| 21. |
- Petersson, Kerstin, et al.
(författare)
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A randomized controlled study evaluating the head-lift exercise in head and neck cancer patients with radiation-induced dysphagia: effect on swallowing function and health-related quality of life over 12 months
- 2023
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Ingår i: European Archives of Oto-Rhino-Laryngology. - 0937-4477. ; 280:12, s. 5445-5457
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Tidskriftsartikel (refereegranskat)abstract
- PurposeDysphagia is common after radiotherapy for head and neck cancer (HNC) and can affect health-related quality of life (HRQL). This randomized controlled trial aimed to evaluate the effect of the head-lift exercise (HLE) over 12 months in HNC patients with radiation-induced dysphagia.MethodsSixty-one patients with dysphagia were randomized to intervention group (n = 30) and control group (n = 31) at 6-36 months after completion of radiotherapy for HNC. Dysphagia-specific HRQL was measured with the MD Anderson Dysphagia Inventory (MDADI); general and HNC-specific HRQL was measured with the European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30) and QLQ-H & N35. Measurements were made at baseline, and at 8 weeks and 12 months after start of intervention.ResultsAdherence to the intervention was good throughout the year. When comparing change from baseline reports to each follow-up no statistically significant differences between the groups were found in any of the HRQL instruments. There were some statistically significant changes within groups compared to baseline. The intervention group improved self-rated swallowing function on the MDADI at 8 weeks (emotional domain, p = 0.03; functional domain, p = 0.007; total score, p = 0.01) and the control at twelve months (emotional domain, p = 0.03; functional domain, p = 0.02; physical domain, p = 0.004; total score, p = 0.002).ConclusionIn this randomized control study, no effect was observed short term or at 12 months on HRQL after use of the HLE as rehabilitation for radiation-induced dysphagia.
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| 22. |
- Petersson, Kerstin, et al.
(författare)
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Predictors of severe dysphagia following radiotherapy for head and neck cancer
- 2021
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Ingår i: Laryngoscope Investigative Otolaryngology. - : Wiley. - 2378-8038. ; 6:6, s. 1395-1405
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Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate if severe dysphagia following radiotherapy for head and neck cancer (HNC) could be predicted by patient and tumor characteristics, feeding tube use, weight factors, jaw opening function, and saliva secretion. Methods Data was collected from 94 HNC patients 6 to 36 months post radiotherapy. Swallowing function was assessed by videofluroscopy (VFS). Severe dysphagia was defined by Penetration Aspiration Scale (PAS) as PAS >= 5 or a total score <= 60 on the M. D. Anderson Dysphagia Inventory (MDADI). Results Thirty-three patients (35%) had PAS >= 5 and 19 (20%) a MDADI <= 60, that is, presented with severe dysphagia. Univariable logistic regression analysis (UVA) gave that tumor of the tonsil, overweight at time of VFS and each unit increase in Body Mass Index (BMI) predicted less risk of PAS >= 5. Dependency of feeding tube at time of VFS and each month's continued use and weight loss >= 7.5% since treatment to time of VFS predicted increased risk of PAS >= 5. Predictive variables from the UVA of PAS >= 5 (tumor of the tonsil, overweight, and total duration of feeding tube), were analyzed by multivariate logistic regression analysis. All retained power as independent predictors. UVA for MDADI showed that use of feeding tube at time of VFS predicted MDADI <= 60 with the risk increasing each month. Each increasing unit of BMI decreased risk of MDADI <= 60. Conclusion Long time users of feeding tube and higher weight-loss are at risk of severe dysphagia. This makes collaboration between professionals working with dysphagia an important step in detecting severe dysphagia. Level of Evidence: 3.
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| 23. |
- Ramfelt, Kerstin, et al.
(författare)
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Experiences From a Coaching Program for Parents of Children and Adolescents With Type 1 Diabetes Developed Through Experienced-Based Co-Design (EBCD)
- 2020
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Ingår i: Journal of Patient Experience. - : Sage Publications. - 2374-3735 .- 2374-3743. ; 7:6, s. 1181-1188
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Tidskriftsartikel (refereegranskat)abstract
- Many children and adolescents with type 1 diabetes (T1D) have difficulties reaching the national treatment goal for HbA1c (long-term blood sugar) which is associated with increased risk for complications. This makes it important to explore what patients and their caregivers describe important in coping with everyday life. The study has been conducted within a pediatric diabetes team in the south of Sweden. The aim was to explore how Experienced-Based Co-Design (EBCD) can be used to identify, test, and evaluate improvement efforts in order to support the family with a child with T1D. A modified variant of EBCD based on focus groups, workshops, and interviews with stakeholders was used. The improvement proposal parental coaching was tested and was appreciated by the participants. The qualitative content analysis of the interviews showed that the coaching program contributed to better confidence and self-efficacy. Both coaches and coachees described that the coaching contributed to better competence and a feeling of hope after attending the coach program. Experienced-Based Co-Design gave an opportunity to explore what?s important to improve, based on experiences and needs of several stakeholders.
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| 24. |
- Ramfelt, Kerstin, et al.
(författare)
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'It's like a never-ending diabetes youth camp' : Co-designing a digital social network for young people with type 1 diabetes.
- 2023
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 26:2, s. 662-669
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Living with a chronic condition such as type 1 diabetes (T1D) affects everyday life and support from others experiencing a similar situation can be helpful. A way to receive such support is to use an online network where people can connect and share experiences. Research has described the benefits of using such tools for connecting patients. The aim of this study was to describe the co-design of a social network for young people with T1D and to describe their experiences when using this network.METHODS: A co-design approach was used, following three steps adapted from Sanders and Stappers (2008). In all, 36 adolescents with T1D participated. Data in the form of recordings and notes from telephone interviews, workshops and focus groups were collected and then analysed using content analysis. Numerical data from the digital platform were also used.FINDINGS: For the interpersonal values, supporting, learning and relating to emerge, the framework of the network must be appealing and user-friendly. The limits of time and place are eliminated, and there is a possibility for many more to join in.CONCLUSION: Co-design ensures that what stakeholders think is important forms the basis for the design. The interpersonal values that are promoted are ones that only the exchange of lived knowledge and experience can generate. It is complementary to the support that healthcare professionals can offer; thus, this kind of social network is important for improved, coproduced care.PATIENT OR PUBLIC CONTRIBUTION: The participants in the present study were persons living with T1D. They were active co-creators from the start to the end. An adult person with experience of living with T1D was involved as an advisor in the research team when drafting the manuscript.
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| 25. |
- Tuomi, Lisa, 1985, et al.
(författare)
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The effect of the Shaker head-lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation
- 2022
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Ingår i: Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. - : Wiley. - 1043-3074 .- 1097-0347. ; 44:4, s. 862-875
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Tidskriftsartikel (refereegranskat)abstract
- Background Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head-lift exercise (HLE) to improve dysphagia in HNC patients. Methods Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration-aspiration, initiation, residue, movement of selected structures, and self-perceived swallowing function, before and after 8 weeks of treatment, were compared. Results Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within-group changes were found. Self-perceived swallowing function improved in the intervention group. Conclusions In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.
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| 26. |
- Uvnäs-Moberg, Kerstin, et al.
(författare)
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Neuroendocrine mechanisms involved in the physiological effects caused by skin-to-skin contact - With a particular focus on the oxytocinergic system
- 2020
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Ingår i: Infant Behavior and Development. - : Elsevier. - 0163-6383 .- 1879-0453 .- 1934-8800. ; 61:November
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Forskningsöversikt (refereegranskat)abstract
- The positive clinical effects caused by skin-to-skin contact immediately after birth or after repeated skin-to-skin contact of premature infants (kangaroo care) or fullterm infants are well documented in the literature. However, information regarding the physiological mechanisms mediating these effects are surprisingly scarce and incomplete. In this article the oxytocinergic system and the cutaneous sensory pathways by which the oxytocinergic system is activated in response to skin-to-skin contact are presented in more detail. In addition, we discuss how the effects of skin-to-skin treatment can be attributed to different aspects of the effect spectrum of the oxytocinergic or calm and connection system.The structure of the oxytocinergic system, comprising the peripheral (circulating, hormonal) and the central (neurotransmitter) components, as well as, the pathways and mechanisms by which these functions are coordinated are described. Also the various effects induced by the oxytocinergic system (the calm and connection system) are reviewed.The sensory pathways, which include visual, auditory, olfactory and tactile stimuli, given and received by both mother and newborn and which activate the oxytocinergic system in response to skin-to-skin contact, are reviewed. A special emphasis is placed on the role of cutaneous sensory nerves and their activation by touch, light pressure and in particular warmth. The important role of the rise and the pulsatility of maternal temperature in mediating the positive effects of skin-to-skin contact in the newborn is highlighted. The concept of maternal giving of warmth and its possible link to the experience of trust and safety in the newborn is discussed from an evolutionary perspective.The effects induced by skin-to-skin contact can be attributed to the different functions of the oxytocinergic system. Ameliorated social interaction (e.g., more tactile and auditory interaction, more sensitive and synchronous interaction between mother and baby, the baby’s crawling behavior) are expressions of oxytocin’s ability to stimulate social interaction. The decreased levels of fear and stress are expressions of oxytocin’s ability to reduce the activity of the amygdala and of the stress system, e.g. the activity in the HPA-axis and the sympathetic nervous system. Increased HRV, increased activity in endocrine system of the gastrointestinal tract as well as stimulation of growth and maturation are examples of oxytocin’s ability to stimulate the activity of the parasympathetic nervous system and other peripheral and central mechanisms related to restoration and growth.The propensity of different types of treatment with skin-to-skin contact to induce long-term effects is also highlighted. We propose that the sustained effects caused by skin-to-skin contact are induced by an enduring shift in the balance between the oxytocinergic system (the calm and connection system) and the stress system (fight flight reaction) in favor of the oxytocinergic system. This shift leads to a sustained decrease in the HPA-axis and the sympathetic nervous system probably involving alpha 2-adrenoceptors.It is of clinical importance to be aware of the mechanisms by which skin-to-skin contact induces short and longterm positive effects in parents and newborns. If ward routines are adapted to ascertain a maximal stimulation of these mechanisms, the function of the oxytocinergic system will be optimized, which will be linked to a better clinical outcome for parents and newborns.
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| 27. |
- Uvnäs-Moberg, Kerstin, et al.
(författare)
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Physiological effects induced by stimulation of cutaneous sensory nerves, with a focus on oxytocin
- 2022
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Ingår i: Current Opinion in Behavioral Sciences. - : Elsevier BV. - 2352-1546. ; 43, s. 159-166
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Tidskriftsartikel (refereegranskat)abstract
- Gentle touch is mediated by CT afferents and is linked to the experience of pleasure by effects in the insular cortex. It is also associated with some antistress effects, lower levels of anxiety and pain reduction. A similar effect pattern is induced by oxytocin. In the present article, we describe the structure of the hypothalamic oxytocinergic system, in particular the pathways involved in reduction of anxiety, stress and pain. We detail how oxytocin exerts powerful anti-stress effects by antagonizing the release of and effects of corticotrophin releasing factor (CRF) and noradrenaline (NA), the main central regulators of the hypothalamo-pituitary-adrenal (HPA) axis and of the autonomic nervous system. It is suggested that CT fibers connect to the oxytocin system, and that oxytocin mediates the decrease of sympathetic nerve activity, increase of parasympathetic nerve activity as well as the reduction of pain and anxiety, induced by gentle touch. Thus, by reducing stress, repeated activation of CT afferents may be linked to better health.
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| 28. |
- Uvnäs-Moberg, Kerstin, et al.
(författare)
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Sensory Stimulation and Oxytocin : Their Roles in Social Interaction and Health Promotion
- 2022
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this call was to collect papers describing how oxytocin may be released by different kinds of sensory stimulation to induce wellbeing and restorative processes and to inhibit pain, stress and inflammation. A large number of interesting articles of very high quality were received and 19 papers were accepted for publication. All the included articles have contributed to expand the knowledge about oxytocin in a very substantial way both regarding its effect spectrum and regarding its association with sensory, somatosensory stimulation, in particular. In fact, the obtained data contribute to prove the hypothesis that the oxytocinergic system is a widespread integrative system, which is linked to social interaction, wellbeing, reduction of stress and pain as well as to reproductive, growth promoting and restorative effects. The activity of this archaic oxytocin system is under control of hormones and sensory nerves, which convey information regarding the state of the internal and the external environment. The oxytocin linked effects may be induced in the short-term as well as in the long-term perspective. All of the articles which were accepted and included in this issue, in their own unique way, contribute to describe oxytocin beyond its classical role in birth and milk ejection in accordance with the concept described above. We describe and discuss the data after having categorized the results presented in the articles according to certain subjects.
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