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- Bergh, Cecilia, 1972-
(author)
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Life-course influences on occurrence and outcome for stroke and coronary heart disease
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.
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| 2. |
- Carling, Anna, 1985-
(author)
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Impaired balance and fall risk in people with multiple sclerosis
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The symptoms from the neurological disease multiple sclerosis vary from person to person and over time. Impaired balance is common in people with multiple sclerosis and can lead to falls. Fall frequency is high in people with multiple sclerosis, above 50%. Multiple sclerosis affects not only the person having the disease but also their next of kin. To be able to reduce fall risk it is important to know when, why and where people with multiple sclerosis fall, and how to improve balance and reduce falls with exercise. It is also important to know how the falls affect the residing next of kin to people with multiple sclerosis.The overall aim of this thesis was to gain enhanced knowledge by investigating when and why people with MS fall and how these falls possibly affect their next of kin, and also to evaluate the effects and perceptions of participating in a specific balance exercise.Data were gathered using four different data collections, and this thesis contains both qualitative and quantitative data.The major finding in this thesis is that people with multiple sclerosis fall in the course of everyday life activities, most often in their own homes due to various intrinsic and extrinsic factors. Balance can be improved and falls reduced and everyday life may be made easier and facilitated after participating in the CoDuSe balance exercise. This is important also for the next of kin, since they are adapting, adjusting and renouncing their activities due to the falls of the PwMS, in order to make it work for the whole family.
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| 3. |
- Nilsagård, Ylva, 1964-
(author)
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Walking ability, balance and accidental falls in persons with Multiple Sclerosis
- 2008
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Doctoral thesis (other academic/artistic)abstract
- By using a pragmatic paradigm, different research methodologies were employed in this thesis. MS-related symptoms may be exaggerated due to heatsensitivity and it is supposed that cooling garments relieve the symptoms. The effects of wearing a Rehband® vest were evaluated in a sample of 42 persons with MS in a randomised controlled crossover study. Both objective and subjective statistically significant improvements were found when a cooled Rehband® vest was worn compared to the wearing of a room-tempered vest. Using a repeated-measures design, 10m and 30m timed walks and Timed Up and Go were studied in 42 persons with MS. Reproducibility was investigated within and between test points. High reproducibility was found both within (r=0.97–0.98) and between measure points (r=0.91–0.93). The correlation between the three tests was high (r=0.85). Differences at –23% to +40% were established as being needed to detect genuine changes. Severity of MS infl uenced the size of the differences, especially for the 30m timed walk test. The 12-item MS Walking Scale was translated and used in a cross-sectional study. Out of 81 persons with MS, 89–96% perceived limitations in standing or walking. The internal consistency of the scale was acceptable for nine items (0.69–0.84). The concurrent validity between the 12-item MS Walking Scale and the investigated objective tests was low: Berg Balance Scale (r=–0.368**), Four Square Step Test (r=0.338**) and Timed Up and Gocognitive (r=0.319*). A prevalence of falling was found at 63% in a longitudinal cohort study with prospectively registered falls including 76 persons with MS. The odds of falling were fi ve fold when there was a reported need of using a walking aid indoors and outdoors and by 2.5 to 15.6 times while there was disturbed proprioception, depending on severity. The highest sensitivity was found for the Berg Balance Scale (94%) and the highest specifi city was found for the 12-item MS Walking Scale (82%). Positive predictive values at 70–83% were found for the Berg Balance Scale, Timed Up and Gocognitive, the Four Square Step Test and the 12-item MS Walking Scale. Finally, we explored and described factors that persons with MS perceive as related to accidental falls. A content analysis with a deductive approach was chosen. By conducting interviews, we found previously untargeted factors: divided attention, reduced muscular endurance, fatigue and heat-sensitivity. The content of the interviews also gave support to previously reported risk factors such as changes in gait pattern, walking disability, impaired proprioception and vision, and spasticity.
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