life at age 72, additionally, fewerdiagnosed diseases and a light level of physical activity at work at 66. Senior workers described that workingcontributed to sustained internal and external resources, added meaningfulness to life and flexible working conditionsenabled a satisfying balance between work and leisure. Altogether, these different aspects of working life wereinterpreted as contributing to increased feelings of vitality, the innermost dimension of health.Conclusion. Regardless of biological age, being able to remain active in working life can be beneficial to vitality.Actions to provide flexible working conditions, especially for disadvantaged senior workers, may facilitate working lifeafter the expected retirement age with extended equality.
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| 30. |
- Drissi, Natasha Morales, 1980-
(author)
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Brain Networks and Dynamics in Narcolepsy
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Narcolepsy is a chronic sleep disorder, characterised by excessive daytime sleepiness with frequent uncontrollable sleep attacks. In addition to sleeprelated problems, changes in cognition have also been observed in patients with narcolepsy and has been linked to the loss of Orexin-A in a number of studies. Results from previous functional and structural neuroimaging studies would suggest that the loss of Orexin-A has numerous downstream effects in terms of both resting state glucose metabolism and perfusion and reduction in cortical grey matter.Specifically, studies investigating narcolepsy with positron emission tomography (PET) and single photon emission computed tomography (SPECT) have observed aberrant perfusion and glucose metabolism in the hypothalamus and thalamus, as well as in prefrontal cortex. A very recent PET study in a large cohort of adolescents with type 1 narcolepsy further observed that the hypoand hypermetabolism in many of these cortico-frontal and subcortical brain regions also exhibited significant correlations with performance on a number of neurocognitive tests. These findings parallel those found in structural neuroimaging studies, where a reduction of cortical grey matter in frontotemporal areas has been observed.The Aim of this thesis was to investigate mechanisms and aetiology behind the symptoms in narcolepsy through the application of different neuroimaging techniques. I present in this thesis evidence supporting that the complaints about subjective memory deficits in narcolepsy are related to a misallocation of resources.I further describe how this has its seat in defective default mode network activation, possibly involving alterations to GABA and Glutamate signaling. In addition to this, I present our findings of a structural deviation in an area of the brainstem previously not described in the aetiology of narcolepsy.This finding may have implications for further understanding the aetiology of the disease and the specific neuronal populations involved.In addition to this, I show evidence from adipose tissue measurements in specific compartments, confirming that weight gain in narcolepsy is characterized by centrally located weight gain and may be specifically related to OX changes, but maybe not brown adipose tissue volume.The findings presented in this thesis provides new insights to the pathophysiology of narcolepsy beyond the well-known depletion of OX producing neurons in the hypothalamus.
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| 31. |
- Engström, Maria, 1958-, et al.
(author)
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Aberrant brain activation in the core control network for cognitive function in MS
- 2011
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Conference paper (other academic/artistic)abstract
- Purpose: The purpose of this study was to investigate if patients with multiple sclerosis (MS) and fatigue have aberrant brain activation in the anterior insular cortex (AIC) and the anterior cingulate cortex (ACC), which are regions in the brain that are suggested to be a core network for cognitive control (Cole and Schneider, 2007; Sridharan et al., 2008). Materials and Methods: Twelve patients with MS and eleven healthy controls were examined with functional Magnetic Resonance Imaging (fMRI) while performing a complex working memory task. The task was to indicate if words presented in video goggles had appeared in previously presented sentences. Axial blood oxygen level dependent (BOLD) images were analyzed with SPM8 software. Images were realigned for movement correction, normalised to standard brain template, and smoothed with 8mm Gaussian kernel. We used a parametric contrast that tapped brain activation as a function of difficulty level of the task, i.e. words presented after 1, 2, 3, or 4 consecutive sentences. Results: Healthy controls elicited more activation in the left superior parietal lobe (p<0.001 family wise error (FWE) corrected for multiple comparisons), the right caudate head (p=0.002), and ACC (p=0.004) compared to MS patients. The MS patients had more activity in the left and right inferior parietal lobe (p=0.001 and p=0.029, respectively). In addition, in a region of interest analysis the MS patients had more activation in the left dorsal and ventral AIC (p=0.011 and p=0.009, respectively). The figure shows brain activation at working memory across both healthy controls and MS. Conclusion: MS patients elicited, as predicted, aberrant activation in the AIC-ACC network in that they had activation depletion in ACC and increased activity in the left AIC. It has recently been proposed that the AIC engenders awareness and the ACC engenders volitional action (Craig, 2009). The abnormal activation in this region could therefore explain the frequent symptoms of fatigue and cognitive impairment in MS. Clinical Relevance statement: Cognitive impairment occurs in 40-70% of individuals with MS and the patophysiology is unknown. Increased knowledge might contribute to novel strategies for symptomatic treatment.
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| 32. |
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| 33. |
- Engström, Maria, 1958-, et al.
(author)
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An fMRi investigation of mental effort in a complex working memory task
- 2010
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In: 16th Annual Meeting of the Organization for Human Brain Mapping, Barcelona 2010.
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Conference paper (other academic/artistic)abstract
- A fundamental component of attention and working memory is the ability to allocate sufficient amount of mental resources to ongoing activity. Despite the fact that ’effort’ is a key ingredient to current theories about attention and memory, little is known about the brain’s regulation of cognitive effort. In this fMRI study, we employed the momentous Daneman reading span task (Daneman & Carpenter, 1980) to induce cognitive effort. We have previously used complex working memory tasks to study deficits with respect to effortful processing in patients with sleep disorders (Engström, et al., 2009). We have noted profound involvement of the anterior cingulate cortex in relation to cognitive effort. We now wish to corroborate this finding in a larger group of healthy participants.
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| 34. |
- Engström, Maria, 1958-, et al.
(author)
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Brain Activation During Compassion Meditation : A Case Study
- 2010
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In: Journal of Alternative and Complementary Medicine. - United States : Mary Ann Liebert, Inc. Publishers. - 1075-5535 .- 1557-7708. ; 16:5, s. 597-599
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Journal article (peer-reviewed)abstract
- Objectives: B.L. is a Tibetan Buddhist with many years of compassion meditation practice. During meditation B.L. uses a technique to generate a feeling of love and compassion while reciting a mantra. The aim of the present study was to investigate the neural correlates of compassion meditation in 1 experienced meditator. Methods: B.L. was examined by functional magnetic resonance imaging during compassion meditation, applying a paradigm with meditation and word repetition blocks. Results: The most significant finding was the activation in the left medial prefrontal cortex extending to the anterior cingulate gyrus. Other significant loci of activation were observed in the right caudate body extending to the right insula and in the left midbrain close to the hypothalamus. Conclusions: The results in this study are in concordance with the hypothesis that compassion meditation is accompanied by activation in brain areas involved with empathy as well as with happy and pleasant feelings (i.e., the left medial prefrontal cortex and the anterior cingulate gyrus).
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| 35. |
- Engström, Maria, 1958-, et al.
(author)
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Brain and effort : brain activation and effort-related working memory in healthy participants and patients with working memory deficits
- 2013
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In: Frontiers in Human Neuroscience. - Switzerland : Frontiers Research Foundation. - 1662-5161. ; 7:140, s. 1-17
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Journal article (peer-reviewed)abstract
- Despite the interest in the neuroimaging of working memory, little is still known about the neurobiology of complex working memory in tasks that require simultaneous manipulation and storage of information. In addition to the central executive network, we assumed that the recently described salience network [involving the anterior insular cortex (AIC) and the anterior cingulate cortex (ACC)] might be of particular importance to working memory tasks that require complex, effortful processing.Method: Healthy participants (n = 26) and participants suffering from working memory problems related to the Kleine–Levin syndrome (KLS) (a specific form of periodic idiopathic hypersomnia; n = 18) participated in the study. Participants were further divided into a high- and low-capacity group, according to performance on a working memory task (listening span). In a functional magnetic resonance imaging (fMRI) study, participants were administered the reading span complex working memory task tapping cognitive effort.Principal findings: The fMRI-derived blood oxygen level dependent (BOLD) signal was modulated by (1) effort in both the central executive and the salience network and (2) capacity in the salience network in that high performers evidenced a weaker BOLD signal than low performers. In the salience network there was a dichotomy between the left and the right hemisphere; the right hemisphere elicited a steeper increase of the BOLD signal as a function of increasing effort. There was also a stronger functional connectivity within the central executive network because of increased task difficulty.Conclusion: The ability to allocate cognitive effort in complex working memory is contingent upon focused resources in the executive and in particular the salience network. Individual capacity during the complex working memory task is related to activity in the salience (but not the executive) network so that high-capacity participants evidence a lower signal and possibly hence a larger dynamic response.
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| 36. |
- Engström, Maria, 1958-, et al.
(author)
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Disorganised working memory functional connectivity in periodic hypersomnia
- 2010
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In: 16th Annual Meeting of the Organization for Human Brain Mapping, Barcelona 2010.
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Conference paper (other academic/artistic)abstract
- The Kleine–Levin Syndrome (KLS) is a rare but relatively well-defined disorder characterised by excessive sleep periods (periodic hypersomnia) associated with cognitive deficits and behavioural disturbances such as binge eating and hypersexuality [1]. The etiology of KLS is unknown and several neuroimagning methods have been applied to investigate the neural corrlates to KLS. A functional Magnetic Resonance Imaging (fMRI) study by us implicated hyperactivity in the thalamus and hypoactivity in the anterior cingulate cortex and the right anterior insula in a working memory task [2], which imply the involvement of a recently proposed anterior cingulate-insular control network in KLS [3]. As we expected less coherent organisation in KLS, we compared the connectivity of the anterior cingulate-insular and thalamic (AIT) network and the well-known, working memory-related, dorsal attention network (involving the dorsolateral prefrontal cortex and parietal areas) between KLS and controls.
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| 37. |
- Engström, Maria, 1958-, et al.
(author)
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Fatigue and cognitive effort in multiple sclerosis: an fMRI study
- 2011
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Conference paper (other academic/artistic)abstract
- Despite recent advances in therapy and diagnosis, fatigue remains a mayor challenge in multiple sclerosis (MS). To further the understanding of the neural underpinnings of fatigue, we undertook a study using functional magnetic resonance imaging (fMRI) to investigate neural networks that may be affected by MS-related fatigue. Twelve MS patients and 12 age- and sex matched controls were administered the Fatigue Impact Scale (FIS) to assess clinically significant fatigue, and underwent a neuropsychological examination. The participants performed a working memory task (Daneman’s ‘Reading Span’ task) while being monitored by means of a 1.5 T Philips Achieva MR scanner. We have previously shown that this task triggers an executive network comprising frontal and parietal areas typically involved in working memory. In addition, the task engages a core network involving the anterior insula and the anterior cingulate cortex. This latter network may be implicated in allocation of mental resources and monitoring of the present state of the individual. There were two main findings. MS participants evidenced less activation than controls in the anterior cingulate and the left parietal cortex (Brodmann area 7) and more activation in left hemisphere language areas as well as the anterior insula. The second main finding was that clinical ratings of fatigue were strongly correlated with activity in wide areas of the core network, as well as posterior language areas. We take this finding to indicate that fatigue is related to compensatory involvement of the core network, and that excess activity in the core network possibly could be used as an objective marker of fatigue in MS.
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| 38. |
- Engström, Maria, 1958-, et al.
(author)
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Functional magnetic resonance imaging in narcolepsy and the Kleine-Levin syndrome
- 2014
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In: Frontiers in Neurology. - Switzerland : Frontiers Media SA. - 1664-2295. ; 5
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Journal article (peer-reviewed)abstract
- This work aims at reviewing the present state of the art when it comes to understanding the pathophysiology of narcolepsy and the Kleine-Levin syndrome (KLS) from a neuroimaging point of view. This work also aims at discussing future perspectives of functional neuroimaging in these sleep disorders. We focus on functional magnetic resonance imaging (fMRI), which is a technique for in vivo measurements of brain activation in neuronal circuitries under healthy and pathological conditions. fMRI has significantly increased the knowledge on the affected neuronal circuitries in narcolepsy and the Kleine-Levin syndrome. It has been shown that narcolepsy is accompanied with disturbances of the emotional and the closely related reward systems. In the Kleine Levin syndrome, fMRI has identified hyperactivation of the thalamus as a potential biomarker that could be used in the diagnostic procedure. The fMRI findings in both narcolepsy and the Kleine-Levin syndrome are in line with previous structural and functional imaging studies. We conclude that fMRI in combination with multi-modal imaging can reveal important details about the pathophysiology in narcolepsy and the Kleine-Levin syndrome. In the future, fMRI possibly gives opportunities for diagnostic support and prediction of treatment response in individual patients.
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| 39. |
- Engström, Maria, 1958-
(author)
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Funktionella områden i hjärnan
- 2004
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In: Forskning för livet. - : Hjärnfonden. ; 6
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Journal article (other academic/artistic)
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| 40. |
- Engström, Maria, 1958-
(author)
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Quantum chemical calculations of electron paramagnetic resonance of biological radicals
- 2001
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Doctoral thesis (other academic/artistic)abstract
- The aim of this thesis was to use state-of-the-art quantum chemical calculations of electron paramagnetic resonance (EPR) with applications to radicals in biomolecular systems. Special emphasis has been devoted to investigations of structure-to-property relations of amino acid radicals and spin labels in proteins. The g-tensor calculations constitute the principal point employing novel response theory and density functional theory (DFT) algorithms. The A-tensor calculations supply additional means for a comprehensive comparison with experimental results. Calculations on substituted benzene radicals as a test set showed that restricted open-shell Hartree-Fock (ROHF) wave functions provide accurate results for the g-tensor. Some radicals, however, like the phenoxyl radical, call for a more sophisticated approach such as the multi-configuration self-consistent field (MCSCF) method. This method provide accurate results for the g-tensor in every case. The main contributions to the g-tensor could be traced qualitatively to the organization of the few lowest excited states of the radical. However, to obtain quantitative accurate results the contributions from all excited states must be accounted for, as attained by the response theory method.The EPR parameters are sensitive probes of molecular interactions in the close vicinity of the radical. In a combined theoretical and experimental study it was possible to specify the causes of the parameter shifts in detail. The calculations confirmed that 9xx decreases and Azz increases at hydrogen bonding of the label. MCSCF calculations on tyrosyl radicals resulted in a lower 9xx at hydrogen bonding as observed experimentally in ribonucleotide reductase (RNR). A sulfur substitution, modeling the tyrosyl radical in galactose oxidase (GO), did unexpectedly not significantly influence the g-tensor or the spin density distribution. Calculations on sulfur centered radicals with different structures and charges showed that the g-tensor pattern is significantly different among these radicals. Thus the calculations provided means to distinguish different radical structures from each other. By DFT it is possible to make EPR calculations on large molecular systems. This was shown by calculations on a nitroxide spin label and nearby amino acids in a protein complex. The combination of EPR spectroscopy and DFT calculations provide a prospect of obtaining detailed knowledge about protein radicals.
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| 41. |
- Engström, Maria, 1958-, et al.
(author)
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Reduced thalamic and pontine connectivity in Kleine–Levin syndrome
- 2014
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In: Frontiers in Neurology. - Lausanne : Frontiers Research Foundation. - 1664-2295. ; 5:42
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Journal article (peer-reviewed)abstract
- The Kleine–Levin syndrome (KLS) is a rare sleep disorder, characterized by exceptionally long sleep episodes. The neuropathology of the syndrome is unknown and treatment is often inadequate. The aim of the study was to improve understanding of the underlying neuropathology, related to cerebral networks, in KLS during sleep episodes. One patient with KLS and congenital nystagmus was investigated by resting state functional magnetic resonance imaging during both asymptomatic and hypersomnic periods. Fourteen healthy subjects were also investigated as control samples. Functional connectivity was assessed from seed regions of interest in the thalamus and the dorsal pons. Thalamic connectivity was normal in the asymptomatic patient whereas the connectivity between the brain stem, including dorsal pons, and the thalamus was diminished during hypersomnia. These results suggest that the patient’s nystagmus and hypersomnia might have their pathological origin in adjacent dorsal pontine regions. This finding provides additional knowledge of the cerebral networks involved in the neuropathology of this disabling disorder. Furthermore, these findings regarding a rare syndrome have broad implications, and results could be of interest to researchers and clinicians in the whole field of sleep medicine.
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| 42. |
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| 43. |
- Engström, Maria, 1958-, et al.
(author)
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Thalamic Activation in the Kleine-Levin Syndrome
- 2014
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In: Sleep. - United States : Associated Professional Sleep Societies, Llc. - 0161-8105 .- 1550-9109. ; 37:2, s. 379-386
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Journal article (peer-reviewed)abstract
- STUDY OBJECTIVES:The objective of this study was to investigate if combined measures of activation in the thalamus and working memory capacity could guide the diagnosis of Kleine-Levin Syndrome (KLS). A second objective was to obtain more insight into the neurobiological causes of KLS.DESIGN:Matched group and consecutive recruitment.SETTING:University hospital neurology department and imaging center.PATIENTS OR PARTICIPANTS:Eighteen patients with KLS diagnosed according to the International Classification of Sleep Disorders and 26 healthy controls were included.INTERVENTIONS:N/A.MEASUREMENTS AND RESULTS:Working memory capacity was assessed by the listening span task. A version of this task (reading span) was presented to the participants during functional magnetic resonance imaging (fMRI). Activation in the thalamus was measured in a region of interest analysis. A combination of the working memory capacity and the thalamic activation measures resulted in 80% prediction accuracy, 81% sensitivity, and 78% specificity regarding the ability to separate KLS patients from healthy controls. The controls had an inverse relation between working memory capacity and thalamic activation; higher performing participants had lower thalamic activation (r = -0.41). KLS patients showed the opposite relationship; higher performing participants had a tendency to higher thalamic activation (r = -0.35).CONCLUSIONS:This study shows that functional neuroimaging of the thalamus combined with neuropsychological assessment of working memory function provides a means to guide diagnosis of Kleine-Levin Syndrome. Results in this study also indicate that imaging of brain function and evaluation of cognitive capacity can give insights into the neurobiological mechanisms of Kleine-Levin Syndrome.
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| 44. |
- Engström, Maria, 1958-, et al.
(author)
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Thalamo-striato-cortical determinants to fatigue in multiple sclerosis
- 2013
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In: Brain and Behavior. - : Wiley. - 2162-3279 .- 2162-3279. ; 3:6, s. 715-728
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Journal article (peer-reviewed)abstract
- Background The aim was to explore the thalamo-striato-cortical theory of central fatigue in multiple sclerosis (MS) patients with self-reported fatigue. If the theory correctly predicted fatigue based on disruptions of the thalamo-striato-cortical network, we expected altered brain activation in this network in MS participants while performing a complex cognitive task that challenged fatigue. Methods
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| 45. |
- Eriksson, Elisabet, 1971-, et al.
(author)
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Job satisfaction and wellbeing among migrant care workers in nursing homes : An integrative review
- 2023
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In: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 10:6, s. 3486-3505
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Research review (peer-reviewed)abstract
- Aim: To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.Design: An integrated review was conducted.Methods: Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.Results: Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.Public Contribution: Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.
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| 46. |
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| 47. |
- Fredholm, Angelica, et al.
(author)
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Learning in intensive care during the COVID-19 pandemic - postgraduate critical care nursing students’ experiences
- 2022
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In: International Journal of Medical Education. - : NLM (Medline). - 2042-6372. ; 13, s. 335-344
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Journal article (peer-reviewed)abstract
- Objectives: This study explored postgraduate critical care nursing students' experiences of learning in the ICU during the COVID-19 pandemic and to understand these experiences in relation to self-directed learning and professional development. Methods: An explorative qualitative design was used. Eight postgraduate critical care nursing students from two different universities were interviewed. Questions focused on learning, supervision, ethically difficult situations, issues regarding communication, as well as the impact of the pandemic on students' health. Interviews thematically analyzed, and further analyzed using a theoretical framework focusing self-directed learning and professional development containing the concepts of autonomy, authenticity, and attachment. Results: The result consists of three themes: 1) Attachment with subthemes Attachment to the patient, Attachment to family and friends, Attachment to the ICU-context, and Attachment to the clinical supervisor. 2) Authenticity with subthemes Experiencing a varying degree of authenticity, Clinical reasoning about how to prioritize care. 3) Autonomy with subthemes Being just a student - with limited responsibility, taking responsibility, and having worries regarding one's professional development. Conclusion: Findings show the need for participation in the ICU community of practice without the demands and responsibility of full participation. Students need to be given the opportunity to form a relationship with practice. For attachment, participation, and consequently professional development to take place, there is need for inviting students to be a part of the team even during such straining circumstances as an ongoing pandemic. These findings can advance the understanding of how to organize clinical education during future crisis such as a new pandemic.
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| 48. |
- Georgiopoulos, Charalampos, 1984-
(author)
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Imaging Studies of Olfaction in Health and Parkinsonism
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Olfactory loss is a common non-motor symptom of Parkinson’s disease (PD), often preceding the cardinal motor symptoms of the disease. The aim of this thesis was to: (a) evaluate whether olfactory examination can increase diagnostic accuracy, and (b) study the structural and functional neural basis of olfactory dysfunction in PD with different applications of Magnetic Resonance Imaging (MRI).Paper I was a comparison of the diagnostic accuracy between a simple smell identification test and DaTSCAN Single Photon Emission Computerized Tomography (SPECT), a nuclear medicine tomographic imaging technique that is commonly used in patients with suspected parkinsonism. The results indicate that smell test is inferior to DaTSCAN SPECT, but the combination of these two methods can lead to improved diagnostic accuracy.Paper II showed that diffusion MRI could detect discrete microstructural changes in the white matter of brain areas that participate in higher order olfactory neurotransmission, whereas MRI with Magnetization Transfer contrast could not.Paper III was a methodological study on how two different acquisition parameters can affect the activation pattern of olfactory brain areas, as observed with functional MRI (fMRI). The results indicate that brief olfactory stimulation and fast sampling rate should be preferred on olfactory fMRI studies.Paper IV used olfactory fMRI and resting-state fMRI in order to elucidate potentially altered activation patterns and functional connectivity within olfactory brain areas, between PD patients and healthy controls. Olfactory fMRI showed that olfactory impairment in PD is associated with significantly lower recruitment of the olfactory network. Resting-state fMRI did not detect any significant changes in the functional connectivity within the olfactory network of PD patients.In conclusion, the included studies provide evidence of: (a) disease-related structural and functional changes in olfactory brain areas, and (b) beneficial addition of olfactory tests in the clinical work-up of patients with parkinsonism.
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| 49. |
- Gustafsson, Håkan, et al.
(author)
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Fe(III) distribution varies substantially within and between atherosclerotic plaques
- 2014
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In: Magnetic Resonance in Medicine. - United States : John Wiley & Sons. - 0740-3194 .- 1522-2594. ; 2:71, s. 885-892
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Journal article (peer-reviewed)abstract
- PURPOSE:Vulnerable atherosclerotic plaques are structurally weak and prone to rupture, presumably due to local oxidative stress. Redox active iron is linked to oxidative stress and the aim of this study was to investigate the distribution of Fe(III) in carotid plaques and its relation to vulnerability for rupture.METHODS:Atherosclerotic plaques from 10 patients (three asymptomatic and seven symptomatic) were investigated. Plaque vulnerability was classified using ultrasound and immunohistochemistry and correlated to Fe(III) measured by electron paramagnetic resonance spectroscopy.RESULTS:Large intra-plaque Fe(III) variations were found. Plaques from symptomatic patients had a higher Fe(III) concentration as compared with asymptomatic plaques (0.36 ± 0.21 vs. 0.06 ± 0.04 nmol Fe(III)/mg tissue, P < 0.05, in sections adjoining narrowest part of the plaques). All but one plaque from symptomatic patients showed signs of cap rupture. No plaque from asymptomatic patients showed signs of cap rupture. There was a significant increase in cap macrophages in plaques from symptomatic patients compared with asymptomatic patients (31 ± 11% vs. 2.3 ± 2.3%, P < 0.01).CONCLUSION:Fe(III) distribution varies substantially within atherosclerotic plaques. Plaques from symptomatic patients had significantly higher concentrations of Fe(III), signs of cap rupture and increased cap macrophage activity.
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| 50. |
- Gustafsson, Håkan, 1976-, et al.
(author)
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Is vulnerability for carotid plaque rupture related to intrinsic Fe (III) distribution
- 2012
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Conference paper (other academic/artistic)abstract
- Atherosclerotic plaques vulnerable for rupture are characterised by e.g., a large lipid pole, a high concentration of inflammatory cells and a thin fibrous cap. Recent research has showed that vulnerable plaques are structurally weaker and therefore more likely to rupture in response to physical forces; possible due to high local concentrations of macrophages and reactive oxygen species (ROS). It is well known that redox active iron catalyses production of ROS and that the presence of Fe(III) is linked to ROS production. The aim of this study was to investigate the distribution of Fe(III) in carotid plaques.
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