| 1. |
- Johansson, Ewa-Lena, et al.
(författare)
-
Doftöverkänslighet : sensorisk hyperreaktivitet i luftvägarna
- 2016
-
Bok (populärvet., debatt m.m.)abstract
- Kemisk överkänslighet innebär att man får hälsobesvär av vissa dofter och kemikalier. Utlösande faktorer kan till exempel vara parfym, blomdoft, rök eller rengöringsprodukter. De drabbade reagerar betydligt kraftigare än vad som är normalt redan vid låga doser som inte anses skadliga eller toxiska.Det finns en särskild grupp av personer som får luftvägsbesvär av dofter och kemikalier. I dagligt tal kallar vi det doftöverkänslighet. Inom vården används begreppet sensorisk hyperreaktivitet, SHR, för detta tillstånd. Ungefär sex procent av befolkningen uppfyller kriterierna för diagnos.I den här kunskapssammanställningen belyses epidemiologi, trolig patofysiologi, utredning och behandlingsmöjligheter av SHR ur olika aspekter. Den är främst ämnad för dig som i din yrkesroll kommer i kontakt med patienter med SHR, men rekommenderas till alla med särskilt intresse för området.
|
|
| 2. |
- Johansson, Ewa-Lena, et al.
(författare)
-
Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity
- 2017
-
Ingår i: Physiotherapy Research International. - : Wiley. - 1358-2267. ; 22:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose. In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. Methods. Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. Results. Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p<0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p<0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p<0.001). Conclusion. Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients with SHR and signs of dysfunctional breathing. Copyright (C) 2016 John Wiley & Sons, Ltd.
|
|
| 3. |
- Johansson, Ewa-Lena, et al.
(författare)
-
Small and large airway reactions to osmotic stimuli in asthma and chronic idiopathic cough
- 2018
-
Ingår i: Pulmonary Pharmacology & Therapeutics. - : Elsevier BV. - 1094-5539. ; 49, s. 112-118
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic cough is a common symptom and related to several pulmonary, airway and heart diseases. When all likely medical explanations for the coughing are excluded, there remains a large group of patients with chronic coughing, which is mostly a cough reflex easily triggered by environmental irritants and noxious stimuli. The main aim of this study was to improve the diagnostic ability to differentiate chronic idiopathic cough (CIC) from asthma. Methods: Twenty-three patients with CIC, 16 patients with mild asthma and 21 control participants were included. The study consisted of three randomised bronchial provocations with osmotic stimuli: mannitol, eucapnic dry air and hypertonic saline. At each provocation lung function was assessed by spirometry and impulse oscillometry (IOS). Results: In a comparison of the groups, while the FEV1 measurements did not differ, the CIC group had increased airway resistance and reactance after provocation with hypertonic saline compared to the control subjects. After mannitol provocation the patients with asthma had significantly increased airway resistance compared to the controls and from eucapnic dry air provocations these patients had a significant reduction in spirometry values and increased airway resistance compared to both the patients with CIC and the controls. Conclusion: The asthma group reacted in a predictable way with impaired lung function from osmotic provocations, whereas the patients with CIC demonstrated peripheral airway changes from hypertonic saline, also known to be a noxious stimulus. The IOS method uncovers differences between patients with CIC and control participants that contribute to our ability to provide a correct diagnosis.
|
|
| 4. |
- Johansson, Ewa-Lena, et al.
(författare)
-
Small and large airways' reactions to inhaled capsaicin in patients with chronic idiopathic cough, or asthma and in healthy control subjects
- 2019
-
Ingår i: Experimental Lung Research. - : Informa UK Limited. - 0190-2148 .- 1521-0499. ; 45:3-4
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: Cough is a common medical problem, and when it persists for more than 8 weeks it is arbitrarily defined as chronic. While spirometry assesses the large airways, impulse oscillometry system (IOS) measures peripheral airway function. The present study investigated whether provocation with inhaled capsaicin affects the large and small airways in patients with chronic idiopathic cough (CIC) or asthma and in healthy controls. Materials and methods: Twenty-one patients with CIC, 18 patients with asthma, and 22 healthy controls were subjected to a provocation with capsaicin, and lung function was assessed by IOS and spirometry. Results: At baseline, before the capsaicin provocation, the CIC group had significantly increased airway resistance compared to the controls. After capsaicin provocation, the CIC group exhibited a significant increase in total airway resistance. The asthma group showed a small but significant reduction in spirometry, increased airway resistance, and reactance after capsaicin provocation. Capsaicin inhalation affected neither the spirometry nor the IOS of the healthy controls. Conclusions: The present study demonstrates that inhaled capsaicin induces changes in lung function, both in patients with CIC and in patients with asthma, when IOS, which measures changes also in the peripheral airways, is used. IOS appears to be a more sensitive tool than spirometry for the detection of airway impairment in airway provocation studies. In patients with CIC, higher peripheral resistance at baseline may have clinical significance.
|
|
| 5. |
- Ternesten-Hasséus, Ewa, 1956, et al.
(författare)
-
Cough reduction using capsaicin
- 2015
-
Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111. ; 109:1, s. 27-37
-
Tidskriftsartikel (refereegranskat)abstract
- Chronic unexplained cough triggered by environmental irritants is characterized by increased cough reflex sensitivity, which can be demonstrated by means of inhaled capsaicin. Topical capsaicin can be used to improve non-allergic rhinitis and intestinal hypersensitivity and to reduce neuropathic pain. Objectives: We established whether an oral intake of natural capsaicin (chilli) could desensitize the cough reflex and improve unexplained coughing. Methods: Twenty-four patients with irritant-induced, unexplained chronic cough and 15 controls were included in the study. For 4 weeks, the participants took capsules with pure capsaicin, and for 4 weeks, they took placebo capsules. The protocol was crossover, randomized, and double blind. Cough sensitivity during the study was evaluated by a standardized capsaicin inhalation cough test that assessed the capsaicin concentration required to reach two coughs (C2) and five coughs (C5). Participants were also administered questionnaires on cough and cough-related symptoms. Results: Three patients withdrew before the study end, one during the active treatment period and two during the placebo period. After treatment with capsaicin, the thresholds for C2 were higher (improved) both in patients (p < 0.020) and in controls (p < 0.0061) compared to after the placebo period. Among patients, the concentration needed to reach C2 (p < 0.0004) and C5 (p < 0.0009) increased after the period with the active substance compared to cough thresholds at baseline. The cough symptom scores improved after 4 weeks of active treatment (p < 0.0030) compared to the baseline scores. Conclusion: Capsaicin powder taken orally decreased capsaicin cough sensitivity and cough symptoms. The findings suggest a desensitization of the cough-sensitive transient receptor potential vanilloid-1 (TRPV1). (C) 2014 The Authors. Published by Elsevier Ltd.
|
|
| 6. |
- Abel, Edvard, 1970, et al.
(författare)
-
Impact on quality of life of IMRT versus 3-D conformal radiation therapy in head and neck cancer patients: A case control study
- 2017
-
Ingår i: Advances in Radiation Oncology. - : Elsevier BV. - 2452-1094. ; 2:3, s. 346-353
-
Tidskriftsartikel (refereegranskat)abstract
- Objective The purpose of this study was to prospectively and longitudinally compare the health-related quality of life (HRQOL) outcomes between head and neck (HN) cancer patients treated with parotid-sparing intensity modulated radiation therapy (IMRT) and patients treated with 3-dimensional conventional radiation therapy (3D-CRT). Methods and materials Before and up to 12 months after treatment, HRQOL was recorded in patients with HN cancer who were referred to the Department of Oncology at Sahlgrenska University Hospital for curative IMRT. The study group's HRQOL was compared with a matched group of patients from previous descriptive HRQOL studies treated with 3D-CRT. Both groups' HRQOL was measured by the European Organization for Research and Treatment for Cancer QLQ-C30 and European Organization for Research and Treatment for Cancer QLQ-HN35 at 6 time points in the first year after diagnosis. Results Two hundred and seven patients were included, 111 treated with IMRT and 96 matched controls treated with 3D-CRT. Both groups' HRQOL deteriorated during and after treatment. Just after treatment, worse HRQOL scores were observed in the IMRT group regarding insomnia (38 vs 27; P = .032), appetite loss (64 vs 50; P = .019), senses (54 vs 41; P = .017), and coughing (39 vs 26, P = .009). At 12 months, however, significantly better HRQOL scores were observed in the IMRT group regarding problems with dry mouth (72 vs 62; P = .018), pain (28 vs 20; P = .018), sexuality (37 vs 23; P = .016), social contacts (10 vs 6; P = .026), cognitive functioning (79 vs 87; P = .0057), and financial difficulties (12 vs 20; P = .0019). Conclusions This study further supports the hypothesis that the introduction of IMRT has improved the long-term quality of life of HN cancer patients who have been treated with radiation therapy, but might cause more acute side effects. Longer follow-up is needed to study late complications.
|
|
| 7. |
|
|
| 8. |
- Andersson, Ewa K., et al.
(författare)
-
Relatives' experiences of sharing a written life story about a close family member with dementia who has moved to residential care : An interview study
- 2019
-
Ingår i: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 6:2, s. 276-282
-
Tidskriftsartikel (refereegranskat)abstract
- Aim The aim of this study was to describe relatives' experiences of sharing a written life story about a close family member with dementia who has moved to residential care. Design An explorative descriptive qualitative design was used. Methods The data were collected using semi-structured interviews with a purposeful sample of eight relatives and analyzed using a qualitative content analysis. Results Results show that creating and sharing the life story of a close family member could help relatives handle grief and stress. It was perceived as an important, yet difficult, task to ensure that the close family member got good quality care. The creation of a meaningful life story takes time and requires cooperation with family members and other significant people.
|
|
| 9. |
- Axelsson, Lars, et al.
(författare)
-
Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study.
- 2017
-
Ingår i: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 39:5, s. 908-915
-
Tidskriftsartikel (refereegranskat)abstract
- Dysphagia is common in head and neck cancer. A percutaneous endoscopic gastrostomy (PEG) tube is used to facilitate nutrition; however, some retrospective studies have indicated that the PEG tube causes dysphagia.A randomized study of patients with head and neck cancer was conducted with up to 10 years of follow-up. Patients were randomized to either the prophylactic PEG tube group (study group) or the common clinical nutritional support group (control group). At each follow-up, a dietician assessed the oral intake, noted the patients' weight, and if the patients used a PEG tube. Dysphagia was also assessed by the quality of life questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-H&N35).One hundred thirty-four patients were included in this study. There was no significant difference in swallowing function between the groups after 12 months, 24 months, and 8 years based on the EORTC-QLQ-H&N35, the oral intake scale, tube dependence, esophageal intervention, weight, body mass index (BMI), and overall survival.A prophylactic PEG tube can be used without an increased risk of long-term dysphagia in patients with head and neck cancer. © 2017 Wiley Periodicals, Inc. Head Neck, 2017.
|
|
| 10. |
- Blom, Kerstin, et al.
(författare)
-
Internet-vs. group-delivered cognitive behavior therapy for insomnia : A randomized controlled non-inferiority trial
- 2015
-
Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 70, s. 47-55
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohen's d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups posttreatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction > 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia. Trial registration: The study protocol was approved by, and registered with, the regional ethics review board in Linkoping, Sweden, registration number 2010/385-31. (C) 2015 The Authors. Published by Elsevier Ltd.
|
|
