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1.	Palstam, Annie, 1981, et al. (författare) Perceived exertion at work in women with fibromyalgia: Explanatory factors and comparison with healthy women 2014 Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 46, s. 773-780 Tidskriftsartikel (refereegranskat)abstract Objective: To investigate perceived exertion at work in women with fibromyalgia. Design: A controlled cross-sectional multi-centre study. Subjects and methods: Seventy-three women with fibromyalgia and 73 healthy women matched by occupation and physical workload were compared in terms of perceived exertion at work (0–14), muscle strength, 6-min walk test, symptoms rated by Fibromyalgia Impact Questionnaire (FIQ), work status (25–100%), fear avoidance work beliefs (0–42), physical activity at work (7–21) and physical workload (1–5). Spearman’s correlation coefficient and linear regression analysis were conducted. Results: Perceived exertion at work was significantly higher in the fibromyalgia group than in the reference group (p = 0.002), while physical activity at work did not differ between the groups. Physical capacity was lower and symptom severity higher in fibromyalgia compared with references (p < 0.05). In fibromyalgia, perceived exertion at work showed moderate correlation with physical activity at work, physical workload and fear avoidance work beliefs (rs = 0.53– 0.65, p < 0.001) and a fair correlation with anxiety (rs = 0.26, p = 0.027). Regression analysis indicated that the physical activity at work and fear avoidance work beliefs explained 50% of the perceived exertion at work. Conclusion: Women with fibromyalgia perceive an elevated exertion at work, which is associated with physical workrelated factors and factors related to fear and anxiety.
2.	Bäckryd, Emmanuel, et al. (författare) Do low levels of Beta-endorphin in the cerebrospinal fluid indicate defective top-down inhibition in patients with chronic neuropathic pain? A cross-sectional, comparative study 2014 Ingår i: Pain medicine (Malden, Mass.). - : Wiley-Blackwell. - 1526-2375 .- 1526-4637. ; 15:1, s. 111-119 Tidskriftsartikel (refereegranskat)abstract ObjectivePain medicine still lacks mechanism-specific biomarkers to guide diagnosis and treatment, and defective top-down modulation is an important factor in the pathophysiology of chronic pain conditions. Using modern analytical tools and advanced multivariate statistical analysis, the aim of this study was to revisit two classical potential biomarkers of pro- and anti-nociception in humans (substance P and beta-endorphin), focusing particularly on the cerebrospinal fluid (CSF).DesignCross-sectional, comparative, observational study.SubjectsPatients with chronic, post-traumatic and/or post-surgical, neuropathic pain refractory to conventional treatment (N = 15) and healthy controls (N = 19) were included.MethodsSamples were taken from CSF and blood, and levels of substance P and beta-endorphin were investigated using a Luminex technology kit.ResultsWe found low levels of beta-endorphin in the CSF of neuropathic pain patients (66 ± 11 pcg/mL) compared with healthy controls (115 ± 14 pcg/mL) (P = 0.017). Substance P levels in the CSF did not differ (20 ± 2 pcg/mL, 26 ± 2, P = 0.08). However, our multivariate data analysis showed that belonging to the patient group was associated with low levels of both substances in the CSF. A higher correlation between the levels of beta-endorphin and substance P in CSF was found in healthy controls than in patients (rs = 0.725, P < 0.001 vs rs = 0.574, P = 0.032).ConclusionsPatients with chronic neuropathic pain due to trauma or surgery had low levels of beta-endorphin in the CSF. We speculate that this could indicate a defective top-down modulation of pain in chronic neuropathic pain. Our results also illustrate the importance of taking a system-wide, multivariate approach when searching for biomarkers.
3.	Calmfors, Lars, et al. (författare) Dåliga jobbvillkor gör att Sverige tappar elitforskare 2014 Ingår i: Dagens nyheter. - : Bonnier. - 1101-2447. Tidskriftsartikel (populärvet., debatt m.m.)
4.	Conley, Daniel, et al. (författare) Hypoxia is increasing in the coastal zone of the Baltic Sea 2011 Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 45:16, s. 6777-6783 Tidskriftsartikel (refereegranskat)abstract Hypoxia is a well-described phenomenon in the offshore waters of the Baltic Sea with both the spatial extent and intensity of hypoxia known to have increased due to anthropogenic eutrophication, however, an unknown amount of hypoxia is present in the coastal zone. Here we report on the widespread unprecedented occurrence of hypoxia across the coastal zone of the Baltic Sea. We have identified 115 sites that have experienced hypoxia during the period 1955-2009 increasing the global total to ca. 500 sites, with the Baltic Sea coastal zone containing over 20% of all known sites worldwide. Most sites experienced episodic hypoxia, which is a precursor to development of seasonal hypoxia. The Baltic Sea coastal zone displays an alarming trend with hypoxia steadily increasing with time since the 1950s effecting nutrient biogeochemical processes, ecosystem services, and coastal habitat.
5.	Ekerljung, Linda, 1979, et al. (författare) Has the increase in the prevalence of asthma and respiratory symptoms reached a plateau in Stockholm, Sweden? 2010 Ingår i: The International Journal of Tuberculosis and Lung Disease. - 1027-3719 .- 1815-7920. ; 14:6, s. 764-771 Tidskriftsartikel (refereegranskat)abstract SETTING: An increase in the prevalence of asthma has previously been reported worldwide. However, the current trend is debatable. OBJECTIVE: To assess changes in the prevalence of asthma and respiratory symptoms in a defined study area in Stockholm, Sweden, using identical methods. DESIGN: A questionnaire was sent by mail in 1996 and 2007 to randomly selected subjects aged 20-69 years. On both occasions, 8000 subjects received the questionnaire, with response rates of 72% and 68%, respectively. Questions on asthma, respiratory symptoms, asthma medication and possible determinants were included. Logistic regression analysis was used to assess determinants. RESULTS: Ever asthma increased from 8.7% in 1996 to 11.0% in 2007 and physician-diagnosed asthma from 7.6% to 9.3%. The proportion of asthma patients reporting one to two symptoms increased by 14% during the study period. There were few significant changes in the prevalence of respiratory symptoms: wheeze in the previous 12 months (15.9-17.3%), wheezing with breathlessness apart from cold (3.2-4.1%) and recurrent wheeze (8.3-6.8%). There was no major difference in the risk factor pattern between the surveys. CONCLUSION: An increase in the prevalence of asthma with few symptoms as well as an unchanged prevalence of symptoms was demonstrated, which may indicate a change in diagnostic practices.
6.	Ekerljung, Linda, 1979, et al. (författare) Incidence and prevalence of adult asthma is associated with low socio-economic status 2010 Ingår i: The Clinical Respiratory Journal. - 1752-6981 .- 1752-699X. ; 4:3, s. 147-56 Tidskriftsartikel (refereegranskat)abstract Background: Low socio-economic status is often related to health problems; however, previous studies on asthma, usually cross-sectional, yield inconsistent results. In this study, longitudinal and cross-sectional data on the association between socio-economic status and asthma as well as respiratory symptoms among adults are presented. Methods: A postal questionnaire was sent on two occasions, 1996 and 2006, to a randomly selected sample of subjects aged 20–69 years in 1996. In total, 4479 subjects participated in both surveys. The questionnaire included questions on asthma, respiratory symptoms and possible determinants. Logistic regression analysis, adjusted for potential confounders, was used to study the association between asthma, respiratory symptoms and socio-economic status. Results: Manual workers in service had the highest prevalence and cumulative incidence for all investigated symptoms and asthma. Despite a large decrease in smokers, the increase in incident bronchitic symptoms was higher than the increase of incident asthma and incident asthmatic symptoms. Low socio-economic status, rhinitis and a family history of asthma were risk factors for having and developing asthma and respiratory symptoms. Conclusion: Low socio-economic status is significantly associated with an increased risk for prevalent and incident asthma and respiratory symptoms in this longitudinal population-based survey. The increase in risk was most pronounced in manual workers. Several studies have recently shown an association between low socio-economic status and respiratory symptoms and we conclude that asthma can not be considered as a disease that mainly affects the middle and upper socio-economic classes.
7.	Ernberg, M., et al. (författare) Experimental myalgia induced by repeated infusion of acidicsaline into the human masseter muscle does not cause the release of algesic substances 2013 Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 17:4, s. 539-550 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Animal studies have shown that two repeated intramuscular injections of acidic saline induce mechanical allodynia that lasts for 4 weeks with spread to the contralateral side. In this study, we tested the hypothesis that two repeated intramuscular infusions of acidic saline into the human masseter muscle is associated with pain, mechanical allodynia and release of algesic substances. Eighteen healthy volunteers participated. On day 1, 2.5 mL of acidic saline (pH 3.3) was infused into one of the masseter muscles and isotonic saline (pH 6.0) into the other (randomized and single-blind). Two days later, intramuscular microdialysis was performed to sample serotonin, glutamate, pyruvate, lactate and glucose, during which the saline infusions were repeated. Pain and pressure pain thresholds (PPTs) were recorded before and after infusions on both days.RESULTS:Pain intensity induced by the infusions was higher after acidic than that after isotonic saline (p < 0.05). PPTs were decreased on both sides after microdialysis compared with baseline day 1 (p's < 0.05), but there were no differences in PPTs between sides at any time point. The levels of serotonin, glutamate, pyruvate, lactate or glucose did not change significantly during microdialysis.CONCLUSION:Infusion of acidic saline caused low levels of muscle pain, but no mechanical allodynia and no increased release of algesic substances. The value of this model appears modest, but future studies could be performed with larger sample size and higher flow rate before definite conclusions about the validity of the model for craniofacial myalgia can be drawn.
8.	Falkeborn, Tina, et al. (författare) Endocine™, N3OA and N3OASq; Three Mucosal Adjuvants That Enhance the Immune Response to Nasal Influenza Vaccination 2013 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:8 Tidskriftsartikel (refereegranskat)abstract Annual outbreaks of seasonal influenza are controlled or prevented through vaccination in many countries. The seasonal vaccines used are either inactivated, currently administered parenterally, or live-attenuated given intranasally. In this study three mucosal adjuvants were examined for the influence on the humoral (mucosal and systemic) and cellular influenza A-specific immune responses induced by a nasally administered vaccine. We investigated in detail how the anionic Endocine™ and the cationic adjuvants N3OA and N3OASq mixed with a split inactivated influenza vaccine induced influenza A-specific immune responses as compared to the vaccine alone after intranasal immunization. The study showed that nasal administration of a split virus vaccine together with Endocine™ or N3OA induced significantly higher humoral and cell-mediated immune responses than the non-adjuvanted vaccine. N3OASq only significantly increased the cell-mediated immune response. Furthermore, nasal administration of the influenza vaccine in combination with any of the adjuvants; Endocine™, N3OA or N3OASq, significantly enhanced the mucosal immunity against influenza HA protein. Thus the addition of these mucosal adjuvants leads to enhanced immunity in the most relevant tissues, the upper respiratory tract and the systemic circulation. Nasal influenza vaccination with an inactivated split vaccine can therefore provide an important mucosal immune response, which is often low or absent after traditional parenteral vaccination.
9.	Gerdle, Björn, et al. (författare) Algogenic substances and metabolic status in work-related Trapezius Myalgia: a multivariate explorative study 2014 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central / Springer Verlag (Germany). - 1471-2474. ; 15:357 Tidskriftsartikel (refereegranskat)abstract Background: This study compares the levels of algesic substances between subjects with trapezius myalgia (TM) and healthy controls (CON) and explores the multivariate correlation pattern between these substances, pain, and metabolic status together with relative blood flow changes reported in our previous paper (Eur J Appl Physiol 108: 657-669, 2010). Methods: 43 female workers with (TM) and 19 females without (CON) trapezius myalgia were - using microdialysis - compared for differences in interstitial concentrations of interleukin-6 (IL-6), bradykinin (BKN), serotonin (5-HT), lactate dehydrogenas (LDH), substance P, and N-terminal propeptide of procollagen type I (PINP) in the trapezius muscle at rest and during repetitive/stressful work. These data were also used in multivariate analyses together with previously presented data (Eur J Appl Physiol 108: 657-669, 2010): trapezius muscle blood flow, metabolite accumulation, oxygenation, and pain development and sensitivity. Results: Substance P was significantly elevated in TM (p=0.0068). No significant differences were found in the classical algesic substances (p: 0.432-0.926). The multivariate analysis showed that blood flow related variables, interstitial concentrations of metabolic (pyruvate), and algesic (BKN and K+) substances were important for the discrimination of the subjects to one of the two groups (R-2: 0.19-0.31, pless than0.05). Pain intensity was positively associated with levels of 5-HT and K+ and negatively associated with oxygenation indicators and IL-6 in TM (R-2: 0.24, pless than0.05). A negative correlation existed in TM between mechanical pain sensitivity of trapezius and BKN and IL-6 (R-2: 0.26-0.39, pless than0.05). Conclusion: The present study increased understanding alterations in the myalgic muscle. When considering the system-wide aspects, increased concentrations of lactate, pyruvate and K+ and decreased oxygenation characterized TM compared to CON. There are three major possible explanations for this finding: the workers with pain had relatively low severity of myalgia, metabolic alterations preceded detectable alterations in levels of algesics, or peripheral sensitization and other muscle alterations existed in TM. Only SP of the investigated algesic substances was elevated in TM. Several of the algesics were of importance for the levels of pain intensity and mechanical pain sensitivity in TM. These results indicate peripheral contribution to maintenance of central nociceptive and pain mechanisms and may be important to consider when designing treatments.
10.	Gerdle, Björn, et al. (författare) Chronic musculoskeletal pain : review of mechanisms and biochemical biomarkers as assessed by the microdialysis technique 2014 Ingår i: Journal of Pain Research. - : Dove Medical Press. - 1178-7090. ; 7, s. 313-326 Forskningsöversikt (refereegranskat)abstract Chronic musculoskeletal pain conditions are multifaceted, and approximately 20% of the adult population lives with severe chronic pain, with a higher prevalence in women and in lower income groups. Chronic pain is influenced by and interacts with physical, emotional, psychological, and social factors, and a biopsychosocial framework is increasingly applied in clinical practice. However, there is still a lack of assessment procedures based on the activated neurobiological pain mechanisms (ie, the biological part of the biopsychosocial model of pain), which may be a necessary step for further optimizing outcomes after treatments for patients with chronic pain. It has been suggested that chronic pain conditions are mainly driven by alterations in the central nervous system with little or no peripheral stimuli or nociception. In contrast, other authors argue that such central alterations are driven by peripheral alterations and nociceptive input. Microdialysis is an in vivo method for studying local tissue alterations and allows for sampling of substances in the interstitium of the muscle, where nociceptor free nerve endings are found close to the muscle fibers. The extracellular matrix plays a key role in physiologic functions of cells, including the primary afferent nociceptor. The present review mainly concerns the results of microdialysis studies and how they can contribute to the understanding of activated peripheral nociceptive and pain mechanisms in humans with chronic pain. The primary aim was to review molecular studies using microdialysis for the investigation of human chronic muscle pain, ie, chronic masticatory muscle pain, chronic trapezius myalgia, chronic whiplash-associated disorders, and chronic widespread pain/fibromyalgia syndrome. Several studies clearly showed elevated levels of serotonin, glutamate, lactate, and pyruvate in localized chronic myalgias and may be potential biomarkers. These results indicate that peripheral muscle alterations are parts of the activated pain mechanisms in common chronic pain conditions. Muscle alterations have been reported in fibromyalgia syndrome and chronic widespread pain, but more studies are needed before definite conclusions can be drawn. For other substances, results are inconclusive across studies and patient groups.
11.	Gerdle, Björn, et al. (författare) Chronic Widespread Pain : Increased Glutamate and Lactate Concentrations in the Trapezius Muscle and Plasma 2014 Ingår i: The Clinical Journal of Pain. - : Lippincott Williams & Wilkins. - 0749-8047 .- 1536-5409. ; 30:5, s. 409-420 Forskningsöversikt (refereegranskat)abstract BACKGROUND:: Chronic widespread pain (CWP), including fibromyalgia syndrome (FM), is associated with prominent negative consequences. CWP has been associated with alterations in the central processing of nociception. Whereas some researchers consider CWP/FM as a central hyperexcitability pain condition, others suggest that the central alterations are maintained by peripheral nociceptive input. Microdialysis can be used in vivo to study muscle alterations in chronic myalgia. AIM:: The aim of the study was to investigate the plasma and interstitial concentrations of metabolites and algesics in the trapezius muscle of women with CWP and in pain-free women (CON).MATERIALS AND METHODS:: Seventeen women with CWP and 24 CON went through a clinical examination and completed a questionnaire; the pressure pain thresholds in the upper and lower extremities were registered. Microdialysis was conducted in the trapezius muscle, and a blood sample was drawn. Muscle blood flow, interstitial muscle concentrations, and plasma concentrations of lactate, pyruvate, glutamate, glucose, and glycerol (not in the plasma) were determined.RESULTS:: CWP patients had significantly increased interstitial muscle (P=0.02 to 0.001) and plasma (P=0.026 to 0.017) concentrations of lactate and glutamate. No significant differences existed in blood flow between CWP and CON. The interstitial concentrations-but not the plasma levels-of glutamate and lactate correlated significantly with aspects of pain such as pressure pain thresholds of the trapezius (R=0.22) and tibialis anterior (R=0.18) and the mean pain intensity (R=0.10) in CWP but not in CON.CONCLUSIONS:: The present study supports the suggestion that aspects of pain and central alterations in CWP/FM are influenced by peripheral tissue alterations.
12.	Gerdle, Björn, et al. (författare) INCREASED INTERSTITIAL CONCENTRATIONS OF PYRUVATE AND LACTATE IN THE TRAPEZIUS MUSCLE OF PATIENTS WITH FIBROMYALGIA: A MICRODIALYSIS STUDY 2010 Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 42:7, s. 679-687 Tidskriftsartikel (refereegranskat)abstract Objective: The aim of this study was to compare the interstitial concentrations of pyruvate, lactate and glutamate in the trapezius muscle between patients with fibromyalgia syndrome and healthy controls. Design: Comparative cross-sectional study. Subjects: Patients with fibromyalgia (n=19) and healthy controls (n=19); all women. Methods: Subjects answered a questionnaire about different aspects of pain. Pressure pain thresholds over the trapezius and tibialis anterior muscles were determined. The interstitial concentrations of pyruvate, lactate and glutamate were determined in the resting trapezius muscle by the microdialysis technique, with samples collected every hour for 5 consecutive hours. Pain intensity was also rated. Results: Significantly higher interstitial concentrations of pyruvate and lactate were found in patients with fibromyalgia syndrome. The multivariate regression analyses of group membership and pressure pain thresholds of the trapezius confirmed the importance of pyruvate and lactate. Conclusion: Different mechanisms that may increase pyruvate and lactate in patients with fibromyalgia syndrome are discussed. Improved understanding of peripheral muscle alterations in patients with fibromyalgia syndrome could lead to mechanism-based rehabilitation.
13.	Gerdle, Björn, et al. (författare) Potential Muscle Biomarkers of Chronic Myalgia in Humans - A Systematic Review of Microdialysis Studies 2012 Ingår i: Biomarker. - : INTECH. - 9789535105770 ; , s. 102-132 Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract The impact of biomarkers in present day health care system, health management and healthy life is enormous. Clinicians need them for diagnosis, prognosis, effect of therapeutic intervention, and most importantly, for early detection of a disease. Pharmaceutical industries need them for new drug discovery and drug efficiency test. Regulatory authorities need them for testing toxicity and environmental impact. Epidemiologists need them for population screening and risk factor determination. In post genomic era biomarkers would have a huge impact in personalized medicine and personalized health management. This scope of this book is not limited to just a few of the most important aspects of biomarkers but covers wide variety of subjects, from biomarkers cancer to neurodegenerative diseases. Chapters cover variety of aspects, from modern cell based technologies to molecular imaging; from drug discovery to critical care prognosis. A great amount of information is also devoted to bioinformatics and statistics. There is an enormous potential for commercial value of biomarkers. The global diagnostic market accounts for only 1-2% of government healthcare expense, however, it influences on 60-70% decisions in healthcare. My sincere thanks go to all the contributors of this book who took the extra effort beyond their busy schedules. Last, but not least I would like to express my gratitude to the publishing group for their tireless support
14.	Ghafouri, Bijar, et al. (författare) Interstitial concentration of serotonin is increased in myalgic human trapezius muscle during rest, repetitive work and mental stress - an in vivo microdialysis study 2010 Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Taylor and Francis. - 0036-5513 .- 1502-7686. ; 70:7, s. 478-486 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: The pathophysiology of trapezius myalgia is not fully elucidated. Serotonin (5-HT) is involved in modulation of nociception and hyperalgesia. Our aim was to compare the interstitial 5-HT levels of the trapezius muscle in women with chronic trapezius myalgia and in pain-free controls. MATERIALS AND METHODS: Microdialysate of the trapezius muscle collected every 20 minutes during rest, work (100 min) and stress (20 min) was used to study the dynamics of 5-HT in women with chronic trapezius myalgia (MYA; n=18) and in pain-free controls (CON; n=30). RESULTS: MYA had higher levels of 5-HT than CON at baseline, during repetitive work, during mental stress and during recovery. There were no significant time effects on 5-HT levels. CONCLUSION: 5-HT has the potential of a biomarker of chronic myalgia. Elevated levels of 5-HT may be involved in maintenance of habitual chronic pain and might contribute to increased pain during exercise by facilitating the effect of released algesic substances linked to such muscle demands.
15.	Ghafouri, Nazdar, et al. (författare) Effects of two different specific neck exercise interventions on palmitoylethanolamide and stearoylethanolamide concentrations in the interstitium of the trapezius muscle in women with chronic neck shoulder pain 2014 Ingår i: Pain medicine (Malden, Mass.). - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 15:8, s. 1379-1389 Tidskriftsartikel (refereegranskat)abstract Purpose. Chronic neck/shoulder pain (CNSP) is one of the most common pain conditions. The understanding of mechanisms, including the peripheral balance between nociceptive and antinociceptive processes, is incomplete. N-acylethanolamines (NAEs) are a class of endogenous compounds that regulate inflammation and pain. The aim of this study was to investigate the levels of two NAEs: the peroxisome proliferator-activated receptor type-a ligand palmitoylethanolamide (PEA) and stearoylethanolamide (SEA) in the muscle interstitium of the trapezius muscle in women with CNSP randomized to two different neck specific training programs and in a healthy pain-free control group (CON). Materials and Methods. Fifty-seven women with CNSP were randomized to strength + stretch or stretch alone exercise programs. Twenty-nine subjects underwent microdialysis procedure before and after 4-6 months of exercise. Twenty-four CON subjects underwent microdialysis procedure before and after 4-6 months without any intervention in between. Microdialysate samples were collected from the trapezius muscle and analyzed by mass spectrometry for PEA and SEA levels. Results. PEA and SEA levels were significantly higher in CNSP patients compared with CON. PEA was significantly higher in CNSP than in CON after both training programs. SEA was significantly higher in CNSP than in CON after stretch alone but not after strength + stretch training. A significant positive correlation was found between changes in pain intensity and in SEA levels in the strength + stretch group, but not in the stretch alone group. Conclusion. Our results indicate that exercise interventions differentially affect the levels of the bioactive lipids PEA and SEA in the interstitium of the trapezius muscle in women with CNSP.
16.	Ghafouri, Nazdar, et al. (författare) High Levels of N-Palmitoylethanolamide and N-Stearoylethanolamide in Microdialysate Samples from Myalgic Trapezius Muscle in Women 2011 Ingår i: PLOS ONE. - San Fransisco : Public Library of Science. - 1932-6203. ; 6:11 Tidskriftsartikel (refereegranskat)abstract Background: N-acylethanolamines (NAEs) are endogenous compounds that regulate inflammation and pain. These include the cannabinoid ligand anandamide (AEA) and the peroxisome proliferator-activated receptor-a ligand palmitoylethanolamide (PEA). Little is known as to the levels of NAEs in pain states in human, particularly in the skeletal muscle. The aim of this study was to investigate the levels of these lipid mediators in muscle dialysate from women with chronic neck-/shoulder pain compared to healthy controls. Methods: Eleven women with chronic neck-/shoulder pain and eleven healthy women participated in this study. All participants went through microdialysis procedures in the trapezius muscle. Muscle dialysate samples were collected during four hours and analysed by nano liquid chromatography tandem mass spectrometry (nLC-MS/MS). Results: We were able to detect AEA, PEA, N-stearoylethanolamine (SEA) and 2-arachidonoylglycerol (2-AG) in a single chromatographic run. Of the NAEs studied, PEA and SEA were clearly detectable in the muscle microdialysate samples. The muscle dialysate levels of PEA and SEA were significantly higher in myalgic subjects compared to healthy controls. Conclusion: This study demonstrates that microdialysis in combination with mass spectrometry can be used for analysing NAEs in human muscle tissue regularly over time. Furthermore the significant group differences in the concentration of PEA and SEA in this study might fill an important gap in our knowledge of mechanisms in chronic myalgia in humans. In the long run this expanded understanding of nociceptive and anitinociceptive processes in the muscle may provide a base for ameliorating treatment and rehabilitation of pain.
17.	Ghafouri, Nazdar, et al. (författare) Palmitoylethanolamide and stearoylethanolamide levels in the interstitium of the trapezius muscle of women with chronic widespread pain and chronic neck-shoulder pain correlate with pain intensity and sensitivity 2013 Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 154:9, s. 1649-1658 Tidskriftsartikel (refereegranskat)abstract Chronic widespread pain (CWP) is a complex condition characterized by central hyperexcitability and altered descending control of nociception. However, nociceptive input from deep tissues is suggested to be an important drive. N-Acylethanolamines (NAEs) are endogenous lipid mediators involved in regulation of inflammation and pain. Previously we have reported elevated levels of the 2 NAEs, the peroxisome proliferator-activated receptor type-alpha ligand N-palmitoylethanolamine (PEA) and N-stearoylethanolamine (SEA) in chronic neck/shoulder pain (CNSP). In the present study, the levels of PEA and SEA in women with CWP (n = 18), CNSP (n = 34) and healthy controls (CON, n = 24) were investigated. All subjects went through clinical examination, pressure pain threshold measurements and induction of experimental pain in the tibialis anterior muscle. Microdialysis dialysate of the trapezius was collected before and after subjects performed a repetitive low-force exercise and analyzed by mass spectrometry. The levels of PEA and SEA in CNSP were significantly higher post exercise compared with CWP, and both pre and post exercise compared with CON. Levels of both NAEs decreased significantly pre to post exercise in CWP. Intercorrelations existed between aspects of pain intensity and sensitivity and the level of the 2 NAEs in CWP and CNSP. This is the first study demonstrating that CNSP and CWP differ in levels of NAEs in response to a low-force exercise which induces pain. Increases in pain intensity as a consequence of low-force exercise were associated with low levels of PEA and SEA in CNSP and CWP. These results indicate that PEA and SEA have antinociceptive roles in humans.
18.	Hadrévi, Jenny, 1977-, et al. (författare) Comparative metabolomics of muscle interstitium fluid in human trapezius myalgia: an in vivo microdialysis study 2013 Ingår i: European Journal of Applied Physiology. - : Springer Verlag (Germany). - 1439-6319 .- 1439-6327. ; 113:12, s. 2977-2989 Tidskriftsartikel (refereegranskat)abstract The mechanisms behind trapezius myalgia are unclear. Many hypotheses have been presented suggesting an altered metabolism in the muscle. Here, muscle microdialysate from healthy and myalgic muscle is analysed using metabolomics. Metabolomics analyse a vast number of metabolites, enabling a comprehensive explorative screening of the cellular processes in the muscle. less thanbrgreater than less thanbrgreater thanMicrodialysate samples were obtained from the shoulder muscle of healthy and myalgic subjects that performed a work and stress test. Samples from the baseline period and from the recovery period were analysed using gas chromatography-mass spectrometry (GC-MS) together with multivariate analysis to detect differences in extracellular content of metabolites between groups. Systematic differences in metabolites between groups were identified using multivariate analysis and orthogonal partial least square discriminate analysis (OPLS-DA). A complementary Mann-Whitney U test of group difference in individual metabolites was also performed. less thanbrgreater than less thanbrgreater thanA large number of metabolites were detected and identified in this screening study. At baseline, no systematic differences between groups were observed according to the OPLS-DA. However, two metabolites, l-leucine and pyroglutamic acid, were significantly more abundant in the myalgic muscle compared to the healthy muscle. In the recovery period, systematic difference in metabolites between the groups was observed according to the OPLS-DA. The groups differed in amino acids, fatty acids and carbohydrates. Myristic acid and putrescine were significantly more abundant and beta-d-glucopyranose was significantly less abundant in the myalgic muscle. less thanbrgreater than less thanbrgreater thanThis study provides important information regarding the metabolite content, thereby presenting new clues regarding the pathophysiology of the myalgic muscle.
19.	Hadrévi, Jenny, 1977-, et al. (författare) Multivariate Modeling of Proteins Related to Trapezius Myalgia, a Comparative Study of Female Cleaners with or without Pain 2013 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:9, s. e73285- Tidskriftsartikel (refereegranskat)abstract The prevalence of chronic trapezius myalgia is high in women with high exposure to awkward working positions, repetitive movements and movements with high precision demands. The mechanisms behind chronic trapezius myalgia are not fully understood. The purpose of this study was to explore the differences in protein content between healthy and myalgic trapezius muscle using proteomics. Muscle biopsies from 12 female cleaners with work-related trapezius myalgia and 12 pain free female cleaners were obtained from the descending part of the trapezius. Proteins were separated with two-dimensional differential gel electrophoresis (2D-DIGE) and selected proteins were identified with mass spectrometry. In order to discriminate the two groups, quantified proteins were fitted to a multivariate analysis: partial least square discriminate analysis. The model separated 28 unique proteins which were related to glycolysis, the tricaboxylic acid cycle, to the contractile apparatus, the cytoskeleton and to acute response proteins. The results suggest altered metabolism, a higher abundance of proteins related to inflammation in myalgic cleaners compared to healthy, and a possible alteration of the contractile apparatus. This explorative proteomic screening of proteins related to chronic pain in the trapezius muscle provides new important aspects of the pathophysiology behind chronic trapezius myalgia.
20.	Heimer, Gun, et al. (författare) ”Vården måste fråga kvinnor om de har utsatts för våld” 2011 Ingår i: DN.se / DN-debatt. ; :13 maj Tidskriftsartikel (populärvet., debatt m.m.)
21.	Heimer, Gun, et al. (författare) ”Vården måste fråga kvinnor om de har utsatts för våld” 2011 Ingår i: DN.se / DN-debatt. ; :13 maj Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
22.	Hulsart-Billström, Gry, et al. (författare) Morphological differences in BMP-2-induced ectopic bone between solid and crushed hyaluronan hydrogel templates 2013 Ingår i: Journal of materials science. Materials in medicine. - : Springer Science and Business Media LLC. - 0957-4530 .- 1573-4838. ; 24:5, s. 1201-1209 Tidskriftsartikel (refereegranskat)abstract The possibility to affect bone formation by using crushed versus solid hydrogels as carriers for bone morphogenetic protein 2 (BMP-2) was studied. Hydrogels, based on chemical crosslinking between hyaluronic acid and poly(vinyl alcohol) derivatives, were loaded with BMP-2 and hydroxyapatite. Crushed and solid forms of the gels were analyzed both in vitro via a release study using I-125 radioactive labeling of BMP-2, and in vivo in a subcutaneous ectopic bone model in rats. Dramatically different morphologies were observed for the ectopic bone formed in vivo in the two types of gels, even though virtually identical release profiles were observed in vitro. Solid hydrogels induced formation of a dense bone shell around non-degraded hydrogel, while crushed hydrogels demonstrated a uniform bone formation throughout the entire sample. These results suggest that by crushing the hydrogel, the construct's three-dimensional network becomes disrupted. This could expose unreacted functional groups, making the fragment's surfaces reactive and enable limited chemical fusion between the crushed hydrogel fragments, leading to similar in vitro release profiles. However, in vivo these interactions could be broken by enzymatic activity, creating a macroporous structure that allows easier cell infiltration, thus, facilitating bone formation.
23.	Johansson, Unn-Britt, et al. (författare) Nationell klinisk slutexamination för sjuksköterskeexamen – ett verktyg för en säker och likvärdig bedömning av klinisk kompetens 2010 Konferensbidrag (refereegranskat)
24.	Johansson, Unn-Britt, et al. (författare) Nationell klinisk slutexamination för sjuksköterskeexamen - ett verktyg för en säker och likvärdig bedömning av klinisk komptens : Profession, organisation och lärande 2010 Ingår i: Symposium. - Stockholm : Svenska läkaresällskapet. Konferensbidrag (refereegranskat)abstract Nationell klinisk slutexamination för sjuksköterskeexamen startade hösten 2003 som ett projekt i samarbete mellan fyra lärosäten och Svensk sjuksköterskeförening. Läkarnas s.k. AT-prov har delvis utgjort modell för examinationen. En styrelse är bildad med ansvar för samordning, kvalitetssäkring och vidareutveckling. Idag är mer än hälften (n=13) av de lärosäten som bedriver sjuksköterskeprogram (n=25) involverade i examinationen. Deltagandet sker enligt avtal för att åstadkomma en nationell kvalitetskontroll med tydlig verksamhetsförankring av sjuksköterskans kliniska kompetens. Examinationen som genomförs i slutet av sista terminen avser att möta Socialstyrelsens och verksamhetens krav på nyexaminerad sjuksköterska. Examinationen består av en skriftlig och en praktisk del, och skall kunna genomföras oavsett i vilken klinisk verksamhet studenten fullgör sin sista termin, under förutsättning att den kliniska verksamheten motsvarar den grundutbildade sjuksköterskans kompetensområde. Den skriftliga delen består av två patientfall som studenten analyserar. I den praktiska delen bedöms studenten enligt särskild instruktion av en ”bedömningsansvarig sjuksköterska” i samband med vård av en utvald patient. Bedömningen avslutas med en dialog mellan student, bedömningsansvarig sjuksköterska och examinator. Examinationen följer intentionerna i Bolognaprocessen d.v.s. utbildningarna och utbildningsnivåer ska vara jämförbara med varandra oavsett var utbildningen genomförs. Högskoleverkets utvärdering av sjuksköterskeutbildningarna visar också på behov av att utveckla framförallt kliniska examinationer. Styrelsen har under vårterminen 2010 genomfört en enkätutvärdering. Syftet var att utvärdera om Nationell klinisk slutexamination mäter den kliniska kompetens som krävs för en nyexaminerad sjuksköterska på grundnivå utifrån förväntade krav på yrkeskompetens enligt Kompetensbeskrivning för legitimerad sjuksköterska (Socialstyrelsen, 2005) och Högskoleförordningens examensordning (SFS 2006:1053). Enkäten riktades till fyra grupper; rättande lärare av skriftlig del, bedömningsansvarig sjuksköterska vid praktiskt prov, klinisk lärare/examinator praktiskt prov och sjuksköterskestudent. Under symposiet kommer enkätutvärderingen att presenteras och diskuteras. Nationell klinisk slutexamination för sjuksköterskeexamen tillhör en av de mest välutvecklade, standardiserade, systematiskt prövade examinationer som sjuksköterskestudenter genomgår.
25.	Johansson, Unn-Britt, et al. (författare) Use of a national clinical final examination in a Bachelor's Programme in Nursing to assess clinical competence : students', lecturers' and nurses' perceptions 2014 Ingår i: Open Journal of Nursing. - Irvine, United States : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 4:7, s. 501-511 Tidskriftsartikel (refereegranskat)abstract Objective: The objective of this study was to evaluate the perceptions of students, lecturers, nurses and clinical lecturers regarding the ability of the National Clinical Final Examination (NCFE) to assess clinical competence, and whether the assessment was consistent with the qualifications for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. The NCFE is divided into two parts (written and bedside) and aims to evaluate third-year nursing students’ clinical competence. Methods: Data were collected at 10 universities using study-specific questionnaires. The total response rate was 84% (n = 1652). Results: The clinical lecturers indicated that there was a need for improvement in the written part of the examination in order to adequately assess clinical competence. Regarding the bedside part the clinical lecturers, nurses and students perceived that the bedside part of the examination assessed whether the student had the clinical competence required by a newly registered nurse. Conclusion: The two-part examination described in this study was perceived as useful for assessing clinical competence and for the qualification requirements for a Bachelor of Science in Nursing as outlined by the Swedish Higher Education Authority. However, especially the written part requires further development. The model and form of assessment ought to be applicable to graduate nursing programme internationally.
26.	Karlson, Björn, et al. (författare) ArbetsplatsDialog för Arbetsåtergång (ADA): en metod för att underlätta återgång i arbete för patienter sjukskrivna för utmattning 2011 Rapport (populärvet., debatt m.m.)
27.	Karlson, Björn, et al. (författare) Return to work after a workplace-oriented intervention for patients on sick-leave for burnout : a prospective controlled study 2010 Ingår i: BMC Public Health. - 1471-2458 .- 1471-2458. ; 10 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout, aimed at facilitating return to work (RTW) by job-person match through patient-supervisor communication, was evaluated. We hypothesised that the intervention group would show a more successful RTW than a control group.METHODS: In a prospective controlled study, subjects were identified by the regional social insurance office 2-6 months after the first day on sick leave. The intervention group (n = 74) was compared to a control group who had declined participation, being matched by length of sick leave (n = 74). The RTW was followed up, using sick-listing register data, until 1.5 years after the time of intervention.RESULTS: There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period, and 89% of subjects had returned to work to some extent at the end of the follow-up period. The increase in RTW in the control group came to a halt after six months, and only 73% had returned to work to some extent at the end of the 1.5-year follow-up.CONCLUSIONS: We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout.TRIAL REGISTRATION: Current Controlled Trials NCT01039168.
28.	Karlson, Björn, et al. (författare) Return to work after work after a workplace-oriented intervention for patients on sick-leave for burnout - a prospective controlled study 2010 Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 10 Tidskriftsartikel (refereegranskat)abstract Background: In the present study the effect of a workplace-oriented intervention for persons on long-term sick leave for clinical burnout, aimed at facilitating return to work (RTW) by job-person match through patient-supervisor communication, was evaluated. We hypothesised that the intervention group would show a more successful RTW than a control group. Methods: In a prospective controlled study, subjects were identified by the regional social insurance office 2-6 months after the first day on sick leave. The intervention group (n = 74) was compared to a control group who had declined participation, being matched by length of sick leave (n = 74). The RTW was followed up, using sick-listing register data, until 1.5 years after the time of intervention. Results: There was a linear increase of RTW in the intervention group during the 1.5-year follow-up period, and 89% of subjects had returned to work to some extent at the end of the follow-up period. The increase in RTW in the control group came to a halt after six months, and only 73% had returned to work to some extent at the end of the 1.5-year follow-up. Conclusions: We conclude that the present study demonstrated an improvement of long-term RTW after a workplace-oriented intervention for patients on long-term sick leave due to burnout. Trial registration: Current Controlled Trials NCT01039168.
29.	Karlsson, Linn, et al. (författare) Evaluation of pain and function after two home exercise programs in a clinical trial on women with chronic neck pain - with special emphasises on completers and responders 2014 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 15:6 Tidskriftsartikel (refereegranskat)abstract Background: Different types of exercises can help manage chronic neck pain. Supervised exercise interventions are widely used, but these protocols require substantial resources. The aim of this trial, which focused on adherence, was to evaluate two home exercise interventions. Methods: This parallel group randomized controlled trial included 57 women randomly allocated into two groups - a strength training group (STRENGTH, 34 subjects) and a stretching group (STRETCH, 23 subjects). The interventions focused on the neck and shoulder muscles and lasted for 12 months. The STRENGTH group performed weight training and ended each session with stretching exercises. These stretching exercises constituted the entirety of the STRETCH groups training session. Both groups were instructed to exercise three times per week. All the participants kept an exercise diary. In addition, all participants were offered support via phone and e-mail. The primary outcomes were pain intensity and function. The trial included a four-to six-month and a twelve-month follow-up. A completer in this study exercised at least 1,5 times per week during eight unbroken weeks. A responder in this study reported clinically significant improvements on pain and function. The statistical analyses used the Mann Whitney U-test, Wilcoxon signed-rank test, and X-2 test. Results: At four-to six-months, the numbers of completers were 19 in the STRENGTH group and 17 in the STRETCH group. At twelve months, the corresponding numbers were 11 (STRENGTH) and 10 (STRETCH). At four-to six-months, the proportions of subjects reporting clinically important changes (STRENGTH and STRETCH) were for neck pain: 47% and 41%, shoulder pain: 47% and 47%, function: 37% and 29%. At twelve months, the corresponding numbers were for neck pain: 45% and 40%, shoulder pain: 55% and 50%, function: 55% and 20%. Conclusions: No differences in the two primary outcomes between the two interventions were found, a finding that may be due to the insufficient statistical power of the study. Both interventions based on home exercises improved the two primary outcomes, but the adherences were relatively low. Future studies should investigate ways to improve adherence to home exercise treatments.
30.	Kindmark, Henrik, et al. (författare) Five patients with malignant endocrine tumors treated with imatinib mesylate (Glivec®) 2010 Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 49:1, s. 100-101 Tidskriftsartikel (refereegranskat)
31.	Kram, Ebon, et al. (författare) Prostituerade är brottsoffer 2011 Ingår i: Svenska Dagbladet, Opinion-Brännpunkt. ; 9 april Tidskriftsartikel (populärvet., debatt m.m.)abstract Även om Sverige har kriminaliserat sexköparna saknar vi rätt stöd för de personer som vill lämna prostitutionen. Riksdagen bör förtydliga att alla personer som köps i prostitution är offer för sexköpsbrottet, vilket skulle ge dem rätt till skadestånd och andra former av kompensation, skriver en rad debattörer, bland andra Gudrun Schyman.
32.	Kram, Ebon, et al. (författare) Vårt förslag handlar inte om tvång : Slutreplik; Prostitution 2011 Ingår i: Svenska Dagbladet, Opinion-Brännpunkt, www.SvD.se. - Stockholm. ; 14 april Tidskriftsartikel (populärvet., debatt m.m.)
33.	Larsson, Britt-Marie, et al. (författare) Limited airway effects in mild asthmatics after exposure to air pollution in a road tunnel 2010 Ingår i: Respiratory Medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 104:12, s. 1912-1918 Tidskriftsartikel (refereegranskat)abstract Ambient air pollution is a contributing factor to respiratory morbidity and mortality and asthmatics are a particularly vulnerable population. The aim of the study was to investigate whether acute exposure to traffic related air pollution in a road tunnel would increase bronchial responsiveness in mild asthmatics, and if this would be accompanied by increased measures of inflammatory markers in the airways assessed by nasal lavage (NAL) and induced sputum. Fourteen mild asthmatics (7 treated with inhaled corticosteroids) were exposed for 2 h in a road tunnel and a control environment, respectively, separated by at least 3 weeks. Symptoms and peak expiratory flow (PEF) were recorded. Seven hours following exposure sessions, subjects underwent measurements of fraction of exhaled nitric oxide (FENO), spirometry, and a bronchial provocation test. NAL, induced sputum and blood samples were collected. The median PM(2.5) and PM(10) levels during the exposure occasions in the road tunnel were 80 (range 41-93) μg/m(3) and 183 (72-213) μg/m(3) respectively. Irritative symptoms from the airways increased and PEF decreased after road tunnel exposure. Increased levels of IL-10, IL-12 and TNF-α were observed in NAL fluid from subjects without ongoing inhaled corticosteroid treatment. Forced expiratory volume in 1 s (FEV(1)) and the degree of bronchial responsiveness in asthmatics did not change significantly after tunnel exposure. We conclude that asthmatics exhibit increased symptoms, decreased PEF and signs of inflammatory response in the upper airways, after a 2 h road tunnel exposure. Our findings may further emphasize asthmatics as a vulnerable group to common air pollutants.
34.	Levänen, Bettina, et al. (författare) Altered microRNA profiles in bronchoalveolar lavage fluid exosomes in asthmatic patients. 2013 Ingår i: Journal of Allergy and Clinical Immunology. - : Elsevier BV. - 0091-6749 .- 1097-6825. ; 131:3, s. 894-903 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Asthma is characterized by increased airway narrowing in response to nonspecific stimuli. The disorder is influenced by both environmental and genetic factors. Exosomes are nanosized vesicles of endosomal origin released from inflammatory and epithelial cells that have been implicated in asthma. In this study we characterized the microRNA (miRNA) content of exosomes in healthy control subjects and patients with mild intermittent asthma both at unprovoked baseline and in response to environmental challenge.OBJECTIVE: To investigate alterations in bronchoalveolar lavage fluid (BALF) exosomal miRNA profiles due to asthma, and following subway air exposure.METHODS: Exosomes were isolated from BALF from healthy control subjects (n = 10) and patients with mild intermittent asthma (n = 10) after subway and control exposures. Exosomal RNA was analyzed by using microarrays containing probes for 894 human miRNAs, and selected findings were validated with quantitative RT-PCR. Results were analyzed by using multivariate modeling.RESULTS: The presence of miRNAs was confirmed in exosomes from BALF of both asthmatic patients and healthy control subjects. Significant differences in BALF exosomal miRNA was detected for 24 miRNAs with a subset of 16 miRNAs, including members of the let-7 and miRNA-200 families, providing robust classification of patients with mild nonsymptomatic asthma from healthy subjects with 72% cross-validated predictive power (Q(2) = 0.72). In contrast, subway exposure did not cause any significant alterations in miRNA profiles.CONCLUSION: These studies demonstrate substantial differences in exosomal miRNA profiles between healthy subjects and patients with unprovoked, mild, stable asthma. These changes might be important in the inflammatory response leading to bronchial hyperresponsiveness and asthma.
35.	Lilja Andersson, Petra, et al. (författare) Nursing students' experiences of assessment by the Swedish National Clinical Final Examination 2013 Ingår i: Nurse Education Today. - : CHURCHILL LIVINGSTONE. - 0260-6917 .- 1532-2793. ; 33:5, s. 536-540 Tidskriftsartikel (refereegranskat)abstract The Swedish National Clinical Final Examination (NCFE) was established in 2007 in order to examine nursing students' clinical competence upon completing their Bachelor's degree in nursing. The NCFE constitutes an innovative method of examination, divided into two parts: a written and bedside test. The aim of this study was to evaluate nursing students' experiences of being assessed by means of the NCFE, in order to obtain information that could be used to improve the examination. A survey was conducted using a questionnaire with open-ended questions concerning the written and the bedside part of the NCFE. The answers from 577 third-year nursing students were analysed using content analysis. The nursing students regarded the NCFE as promoting further learning and as an important means of quality assurance. Its comprehensive nature was perceived to tie the education together and contributed to the students' awareness of their own clinical competence. The strengths of the NCFE especially highlighted were its high degree of objectivity and the fact that it took place in a natural setting. However, the students felt that the NCFE did not cover the entire nursing programme and that it caused stress. It thus appears to be important to reconsider the written theoretical part of the examination and to standardise the bedside part. (C) 2011 Elsevier Ltd. All rights reserved.
36.	Lundström, Susanna L., et al. (författare) Asthmatics exhibit altered oxylipin profiles compared to healthy individuals after subway air exposure 2011 Ingår i: PLOS ONE. - San Francisco, CA : Public Library of Science. - 1932-6203. ; 6:8, s. e23864- Tidskriftsartikel (refereegranskat)abstract Background: Asthma is a chronic inflammatory lung disease that causes significant morbidity and mortality worldwide. Air pollutants such as particulate matter (PM) and oxidants are important factors in causing exacerbations in asthmatics, and the source and composition of pollutants greatly affects pathological implications.Objectives: This randomized crossover study investigated responses of the respiratory system to Stockholm subway air in asthmatics and healthy individuals. Eicosanoids and other oxylipins were quantified in the distal lung to provide a measure of shifts in lipid mediators in association with exposure to subway air relative to ambient air.Methods: Sixty-four oxylipins representing the cyclooxygenase (COX), lipoxygenase (LOX) and cytochrome P450 (CYP) metabolic pathways were screened using liquid chromatography-tandem mass spectrometry (LC-MS/MS) of bronchoalveolar lavage (BAL)-fluid. Validations through immunocytochemistry staining of BAL-cells were performed for 15-LOX-1, COX-1, COX-2 and peroxisome proliferator-activated receptor gamma (PPAR gamma). Multivariate statistics were employed to interrogate acquired oxylipin and immunocytochemistry data in combination with patient clinical information.Results: Asthmatics and healthy individuals exhibited divergent oxylipin profiles following exposure to ambient and subway air. Significant changes were observed in 8 metabolites of linoleic- and alpha-linolenic acid synthesized via the 15-LOX pathway, and of the COX product prostaglandin E(2) (PGE(2)). Oxylipin levels were increased in healthy individuals following exposure to subway air, whereas asthmatics evidenced decreases or no change.Conclusions: Several of the altered oxylipins have known or suspected bronchoprotective or anti-inflammatory effects, suggesting a possible reduced anti-inflammatory response in asthmatics following exposure to subway air. These observations may have ramifications for sensitive subpopulations in urban areas.
37.	Lönnerholm, Gudmar, 1941-, et al. (författare) In vitro cellular drug resistance adds prognostic information to other known risk-factors in childhood acute lymphoblastic leukemia 2011 Ingår i: Leukemia Research. - : Elsevier. - 0145-2126 .- 1873-5835. ; 35:4, s. 472-478 Tidskriftsartikel (refereegranskat)abstract Leukemic cells from 230 children with newly diagnosed B-cell precursor ALL were tested for in vitro drug resistance to a panel of anti-cancer drugs. Minimal residual disease (MRD) was measured by RQ-PCR. During follow-up, 24 relapses occurred in the 159 children with MRD <0.1% day 29. The risk of any relapse was correlated to vincristine and doxorubicin resistance, with a relative risk of 3.7 (95% CI 1.3-10.5; p=0.016) for patients resistant to both drugs. There was a significant correlation also for the subgroup with extra-medullary relapses. Our findings indicate that analysis of drug resistance can add prognostic information to other known risk-factors including MRD.
38.	Martinell, Louise, et al. (författare) Survival in Out of Hospital Cardiac Arrest Before and After Use of Advanced Post Resuscitation Care 2010 Ingår i: American Journal of Emergency Medicine. - : Elsevier. - 0735-6757 .- 1532-8171. ; 28:5, s. 543-551 Tidskriftsartikel (refereegranskat)abstract Background: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia. Methods: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Goteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared. Results: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011).For all patients, I-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in I-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >= 3) decreased from 28% to 6% (P = .0006) among all patients. Conclusion: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm. (C) 2010 Elsevier Inc. All rights reserved.
39.	Martinell, Louise, et al. (författare) Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care. 2010 Ingår i: The American journal of emergency medicine. - : Elsevier BV. - 1532-8171 .- 0735-6757. ; 28:5, s. 543-51 Tidskriftsartikel (refereegranskat)abstract Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia.
40.	Norberg, Eva-Britt, 1956- (författare) Dagliga aktiviteter bland äldre personer med kronisk hjärtsvikt : begränsningar och möjligheter 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Chronic Heart Failure (CHF) is known to have a substantial impact on activities of daily living (ADL) and symptoms such as breathlessness and fatigue are characteristic. Despite this, research in occupational therapy concerning people with CHF is rare. The overall aim of this thesis was to increase the knowledge of ADL ability and fatigue among those with CHF, to describe experiences of limitations in occupational performance and the strategies that these elderly people use to manage their daily activities and also to describe a programme including energy conservation for clients with CHF in primary healthcare.Method Three groups of older people with a verified diagnosis of CHF and one group of occupational therapists (OTs), all recruited from primary healthcare, were analyzed. The ADL ability of 40 participants was described, with reference to dependence on others, perceived strain and quality of occupational performance. The association between ADL ability and the New York Heart Association Classification (NYHA), a functional classification for people with CHF, was analyzed. Fatigue and its association to ADL ability, use of assistive devices and community support were also analyzed. Ten respondents were then interviewed and asked to describe the strategies they used to manage ADL. The interview results were combined with the current body of research and CHF guidelines to form a base for the development of an intervention programme, including energy conservation, for people with CHF. The programme, based on the Occupational Therapy Intervention Process Model (OTIPM), was used by OTs in primary healthcare, and the clients’ ADL, goal achievements and use of energy conservation strategies were described, as well as the five clients’ and two OTs’ experiences of the program.Results Most participants were independent in personal ADL activities (PADL). A majority was dependent in one or more instrumental ADL activities (IADL) and perceived strain when performing the activities independently. The Assessment of Motor and Process Skills (AMPS) showed a reduced quality of occupational performance compared with healthy people of the same age. Age had a significant impact on ADL performance. Despite this, participants in NYHA III/IV showed significantly increased effort (under motor cutoff) when performing ADL tasks compared with those in NYHA I/II. Fatigue was common and greater fatigue was associated significant with increased dependence and decreased quality of occupational performance, with the exception of shopping. Participants who used assistive devices and home care estimated higher physical fatigue, but no correlation was found with community mobility services. Comorbidities, which can affect occupational performance, were common in all the studies.The participants experiences of limitations in occupational performance and the strategies that they used to manage their daily activities were described as redefining an active life, aware of one’s impaired body and planning activities and balancing the degree of effort.During the interventions according to the programme the clients’ increased their participation and independence in daily activities, consciously gave up what were less meaningful activities for them and deteriorated because of the progression of the CHF. Most goals were achieved and many energy conservation strategies were used by the clients. The clients’ experiences were described as working in collaboration to manage daily activities and using professional support from OTs to enhance their activities. The OTs’ experiences of the programme were described as being supported with specific knowledge and a structured way of working and finding clinical benefits from working according to the program, but doubt the possibilitiy of using it, due to constraints in clinical practice.Discussion The participants' physical fatigue and breathlessness had a negative impact on their ADL-ability. Age affected ADL performance, but the impact of a more severe CHF remained adjusted for age. An ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability was described. Many of the strategies used by the participants to handle daily activities could be described as energy conservation strategies, an indication that occupational therapy interventions including energy conservation management would be beneficial for clients with CHF. Both the OTs and the clients described that the specialized programme provided structure for the OTs’ work, knowledge about CHF and about valuable energy conservation strategies. The programme seemed to support the OTs to work in a more comprehensive client-centered way.Conclusion The work with this thesis has increased the limited existing knowledge about elderly people with CHF and their ADL ability, fatigue and the adaptation of occupational performance that they use to manage their daily activities. The experiences indicated that a specialized programme including energy conservation for occupational therapy in primary healthcare seemed to support the OTs work in a more comprehensive client-centered way. The programme needs to be further evaluated.
41.	Nordlund, Jessica, et al. (författare) Genome-wide signatures of differential DNA methylation in pediatric acute lymphoblastic leukemia 2013 Ingår i: Genome Biology. - : Springer Science and Business Media LLC. - 1465-6906 .- 1474-760X. ; 14:9, s. r105- Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Although aberrant DNA methylation has been observed previously in acute lymphoblastic leukemia (ALL), the patterns of differential methylation have not been comprehensively determined in all subtypes of ALL on a genome-wide scale. The relationship between DNA methylation, cytogenetic background, drug resistance and relapse in ALL is poorly understood.RESULTS:We surveyed the DNA methylation levels of 435,941 CpG sites in samples from 764 children at diagnosis of ALL and from 27 children at relapse. This survey uncovered four characteristic methylation signatures. First, compared with control blood cells, the methylomes of ALL cells shared 9,406 predominantly hypermethylated CpG sites, independent of cytogenetic background. Second, each cytogenetic subtype of ALL displayed a unique set of hyper- and hypomethylated CpG sites. The CpG sites that constituted these two signatures differed in their functional genomic enrichment to regions with marks of active or repressed chromatin. Third, we identified subtype-specific differential methylation in promoter and enhancer regions that were strongly correlated with gene expression. Fourth, a set of 6,612 CpG sites was predominantly hypermethylated in ALL cells at relapse, compared with matched samples at diagnosis. Analysis of relapse-free survival identified CpG sites with subtype-specific differential methylation that divided the patients into different risk groups, depending on their methylation status.CONCLUSIONS:Our results suggest an important biological role for DNA methylation in the differences between ALL subtypes and in their clinical outcome after treatment.
42.	Olausson, Patrik, et al. (författare) Identification of Proteins from Interstitium of Trapezius Muscle in Women with Chronic Myalgia Using Microdialysis in Combination with Proteomics 2012 Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 7:12 Tidskriftsartikel (refereegranskat)abstract Background: Microdialysis (MD) of the trapezius muscle has been an attractive technique to investigating small molecules and metabolites in chronic musculoskeletal pain in human. Large biomolecules such as proteins also cross the dialysis membrane of the catheters. In this study we have applied in vivo MD in combination with two dimensional gel electrophoresis (2-DE) and mass spectrometry to identify proteins in the extracellular fluid of the trapezius muscle. Materials and Methods: Dialysate from women with chronic trapezius myalgia (TM; n = 37), women with chronic wide spread pain (CWP; n = 18) and healthy controls (CON; n = 22) was collected from the trapezius muscle using a catheter with a cut-off point of 100 kDa. Proteins were separated by two-dimensional gel electrophoresis and visualized by silver staining. Detected proteins were identified by nano liquid chromatography in combination with tandem mass spectrometry. Results: Ninety-seven protein spots were identified from the interstitial fluid of the trapezius muscle; 48 proteins in TM and 30 proteins in CWP had concentrations at least two-fold higher or lower than in CON. The identified proteins pertain to several functional classes, e.g., proteins involved in inflammatory responses. Several of the identified proteins are known to be involved in processes of pain such as: creatine kinase, nerve growth factor, carbonic anhydrase, myoglobin, fatty acid binding protein and actin aortic smooth muscle. Conclusions: In this study, by using in vivo microdialysis in combination with proteomics a large number of proteins in muscle interstitium have been identified. Several of the identified proteins were at least two-fold higher or lower in chronic pain patients. The applied techniques open up for the possibility of investigating protein changes associated with nociceptive processes of chronic myalgia. © 2012 Olausson et al.
43.	Olausson, Patrik, et al. (författare) Relative recovery over time – an in vivo microdialysisstudy of human skeletal muscle 2013 Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa Healthcare. - 0036-5513 .- 1502-7686. ; 73:1, s. 10-16 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:The microdialysis technique is a method for sampling endogenous molecules from the interstitial compartments of varying tissues and relies on diffusion of molecules between the tissue and a perfusate via a membrane. Such samples do not allow determination of the true interstitial concentration but only a certain percentage. This gives rise to one of the most crucial parameter that needs to be considered for a dependable microdialysis; the relative recovery. Relative recovery states the efficiency of which an analyte is extracted from its external medium. Aim. To investigate the relative recovery of small molecules (< 20 kDa) such as lactate, fluid recovery and the reproducibility of the relative recovery at group and individual level of the microdialysis technique applied in muscle.MATERIALS AND METHODS:Using in vivo microdialysis of the trapezius muscle of 65 women from two separate occasions 4-6 months apart. Relative recovery of small molecules was measured from samples collected every 20 min during a period of 220 min.RESULTS:Good reproducibility at group level of catheters with cut-offs 100 and 20kDa were found. Furthermore, there was a high and steady relative recovery with an overall good fluid recovery. Poor reproducibility was found at the individual level for both catheters.CONCLUSIONS:This study demonstrates that when using microdialysis in skeletal muscle relative recovery is stable over time and is not affected by low-force exercise. Although there is a good reproducibility at group level this is not the case at the individual level. Thus in vivo, the relative recovery should be determined for each test subject and at each test occasion.
44.	Petranikova, Martina, 1983, et al. (författare) Hydrometallurgical technology for recovery of metals from spent car NiMH batteries 2014 Ingår i: Abstract of Papers of the American Chemical Society. - 0065-7727. ; 247 Konferensbidrag (övrigt vetenskapligt/konstnärligt)
45.	Rescorla, Leslie, et al. (författare) International Epidemiology of Child and Adolescent Psychopathology II: Integration and Applications of Dimensional Findings From 44 Societies 2012 Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567. ; 51:12, s. 1273-1283 Forskningsöversikt (refereegranskat)abstract Objective: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. Method: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. Results: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. Conclusions: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children. J. Am. Acad. Child Aclolesc. Psychiatry; 2012; 51(12):1273-1283.
46.	Romanowska, Julia, et al. (författare) Health Effects on Leaders and Co-Workers of an Art-Based Leadership Development Program. 2010 Ingår i: Psychotherapy and Psychosomatics. - Basel : S. Karger AG. - 0033-3190 .- 1423-0348. ; 80:2, s. 78-87 Tidskriftsartikel (refereegranskat)abstract Background: There are very few evaluations of the effectiveness of leadership development programs. The purpose of the study was to examine whether an art-based leadership program may have a more beneficial effect than a conventional one on leaders' and their corresponding subordinates' mental and biological stress. Methods:Participating leaders were randomized to 2 year-long leadership programs, 1 art-based and 1 conventional, with follow-up of the leaders and their subordinates at 12 and 18 months. The art-based program built on an experimental theatre form, a collage of literary text and music, followed by writing and discussions focused on existential and ethical problems. Results: After 18 months a pattern was clearly visible with advantage for the art-based group. In the art group (leaders and their subordinates together as well as for subordinates only) compared to the conventional group, there was a significant improvement of mental health, covert coping and performance-based self-esteem as well as significantly less winter/fall deterioration in the serum concentration of the regenerative/anabolic hormone dehydroepiandrosterone-sulfate. Conclusions:Our findings indicate a more beneficial long-term health effect of the art-based intervention compared to a conventional approach. Positive results for both standardized questionnaires and biological parameters strengthened the findings. The study provides a rationale for further evaluation of the effectiveness of this alternative educational approach.
47.	Schaller, Anne, et al. (författare) How relatives of patients with head and neck cancer experience pain, disease progression and treatment: A qualitative interview study 2014 Ingår i: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 18:4, s. 405-410 Tidskriftsartikel (refereegranskat)abstract Purpose: This study of relatives to patients with head and neck cancer (HNC) treated with radiotherapy describes how the relatives experienced the patients situation, especially with respect to pain, and how the relatives themselves experienced the situation. Methods: Semi-structured interviews of 21 relatives to HNC patients who suffered from pain were conducted, and a qualitative content analysis was performed. Results: The relatives experienced that the patients suffered from physical, psychological, and social pain. A dark picture consisting of lack of participation and knowledge, psychological distress, and lack of support were reported. Thus, a main category: relatives struggle with loved ones pains related to head and neck cancer treatment and with their own demanding situation - was based on the following four categories: inability to relieve and comprehend the physical suffering of the patients; overwhelming emotions were experienced that affect the patients and the relatives themselves; in need of support from the health care service; and altered daily activities and family roles due to illness and treatment. Conclusion: In patients physical, psychological, and social pain were prominent and in relatives psychological distress, lack of knowledge and support were experienced. Thus, to reduce pain and anxiety in patients and relatives, the health care professionals should provide relevant knowledge about pain management. The health care professionals should also provide educational interventions that address the psychological and social factors that impact pain for HNC patients and their relatives. Well-thought supporting care and easily accessible information about practical concerns should be offered to HNC patients and their relatives.
48.	Sjogaard, Gisela, et al. (författare) Muscle oxygenation and glycolysis in females with trapezius myalgia during stress and repetitive work using microdialysis and NIRS 2010 Ingår i: EUROPEAN JOURNAL OF APPLIED PHYSIOLOGY. - : Springer Science and Business Media LLC. - 1439-6319 .- 1439-6327. ; 108:4, s. 657-669 Tidskriftsartikel (refereegranskat)abstract The aim of this investigation was to study female workers active in the labour market for differences between those with trapezius myalgia (MYA) and without (CON) during repetitive pegboard (PEG) and stress (STR) tasks regarding (1) relative muscle load, (2) trapezius muscle blood flow, (3) metabolite accumulation, (4) oxygenation, and (5) pain development. Among 812 female employees (age 30-60 years) at 7 companies with high prevalence of neck/shoulder complaints, clinical examination identified 43 MYA and 19 CON. At rest, during PEG, and STR the trapezius muscle was measured using (1) EMG and MMG, (2) microdialysis, and (3) NIRS. Further, subjective pain ratings were scored (VAS). EMGrms in %MVE (Maximal Voluntary EMG-activity), was significantly higher among MYA than CON during PEG (11.74 +/- A 9.09 vs. 7.42 +/- A 5.56%MVE) and STR (5.47 +/- A 5.00 vs. 3.28 +/- A 1.94%MVE). MANOVA showed a group and time effect regarding data from the microdialysis: for MYA versus CON group differences demonstrated lower muscle blood flow and higher lactate and pyruvate concentrations. Potassium and glucose only showed time effects. NIRS showed similar initial decreases in oxygenation with PEG in both groups, but only in CON a significant increase back to baseline during PEG. VAS score at rest was highest among MYA and increased during PEG, but not for CON. The results showed significant differences between CON and MYA regarding muscle metabolism at rest and with PEG and STR. Higher relative muscle load during PEG and STR, insufficient muscle blood flow and oxygenation may account for the higher lactate, pyruvate and pain responses among MYA versus CON.
49.	Sjörs, Anna, et al. (författare) An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain 2011 Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 12, s. 230-230 Tidskriftsartikel (refereegranskat)abstract Background: Neck-shoulder pain conditions, e. g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). less thanbrgreater than less thanbrgreater thanMethods: Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. less thanbrgreater than less thanbrgreater thanResults: NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. less thanbrgreater than less thanbrgreater thanConclusion: These results indicate that central mechanisms e. g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds.
50.	Sjörs, Anna, 1981- (författare) I feel terrible! Can you measure that? : Exploring psychophysiological stress responses and their interactions with performance, subjective reports and health status 2010 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Despite recent research advances, there are still several common medical conditions whose underlying mechanisms are poorly understood. In conditions with few or diffuse physical findings, it can be difficult to diagnose and determine the state of the condition and its effects on working ability or performance, and the health care practitioners have to rely on the patient’s self-reports. Identification of objective measurements that are sensitive enough to aid in diagnosis or determination of the state of these conditions would thus be valuable. Psychophysiological measurements are generally non-invasive and have the potential to serve as such diagnostic or prognostic tools. In this thesis, psychophysiological reactions to different stressors were recorded in two selected medical conditions; namely motion sickness and chronic trapezius myalgia (musculoskeletal pain). These subjective conditions are unpleasant, unwanted and apparently serve no survival purpose. It is therefore important to elucidate any physical findings associated with them to, eventually, find new means to prevent the development of these conditions or to ameliorate symptoms.The overall aim of the thesis was to explore the development of psychophysiological responses to stressors in relation to performance and subjective reports in healthy individuals and in women with chronic trapezius myalgia. More in detail, the purpose was to identify psychophysiological responses that could provide information about the mechanisms behind, or serve as candidates for characterization of motion sickness and chronic trapezius myalgia, respectively.Responses to motion sickness, triggered by optokinetic stimulation, were studied in healthy individuals, whereas responses to repetitive low-force work and psychosocial stress were studied in women with chronic trapezius myalgia and in pain-free controls. In both medical conditions, the psychophysiological responses were accompanied by subjective reports. The effects of motion sickness on two different aspects of memory performance were tested during exposure to optokinetic stimulation. In the studies of chronic trapezius myalgia, psychophysiological responses were also related to health status, i.e., being a patient or a pain-free control and measurements of pain intensity, psychological symptoms, sleep-related problems and quality of life.The psychophysiological responses to optokinetic stimulation were inconclusive. Moderate levels of motion sickness did not affect memory performance, whereas decreased short term memory performance was seen in subjects reporting high levels of motion sickness. The autonomic responses and stress hormone secretion in response to low-force repetitive work and psychosocial stress in the chronic trapezius myalgia group were similar to those of the pain-free controls. However, muscle activity in the trapezius muscle was generally higher in the chronic trapezius myalgia group. There were indications of negative psychological states being related to a slower response and lower circadian variations of stress hormone secretion.With the present methods, it was possible to measure general stress responses but none of the measurements showed sufficient specificity to serve as predictors or indicators of motion sickness and chronic musculoskeletal pain, respectively. Summarizing, I cannot objectively measure how you feel; I still have to rely on your description of your condition.

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