| 1. |
- Andersson, B, et al.
(författare)
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Ökad fysisk aktivitet viktigt för att bromsa sjukfrånvaron
- 2015
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Ingår i: Dagens nyheter, DN.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Försäkringskassans rapport (DN Debatt 27/11 2015) visar att sjukfrånvaron fortsätter att öka och lovar att kraftsamla i sjukförsäkringshandläggningen. Men, precis som Försäkringskassan skriver, kommer det inte att räcka för att nå regeringens mål. Regeringens åtgärdsprograms program i sju punkter för att minska sjukfrånvaron saknar en viktig komponent. Det måste kompletteras med fysisk aktivitet som ett åttonde område för att trenden ska kunna brytas, skriver 13 debattörer.
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| 2. |
- Franzén, Karin M, 1958-, et al.
(författare)
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Surgery for urinary incontinence in women 65 years and older : a systematic review
- 2015
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 26:8, s. 1095-1102
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Forskningsöversikt (refereegranskat)abstract
- Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.
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| 3. |
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| 4. |
- Hägglund, Patricia, et al.
(författare)
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Study protocol for the SOFIA project : Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial
- 2017
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Ingår i: BMC Geriatrics. - : BioMed Central (BMC). - 1471-2318. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia). Methods/Design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT < 10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups. Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.
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| 5. |
- Samuelsson, Eva, et al.
(författare)
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Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: A systematic review
- 2015
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Ingår i: Geriatrics & Gerontology International. - : Wiley. - 1444-1586 .- 1447-0594. ; 15:5, s. 521-534
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits of pharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review the efficacy of pharmacological treatment for UI in the elderly and frail elderly. Methods: We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 to identify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged >= 65 years. Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of life and adverse events. Results: We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderate quality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in the frail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trials evaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased (standard mean difference: -0.24, 95% confidence interval -0.32-0.15), corresponding to a reduction of half a leakage per 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluation of the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. No eligible studies on mirabegron and estrogen were found. Conclusions: Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI. Treatment with drugs for UUI in the frail elderly is not evidence based.
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| 6. |
- Stenzelius, Karin, et al.
(författare)
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The effect of conservative treatment of urinary incontinence among older and frail older people : a systematic review
- 2015
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Ingår i: Age and Ageing. - Oxford, United Kingdom : Oxford University Press. - 0002-0729 .- 1468-2834. ; 44:5, s. 736-744
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Forskningsöversikt (refereegranskat)abstract
- Background: urinary incontinence (UI) is a common symptom among older people, with a higher prevalence among frail older persons living in nursing homes. Despite consequences such as reduced health and quality of life, many older people do not seek help for their symptoms, resulting in missed opportunity for treatment. Objective: the aim of this study was to investigate the evidence and the effect of conservative treatment of UI and the quality of life among older and frail older persons. Methods: a systematic review of randomised controlled studies and prospective, non-randomised studies was conducted, evaluating interventions of conservative treatment of UI in an older population (65 years or older). A total of 23 studies fulfilled the inclusion criteria and 9 were of high or moderate quality. Fourteen studies were of low quality and were therefore excluded from the analysis. Results: documented and effective conservative treatments are available even for older persons with UI. Pelvic muscle exercise, physical training in combination with ADL, prompted voiding and attention training, and help to toilet are important treatments. In some studies, however, the evidence of effectiveness is limited. Conclusions: this systematic review concludes that there are conservative treatments for UI for older and frail older persons that reduce leakage and increase quality of life. There is however a need for further high-quality studies.
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| 7. |
- Alfvén, Gösta, et al.
(författare)
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Barn med stressutlöst smärta hade kraftigare startle-reflex
- 2017
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Återkommande stressutlöst smärta är ett närmast vardagligt fenomen. Avsaknaden av enkla test inom sjukvården för att diagnostisera stressutlöst smärta medför diagnostiska svårigheter och därmed svårigheter med handläggning. Ett grundläggande problem är att förståelse för den patofysiologiska processen bakom långvarig stressutlöst smärta saknas.Tidigare studier från samma forskare har visat att barn och tonåringar med långvarig stressutlöst smärta diagnostiserad enligt fastställda kriterier utvecklar ett karakteristiskt mönster av ömma punkter (tender points) i muskler på platser för bland annat huvudvärk, skuldersmärtor och buksmärtor nära naveln. Dessa muskler ingår i startle-reflexen, en neuromuskulär försvarsreaktion som utlöses från en kärna i hjärnstammen. Startle-reflexen startar med en blinkreflex och följs på mindre än en tiondels sekund av framåtböjning av huvudet och en nedstigande böjningsreaktion av kroppen, som sträcker sig ned till benen. Stress kan bland annat via amygdala leda till förstärkt och lättare utlöst startle-reflex.Vår hypotes var att startle-reflexen hos individer med stressutlöst smärta är mer lättutlöst och ger ett högre svar än hos friska. I en kontrollerad studie ingick 19 individer i åldern 10–17 år som hade stressutlöst återkommande smärta enligt fastställda kriterier. Gruppen jämfördes med 23 friska i jämförbar ålder, av motsvarande kön och utan smärtbesvär. Under likvärdiga, lugna förhållanden utlöstes startle-reflex vid upprepade starka auditiva signaler på 105 dB via hörlurar, och EMG registrerades från ögonblinkningsmuskeln (orbicularis oculi), tinningmuskel (temporalis), nacknära skuldermuskel (trapezius), stora bröstmuskeln (pectoralis major), bukmuskel (rectus abdominis) samt ryggmuskel (lumbala erector spinae).I smärtgruppen var muskelspänningen signifikant förhöjd i ovan nämnda muskler. Startle-reflexen utlöstes också lättare och tidigare, var kraftigare och varade längre. Muskelaktivitetsgraden efter ljudstimuli visade i smärtgruppen signifikant högre medelamplitud än i kontrollgruppen för alla sex muskler och de åtta upprepade startle-responserna sammantagna. Aktuell forskning om möjliga muskulära och centralnervösa smärtmekanismer presenteras i artikeln.För första gången har ökad muskelspänning och förstärkt startle-reaktion påvisats med EMG hos barn/ungdomar med återkommande stressutlöst smärta i ett mönster som sammanfaller med mönstret av ömma punkter och smärtlokalisation. Vår förhoppning är att dessa fynd ska stimulera till fortsatt forskning och förbättra klinisk praxis.Alfvén, G, Grillner, S, Andersson E. Eur J Pain. Epub 4 maj 2017. doi: 10.1002/ejp.1057
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| 8. |
- Alfven, Gösta, et al.
(författare)
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Review of childhood pain highlights the role of negative stress.
- 2019
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 108:12, s. 2148-2156
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Forskningsöversikt (refereegranskat)abstract
- AIM: Recurrent pain of unknown origin is a major problem in children. The aim of the present review was to examine the hypothesis of negative stress as an aetiology of recurrent pain from different aspects.METHODS AND RESULTS: Epidemiological studies, clinical experience and hormonal data give support for such a hypothesis. Negative stress as a tentative aetiology for recurrent pain is reviewed. Stress, muscular tension, the startle reaction and its tentative relation to pain is illuminated. Deviations of hormonal secretion supporting a stress aetiology is mentioned. The role of central sensitization for recurrent pain is discussed. Possible aetiological implications of recurrent pain as a local symptom or a general disorder are presented. Brain changes due to stress is shortly reviewed. Stress and pain in the clinic are highlighted. The importance of biological, psychological and social factors, as well as genetic elements, are-Ddiscussed.CONCLUSION: Stress elicits neurobiological mechanisms. They may lead to many neurophysiological deviances. Increase of muscle tension and neuromuscular excitability and enhanced startle reaction may be of importance for recurring pain. The identification of stress as a primary cause of recurrent pain can have huge implications for understanding signs and treatment in clinical practice. This article is protected by copyright. All rights reserved.
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| 9. |
- Andersson, Eva, 1958-, et al.
(författare)
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Fysisk aktivitet lika bra som KBT eller läkemedel vid depression
- 2015
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; :47, s. 2102-2104
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Tidskriftsartikel (refereegranskat)abstract
- Fyisk aktivitet har dokumenterad effekt vid depression. Effekten är lika god som effekten av antidepressiva läkemedel eller kognitiv beteendeterapi (KBT) vid lindrig till måttlig depression. Dessutom är fysisk aktivitet i stort sett biverkningsfritt.
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| 10. |
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