| 1. |
- Adolfsson, Annsofie, 1960-, et al.
(författare)
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Miscarriage : Evidence Based Information for the Web and Its Development Procedure
- 2015
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Ingår i: Advances in Sexual Medicine. - Irvine, USA : Scientific Research Publishing. - 2164-5191 .- 2164-5205. ; 5:4, s. 89-110
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this paper is to describe the process of developing web information on miscarriage based on scientific evidence, for women and couples in Sweden experiencing miscarriage. Method: A participatory design was used which included researchers, professional xperts and users. A participatory design was used involving researchers, professional experts and users. The information was developed in six stages: 1) identifying the needs of information; 2) identifying and constructing the main areas of information and its paths; 3) identifying and inviting experts for revision; 4) developing the text; 5) reviewing the text; 6) design and structuring for adaption to website. Results: The text of information developed gradually based on the seven steps. The final text comprised three parts: 1) what is miscarriage; 2) experiences of miscarriage; 3) processing and lanning for new pregnancy. Conclusion: Using participatory design was time and resource consuming, however it was functional for producing appropriate information for the target group. The developed evidence based facts text is assumed to be a complement to the information that is provided by the health care system.
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| 2. |
- Andersson, Staffan, et al.
(författare)
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Samverkan om genomströmning
- 2012
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Ingår i: NU 2012. - Göteborg, Sweden.
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Konferensbidrag (refereegranskat)abstract
- Avhopp och genomströmning är viktiga faktorer för högre utbildning. Studenter som börjar en utbildning bör också känna sig motiverade att fortsätta, lyckas och nå sina mål. Olika mått på avhopp och genomströmning kan också ses som indikatorer på utbildningens kvalitet (Högskoleverket, 2009). Detta är mycket viktigt för hela högre utbildningssystemet, men ses som kritiskt inom naturvetenskaplig och teknisk utbildning (Teknikdelegationen, 2010). Det finns ett uttalat behov av fler personer med civilingenjörsexamen, men andelen studenter som når examen har minskat under många år (Andersson, 2011). Denna trend har också observerats för flera andra programutbildningar (Högskoleverket & SCB, 2011).Vi har medverkat i flera olika samarbetsprojekt med mål att bland annat förstå och förbättra genomströmningen på utbildningsprogram (Marklund, 2009; Andersson, Gelin och Marklund, 2011; Andersson Chronholm och Andersson, 2011). Utifrån våra erfarenheter från dessa projekt vill vi diskutera erfarenheter och möjligheter för framtida samverkan med andra som delar vårt intresse för denna viktiga fråga. Inom de olika projekten har vi särskilt intresserat oss för tre områden:• Att mäta och visualisera genomströmningHur mäter vi genomströmning på bästa sätt? Vilka mått är viktiga? Hur kan vi visualisera genomströmning? Hur kan visualiseringen hjälpa utvecklingsarbete?• Att utforska och beskriva faktorer som påverkar genomströmningVilka verktyg använder vi för att utforska de faktorer som kan påverka genomströmning? Vilka beskrivningsmodeller finns kring genomströmning? Vilka möjligheter och begränsningar finns med dessa modeller?• Att genomföra framgångsrika insatser för att förbättra genomströmningVad kan man göra för att förbättra genomströmning på utbildningar? Hur kan insatser förbättras utifrån forskning och annan information?Vår förhoppning är att en diskussion kring dessa områden kan leda till värdefullt erfarenhetsutbyte. Vi vill också lyfta den övergripande frågan om hur olika lärosäten kan samverka kring dessa frågor och vad vi kan lära av varandra.Referenser:Andersson, S. (2011). “Identitetsresan", I Fler som kan s. 63-77. Stockholm: SkolverketAndersson, S., Gelin, B. och Marklund, B. (2011). ATTRACT - International collaboration to help students succeed. Proceedings from Utvecklingskonferens för Sveriges ingenjörsutbildningar 2011.Andersson Chronholm, J. & Andersson, S. (2011). Lär för din framtid - Så lyckas du med högskolestudier Lund:StudentlitteraturHögskoleverket (2009). Mått för genomströmning i utbildning på grund- och avancerad niva, Högskoleverkets rapportserie 2009:29Högskoleverket och SCB (2011). Universitet och högskolor Genomströmning och resultat på grundnivå och avancerad nivå till och med 2009/2010 Statistiska meddelanden UF20SM1103, Stockholm: SCBMarklund, B. (2009). “Hur kan genomströmningen i våra program- utbildningar mätas, presenternas och analyseras? Vilka hinder och kritiska framgångsfaktorer finns för en god genomströmning?" Proceedings from Utvecklingskonferens för Sveriges ingenjörsutbildningar 2009.Teknikdelegationen (2010). Vändpunkt Sverige - ett ökat intresse för matematik, naturvetenskap och IKT, Statens Offentliga Utredningar 2010:28, Stockholm
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| 3. |
- Arrhenius, Gustaf, et al.
(författare)
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Bevare oss för det brittiska utvärderingseländet
- 2012
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Ingår i: Universitetsläraren. - 0282-4973. ; 2012:18 dec
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- SVENSKA universitetsledningar tenderar numera att prioritera lärosätets intäkter högre än allt annat, inklusive klassiska akademiska ideal som bildning och fri forskning. Därför fruktar vi att ett genomförande av Jan Björklunds planer kommer att leda till samma slags vansinne i Sverige som vi nu ser i Storbritannien.
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| 4. |
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| 5. |
- Bergius, Marianne, 1950, et al.
(författare)
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Ortodonti i relation till oral funktion : Orthodontics in relation to oral function
- 2007
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Ingår i: Tandläkartidningen. ; 99:2, s. 52-59
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Tidskriftsartikel (refereegranskat)abstract
- The association between the activity of masticatory muscles and craniofacial development has been studied in humans as well as in animals. The common finding of these investigations is that the muscles closing the mandible influence the transversal and the vertical dimensions of the craniofacial skeleton. The loading of the facial bones due to masticatory muscle function may stimulate sutural growth and increase bone apposition, leading in turn to an increase of the transversal growth of the maxilla and broader bone bases for the dental arches. The big functional demands of the masticatory muscles are often associated with anterior growth rotation pattern and well-developed angular, coronoid, and condylar processes in the mandible. Individuals with disabilities have an increased prevalence of malocclusion and poor oral function. Behavioural problems and deviating orofacial growth and function will complicate the orthodontic treatment. But with behavioural and various treatment modifications, those patients can achieve a well adopted orthodontic treatment. The treatment may improve the facial appearance, achieving a better mouth closure and improve the possibilities of eating and speaking. The development and critical evaluation of treatment methods aiming towards normalizing craniofacial and occlusal development is essential. Modified functional appliances such as the "mandibular repositioning appliance" (MRA) has in placebo-controlled studies been shown to reduce periods of respiratory arrest and snoring in patients with mild sleep apnea. This method may also be an alternative in more severe cases where patients do not accept treatment with continuous overpressured air (CPAP). Successful treatment of sleep apnea must be based on a close cooperation of dentists with knowledge in this field and doctors at sleep apnea clinics. Effects and side effects of treatment must be supervised during extended periods of time.
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| 6. |
- Bergius, Marianne, et al.
(författare)
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Ortodonti i relation till oral funktion
- 2007
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Ingår i: Tandläkartidningen. ; 99:2, s. 52-59
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Forskningsöversikt (populärvet., debatt m.m.)abstract
- The association between the activity of masticatory muscles and craniofacial development has been studied in man as well as in animals. The common finding of these investigations is that the muscles closing the mandible influence the transversal closing the mandible inflkuence the transversal and the vertical dimensions of the craniofacial skeleton. The loading of the facial bones due to masticatory muscle function may stimulate sutural growth and increase bone apposition, leading in turn to an increase of the transversal growth of the maxilla and broader bone bases for the dental arches. The big functional demands of the masticatory muscles are often associated with anterior growth rotation pattern and well-developed angular, coronoid, and condylar processes in the mandible. Individuals with disabilities have an increased prevalence of malocclusion and poor oral function. Behavioural problems and deviating orofacial growth and function will complicate the orthodontic treatment. But with behavioural and various treatment modifications, we can give those patients a well adopted orthodontic treatment. That may favour the facial appearance, achieving a better mouth closure and improve the posibilities to eat and speak. The development and critical evaluation of treatment methods aiming towards normalizing craniofacial and occlusal development is essential. Modified functional appliances such as the ”mandibular repositioning appliance” (MRA) has in placebo controlled studies been shown to reduce periods of respiratory arrest and snoring in patients with mild apnea. This method may also be an alternative in more severe cases where patients do not accept treatment with continous overpressured air (CPAP). Sucessful treatment of sleep apnea must be based on a close cooperation of dentists with knowledge in this field and doctors at sleep apnea clinics. Effects and side effects of treatment must be supervised during long periods.
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| 7. |
- Boudewyns, A, et al.
(författare)
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Alternatives of OSAHS treatment: selection of patients for upper airway surgery and oral appliances
- 2007
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Ingår i: European Respiratory Review. - 0905-9180. ; 16:106, s. 132-145
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Tidskriftsartikel (refereegranskat)abstract
- Although continuous positive airway pressure (CPAP) is considered to represent the standard treatment for patients with moderate-to-severe obstructive sleep apnoea/hypopnoea syndrome (OSAHS), poor treatment compliance and/or refusal is an issue in ∼20-3% of these patients.As an alternative to life-long CPAP treatment, conservative procedures exist with dental appliances for mandibular advancement, as well as curative surgical techniques.Surgical treatment of OSAHS can be divided into the following two main groups:1) upper airway surgery by soft tissue resection (uvulopalatopharyngoplasty, etc.), and2) skeletal procedures, such as maxillo-mandibular advancement. Proper selection of patients for the different treatment modalities is the key for full treatment success.Patient-related factors, such as the site of upper airway collapse, craniofacial characteristics, dental health, obesity, age, profession and positional dependence, as well as treatment-related factors, should be evaluated before a final proposal for these treatment alternatives is formulated.
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| 8. |
- Carlsson, Marcus, et al.
(författare)
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NetSync
- 2000
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This paper describes NetSync, a protocol for automation of software updates and log file retrieval on lightweight terminals. It is mainly developed for use in a scientific test environment, but there are other possible uses as well. NetSync is a very flexible protocol, and while designed to be able to be run on handheld units with low storage and computing capacity, it could also be used for high end systems with much storage and computing capacity.
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| 9. |
- Carlsson, Marcus, et al.
(författare)
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NetSync client and server
- 2000
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This document describes the server and client for the NetSync protocol implemented as part of the networking project course at Lulea University of Technology. The server was implemented as a daemon for the FreeBSD operating system, and the client was implemented for PalmOS
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| 10. |
- Cistulli, Peter, et al.
(författare)
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Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances
- 2004
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Ingår i: Sleep Medicine Reviews. ; 8, s. 443-457
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Snoring and obstructive sleep apnea form part of a spectrum of sleep disordered breathing affecting a significant proportion of the general population and particularly the middle aged. The consequences can be severe and even life threatening for both the individual directly affected and those more remotely involved. Adverse sequelae can manifest themselves acutely or in the longer term as a result of obstructive breathing induced hypersomnolence, neurocognitive deficits and cardiovascular abnormilities. The combination of anatomical and neuromuscular risk factors in the pathogenesis of OSA has resulted in a varied appoach to its management. One such treatment option is mandibular repositioning appliances (MRA), which mechanically stabilize the airway. Whilst the efficacy of this simple intervention has been rigorously proven quite recently in a significant proportion of patients with varying disease severity, individual patient selection in its application remains uncertain. Short-term side-effects are common but usually transient, whilst in the long-term minor permanent adverse developments on the dentition and occlusion have been reported. Considering both the medicolegal implications of snoring and OSA and the increasing popularity of MRA, it is recommended that skilled multidisciplinary respiratory and dental personnel form the primary care team.
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| 11. |
- Dahlqvist, Johanna, 1979-, et al.
(författare)
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Physical findings in the upper airways related to obstructive sleep apnea in men and women.
- 2007
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Ingår i: Acta Oto-Laryngologica. - : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 127:6, s. 623-30
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Tidskriftsartikel (refereegranskat)abstract
- UNLABELLED: CONCLUSIONS, There are gender differences when it comes to the risk factors for sleep apnea. Large tonsils, a high tongue and a wide uvula are risk factors for sleep apnea in men, while large tonsils and a retrognathic mandible are risk factors in women. Upper airway abnormalities including mandibular retrognathia are, however, unable to predict sleep apnea among snorers being investigated for suspected sleep apnea.OBJECTIVES: To identify gender-specific risk factors for obstructive sleep apnea and the diagnostic performance from physical upper airway examinations among snoring men and women investigated because of suspected sleep apnea.PATIENTS AND METHODS: The dimensions of the uvula, tonsils, velopharynx and tongue, and nasal septal deviation, mandibular position, neck circumference, weight, and height were systematically scored in 801 consecutive snoring patients (596 men and 205 women), who had been referred for a primary sleep apnea recording.RESULTS: In men, large tonsils, a high tongue, and a wide uvula were independent factors associated with an apnea-hypopnea index of >15. In women, large tonsils and mandibular retrognathia were independent factors associated with an apnea-hypopnea index of >15. The positive predictive values for upper airway abnormalities ranged between 0.20 and 0.25 in men and between 0.09 and 0.15 in women.
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| 12. |
- Denolf, Petra L., et al.
(författare)
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The status of cephalometry in the prediction of non-CPAP treatment outcome in obstructive sleep apnea patients
- 2016
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Ingår i: Sleep Medicine Reviews. - : Elsevier BV. - 1087-0792 .- 1532-2955. ; 27, s. 56-73
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Forskningsöversikt (refereegranskat)abstract
- Obstructive sleep apnea syndrome (OSAS) is the most common sleep disordered breathing disorder (SDB) in adults and is characterized by a recurrent partial or complete collapse of the upper airway during sleep. This can be caused by many factors, sometimes interacting, such as skeletal malformations, soft tissue crowding, respiratory instability and the various effects of aging, obesity and gender that dictate craniofacial and upper airway anatomy. Research has demonstrated that the majority of patients exhibit at least one anatomical component such as retrognathia or a narrow posterior airway space that predisposes to the development of OSAS. Within the predisposing elements for OSAS many seem to point to anatomical characteristics. A standardized and relatively simple radiologic technique to evaluate anatomical craniofacial relationships is cephalometry. This has been used already for a long time in orthodontics, but is now gradually being introduced in OSAS treatment to envisage optimal treatment selection as well as to predict treatment outcomes. The purpose of the present review is to evaluate the contribution of cephalometry in the prediction of outcomes from OSAS treatments that depend on the upper airway morphology in their mechanisms of action such as oral appliances that advance the mandible as well as various surgical methods. In addition, an overview of imaging modalities and methods that currently are being used in cephalometric analysis in OSAS patients is provided. The findings indicate that isolated cephalometric parameters cannot be used to reliably predict treatment outcomes from mandibular advancement devices and surgical methods for OSAS. Extreme or outlying values of cephalometric parameters may rather be used as contra-indicators or 'red flags' instead of predictors.
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| 13. |
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| 14. |
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| 15. |
- Engström, Åsa, et al.
(författare)
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Follow-up visit in an ICU : receiving a sense of coherence
- 2018
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Ingår i: Nursing in Critical Care. - : John Wiley & Sons. - 1362-1017 .- 1478-5153. ; 23:6, s. 308-315
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Tidskriftsartikel (refereegranskat)abstract
- AimTo describe patients' experiences of a follow-up visit to an intensive care unit (ICU) after being critically ill and nursed there.BackgroundKnowledge about the follow-up visit needs to be developed, with the previously critically ill patient in focus.DesignQualitative descriptive.MethodSemi-structured interviews were conducted with nine patients and analysed using qualitative content analysis. The data collection occurred during spring 2014.FindingsDuring the follow-up visits in ICU, the relatives, the patient diary, and those who took part in the care contribute to fill memory gaps to create a picture and an explanation of the care period.ConclusionThe follow-up visit is an important tool in the patients' struggle to create a context and coherence from a missing or unreal time. The patient diary is essential to subsequently be able to relate to the period of care.Relevance to clinical practiceThe follow-up visit, together with a personal diary, after an ICU stay could be seen as significant for strengthening the patients' feeling of coherence and better health.
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| 16. |
- Friling, Stina, et al.
(författare)
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Efficient production of mesencephalic dopamine neurons by Lmx1a expression in embryonic stem cells
- 2009
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Ingår i: Proceedings of the National Academy of Sciences. - : Proceedings of the National Academy of Sciences. - 1091-6490 .- 0027-8424. ; 106:18, s. 7613-7618
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Tidskriftsartikel (refereegranskat)abstract
- Signaling factors involved in CNS development have been used to control the differentiation of embryonic stem cells (ESCs) into mesencephalic dopamine (mesDA) neurons, but tend to generate a limited yield of desired cell type. Here we show that forced expression of Lmx1a, a transcription factor functioning as a determinant of mesDA neurons during embryogenesis, effectively can promote the generation of mesDA neurons from mouse and human ESCs. Under permissive culture conditions, 75%-95% of mouse ESC-derived neurons express molecular and physiological properties characteristic of bona fide mesDA neurons. Similar to primary mesDA neurons, these cells integrate and innervate the striatum of 6-hydroxy dopamine lesioned neonatal rats. Thus, the enriched generation of functional mesDA neurons by forced expression of Lmx1a may be of future importance in cell replacement therapy of Parkinson disease.
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| 17. |
- Garza, Raquel, et al.
(författare)
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Single-cell transcriptomics of human traumatic brain injury reveals activation of endogenous retroviruses in oligodendroglia
- 2023
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Ingår i: Cell Reports. - : Elsevier. - 2211-1247. ; 42:11, s. 113395-
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Tidskriftsartikel (refereegranskat)abstract
- Traumatic brain injury (TBI) is a leading cause of chronic brain impairment and results in a robust, but poorly understood, neuroinflammatory response that contributes to the long-term pathology. We used single-nuclei RNA sequencing (snRNA-seq) to study transcriptomic changes in different cell populations in human brain tissue obtained acutely after severe, life-threatening TBI. This revealed a unique transcriptional response in oligodendrocyte precursors and mature oligodendrocytes, including the activation of a robust innate immune response, indicating an important role for oligodendroglia in the initiation of neuroinflammation. The activation of an innate immune response correlated with transcriptional upregulation of endogenous retroviruses in oligodendroglia. This observation was causally linked in vitro using human glial progenitors, implicating these ancient viral sequences in human neuroinflammation. In summary, this work provides insight into the initiating events of the neuroinflammatory response in TBI, which has therapeutic implications.
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| 18. |
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| 19. |
- Haraldsson, Katarina, 1958, et al.
(författare)
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Evaluation of a school-based health promotion programme for adolescents aged 12-15 years with focus on well-being related to stress.
- 2008
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Ingår i: Public health. - London : Elsevier BV. - 0033-3506 .- 1476-5616. ; 122:1, s. 25-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to evaluate a school-based adolescent health promotion programme with focus on well-being related to stress. STUDY DESIGN: Interventional and evaluative with tests before and after the intervention. The study was performed in two secondary schools in a town on the west coast of Sweden. METHODS: A health promotion programme comprising massage and mental training was implemented for a single academic year in one school (intervention school, 153 participants) in order to strengthen and maintain well-being. No intervention was implemented in the other school (non-intervention school, 287 participants). A questionnaire was developed and tested, resulting in 23 items distributed across the following six areas: self-reliance; leisure time; being an outsider; general and home satisfaction; school satisfaction; and school environment. RESULTS: A pre- and postintervention comparison of the six areas was made within each school. In the intervention school, the boys maintained a very good or good sense of well-being related to stress in all six areas, while the girls' sense of well-being was maintained in five areas and deteriorated in one area. In the non-intervention school, the boys maintained a very good or good sense of well-being related to stress in four areas and deteriorated in two areas, while the girls' sense of well-being was maintained in two areas and deteriorated in four areas. CONCLUSION: Massage and mental training helped to maintain adolescents' very good or good sense of well-being related to stress. A questionnaire with acceptable validity and reliability was developed and tested in order to evaluate the health promotional approach. However, there is a need for further study to develop both the intervention and the questionnaire for young people.
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| 20. |
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| 21. |
- Jacobowitz, Ofer, et al.
(författare)
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Endorsement of: “treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of Sleep Medicine Clinical Practice Guideline” by World Sleep Society
- 2022
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Ingår i: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 89, s. 19-22
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Tidskriftsartikel (refereegranskat)abstract
- Guidelines for the evaluation and management of sleep disorders from national societies provide recommendations that may be regionally appropriate but may not always be practical or relevant in other parts of the world. A task force of experts from the World Sleep Society's (WSS) International Sleep Medicine Guidelines Committee and Sleep and Breathing Disorders Taskforce reviewed the American Academy of Sleep Medicine's Clinical Practice Guideline on the Treatment of Adult Obstructive Sleep Apnea (OSA) with Positive Airway Pressure with respect to its relevance and applicability to the practice of sleep medicine by sleep specialists in various regions of the world. To improve the evaluation of the guideline, surveys were sent by the senior author and the WSS to approximately 800 sleep doctors around the world to query the availability of OSA treatments in their respective region. The task force and the WSS guidelines committee endorsed the AASM's CPAP guidelines with respect to the indications for PAP therapy, utilization of different PAP modalities, and concurrent strategies to improve outcomes, noting appropriate caveats for universal applicability.
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| 22. |
- Johal, Ama, et al.
(författare)
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The role of oral appliance therapy in obstructive sleep apnoea
- 2023
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Ingår i: European Respiratory Review. - : European Respiratory Society. - 0905-9180 .- 1600-0617. ; 32:168
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Tidskriftsartikel (refereegranskat)abstract
- There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.
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| 23. |
- Latini, Francesco, Ph.D. 1982-, et al.
(författare)
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Refined Analysis of Chronic White Matter Changes after Traumatic Brain Injury and Repeated Sports-Related Concussions: Of Use in Targeted Rehabilitative Approaches?
- 2022
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 11:2
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Tidskriftsartikel (refereegranskat)abstract
- Traumatic brain injury (TBI) or repeated sport-related concussions (rSRC) may lead to long-term memory impairment. Diffusion tensor imaging (DTI) is helpful to reveal global white matter damage but may underestimate focal abnormalities. We investigated the distribution of post-injury regional white matter changes after TBI and rSRC. Six patients with moderate/severe TBI, and 12 athletes with rSRC were included ≥6 months post-injury, and 10 (age-matched) healthy controls (HC) were analyzed. The Repeatable Battery for the Assessment of Neuropsychological Status was performed at the time of DTI. Major white matter pathways were tracked using q-space diffeomorphic reconstruction and analyzed for global and regional changes with a controlled false discovery rate. TBI patients displayed multiple classic white matter injuries compared with HC (p < 0.01). At the regional white matter analysis, the left frontal aslant tract, anterior thalamic radiation, and the genu of the corpus callosum displayed focal changes in both groups compared with HC but with different trends. Both TBI and rSRC displayed worse memory performance compared with HC (p < 0.05). While global analysis of DTI-based parameters did not reveal common abnormalities in TBI and rSRC, abnormalities to the fronto-thalamic network were observed in both groups using regional analysis of the white matter pathways. These results may be valuable to tailor individualized rehabilitative approaches for post-injury cognitive impairment in both TBI and rSRC patients.
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| 24. |
- Lindgren, Britt-Marie, et al.
(författare)
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A Necessary Pain : A Literature Review of Young People’s Experiences of Self-Harm
- 2022
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis Group. - 0161-2840 .- 1096-4673. ; 43:2, s. 154-163
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Forskningsöversikt (refereegranskat)abstract
- Background: Self-harm is defined as intentional self-injury without the wish to die. People who self-harm report feeling poorly treated by healthcare professionals, and nurses wish to know how best to respond to and care for them. Increased understanding of the meaning of self-harm can help nurses collaborate with young people who self-harm to achieve positive healthcare outcomes for them.Aim: This review aimed to synthesise qualitative research on young peoples' experiences of living with self-harm.Method: A literature search in CINAHL, PubMed, and PsycINFO resulted in the inclusion of 10 qualitative articles that were subjected to metasynthesis.Results: The results show that young people’s experiences of living with self-harm are multifaceted and felt to be a necessary pain. They used self-harm to make life manageable, reporting it provided relief, security, and a way to control overwhelming feelings. They suffered from feeling addicted to self-harm and from shame, guilt, and self-punishment. They felt alienated, lonely, and judged by people around them, from whom they tried to hide their real feelings. Instead of words, they used their wounds and scars as a cry for help.Conclusion: Young people who harm themselves view self-harm as a necessary pain; they suffer, but rarely get the help they need. Further research is necessary to learn how to offer these people the help they need.
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| 25. |
- Lydell, Marie C, 1961, et al.
(författare)
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Predictive factors for work capacity in patients with musculoskeletal disorders.
- 2005
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - Oslo, Norway : Taylor & Francis. - 1650-1977 .- 1651-2081. ; 37:5, s. 281-5
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify predictive factors for work capacity in patients with musculoskeletal disorders. DESIGN: A descriptive, evaluative, quantitative study. SUBJECTS/PATIENTS: The study was based on 385 patients who participated in a rehabilitation programme. METHODS: Patients were divided into 2 groups depending on their ability to work. The groups were compared with each other with regard to sociodemographic factors, diagnoses, disability pension and number of sick days. The patient's level of exercise habits, ability to undertake activities, physical capacity, pain and quality of life were compared further using logistic regression analysis. RESULTS: Predictive factors for work capacity, such as ability to undertake activities, quality of life and fitness on exercise, were identified as important independent factors. Other well-known factors, i.e. gender, age, education, pain and earlier sickness certification periods, were also identified. Factors that were not significantly different between the groups were employment status, profession, diagnosis and levels of exercise habits. CONCLUSION: Identifying predictors for ability to return to work is an essential task for deciding on suitable individual rehabilitation. This study identified new predictive factors, such as ability to undertake activities, quality of life and fitness on exercise.
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| 26. |
- Lydell, Marie C, 1961, et al.
(författare)
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Predictive factors of sustained return to work for persons with musculoskeletal disorders who participated in rehabilitation.
- 2009
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Ingår i: Work (Reading, Mass.). - Amsterdam : IOS Press. - 1051-9815 .- 1875-9270. ; 33:3, s. 317-328
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Tidskriftsartikel (refereegranskat)abstract
- Musculoskeletal disorders (MSD) account for the majority of total morbidity cases in the working-age Swedish population. These disorders are thought to be the reason given for one-third of total certified sick leave requests. In addition to the high cost to society, MSD involve both physical and emotional suffering, pain and financial and social problems for the injured persons. The aim of this study was to identify predictive multidimensional factors for sustainable return to work (RTW) in a long-term follow-up persons with MSD. During the period 1992-1999, 385 persons participated in a rehabilitation program. Ten years later, 354 of these took part in a prospective follow-up study. The average post-rehabilitation time was ten years (range=7-13 years) and 243 persons (69%) completed a questionnaire. The "working full-time" group (n=110) and the "sick-listed" group (n=73) were included in the study. The two groups were compared in terms of predictors for RTW. Multiple stepwise logistic regression and bivariate analysis, as well as parametric and non-parametric tests, were used to identify predictive factors. The number of sick-listed days before rehabilitation, age, self-rated pain, life events, gender, physical capacity, self-rated functional capacity, educational level and light physical labor were predictors of long-term RTW. Return to work an be facilitated by planning at an early stage of the certified sick leave period using instrument that take these predictors into account.
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| 27. |
- Lydell, Marie C, 1961, et al.
(författare)
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Return or no return - psychosocial factors related to sick leave in persons with musculoskeletal disorders: a prospective cohort study.
- 2011
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Ingår i: Disability and rehabilitation. - Abingdon : Informa UK Limited. - 1464-5165 .- 0963-8288. ; 33:8, s. 661-666
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. The aim of this study was to compare psychosocial factors between healthy persons and sick-listed persons with musculoskeletal disorders (MSD); both groups with MSD 10 years ago. Methods. This cohort study was prospective and 385 persons participated in a rehabilitation program 10 years ago, and 354 persons took part in the follow-up. Of these, 243 persons completed a questionnaire. Two groups were included in the study: a healthy group (not sick-listed) (n = 112) and a sick-listed group (n = 74). Psychosocial factors related to sick leave were compared between the groups. Results. In the 10-year follow-up, the healthy group showed a significantly higher quality of life, more control over the working situation, better sense of coherence and unexpectedly more life events. There was no significant difference in social integration and emotional support between the groups. Conclusions. Using the knowledge about the characteristics of the healthy group, adequate rehabilitation for every sick-listed person with a musculoskeletal disorder can be given and therefore facilitate the returning to work process. A multidimensional approach taking into account a person's physical condition and workplace related problems, as well as psychosocial factors, is of great importance for the person and for society.
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| 28. |
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| 29. |
- Lydell, Marie, 1961-, et al.
(författare)
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Thoughts and feelings of future working life as a predictor of return to work : a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders
- 2011
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Ingår i: Disability and Rehabilitation. - London : Taylor & Francis Group. - 0963-8288 .- 1464-5165. ; 33:13-14, s. 1262-1271
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Tidskriftsartikel (refereegranskat)abstract
- Purpose. The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person’s actual working situation 1, 5 and 10 years after a rehabilitation period.Methods. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline.Results. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories.Conclusions. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person’s needs and facilitating RTW.
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| 30. |
- Marklund, Bertil, et al.
(författare)
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Promoting medical self-care : evaluation of a family intervention implemented in the primary health care by pharmacies
- 1999
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Ingår i: Family Practice. - : Oxford University Press. - 0263-2136 .- 1460-2229. ; 16:5, s. 522-527
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem.Objectives: The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement.Methods: The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated.Results: The results showed (P < 0.05–0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68).Conclusions: Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings.
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| 31. |
- Marklund, Ingela, et al.
(författare)
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Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke
- 2023
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Ingår i: European Journal of Physical and Rehabilitation Medicine. - : Edizioni Minerva Medica. - 1973-9087 .- 1973-9095. ; 59:2, s. 136-144
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients' mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes. DESIGN: Longitudinal cohort study.SETTING: Outpatient clinic in Stockholm, Sweden.POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT.METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention.RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results.CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT.CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.
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| 32. |
- Marklund, Ingela, 1970-
(författare)
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Lower-extremity constraint-induced movement therapy in individuals with stroke : improvements, experiences, and health-related quality of life
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Stroke is the third-leading cause of disability worldwide, and there are rehabilitation needs not only in the first year but throughout the lifetime. The ability to walk is crucial in everyday life since it affects mobility, self-care, and social activities. National guidelines recommend treating impairments with repetitive task- and goal-oriented exercises. One form of highly intensive and task-specific treatment is constraint-induced movement therapy (CIMT), a treatment method developed based on understanding brain plasticity with a behavioural explanatory model. There is insufficient evidence regarding CIMT for the lower extremities (LE-CIMT) since it has only been investigated in a few published studies involving only a small number of participants.Aim: The overall aims of this thesis were to explore the extent to which LE-CIMT (six hours per day for two weeks) can improve impaired body functions and limited activities, describe how the treatment is experienced, and investigate whether it affects the health-related quality of life (HRQoL) in individuals with stroke.Methods: This thesis contains five papers that analysed data from two study populations using quantitative and qualitative research methods. A single-subject experimental study with five subjects and a longitudinal uncontrolled cohort study with 147 subjects with stroke treated with LECIMT and follow-up after three and six months were conducted. Subjects were assessed with Fugl–Meyer assessment, the Berg balance scale (BBS), single-leg stance, step test, timed up and go with and without dual-task, ten-metre (10MWT) and six-minute (6MWT) walk tests, one repetition maximum, and weight-bearing standing on two scales. Data were analysed with the two-standard deviation band method and linear mixed modelling, controlling for heterogeneity. Seven individual semistructured interviews were performed and analysed with qualitative content analysis to explore LE-CIMT experiences. Finally, a questionnaire including RAND-36 was sent out to former LE-CIMT participants, with 106 responses (response rate 65%). Data were compared with norm-baseddata and analysed with the summary independent-samples t-test. Univariable analysis was performed to investigate the linear relationships between RAND-36 health domain scores and the 6MWT result per 100meters, time since treatment, living alone, and need for home care. Independent t-tests were used for drop-out analyses.Results: Highly intensive LE-CIMT significantly improved motor function, strength, balance, dual-task ability, mobility, and walking ability in individuals in the sub-acute and chronic post-stroke phases. They maintained or improved their weight bearing on the more affected leg to provide a more symmetric distribution. The improvements remained at the three- and six-month follow-up. There was a significant interaction for time and age. Those who completed LE-CIMT within six months after their stroke onset had significantly greater improvements in 10MWT self-selected speed during the follow-up than those who completed LE-CIMT after at least seven months. Younger participants had higher BBS scores than older participants. The informants’ experiences generated the overall theme that LE-CIMT gave them knowledge about themselves and how their body works, facilitating the opportunity to live life more easily. There was still hope and opportunity for functional improvements to increase their independence and self-esteem. While LE-CIMT was intense and challenging, it was experienced as entirely necessary. The participants had significantly reduced HRQoL, overall and by sex in physical functioning, role-functioning physical, general health (not females), and social functioning compared to the general population. A significant relationship existed between their previous 6MWT result and the HRQoL physical functioning domain. Every 100-metre improvement in the 6MWT led to a 6.45 higher physical functioning score. No other significant associations were found. The dropout analysis showed no significant differences in characteristics between the participants and those who did not complete all three assessments or answer the questionnaire.Conclusion: LE-CIMT seems helpful in improving lower extremity body functioning and activities, even a long time after the stroke, leading to persistent improvements. The patients perceived LE-CIMT as entirely necessary. LE-CIMT may be a feasible treatment option and could be conducted in both day hospital rehabilitation and outpatient settings. Six minutewalk performance predicts physical functioning in HRQoL, emphasising the importance of mobility and gait training in rehabilitation after stroke.
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| 33. |
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| 34. |
- Marklund, Lisa, et al.
(författare)
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‘I know what I need to recover’ : Patients’ experiences and perceptions of forensic psychiatric inpatient care
- 2020
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Ingår i: International Journal of Mental Health Nursing. - New Jersey : John Wiley & Sons. - 1445-8330 .- 1447-0349. ; 29:2, s. 235-243
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Tidskriftsartikel (refereegranskat)abstract
- Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients’ experiences and perceptions of forensic psychiatric inpatient care. Semi‐structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, ‘I know what I need to recover’, and three main categories: ‘A need for meaning in a meagre existence’, ‘A need to be a person in an impersonal context’, and ‘A need for empowerment in a restricted life’. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person‐centred and recovery‐oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.
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| 35. |
- Marklund, Marie, et al.
(författare)
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An orthodontic oral appliance
- 2010
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Ingår i: Angle orthodontist. - : The Angle Orthodontist (EH Angle Education & Research Foundation). - 0003-3219 .- 1945-7103. ; 80:6, s. 1116-1121
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This pilot study was performed to test the hypothesis that an orthodontic oral appliance (OA) that is designed to work against the backwardly directed forces on the upper incisors may counteract the reduction in overjet from these devices.MATERIALS AND METHODS: Thirty patients with normal bites, good oral health, and milder sleep apnea were randomized to treatment with either OAs or orthodontic OAs. Bite changes were evaluated on plaster casts and radiographs and by questionnaires after a mean of 2.4 years in 19 frequent users.RESULTS: Four of nine patients in the orthodontic OA group increased their overjet by > or =0.4 mm, while none of the 10 patients in the OA group experienced that effect.CONCLUSION: Only the orthodontic OA increases the overjet; this design may therefore be beneficial to patients at risk of negative effects on their bite during OA treatment.
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| 36. |
- Marklund, Marie E.
(författare)
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Oral appliance therapy
- 2021
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Ingår i: Management of obstructive sleep apnea. - Switzerland : Springer. - 9783030541453 - 9783030541460 ; , s. 185-211
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 37. |
- Marklund, Marie E.
(författare)
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Starting mandibular advancement device therapy in patients with good protrusive capacity : a randomized pilot study
- 2023
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Ingår i: Turkish Journal of Orthodontics. - : Galenos Yayinevi. - 2528-9659 .- 2148-9505. ; 36:3, s. 158-164
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Discomfort has been related to the poor acceptance of a mandibular advancement device (MAD) in patients with obstructive sleep apnea. The present study compared severe initial side effects between a smaller and a larger degree of mandibular advancement in patients with a good protrusive capacity.Methods: Consecutive patients with obstructive sleep apnea and a good protrusive capacity (≥8 mm) were randomized to start treatment with the mandible advanced by either 70% of maximum protrusion (Adv70%) or by 4 mm (Adv4mm) in a pilot study with a parallel design. The main outcome was tenderness or pain in the teeth or jaws using a 0-10 visual analogue scale (VAS) (from “not at all” to “very extensive”) or excluded use because of side effects during the first week of treatment. Secondary outcomes included salivation problems and bite changes.Results: Eighteen patients were randomly selected and 17 patients fulfilled the study protocol. Four patients in the Adv70% group and none in the Adv4mm group reported severe tenderness or pain (VAS ≥7) on five or more of the seven days (p=0.03). The degree of mandibular advancement measured in millimeters correlated with the number of days with severe side effects, r=0.64 (p=0.006). The secondary side effects were minor.Conclusion: Starting MAD treatment with 70% mandibular advancement was related to more severe side effects during the first week of treatment compared with a smaller fixed millimeter value in patients with a good protrusive capacity in this pilot study.
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| 38. |
- Marklund, Marie E.
(författare)
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Treatment : oral appliances
- 2014
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Ingår i: Novel insights into the pathophysiology and treatment of obstructive sleep apnea. - : Future Medicine Ltd.. - 9781780842103 - 9781780842127 ; , s. 118-131
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Oral appliance therapy for patients with obstructive sleep apnea was introduced during the early 1980s, not long after the invention of continuous positive airway pressure. At the beginning of that century, Robin had already used an intraoral device that advanced the mandible in children with extreme mandibular retrognathia in order to facilitate breathing during sleep. Today, oral appliance has emerged as a popular alternative to continuous positive airway pressure for patients with obstructive sleep apnea.
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| 39. |
- Marklund, Marie E.
(författare)
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Treatment of obstructive sleep apnea with a mandibular advancement device
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obstructive sleep apnea is associated with snoring, excessive daytime sleepiness, hypertension and an increased risk of early death.The aims of the present studies were to evaluate the short-term and longterm effects on sleep apnea and the tolerability of a one-piece, individually- designed mandibular advancement device. We also hoped to find predictors of treatment success and evaluate the risk factors for dental side-effects of the device.Patients with mild, moderate and severe sleep apnea were evaluated using full-night polysomnographic sleep recordings, cephalometric radiographs and dental casts.At short-term follow-up after 0.7 ± 0.6 years (mean ± SD), the device had reduced the apnea-hypopnea index from 25 ± 17 to 8.6 ± 7.1 (p<0.001) in 44 patients. Sleep stage patterns improved with the device.At long-term follow-up after 5.2 ± 0.4 years, the device had reduced the apnea-hypopnea index from 22 ± 17 to 4.9 ± 5.1 (p<0.001) in 19 of 33 patients. These values did not differ from the short-term results in these patients who had continued treatment in the long term. Patients who had had their devices adjusted or replaced with new ones had a larger reduction in apnea than patients using die same devices for the whole study period (p<0.05). Ninety per cent of patients who had a short-term satisfactory result continued to use their devices on a long-term basis.The odds ratios for a successful reduction in apnea with the device were 42 for supine-dependent sleep apnea (p<0.05) and 21 for a short lower anterior face height (p=0.09) adjusted for age, obesity and mandibular displacement.The dental side-effects of the device were less marked with a soft elastomeric device than with a hard acrylic device and with advancements of below 6 mm compared with larger advancements.It is concluded that the present mandibular advancement device reduces mild, moderate and severe sleep apnea in both the short and the long term. A short-term follow-up is necessary to identify patients suffering from “silent obstructive apneas” during treatment. The device is well tolerated by patients who are recommended the treatment on the basis of the results of this shortterm sleep apnea recording. Supine-dependent sleep apnea predicts treatment success with the device. The device made of soft elastomer is recommended, as it has fewer side-effects on the dental occlusion than a device made of hard acrylic. It is advisable to replace the device with a new
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| 40. |
- Marklund, Marie, et al.
(författare)
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Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea
- 2007
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Ingår i: J Sleep Res. ; 16:4, s. 414-20
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Tidskriftsartikel (refereegranskat)abstract
- Mandibular repositioning appliances (MRAs) reduce symptoms of obstructive sleep apnoea in the short term, but the long-term effects are unknown. Our objective was to evaluate the long-term symptomatic effects of custom-made MRAs and to identify the patients who will experience subjective benefits from treatment. A cohort of 260 consecutive patients treated with appliances for non-apnoeic snoring or sleep apnoea was followed up by a questionnaire and examination after an average of 5.4 years. The subjective effect was defined as good when complaints of daytime sleepiness occurred less than once a week. A total of 185 patients (71%) responded to the questionnaires. Of the respondents, 96 reported frequent use, 33 reported infrequent use, 26 reported discontinued treatment and 30 reported modified treatment. Mild cases (apnoea-hypopnoea index [AHI] < 15) were likelier than more severe cases to continue treatment. Patients who had used MRAs reported fewer complaints of sleepiness, headaches and daytime naps. Frequent use (P = 0.001), few night-time awakenings before start of treatment (P = 0.02) and effective apnoea reduction during treatment of more severe cases (P = 0.02) correlated with a good subjective effect at long-term follow-up. Our conclusion is that custom-made MRAs reduce sleep apnoea symptoms in the long term. The mildest cases will experience the greatest long-term benefit.The reason is that non-apnoeic snorers and patients with a mild disease are more likely to continue treatment and that their long-term results with regard to excessive sleepiness are similar to patients with a more severe disease.
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| 41. |
- Marklund, Marie
(författare)
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Long-term efficacy of an oral appliance in early treated patients with obstructive sleep apnea
- 2016
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Ingår i: Sleep and Breathing. - : Springer. - 1520-9512 .- 1522-1709. ; 20:2, s. 689-694
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the present study was to evaluate the long-term efficacy of oral appliances (OAs) in early treated patients with obstructive sleep apnea (OSA). Polysomnographic sleep recordings without and with an OA were performed at treatment start and in patients who had been continuously treated with OAs for at least 15 years. Nine patients (eight men) with a median age of 68.1 years (interquartile range (IQR) 60.0 to 76.3 years) and a median treatment time of 16.5 years (IQR 16.3 to 18.0 years) were included. The apnea-hypopnea index decreased from a median of 17.3 (IQR 9.7 to 26.5) to 7.2 (IQR 4.0 to 9.6; p = 0.03) at the short-term follow-up. After long-term use, the apnea-hypopnea index was 32.4 (IQR 22.2 to 58.8) without the device and 35.1 (IQR 13.6 to 46.2) with it (p = 0.08). There were increases in the apnea-hypopnea index, both without the device (p = 0.02) and with it (p = 0.008). The degree of mandibular advancement did not differ between the two study occasions (p = 1.0). Patients treated with oral appliances may experience deteriorations in disease severity and treatment efficacy during continuous long-term OA treatment. Regular follow-up schedules with renewed sleep apnea recordings should be considered for these patients in order to avoid suboptimal or a total loss of effects on sleep apneas.
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| 42. |
- Marklund, Marie, et al.
(författare)
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Mandibular Advancement Devices in 630 Men and Women With Obstructive Sleep Apnea and Snoring
- 2004
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Ingår i: Chest. ; 125:4, s. 1270-8
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Tidskriftsartikel (refereegranskat)abstract
- Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep apnea.Design: Prospective study.Setting: Departments of Respiratory Medicine and Orthodontics, Umeå University.Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42).Measurements: Interviews, questionnaires, and overnight sleep apne a recordings. Patients with an apnea-hypopnea index of ≥10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of < 10, together with a supine apnea-hypopnea index of ≥ 10, defined supine-dependent sleep apneas.Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p = 0,01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p = 0.04), and 0.1 for complaints of nasal obstruction (p = 0.03). In the men, the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p = 0.04), 1.3 for each millimeter of mandibular advancement (p = 0.03), and 0.8 for each kilogram of weight increase (p = 0.001).Conclusions: The mandibular advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device.
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| 43. |
- Marklund, Marie, 1949-, et al.
(författare)
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Non-CPAP therapies in obstructive sleep apnoea : mandibular advancement device therapy
- 2012
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 39:5, s. 1241-1247
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Tidskriftsartikel (refereegranskat)abstract
- Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy . Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepness compared with placebo devices. CPAP more effectively dIminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep—disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.
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| 44. |
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| 45. |
- Marklund, Marie, et al.
(författare)
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Oral Appliance Therapy in Patients With Daytime Sleepiness and Snoring or Mild to Moderate Sleep Apnea : A Randomized Clinical Trial
- 2015
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Ingår i: JAMA Internal Medicine. - : American Medical Association (AMA). - 2168-6106 .- 2168-6114. ; 175:8, s. 1278-1285
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Oral appliances that move the mandible forward during sleep are suggested as treatment for mild to moderate obstructive sleep apnea.OBJECTIVE: To test whether an adjustable, custom-made oral appliance improves daytime sleepiness and quality of life in patients with daytime sleepiness and snoring or mild to moderate obstructive sleep apnea.DESIGN, SETTING, AND PARTICIPANTS: Ninety-six patients with daytime sleepiness and an apnea-hypopnea index (AHI) lower than 30 were included in a randomized, placebo-controlled, parallel trial in Umeå, Sweden, from May 2007 through August 2011.INTERVENTIONS: Four months' intervention with an oral appliance or a placebo device.MAIN OUTCOMES AND MEASURES: Daytime sleepiness was measured with the Epworth Sleepiness Scale, the Karolinska Sleepiness Scale, and the Oxford Sleep Resistance (OSLER) test. Quality of life was assessed with the Short-Form 36-Item Health Survey (SF-36) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Secondary outcomes included the apnea-hypopnea index, headaches, symptoms of restless legs, and insomnia.RESULTS: Oral appliance therapy was not associated with improvements in daytime sleepiness from baseline to 4-month follow-up when compared with the placebo device; Epworth score >10: 53% at baseline to 24% at follow-up for the oral appliance group vs 54% at baseline to 40% at follow-up for the placebo device group, P = .11; median (IQR) for Karolinska score ≥7/wk: 10 (8 to 14) at baseline to 7 (4 to 9) at follow-up for the oral appliance group vs 12 (6 to 15) at baseline to 8 (5 to 12) at follow-up for the placebo device group, P = .11; mean between-group difference in OSLER test, -2.4 min (95% CI, -6.3 to 1.4). The mean between-group difference for the total FOSQ score was insignificant (-1.2 [95% CI, -2.5 to 0.1]). No domain of the SF-36 differed significantly between the groups. The AHI was below 5 in 49% of patients using the active appliance and in 11% using placebo, with an odds ratio of 7.8 (95% CI, 2.6-23.5) and a number needed to treat of 3. Snoring (P < .001) and symptoms of restless legs (P = .02) were less frequent when using the oral appliance vs placebo, but this did not apply to headache or insomnia.CONCLUSIONS AND RELEVANCE: A custom-made, adjustable oral appliance reduces obstructive sleep apnea, snoring, and possibly restless legs without effects on daytime sleepiness and quality of life among patients with daytime sleepiness and snoring or mild to moderate sleep apnea.TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00477009.
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| 46. |
- Marklund, Marie
(författare)
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Oral Appliances in the Treatment of Obstructive Sleep Apnea and Snoring
- 2006
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Ingår i: Progress in Repiratory Research. - : Karger. - 3805580495 ; , s. 151-159
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- This overview summarizes current knowledge of effects, side effects and indications for oral appliances in the treatment of patients with obstructive sleep apnea (OSA) and snoring. Mandibular repositioning appliances (MRAs) in various designs represent the most evaluated type of oral appliance. MRAs relocate the lower jaw forward and downward in order to prevent sleep-induced pharyngeal collapse. Short-term success rates with MRAs of over 80% of selected OSA patients have been reported, but figures vary. MRAs are indicated for patients with mild to moderate OSA, men with supine-dependent OSA and women. Patients with initial treatment success may benefit from MRAs over a long time, provided that they do not gain weight and wear high quality devices. There are few randomized controlled trials of treatment effects from MRAs on OSA, particularly regarding symptoms. MRA design, methodology and the teamwork between dentists and physicians has an influence on the treatment outcome. Continuous positive airway presssure is the primary treatment for patients with more severe OSA because of its superior effects compared with MRAs. Another drawback of MRAs is their dependence on healthy teeth and the risk of dental side effects. It is concluded that MRAs are indicated for selected patients with OSA, but more research is needed.
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| 47. |
- Marklund, Marie
(författare)
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Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea
- 2006
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Ingår i: American Journal of Orthodontics & Dentofacial Orthopedics. ; 129:2, s. 214-21
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Orthodontic side effects can complicate the long-term use of mandibular advancement devices (MADs) in the treatment of patients with snoring anad obstructive sleep apnea. The aim of this study was to find predictors of dental side effects from monoblock MADs. Methods: Four hundred fifty patients, who consecutively received treatment with either soft elastomeric or hard acrylic devices, were followed up after 5.4 ± 0.8 years (mean ± SD). The continuing patients responded to questionnaires and had dental examinations and plaster casts made. Results: Twenty-seven patients had moved or died during the follow-up period. Two hundred thirty-six of the remaining 423 patients (56%) continued treatment, and 187 of them reported compliance rates of ≥50% at night. A small reduction in overjet of <1 mm was associated with a deepbite with an overbite of >3mm and an overjet of ≤3 mm (odds ratio [OR] = 7.5; P =.015), nasal congestion (OR = 2.9; P = .005), or the use of a soft elastomeric device (OR = 2.7; P = .014) controlled for age, sex, treatment time, and mandibular displacement. A small reduction in overbite of <1 mm was related to a small opening of the mandible of <11 mm (OR = 2.5; P = .008). Conclusions: Orthodontic side effects might be predictable on the basis of initial characteristics in dental occlusion and the design of MADs.
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| 48. |
- Marklund, Marie
(författare)
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Subjective versus objective dental side effects from oral sleep apnea appliances
- 2020
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Ingår i: Sleep and Breathing. - : Springer. - 1520-9512 .- 1522-1709. ; 24, s. 111-117
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea. The aim of the present study was to compare subjectively reported bite changes with objective findings.Methods: Consecutive adherent treated patients were asked to participate in this study. The patients responded to two questionnaires using numeric visual analogue scales (VAS), ranging from 0 (not at all) to 10 (very much). The first questionnaire included open questions and the second questionnaire comprised specific questions about side effects. Measurements of overjet, overbite, and space for the teeth were made on plaster casts taken before treatment start and at follow-up.Results: Thirty-eight (12 women) patients with a median age of 64 years (interquartile range (IQR) 57 to 69 years) and a median treatment time of 9.5 years (IQR 5.8 to 14.3 years) were included. Overjet, overbite, the molar relationship, and the irregularity of the lower front teeth had changed significantly during treatment. There were no associations between any of the patients’ responses and the objectively measured bite changes. Younger patients, those with a small baseline overjet or overbite and those who developed an anterior crossbite were more likely to report bite changes.Conclusions: Patients who choose to continue long-term treatment with oral appliances for sleep apnea are unaware of various types of bite changes. Such changes will, however, progressively increase in magnitude and be more difficult to take care of, if needed. It is therefore important continuously to follow up patients in regard to bite changes.
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| 49. |
- Marklund, Marie, et al.
(författare)
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The effect of mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea
- 1998
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Ingår i: Chest. - : Elsevier BV. - 0012-3692 .- 1931-3543. ; 113, s. 707-713
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effects of a mandibular advancement device on apneas and sleep in, mild, moderate and severe obstructive sleep apnea. Design: Prospective study. Subjects: Forty-four of 47 patients included. Intervention: Individually adjusted mandibular advancement devices. Measurements: Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings. Results: The device reduced the median apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range 44 to 66) to 14 (range, 2 to 32) (p=<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=-0.41; p<0.01). Conclusions: A mandibular advancement device reduces apnea and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.
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| 50. |
- Marklund, Marie, et al.
(författare)
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Treatment of elderly patients with snoring and obstructive sleep apnea using a mandibular advancement device
- 2015
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Ingår i: Sleep and Breathing. - : Springer. - 1520-9512 .- 1522-1709. ; 19:1, s. 403-405
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The simplicity of oral appliance therapy in the treatment of adult patients with snoring and obstructive sleep apnea (OSA) has resulted in a worldwide interest for this treatment modality. Mandibular advancement devices (MADs) that hold the lower jaw forward during sleep are mainly indicated for patients with milder OSA and those with CPAP intolerance. There has been minor attention on age when suggesting treatment alternatives for patients with OSA. Some studies indicate that there is a weak negative relationship between treatment success from MADs and higher age, but no studies have stratified their samples with respect to age.OBJECTIVE: The present aim was to compare the effects and side effects from MADs between an elderly group of patients (>65 years of age) and a younger age group that were extracted from two of our previous studies.RESULTS: The results showed no difference between the elderly and the younger patients in success rate or the degree of bite changes from MAD treatment.CONCLUSION: These findings indicate that MADs represent an alternative to CPAP irrespective of the age of the patient.
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