| 1. |
- Qvarfordt, Maria, 1982-, et al.
(författare)
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Patients’ experiences of reasons to being physically active in early rheumatoid arthritis – a mixed methods study
- 2019
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Ingår i: Annals of the Rheumatic Diseases. - London, UK : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 78:Suppl 2, s. 1454-1455
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Tidskriftsartikel (refereegranskat)abstract
- Background: The importance of physical activity in rheumatoid arthritis (RA) is well known and patients are informed about the importance of being physically active. Despite this knowledge there is a lack of compliance to this advice. Studies comparing physical activity in different groups of patients with RA and reasons influencing physical activity are needed. Objectives: The objectives were to compare physical activity (PA) in workers, retired and patients with sick-leave with early RA and further to explore reasons to being physically active in these patients. Methods: A total of 66 patients with early RA were included in the study. A sequential explanatory mixed methods design was used. The groups were compared with clinical data as: disease activity (DAS28); pain (VAS 0-100, best to worst); health-related quality of life (EQ5D, -0.594-1 worse to best) and a physical function (HAQ, 0-3 best to worst). ESR and CRP. Patients were dichotomized as being active on recommended levels of PA (MVPArec; physically active on a moderate level ≥150min/week (MPA) or on an intense level ≥75min/week (VPA)) or not (sedentary). The patients were grouped on self-reported working ability; workers, patients with sick-leave and retired patients. Qualitative data was collected by a questionnaire with open-ended questions about reasons influencing PA. The qualitative data was analysed with a manifest qualitative content analysis to gain a greater understanding of patients’ experiences of PA in early RA. Results: There were no significant differences between the groups in disease activity, physical function, swollen joints, health-related quality of life or inflammatory parameters (ESR, CRP). Patients on sick-leave had more tender joints median (min-max) 9 (2-18) vs. 4 (0-20) and 3 (0-10), p=0.013. Workers reported higher intensity of pain, though not significant. Retired patients fulfilled MVPA criteria to a higher rate (86%) than workers (42%) or patients with sick-leave (40%), p=0.010. The qualitative content analysis resulted in three categories. Reasons to being physically active in patients with early RA were; limitations (pain, physical function, stiffness, limited strength and fatigue), awareness as motivation (fear of movement and health benefits) and external environment (weather, transports to activity, economy and time, especially for workers). Conclusion: Knowledge of reasons to being physically active in patients with RA is important to facilitate and support the patients. Joint pain seems to be an issue for patients with sick-leave. This could be associated to fear of movement and in this aspect these patients need to be supported. Time could be a limiting issue for working patients, which need to be highlighted and solved for these patients. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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| 2. |
- Adman, Per, et al.
(författare)
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171 forskare: ”Vi vuxna bör också klimatprotestera”
- 2019
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Ingår i: Dagens nyheter (DN debatt). - Stockholm. - 1101-2447.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- DN DEBATT 26/9. Vuxna bör följa uppmaningen från ungdomarna i Fridays for future-rörelsen och protestera eftersom det politiska ledarskapet är otillräckligt. Omfattande och långvariga påtryckningar från hela samhället behövs för att få de politiskt ansvariga att utöva det ledarskap som klimatkrisen kräver, skriver 171 forskare i samhällsvetenskap och humaniora.
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| 3. |
- Aili, Katarina, et al.
(författare)
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Sleep problems and fatigue as a predictor for the onset of chronic widespread painover a 5- and 18-year perspective : a 20-year prospective study
- 2018
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 77, s. 87-87
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Tidskriftsartikel (refereegranskat)abstract
- Background: If localised pain represent one end of a pain spectra, with overall better general health, chronic widespread pain (CWP) and fibromyalgia represent the other end of the spectra with worse general health and more comorbidities with other somatic diseases and mental illness. Sleep problems and fatigue are common among individuals reporting CWP and previous research indicate that sleep problems may be an important predictor for pain prognosis.Objectives: The aim of this population-based study was to investigate if sleep problems and fatigue predict the onset of CWP 5 and 18 years later.Methods: In order to get more stable baseline classifications of CWP, a wash-out period was used, including only individuals who had not reported CWP (according to ACR 1990 criteria for fibromyalgia) at baseline (−98) and three years prior baseline (−95). In all, data from 1249 individuals entered the analyses for the 5 year follow-up (−03) and 791 entered for the 18 year follow-up (−16). Four parameters related to sleep (difficulties initiating sleep, maintaining sleep, early morning awakening and non-restorative sleep), and one parameter related to fatigue (SF-36 vitality scale) were investigated as predictors for CWP. Binary logistic regression analysis were used for analyses.Results: All investigated parameters predicted the onset of CWP five years later (problems with initiating sleep (OR 1.91; 1.16–3.14), maintaining sleep (OR 1.85; 1.14–3.01), early awakening (OR 2.0; 1.37–3.75), non-restorative sleep (OR 2.27; 1.37–3.75) and fatigue (OR 3.70; 1.76–7.84)) in a model adjusted for age, gender, socio-economy and mental health. All parameters except problems with early awakening predicted the onset of CWP also 18 years later. In all, 785 individuals did not report any of the sleeping problems at baseline (fatigue not included), 268 reported one of the problems, 167 two, 128 three and 117 subjects reported to have all four sleep problems. Reporting all four sleep problems was significantly associated with CWP at follow-up at both time points when adjusting for age, gender, socio economy and mental health (OR 4.00; 2.03–7.91 and OR 3.95; 1.90–8.20); adjusting for age, gender, socio economy and number of pain regions (OR 2.94; 1.48–5.82 and OR 2.65; 1.24–5.64) and in a model adjusting for age, gender, socio economy and pain severity (OR 2.97;1.53–5.76; and OR 3.02;1.47–6.21) for the 5 year and 18 year follow-up respectively, compared to not reporting any of the sleep problems at baseline.Conclusions: Both sleeping problems and fatigue predicts the onset of CWP 5- and 18 years later. The results highlight the importance of the assessment of sleep quality in the clinic.
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| 4. |
- Aili, Katarina, 1980-, et al.
(författare)
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Sleep problems and fatigue as predictors for the onset of chronic widespread pain over a 5-and 18-year perspective
- 2018
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Ingår i: Bmc Musculoskeletal Disorders. - London : Springer Science and Business Media LLC. - 1471-2474. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrevious research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline.MethodsTo get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses.ResultsThe results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other.ConclusionSleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.
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| 5. |
- Andersson, Maria L.E. 1968-, et al.
(författare)
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Reasons to stop drinking alcohol among patients with rheumatoid arthritis – a mixed method study
- 2016
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 75:Suppl 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of alcohol use in patients with rheumatoid arthritis are sparse and studies of why patients choose to stop drinking alcohol in particular.Objectives: The aim of the current study was twofold: first to identify patients with RA who stopped drinking alcohol and compare those to patients drinking alcohol, and second, to explore reasons to stop drinking alcohol.Methods: In 2010 a self-completion postal questionnaire was sent to all 2,102 prevalent patients in the Better anti-rheumatic farmacotherapy (BARFOT) study enquiring about disease severity, physical function (HAQ) and health related quality of life (EQ5D), pain, fatigue, patient global assessment (PatGA) and lifestyle factors e.g. alcohol. The questions assessing alcohol included the question “Have you stopped drinking alcohol?” and an open question “Why have you stopped drinking alcohol?” A mixed method design was used and 1512 patients had answered the alcohol questions and was included in the study of those 86 had stopped drinking alcohol. Seventy-one patients answered the open question and their answers were analyzed with qualitative content analysis (1).Results: Comparing patient with RA using alcohol or not, the patients who stopped drinking alcohol was older median age (min-max) 69 (36–90) vs. 66 (23–95), p=0.011, more men 42% vs. 29%, p=0.015, had worse physical function, median HAQ (min-max) 0.50 (0–3.00) vs. 1.00 (0–2.75), p<0.001, worse health related quality of life, median EQ5D (min-max), 0.69 (-0.59–1.00) vs. 0.76 (-0.02–1.00), p<0.001, worse self-perceived health, median PatGA (min-max) 5 (0–10) vs. 3 (0–10), <0.001, more pain, median (min-max) 5 (0–10) vs. 3 (0–10), p<0.001, and more fatigue median (min-max) 6 (0–10) vs 4 (0–10), p<0.001. There were no differences between the groups regarding disease duration, swollen and tender joints. The qualitative content analysis resulted in five categories describing the reasons for patient with RA to stop drinking alcohol: disease and treatment, health and wellbeing, work and family, faith and belief and dependences and abuse.Conclusions: Patients with RA who stopped drinking alcohol have a lower physical function, health related quality of life, self-perceived health and more pain and fatigue comparing to patients with RA drinking alcohol. The reasons to stop drinking alcohol were of different nature such as medical, physical, mental, social and spiritual
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| 6. |
- Malm, Karina, et al.
(författare)
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Quality of Life in Patient with Established Rheumatoid Arthritis : A Qualitative Study
- 2016
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group Ltd. - 0003-4967 .- 1468-2060. ; 75:Suppl 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fatigue, pain, stiffness and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) that may affect quality of life. Quality of life is an individual experience composed of a wide range of factors, including physical health, psychological state, level of independence, social relationships, and the patients' relationship to salient features of their environment. There is a need to describe and assess quality of life in chronic diseases like established RA. Previous research has mainly focused on disease-specific instruments for assessing quality of life. A deeper understanding of patients' experience of quality of life in established RA is important in both clinical research and daily clinical practice.Objectives: To describe variations in patients' experiences of quality of life in established RA.Methods: The study had a qualitative design with a phenomenographic approach, including 22 interviews with patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort, BARFOT, a long time follow up study of early RA. Patients were strategically selected by gender (14 women and 8 men), age (30 to 84 years old), disease duration (8–23 years), function as measured by HAQ (0–1.38), and quality of life as measured by EQ5D (0.52–1.00). The interviews were recorded, transcribed verbatim and coded into categories.Results: Four categories emerged from the patients' experiences of quality of life in established RA: well-being, freedom, empowerment, and participation. Quality of life as well-being meant pleasure and being physical active. Quality of life as freedom meant dependence or independence in the ability to manage daily life activities. Quality of life as empowerment meant different coping strategies, such as positive thinking and resources to manage fatigue, pain and physical function. Quality of life as participation meant togetherness in different contexts with other people.Conclusions: Quality of life in established RA could be understood by the patients in different ways. The patients experienced quality of life as well-being, freedom, empowerment, and participation. This is important knowledge when evaluating the concept of quality of life in RA research, and for health professionals when promoting quality of life in patients with RA.
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| 7. |
- Malm, Karina, et al.
(författare)
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THU0628-HPR Lifestyle Habits Relates to Quality of Life in Patient with Longstanding Rheumatoid Arthritis
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Books. - 0003-4967 .- 1468-2060. ; 74:Suppl. 2, s. 1318-1318
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fatigue, pain, stiffness, impaired muscle function and impaired physical function are some of the most pronounced symptoms in rheumatoid arthritis (RA) and these may be related to lifestyle habits such as physical activity, diet, smoking and alcohol.There is limited knowledge about how patient with longstanding RA understand their lifestyles habits in relation to their disease and quality of life.Objectives: To describe experiences of how lifestyle habits relate to quality of life in patients with longstanding RA. Methods: A qualitative study with a deductive content analysis design, including 17 patients from the Swedish BARFOT (Better Anti-Rheumatic FarmacoTherapy) cohort. BARFOT is a long time follow up study of early RA. Informants were strategically selected by gender (ten women and seven men), age (range 30-84 years), disease duration (8-23 years), function as measured by HAQ, and quality of life as measured by EQ5D. Semi-structured interviews focused on four lifestyle habits (main categories); Physical activity, Diet, Smoking, and Alcohol. The interviews were recorded, transcribed verbatim and coded into subcategories within each of the four main categories.Results: In patients with longstanding RA quality of life was related to the four given main categories (lifestyle habits). Each main category included two to three subcategories; (1) Physical activity means barrier, opportunities and well-being, (2) Diet means shame, well-being and social relationship, (3) Smoking means reward and fear, and (4) Alcohol means ambivalence and social relationship.Conclusions: In longstanding RA, lifestyle habits relates to quality of life through both positive and negative experiences. This has to be taken into account in clinical care for a better understanding of how patients conceive and adherer to advice on lifestyle.References: Scott DL, Wolfe F, Huizinga TW. Rheumatoid arthritis. Lancet. 2010;376(9746):1094-108.Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative health research. 2005;15(9):1277-88.
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| 8. |
- Nicholls, Thomas J., et al.
(författare)
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Topoisomerase 3α Is Required for Decatenation and Segregation of Human mtDNA
- 2018
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Ingår i: Molecular Cell. - : Elsevier BV. - 1097-2765 .- 1097-4164. ; 69:1
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Tidskriftsartikel (refereegranskat)abstract
- How mtDNA replication is terminated and the newly formed genomes are separated remain unknown. We here demonstrate that the mitochondrial isoform of topoisomerase 3α (Top3α) fulfills this function, acting independently of its nuclear role as a component of the Holliday junction-resolving BLM-Top3α-RMI1-RMI2 (BTR) complex. Our data indicate that mtDNA replication termination occurs via a hemicatenane formed at the origin of H-strand replication and that Top3α is essential for resolving this structure. Decatenation is a prerequisite for separation of the segregating unit of mtDNA, the nucleoid, within the mitochondrial network. The importance of this process is highlighted in a patient with mitochondrial disease caused by biallelic pathogenic variants in TOP3A, characterized by muscle-restricted mtDNA deletions and chronic progressive external ophthalmoplegia (CPEO) plus syndrome. Our work establishes Top3α as an essential component of the mtDNA replication machinery and as the first component of the mtDNA separation machinery. Nicholls et al. identify a role for topoisomerase 3α in the separation of mtDNA following replication. Loss of Top3α activity impairs mtDNA segregation and, consequently, segregation of the mtDNA nucleoid within the mitochondrial network. Mutations in TOP3A cause human mitochondrial disease associated with mtDNA deletions and impaired mtDNA separation. © 2017 Elsevier Inc.
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| 9. |
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| 10. |
- Qvarfordt, Maria, 1982-, et al.
(författare)
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Factors influencing physical activity in patients with early rheumatoid arthritis : A mixed-methods study.
- 2019
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Ingår i: SAGE Open Medicine. - Thousand Oaks, CA : Sage Publications. - 2050-3121. ; 7, s. 1-11
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoid arthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture of rheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with early rheumatoid arthritis.Methods: A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatory mixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann-Whitney, post hoc Kruskal-Wallis and χ2 test in order to detect differences between groups, and find possible associations between physical activity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative data were collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity.Results: Associations between physical activity, disease activity and health-related quality of life were seen in patients with early rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patients on sick leave showed the strongest associations between disease-related variables and lower levels of physical activity. The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and external environment factors influenced physical activity in patients with early rheumatoid arthritis.Conclusion: The results showed a complex underlying motive where physical, psychological and environmental factors influenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective health interventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approach should be considered. Factors such as physical limitations, economic aspects and time for practicing physical activity should be included in the person-centred approach.
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