| 1. |
- Austeng, Dordi, et al.
(författare)
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Incidence of and risk factors for neonatal morbidity after active perinatal care : extremely preterm infants study in Sweden (EXPRESS)
- 2010
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 99:7, s. 978-992
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage >= 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted.
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| 2. |
- Bergstrand, Sara, et al.
(författare)
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Existence of Tissue Blood Flow in Response to External Pressure in the Sacral Region of Elderly Individuals - Using an Optical Probe Prototype
- 2010
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Ingår i: MICROCIRCULATION. - : Taylor and Francis. - 1073-9688 .- 1549-8719. ; 17:4, s. 311-319
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Tidskriftsartikel (refereegranskat)abstract
- Pandgt;Objective: The aim was to investigate the existence of sacral tissue blood flow at different depths in response to external pressure and compression in elderly individuals using a newly developed optical probe prototype. Methods: The tissue blood flow and tissue thickness in the sacral area were measured during load in 17 individuals using laser Doppler flowmetry and photoplethysmography in a combined probe, and digital ultrasound. Results: The mean age was 68.6 +/- 7.0 years. While loading, the mean compression was 60.3 +/- 11.9%. The number of participants with existing blood flow while loading increased with increased measurement depth. None had enclosed blood flow deep in the tissue and at the same time an existing more superficial blood flow. Correlation between tissue thickness and BMI in unloaded and loaded sacral tissue was shown: r = 0.68 (P = 0.003) and r = 0.68 (P = 0.003). Conclusions: Sacral tissue is highly compressed by external load. There seems to be a difference in responses to load in the different tissue layers, as occluded blood flow in deeper tissue layers do not occur unless the blood flow in the superficial tissue layers is occluded.
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| 3. |
- Bergstrand, Sara, et al.
(författare)
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Pressure-induced vasodilation and reactive hyperemia at different depths in sacral tissue under clinically relevant conditions
- 2014
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Ingår i: Microcirculation. - : John Wiley & Sons. - 1073-9688 .- 1549-8719. ; 21:8, s. 761-771
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To characterize pressure-induced vasodilatation and reactive hyperemia at different sacral tissue depths in different populations under clinically relevant pressure exposure.METHODS: Forty-two subjects (< 65 years), 38 subjects (≥ 65 years), and 35 patients (≥ 65 years) participated. Interface pressure, skin temperature, and blood flow at tissue depths of 1 mm, 2 mm, and 10 mm (using laser Doppler flowmetry and photoplethysmography) were measured in the sacral tissue before, during, and after load in a supine position.RESULTS: pressure-induced vasodilatation and reactive hyperemia were observed at three tissue depths. At 10 mm depth, the proportion of subjects with a lack of pressure-induced vasodilatation was higher compared to superficial depths. The patients had higher interface pressure during load than the healthy individuals, but there were no significant differences in blood flow. Twenty-nine subjects in all three study groups were identified with a lack of pressure-induced vasodilatation and reactive hyperemia.CONCLUSIONS: pressure-induced vasodilatation and reactive hyperemia can be measured at different tissue depths. A lack of these responses was found in healthy individuals as well as in patients indicating an innate susceptibility in some individuals, and are potential important factors to evaluate in order to better understand the etiology of pressure ulcers.
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| 4. |
- Bergstrand, Sara, 1978-
(författare)
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Preventing pressure ulcers by assessment of the microcirculation in tissue exposed to pressure
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to combine optical methods into a system with the ability to simultaneously measure blood flow changes at different tissue depths. The goal of such a system was to reveal vascular mechanisms relevant to pressure ulcer etiology under clinically relevant conditions and in relation to the evaluation of pressure-redistribution support surfaces.This thesis consists of four quantitative, cross-sectional studies measuring blood flow responses before, during, and after pressure exposure of the sacral tissue. Two optical methods – photoplethysmography and laser Doppler flowmetry – were combined in a newly developed system that has the ability to discriminate blood flows at different tissue depths. Studies I and II explored blood flow responses at different depths in 17 individuals. In Study I the blood flow was related to tissue thickness and tissue compression during pressure exposure of ≥ 220 mmHg. In Study II, the sacral tissue was loaded with 37.5 mmHg and 50.0 mmHg, and the variation in blood flow was measured. Studies III and IV included 42 healthy individuals < 65 years, 38 healthy individuals ≥ 65 years, and 35 patients ≥ 65 years. Study III included between-subject comparisons of blood flow and pressure between individuals in the three study groups lying in supine positions on a standard hospital mattress. Study IV added within-subject comparisons while the individual was lying on four different types of mattress. The studies explored the vascular phenomena pressure-induced vasodilation (PIV) and reactive hyperemia (RH).The most common blood flow response to tissue exposure in this thesis was PIV, although a decrease in blood flow (a lack of PIV) was observed in some individuals. The patients tended to have higher interface pressure during pressure exposure than the healthy groups but no differences in blood flow responses were seen. Our results showed that pressure levels that are normally considered to be harmless could have a significant effect on the microcirculation in different tissue structures. Differences in individual blood flow responses in terms of PIV and RH were seen, and a larger proportion of individuals lacked these responses in the deeper tissue structures compared to more superficial tissue structures.This thesis identified PIV and RH that are important vascular mechanisms for pressure ulcer development and revealed for the first time that PIV and RH are present at different depths under clinically relevant conditions. The thesis also identified a population of individuals not previously identified who lack both PIV and RH and seem to be particularly vulnerable to pressure exposure. Further, this thesis has added a new perspective to the microcirculation in pressure ulcer etiology in terms of blood flow regulation and endothelial function that are anchored in clinically relevant studies. Finally, the evaluation of pressureredistribution support surfaces in terms of mean blood flow during and after tissue exposure was shown to be unfeasible, but the assessment of PIV and RH could provide a new possibility for measuring individual physiological responses that are known to be related to pressure ulcer development.
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| 5. |
- Carlfjord, Siw, et al.
(författare)
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Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study
- 2011
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Ingår i: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. - : MDPI AG. - 1660-4601. ; 8:2, s. 498-513
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Tidskriftsartikel (refereegranskat)abstract
- The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with. free from tobacco in connection with surgery., and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.
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| 6. |
- Ekberg, Margareta Stigsdotter, 1955-
(författare)
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Dom kallar oss värstingar : Om ungas lärande i mötet med skola, socialtjänst och polis
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is of primary concern, both from the perspective of the individual and of society at large, to take measures to prevent the occurrence of a negative development amongst young people. The starting point of this dissertation is the notion that interpersonal interactions that occur between people contribute to a process of learning, thus focus is placed upon the pedagogic interactions between society's authorities and young people in trouble. How such interactions contribute to the process of learning regarding the young people, and what that learning entails, is seen as a vital pedagogic question. The overriding aim of the dissertation is to identify aspects of learning that occur during the interactions between society's authorities and young people in trouble, in order to contribute to an understanding of how such interactions can be developed in a constructive manner.The thesis is based on the theories of man as a social being, dependent on relationships and interaction for the process of knowledge. The empirical study includes interviews with teachers, social workers, police officers and young people. Vignettes have formed the basis of discussions about the measures and initiatives taken by society and the types of experience the young people feel the measures and initiatives have led to. Since an element of authority is a component of the relationship between the representatives of society and the young people, the concept of governmentality formulated by Foucault has been used in the process of analysis. Also von Wright's concepts of punctual and relational perspective have been used in this process. The purpose of this study is to attempt to determine what consequences the various perspectives taken in the interactions may lead to, in relation to the knowledge these young people develop about themselves and about society.The result shows that society's representatives among themselves have different views of young people in trouble. Young people's experiences of interactions with society's representatives argue for the fact that their backgrounds often direct the course of the interaction and its contents. Young people testify about irrelevant measures and initiatives taken by society; that they are subject to prejudice and that the principle of "equality before the law" is not observed. Their experience has led them to feel that they have less of human dignity. The dissertation ends up in a discussion about the prerequisites necessary, in order that pedagogic interactions between a person in authority and young people in difficulties may proceed from a relational perspective. The ability to take the young person's perspective would thereby be a central aspect in the discussion about what measures and initiatives taken by society are appropriate to change a troubled lifestyle.
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| 7. |
- Hagblad, Jimmie, et al.
(författare)
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A technique based on laser Doppler flowmetry and photoplethysmography for simultaneously monitoring blood flow at different tissue depths
- 2010
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Ingår i: Medical and Biological Engineering and Computing. - : Springer Science Business Media. - 0140-0118 .- 1741-0444. ; 48:5, s. 415-422
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to validate a non-invasive optical probe for simultaneous blood flow measurement at different vascular depths combining three photoplethysmography (PPG) channels and laser Doppler flowmeter (LDF). Wavelengths of the PPG were near-infrared 810 nm with source-to-detector separation of 10 and 25 mm, and green 560 nm with source-to-detector separation of 4 mm. The probe is intended for clinical studies of pressure ulcer aetiology. The probe was placed over the trapezius muscle, and depths from the skin to the trapezius muscle were measured using ultrasound and varied between 3.8 and 23 mm in the 11 subjects included. A provocation procedure inducing a local enhancement of blood flow in the trapezius muscle was used. Blood flows at rest and post-exercise were compared. It can be concluded that this probe is useful as a tool for discriminating between blood flows at different vascular tissue depths. The vascular depths reached for the different channels in this study were at least 23 mm for the near-infrared PPG channel (source-to-detector separation 25 mm), 10-15 mm for the near-infrared PPG channel (separation 10 mm), and shallower than 4 mm for both the green PPG channel (separation 4 mm) and LDF.
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| 8. |
- Hedhammar, Åke, et al.
(författare)
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Energy-intake and activity risk factors for owner-perceived obesity in a defined population of Swedish dogs
- 2010
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Ingår i: Preventive Veterinary Medicine. - : Elsevier BV. - 0167-5877 .- 1873-1716. ; 96, s. 132-141
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Tidskriftsartikel (refereegranskat)abstract
- Our main objective was to obtain baseline data on daily metabolisable energy (ME) intake, activity, and risk factors for obesity in a population of 460 privately owned Swedish dogs in 1999. A previously validated mail-and-telephone questionnaire was used (Sallander et al., 2001a). The dogs were of 124 breeds, 1-3 years old, and had body weights (BW) between 1 and 75 kg. The ME intakes of this population could be described with the equation ME(intake) (kilojoules, kJ/d) = 554BW(0.66) (r(sp) = 0.73, P=0.0001). The energy intake originating from commercial foods was 79% (median, range 45-97). Table foods generally had a higher fat content (median 13 g/megajoule, MJ, range 1-122) than commercial foods (median 8 g/MJ, range 2-18; P = 0.0001). The median energy density was 1603 kJ/100 g (median; range 1106-2105).Almost all (97%) dogs were taken for walks, and there was a significant difference between the duration of the walks during weekdays and weekends (medians 60 and 90 min/d, respectively, P = 0.006). Sixty percent of all dogs were trained in activities such as obedience (31%), hunting (27%) or tracking (18%) for a median of 35 min/d (range 1-146).The final regression model for obesity included the factors sex, appetite and feeding a home-made diet/table foods. Dogs that were perceived to have good or very good appetite had 3.42-fold greater odds for obesity than individuals with bad or very bad appetite (95% CI 1.19-9.80; P = 0.022). Females had 2.17-fold greater odds of being obese than males did (95% CI 1.30-3.70; P = 0.003). Also, dogs fed table foods or home-made diets had 2.06-fold greater odds of obesity than those that were not given these food items (95% CI 0.97-4.35; P = 0.050). (C) 2010 Elsevier B.V. All rights reserved.
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| 9. |
- Hedhammar, Åke, et al.
(författare)
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Feeding patterns and dietary intake in a random sample of a Swedish population of insured-dogs
- 2010
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Ingår i: Preventive Veterinary Medicine. - : Elsevier BV. - 0167-5877 .- 1873-1716. ; 95, s. 281-287
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Tidskriftsartikel (refereegranskat)abstract
- We used a validated mail and telephone questionnaire to investigate baseline data on feeding patterns and dietary intake in a random sample of 460 Swedish dogs. In 1999, purebred individuals 1-3 years old in the largest insurance database of Sweden completed the study.Most dogs were fed restricted amounts twice a day, and the feeding patterns seldom were changed after the age of 6 months. Typically, the main constituent of the meals was dry food [representing 69% of dry matter (DM)]. Four out of five dogs also got foods that (in descending order of the amount of energy provided) consisted of vegetable oil, meat, sour milk, bread, potatoes, pasta, lard/tallow, sausage, cheese, rice and fish.The heavier the dog (kg), the more dry dog food was consumed (g DM/d). The dry-food intakes (g DM/d) increased linearly with body weight (BW, in kg): intake = -15.3 + 8.33 BW (P = 0.0001; r = 0.998), a clear relationship that was not observed for other commercial foods.The non-commercial part of the diet had higher fat (13 and 8 g/megajoule, MJ, respectively; P = 0.00001) and lower protein (12 and 16 g/MJ, respectively; P = 0.00001) compared to the commercial part of the diet. Six out of ten dogs were given treats, and one-fourth was given vitamin/mineral supplements (most commonly daily).Most dogs consumed diets that were nutritionally balanced. No dogs in the study consumed diets that supplied lower amounts of protein than recommended by the NRC (2006). Only two individuals (<1%) were given total diets that were lower than the nutrient profiles in fat. Few dogs consumed total diets that were lower than recommended by the NRC (2006) in calcium, phosphorus, and vitamins A, D and E (2, 1, 3, 5, and 3% of the individuals, respectively). A few individuals consumed higher levels of vitamins A and D (<1 and 4%, respectively) than recommended.Diets that deviated from recommended levels were those consisting of only table foods with no supplements (too-low in vitamins and minerals) or commercial foods + no table foods supplied with extra vitamin and mineral supplements (too-high in vitamins and minerals). (C) 2010 Elsevier B.V. All rights reserved.
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| 10. |
- Igelström, Helena, 1976-, et al.
(författare)
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Level of agreement between methods for measuring moderate-to-vigorous physical activity and sedentary time in people with obstructive sleep apnea and obesity
- 2013
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 93:1, s. 50-59
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is ambiguity about what measures to use to best identify physical activity and sedentary behavior, and agreement between methods for measuring physical activity and sedentary behavior in people with obstructive sleep apnea syndrome (OSAS) and obesity has not been evaluated.ObjectiveThe objective of this study was to examine the level of agreement between an accelerometer and a self-report questionnaire (International Physical Activity Questionnaire [IPAQ]) or a logbook for measuring time spent on moderate to vigorous physical activity and time spent sedentary in people with OSAS and obesity.DesignThis prospective study was a psychometric evaluation of agreement between measurement methods.MethodsThirty-nine people who were obese (mean body mass index 36.1 kg/m2, SD=4.35) and had moderate to severe OSAS (apnea-hypopnea index of ≥15) were consecutively recruited from a sleep clinic in Sweden. All were treated with continuous positive airway pressure and were waiting for a follow-up sleep evaluation.ResultsAgreement between the measurement methods was limited. For physical activity, the mean difference between the accelerometer and the IPAQ was 47 minutes, and the mean difference between the accelerometer and the logbook was 32 minutes. Agreement was limited for sedentary time as well; the mean difference between the accelerometer and the IPAQ was 114 minutes, and the mean difference between the accelerometer and the logbook was 86 minutes.LimitationsThe small sample size may affect the interpretation and generalizability of the results.ConclusionsThe results imply that the methods cannot be used interchangeably. A combination of an accelerometer and a daily logbook seems to provide a detailed description of physical activity and sedentary behavior.
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