| 1. |
- Berggren, Kristina, et al.
(author)
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Oral health problems linked to obstructive sleep apnea are not always recognized within dental care-As described by dental professionals
- 2022
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In: Clinical and Experimental Dental Research. - : Wiley-Blackwell. - 2057-4347. ; 8:1, s. 84-95
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Journal article (peer-reviewed)abstract
- Objectives Obstructive sleep apnea (OSA) has an impact on an individual's quality of life and general health, and can also affect their oral health. The patient's experiences, together with intraoral signs and symptoms could indicate the presence of OSA. Knowledge that the patient has, or is at high risk for having OSA can help the dental healthcare provider maintain the oral health and general health for these patients. The purpose was to explore dentists and dental hygienists' experiences when encountering adult patients with potential, untreated and treated OSA. Methods A qualitative inductive approach was used. Experienced dentists and dental hygienists working within Swedish Public Dental Service were strategically selected. Semi-structured face-to-face interviews were performed followed by qualitative content analysis. Results Interviews from 13 participants, seven dental hygienist and six dentists, led to three areas describing varied experience: Importance of the patient encounter and identifying intraoral signs both of which describe experiences related to the importance of the initial unstructured conversation and focused clinical assessments, and strategies for nurturing care which point to interest about care, treatment, and collaborations with medical health care providers. Conclusions Dental professionals are not able to consistently recognize patients who have, or are at high risk for OSA. During the patient encounter, is it important to determine if a patient is at risk for, or has oral signs of OSA.
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| 2. |
- Bjerke, Joakim
(author)
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Gait and postural control after total knee arthroplasty
- 2014
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Doctoral thesis (other academic/artistic)abstract
- The aim of the thesis was to investigate deficits and compensatory strategies after total knee arthroplasty (TKA) in different conditions during gait and quiet standing. Although TKA is considered the gold standard treatment for end-stage knee osteoarthritis, it is associated with a number of implications. Reduced physical function after osteoarthritis is partly, but apparently not fully, remedied by surgery. The two most common deficits are reduced knee muscle strength and limited range of knee joint motion (ROM), partly due to prosthesis mechanics. Reduced postural control has also been shown shortly after surgery. In spite of sufficient passive knee joint ROM for normal ambulation, gait patterns are characterized by reduced knee flexion. Several factors such as reduced knee muscle strength, reduced proprioception, habitual strategies or fear of movement may be suggested as explanations for difficulties in gait and posture. As an effect, compensatory strategies may result. In order to focus on the implications of TKA, participants had to be less than 65 years of age and healthy, TKA being the only factor different form controls. The same 23 individuals with unilateral TKA ~ 19 months post-operative and 23 controls participated in all studies. 3D whole body kinematics was used to assess gait and posture and electromyography was used to record muscle activity. Isokinetic measurements were used to determine dynamic knee muscle strength. Gait in the frontal and sagittal planes were assessed. The tasks included in the test protocol were negotiation up and down stairs, gait on hard and soft surface, quiet standing with sensory modulation (with and without vision and on soft surface), and single limb stance. Primary outcome variables addressed were: knee and hip joint kinematics in frontal and sagittal planes, upper body inclination, postural sway and relative knee muscle activity as an indicator of relative effort. Background factors used to explain group differences in the primary outcomes were derived from demographics, clinical examination, and questionnaires. Demographic factors were age, body mass index (BMI), and time since surgery. Clinical examinations were conducted for passive knee joint ROM, joint position sense, knee muscle strength, anterior knee joint laxity, and leg length. Questionnaires assessed fear of movement, pain, and knee related function and quality of life. The results showed that knee flexion was reduced during stair descent in both the prosthetic and the contralateral knee in the TKA group compared to controls. Although reduced passive knee joint flexion in the TKA group was sufficient for normal stair descent, it was the only factor identified that explained reduced knee flexion in stair descent. As knee muscle strength was significantly reduced in the TKA group, it is reasonable to suggest that as a contributing factor. Furthermore, the TKA group also displayed increased hip adduction during stair descent, which may indicate both a compensatory strategy as well as reduced hip muscle strength. In stair ascent, no significant group differences were found in relative knee muscle activity as expected due to knee muscle weakness. Nor were there any indications of compensatory forward inclination of the trunk to reduce knee joint moments. Instead, probably compensating for muscle weakness, the TKA group ascended stairs at a significantly slower speed. Surface modulation during level gait showed that reduced knee flexion in the prosthetic knee during the stance phase when walking on a hard surface was further decreased during gait on a soft surface. Knee and hip adduction at the stance phase were not affected by surface conditions. Nevertheless, the TKA group displayed increased knee adduction and hip adduction compared to controls, particularly in the prosthetic side. In addition, the TKA group displayed increased step width on the soft compared to hard surface. Single-limb stance for 20 seconds failed in 30 % of the TKA group and in 4 % of the control group. Those in the TKA group who were able to perform single-limb stance performed equally well as controls. During bilateral quiet standing, postural sway was similar in both groups, and inability to stand on one leg did not affect bilateral stance. Older age, higher BMI and reduced quadriceps strength determined the failure to maintain single-limb stance in the TKA group. In conclusion, this thesis indicates that reduced knee muscle strength is a common denominator as part of the explanatory factors for reduced performance and compensatory strategies in individuals with TKA. Reduced speed during stair ascent as well as reduced knee flexion during stair descent may be compensations for reduced lower extremity strength. Increased hip adduction may compensate for reduced knee flexion in stair descent, but may also represent hip muscle weakness or reduced motor control as increased hip adduction is found also in level gait. The failure to maintain single-limb stance in the TKA group is also partly explained by reduced knee muscle strength. Muscle weakness may be and indicator for reduced physical capacity in general.
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| 3. |
- Broström, Anders, et al.
(author)
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6-month CPAP-treatment in a young male patient with severe obstructive sleep apnoea syndrome - A case study from the couples perspective
- 2008
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:2, s. 103-112
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Journal article (peer-reviewed)abstract
- Background: Obstructive sleep apnoea syndrome (OSAS) is independently associated with an increased risk for hypertension and cardiovascular disease. Continuous positive airway pressure (CPAP) can reduce mortality and morbidity, but low compliance rates are seen. Aim: To explore and describe the experiences of CPAP-treatment in a young male patient with severe OSAS during a 6-month period from the couples perspective. Methods and the case: A single case study with a phenomenographic approach was employed. Diagnostic procedures of OSAS and initiation of treatment with Auto-CPAP, humidifier and a nasal mask were performed during 4 visits. Conceptions were collected at 4 different occasions during the 6-month period (before, and 2 weeks, 3 months, and 6 months after treatment initiation) by means of interviews with a 33-year old male patient and his female partner. Findings: Totally 17 different structural aspects were found to fluctuate during the 6-month period in relation to; influence of stressors, social reactions and adaptation to increase compliance. Conclusion: An increased knowledge about the influence of stressors, the social reactions, and the adaptation can help healthcare personnel to identify and better understand concerns of other patients and spouses during different time phases of the initial 6-month period of CPAP-treatment.
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| 4. |
- Broström, Anders, et al.
(author)
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A mixed method evaluation of a group-based educational programme for CPAP use in patients with obstructive sleep apnea
- 2013
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In: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 19:1, s. 173-184
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Journal article (peer-reviewed)abstract
- Rationale, aims and objectives Continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) has a low long-term adherence. Educational interventions are few and sparsely described regarding content, pedagogical approach and participants' perceptions. The aim was to describe adherence to CPAP treatment, knowledge about OSA/CPAP, as well as OSA patients' perceptions of participating in a group-based programme using problem-based learning (PBL) for CPAP initiation.Educational programme The PBL programme incorporated elements from theories and models concerning motivation and habits. Tutorial groups consisting of four to eight patients met at six sessions during 6 months.Methods A sequential explanatory mixed method design was used on 25 strategically selected patients. Quantitative data regarding, clinical variables, OSA severity, CPAP use, and knowledge were collected at baseline, after 2 weeks and 6 months. Qualitative data regarding patients' perceptions of participation were collected after 6 months by semi-structured interviews using a phenomenographic approach.Results 72% of the patients were adherent to CPAP treatment after 2 weeks and 6 months. All patients improved their baseline knowledge about OSA and CPAP after 2 weeks and sustained it after 6 months. Anxiety and fear, as well as difficulties and needs were motivational factors for participation. Patients described the difficulties of behavioural change, an awareness that improvements do not occur immediately, a realization of the importance of both technical and emotional support and the need for a healthier lifestyle.Conclusion and practice implications A group-based programme using PBL seems to facilitate adaptive and developmental learning and result in acceptable CPAP adherence levels.
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| 5. |
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| 6. |
- Broström, Anders, et al.
(author)
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Association of Type D personality to perceived side effects and adherence in CPAP-treated patients with OSAS
- 2007
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In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 16:4, s. 439-447
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Journal article (peer-reviewed)abstract
- Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side effects are common and long-term adherence low. The Type D (distressed) personality is defined as a combination of negative affectivity and social inhibition. The association of Type D personality with adherence has not been studied in CPAP-treated patients with OSAS. This study aimed to describe the prevalence of Type D personality in OSAS patients with CPAP treatment longer than 6 months and the association with self-reported side effects and adherence. A cross-sectional descriptive design was used. A total of 247 OSAS patients with a mean use of CPAP treatment for 55 months (6-182 months) were included. Data collection was achieved by two questionnaires; the Type D scale 14 (DS14) (Type D personality), SECI (side effects of CPAP), as well as from medical records (clinical variables and objective adherence to CPAP treatment). Type D personality occurred in 30% of the patients with OSAS and significantly (P < 0.05-0.001) increased the perceived frequency and severity of a broad range of side effects. The objective adherence was significantly lower (P < 0.001) for OSAS patients with Type D compared to OSAS patients without Type D, both with regard to a mean use of 4 h per night and 85% of the self-rated sleep time per night. The additional effect of a Type D personality on perceived side effects and adherence to CPAP treatment found in this study could be used by healthcare personnel when evaluating patients waiting for treatment.
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| 7. |
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| 8. |
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| 9. |
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| 10. |
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| 11. |
- Broström, Anders, et al.
(author)
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Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients
- 2012
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In: Scandinavian Journal of Primary Health Care. - : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 30:2, s. 107-113
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Journal article (peer-reviewed)abstract
- Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.
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| 12. |
- Broström, Anders, 1963-, et al.
(author)
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Gender differences in respiratory disturbance, sleep and daytime sleepiness in hypertensive patients with different degrees of obesity
- 2013
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 12:2, s. 140-149
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Journal article (peer-reviewed)abstract
- BackgroundHypertension (HT) and obesity have both been linked to obstructive sleep apnoea (OSA). Difficulties have been described in identifying patients with OSA in primary care, causing low referral rates to sleep clinics. Increased knowledge about gender-specific characteristics and symptoms may help to identify patients.AimThe aim was to describe gender differences regarding undiagnosed OSA, self-rated sleep, insomnia and daytime sleepiness in middle-aged primary care patients with HT and different degrees of obesity.MethodsA cross-sectional design was used and 394 patients (52.5% women), mean age 57.8 years (SD 6.7 years), with HT (BP >140/90 mmHg) were included. Clinical examinations, respiratory recordings and self-rated scales regarding OSA symptoms, sleep, insomnia and daytime sleepiness were used. Body mass index (BMI) was classified according to the criteria from the National Institutes of Health.ResultsPre-obesity and obesity classes I and II were seen among 53%, 26% and 8% of the men and 37%, 19% and 14% of the women, respectively. Occurrence of mild, moderate and severe OSA increased significantly across the BMI classes for both genders (p<0.01). Ninety percent of the men and 80% of the women in obesity class II had OSA. Insomnia was prevalent in obese patients. Other clinical variables did not differ between BMI classes or genders.ConclusionThe occurrence of overweight/obesity and OSA was high among both genders. A high BMI might be a convenient clinical marker for healthcare personnel to identify hypertensive patients with possible OSA in need of further evaluation and treatment.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Broström, Anders, et al.
(author)
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Obstructive sleep apnoea syndrome - Patients' perceptions of their sleep and its effects on their life situation
- 2007
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In: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 57:3, s. 318-327
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Journal article (peer-reviewed)abstract
- Title. Obstructive sleep apnoea syndrome - patients' perceptions of their sleep and its effects on their life situation Aim. This paper reports a descriptive study of how untreated patients with obstructive sleep apnoea syndrome perceived their sleep situation and how the syndrome affected their life situation. Background. Obstructive sleep apnoea syndrome is a prevalent problem independently associated with an increased risk for hypertension, cardiovascular disease, chronic heart failure and mortality. Increased consumption of healthcare resources can often be seen among patients over a long period of time since many have been undiagnosed and untreated. Methods. A phenomenographic approach was employed. Data were collected by interviews during 2005 with 20 purposively selected participants with untreated obstructive sleep apnoea syndrome. Findings. Participants described loud snoring, frequent awakenings, dyspnoea, frustration over nocturia, fear of dying during sleep and partners' anxiety about the apnoea, as being night-time effects of obstructive sleep apnoea syndrome. They described dry and sore throats, tiredness and daytime sleepiness, shame about falling asleep and snoring, thoughts about complications and depressed mood as daytime effects. Needs, such as increased alertness, improved ability to concentrate, improved relationship, adequate information as well as effective treatment, were described. Participants tried self-care strategies such as information-seeking about sleep disturbances and treatment, adapted sleeping routines, change of bedroom arrangements, adapted daily schedules, hyperactivity and avoidance of difficult situations. Conclusion. The perceived effects and needs, as well as tried self-care actions by the patients with obstructive sleep apnoea syndrome in this study, could be used to identify and evaluate concerns of other patients with obstructive sleep apnoea syndrome waiting for treatment. © 2007 The Authors.
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| 17. |
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| 18. |
- Broström, Anders, et al.
(author)
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Perceived informational needs, side-effects and their consequences on adherence-A comparison between CPAP treated patients with OSAS and healthcare personnel
- 2009
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In: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 74:2, s. 228-235
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Journal article (peer-reviewed)abstract
- Objective: To compare perceptions among continuous positive airway pressure (CPAP) treated patients with obstructive sleep apnoea syndrome (OSAS) and healthcare personnel with regard to informational needs, side-effects and their consequences on adherence. Methods: A cross-sectional descriptive design was used including 350 CPAP treated OSAS patients from three Swedish hospitals and 105 healthcare personnel from 26 Swedish hospitals. Data collection was performed using two questionnaires covering informational needs, side-effects and adherence to CPAP. Results: Both groups perceived all surveyed informational areas as very important. Patients perceived the possibilities to learn as significantly greater in all areas (p < 0.001) compared to healthcare personnel, and scored significantly higher regarding positive effects on adherence of information about pathophysiology (p < 0.05), self-care (p < 0.001) and troubleshooting (p < 0.01). A total of I I out of 15 surveyed side-effects were perceived to be more frequent by healthcare personnel (p < 0.01 - p < 0.001). They also scored all side-effects to cause greater problems and decrease the CPAP use to a greater extent (p < 0.001). Conclusion: Knowledge about these differences between patients and healthcare personnel regarding educational needs, side-effects and their effects on adherence can be important when designing educational programmes to increase CPAP adherence. Practice implications: Measurement of these parameters before, during and after educational programs are suggested.
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| 19. |
- Broström, Anders, et al.
(author)
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Putative facilitators and barriers for adherence to CPAP treatment in patients with obstructive sleep apnea syndrome: A qualitative content analysis
- 2010
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In: SLEEP MEDICINE. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 11:2, s. 126-130
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Journal article (peer-reviewed)abstract
- Introduction: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low without a clear consensus Of causes. Objective: To explore the experiences of adherence to CPAP treatment in patients with OSAS. Methods: A qualitative content analysis was employed. Data were collected by in-depth interviews with 23 purposively selected patients. Results: Adherence to CPAP treatment was summarized according to "facilitators" and "barriers" to CPAP treatment. Facilitators for adherence, as described by the patients were a desire to avoid symptoms, knowledge about the risk for medical consequences, fear of negative social consequences and disturbing the sleep of significant others. Other facilitators were a positive attitude to CPAP treatment, trust in healthcare personnel, a sense of engagement from the spouse and a feeling of physical improvement. Barriers included experiencing practical problems, negative psychological effects of the equipment, and negative attitudes to the treatment. Other barriers were side-effects as well as insufficient support from healthcare personnel and the spouse. Conclusion: Adherence to CPAP treatment is a multifaceted problem including patient, treatment, condition, social and healthcare related factors. Knowledge about facilitators and barriers for adherence to CPAP treatment can be used in interventional Strategies.
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| 20. |
- Broström, Anders, 1963-, et al.
(author)
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Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care : a structural equation model analysis
- 2012
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In: Quality in Primary Care. - London, United Kingdom : iMedPub Ltd.. - 1479-1072 .- 1479-1064. ; 20:4, s. 287-298
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Journal article (peer-reviewed)abstract
- BackgroundObstructive sleep apnoea (OSA) has been linked to hypertension in sleep clinic populations, but little is known about the symptom profile of undiagnosed OSA in hypertensive outpatients in primary care.AimTo explore characteristics associated with undiagnosed OSA in hypertensive primary care patients.MethodsCross-sectional design, including 411 consecutive patients (52% women), mean age 57.9 years (standard deviation [SD] 5.9 years), with diagnosed hypertension (blood pressure >140/90 mmHg) fromfour primary care centres. All subjects underwent a full-night, home-based, respiratory recording to establish the presence and severity of OSA. Clinical variables, medication and comorbidities, as well as data from self-rating scales regarding symptoms/characteristics, insomnia, excessive daytime sleepiness, depressive symptoms and health were collected during a clinical examination. Factor analyses and structural equation modelling (SEM) were used to explore the relationships between selfrated symptoms, clinical characteristics and objectively verified diagnosis of OSA.Main outcomeMeasures symptom profile of undiagnosed OSA (as measured by the Apnoea/ Hypopnoea Index [AHI]) in hypertensive outpatients in primary care.ResultsFifty-nine percent of the patients had an AHI _ 5/hour indicating OSA. An exploratory factor analysis based on 19 variables yielded a six-factor model (anthropometrics, blood pressure, OSA-related symptoms, comorbidity, health complaints and physical activity) explaining 58% of the variance. SEM analyses showed strong significant associations between anthropometrics (body mass index, neck circumference, waist circumference) (0.45), OSA-related symptoms (snoring, witnessed apnoeas, dry mouth) (0.47) and AHI. No direct effects of OSA on comorbidities, blood pressure, dyssomnia or self-rated health were observed.ConclusionOSA was highly prevalent and was directly associated with anthropometrics and OSArelated symptoms (snoring, witnessed apnoeas and dry mouth in the morning). When meeting patients with hypertension, these characteristics could be used by general practitioners to identify patients who are in need of referral to a sleep clinic for OSA evaluation.
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| 21. |
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| 22. |
- Broström, Anders, et al.
(author)
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The attitudes to CPAP treatment inventory: development and initial validation of a new tool for measuring attitudes to CPAP treatment
- 2011
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In: Journal of Sleep Research. - : Blackwell Publishing Ltd. - 0962-1105 .- 1365-2869. ; 20:3, s. 460-471
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Journal article (peer-reviewed)abstract
- ontinuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but low adherence rates are common. The aim was to develop the attitudes to CPAP treatment inventory (ACTI), and to investigate the validity and reliability of the instrument among patients with OSAS. ACTI was developed on the basis of: (i) in-depth interviews with 23 patients; (ii) examination of the scientific literature; and (iii) consensus agreement of a multi-professional expert panel. This yielded five different types of attitudes to CPAP treatment. A prospective longitudinal design was used. Two-hundred and eighty-nine patients with OSAS were recruited at three different CPAP centres. Data were collected with ACTI and obtained from medical records. The homogeneity and internal consistency reliability were satisfactorily reflected by the item-total correlations (0.59-0.81) and Cronbachs alpha (0.89), respectively. Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation; PCF). The PCF based on baseline data resulted in a one single-factor solution explaining 69% of the total variance. A confirmatory factor analysis was performed 2 weeks after CPAP initiation, resulting in the same factor solution. No indication of uniform differential item functioning was found. The predictive validity was tested with receiver operating characteristic analyses, and a cut-off of 10 on the ACTI gave a sensitivity of 93% and a specificity of 44% for CPAP termination within 6 months. The satisfactory measurement properties of this new pragmatic instrument are promising and indicate that ACTI can be useful in clinical practice to reliably measure attitudes to CPAP treatment.
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| 23. |
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| 24. |
- Broström, Anders, et al.
(author)
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The side-effects to CPAP treatment inventory : the development and initial validation of a new tool for the measurement of side-effects to CPAP treatment.
- 2010
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In: Journal of Sleep Research. - : Wiley. - 0962-1105 .- 1365-2869. ; 19:4, s. 603-611
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Journal article (peer-reviewed)abstract
- Continuous positive airway pressure (CPAP) is the treatment of choice for obstructive sleep apnoea syndrome (OSAS), but side-effects are common. No validated self-rating scale measuring side-effects to CPAP treatment exists today. The aim was to develop the side-effects to CPAP treatment inventory (SECI), and investigate the validity and reliability of the instrument among patients with OSAS. SECI was developed on the basis of: (1) in-depth interviews with 23 patients; (2) examination of the scientific literature and (3) consensus agreement of a multi-professional expert panel. This yielded 15 different types of side-effects related to CPAP treatment. Each side-effect has three sub-questions (scales): perceived frequency (a) and magnitude (b) of the side-effect, as well as its perceived impact on CPAP use (c). A cross-sectional descriptive design was used. A total of 329 patients with OSAS with an average use of CPAP treatment for 39 months (2 weeks to 182 months) were recruited. Data were collected with SECI, and obtained from medical records (clinical variables and data related to CPAP treatment). Construct validity was confirmed with factor analysis (principal component analysis with orthogonal rotation). A logical two-factor solution, the device subscale and symptom subscale, emerged across all three scales. The symptom subscale describing physical and psychological side-effects and the device subscale described mask and device-related side-effects. Internal consistency reliability of the three scales was good (Cronbach's α = 0.74-0.86) and acceptable for the subscales (Cronbach's α = 0.62-0.86). The satisfactory measurement properties of this new instrument are promising and indicate that SECI can be used to measure side-effects to CPAP treatment.
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| 25. |
- Broström, Anders, 1963-, et al.
(author)
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Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care : Associations with sleep complaints, depressive symptoms and global perceived health
- 2013
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In: Open Journal of Nursing. - : Scientific Research Publishing, Inc.. - 2162-5336 .- 2162-5344. ; 3:6, s. 445-452
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Journal article (peer-reviewed)abstract
- Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.
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| 26. |
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| 27. |
- Broström, Eva Berggren
(author)
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Bronchopulmonary dysplasia from newborn disease to long-term sequelae
- 2010
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Doctoral thesis (other academic/artistic)abstract
- Bronchopulmonary Dysplasia (BPD) is a complication of premature birth that is associated with increased mortality and morbidity in infancy and impaired lung function and obstructive lung disease from childhood to adulthood. The pathogenesis of BPD is multifactorial, and may involve one or more of the following: a deficiency in surfactant production in the immature lung, chronic inflammatory processes before and after birth, oxidative stress, and trauma due to mechanical ventilation. Surfactant replacement therapy, which reduces acute lung injury in the preterm infant, could be one way to prevent later development of BPD. So far, surfactant therapy requires invasive intubation that may itself be traumatic. In this thesis, we evaluated an alternative, non-invasive way to deliver surfactant. This trial of surfactant inhalation via nasal CPAP in spontaneously breathing infants unfortunately did not prove beneficial. Pre- and postnatal inflammatory processes may initiate and aggravate the course of BPD. Some of the underlying inflammatory processes e.g. activation of the neutrophil and macrophage systems, have been well described but other processes, such as the role of eosinophils and other inflammatory markers in the pathology of BPD, have not yet been well characterised. This thesis shows that levels of activated eosinophils in the circulation are elevated in infants with BPD, a sign of chronic, systemic inflammation. We also found that the degree of eosinophil activation was positively associated with the severity of BPD (as determined by the duration of supplementary O2 treatment). Future studies may establish whether a causal relationship exists between states of eosinophil activation in preterm infants and BPD. Moderate and severe BPD is associated with an increased risk for airway obstruction and low forced expiratory volume in childhood. As shown herein, respiratory mechanics is also altered in children with mild BPD. This finding is important because it emphasizes the need for careful clinical follow up of all BPD children, regardless of the severity of the disease, in order to minimize further deterioration in lung function. BPD not only affects lung function but general development as well; thoseffected may develop cognitive and motor performance deficits and exhibit behavioural difficulties. This thesis also sheds new light on public health consequences of very preterm birth. We know little about the possible long-term consequences of premature birth for lung function in old age. In a unique birth cohort born in 1925-49 in Sweden, we found that moderate to-very preterm birth is associated with obstructive lung disease in old age, the severity of which required frequent hospitalisation. The results from this historic cohort cannot be directly extrapolated to preterm infants born today. However, the much higher survival rate in the modern era of neonatal intensive care suggests that infants born preterm nowadays could be at even higher risk of developing obstructive airways disease in adult life than were previous generations. This finding emphasizes the importance of extending follow up programs into adult life. Preterm birth is a global and serious health issue. A better understanding of its potential adverse impact in infancy and childhood may lead to better intervention and treatment strategies and improved long-term outcome.
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| 28. |
- Broström, Eva
(author)
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Juvenile idiopathic arthritis : disease consequences and treatment effects on muscle strength, gait and pain
- 2004
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Doctoral thesis (other academic/artistic)abstract
- Juvenile idiopathic arthritis (JIA) may have a profound effect on the life of a child. Rheumatic diseases in children manifest mainly as synovitis, pain, stiffness, deformity, growth disturbances and fatigue. It is not uncommon to have reduced activity, lower aerobic endurance, and decreased muscle strength. The inflammatory process of the disease most often affects extremities and restriction of joint motion often occurs. Forty percent of the children with JIA report difficulty in daily activities. The aims of this thesis were to compare lower extremity strength and gait and to evaluate pain in children with JIA and children without musculoskeletal dysfunction. Both a Hand Held Dynamometer (HHD) and an isokinetic dynamometer were used to test maximal isometric muscle strength. The maximal isometric plantar- and dorsiflexor strength evaluated with the two dynamometers were lower in the children with JIA than in the controls. In dynamic muscle actions, measured with the isokinetic dynamometer the controls were significantly stronger than the JIA group in shortening plantarflexor and in shortening and lengthening dorsiflexor actions. Comparisons between action types showed larger lengthening torques than isometric or shortening, and comparisons between muscle groups showed all plantarflexor torques to be four to five times greater than dorsiflexor torque. Children with JIA walked with a slower velocity than healthy controls. After intraarticular corticosteroid injections (ICI) the children with JIA increased their speed. Difference in the vertical ground reaction forces at loading response and at terminal stance was observed between children with JIA and controls wherein the peaks observed in the normal ground reaction force are attenuated in the children with JIA. The results after treatment with ICI indicated increased knee and ankle flexion extension angles during walking. Hip extension moment at loading response and knee- and plantarflexion moment at preswing increased after treatment with ICI. Positive effects of treatment with ICI were observed during gait even in joints not injected. The Pain-O-Meter word descriptors are a possible tool for assessment of sensory and affective dimension of pain in children age 616 yrs. The number of words, however known in small children was fewer and no difference in pain experience was observed between children with acute or chronic pain. Novelty data in this thesis are dynamic plantarflexor torque measured on children with JIA and assessment of ICI on gait. The clinical implications are numerous - weakness in almost all action types in plantar-and dorsiflexors indicates the importance of sthrength-training these muscle groups and the need to evaluate the muscle strength with a safe and objective method continuously. Three dimensional gait analyses provide information about gait such as joint angles, joint moments and power during walking which are impossible to quantify during a standard clinical medical examination. The findings of lower walking velocity, muscle strength and joint moments in children of JIA indicate the importance of encouraging the children to participate in physical activities as much as possible to prevent a vicious circle with deteriorating fitness.
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| 29. |
- Broström, Eva, et al.
(author)
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Plantar- and dorsiflexor strength in prepubertal girls with juvenile idiopathic arthritis.
- 2004
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In: Archives of Physical Medicine and Rehabilitation. - : Elsevier BV. - 0003-9993 .- 1532-821X. ; 85:8, s. 1224-30
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare lower-leg strength of young girls with polyarticular juvenile idiopathic arthritis (JIA) with that of healthy, age-matched controls. DESIGN: Isometric and isokinetic strength tests of the plantar- and dorsiflexors. All strength measures were made at an ankle angle of 90 degrees. Isokinetic plantar- and dorsiflexor measures were made at 15 degrees/s during shortening (concentric) and lengthening (eccentric) actions. SETTING: Strength testing laboratory. PARTICIPANTS: Ten prepubertal girls diagnosed with JIA and 10 healthy girls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isometric and isokinetic plantar- and dorsiflexor strength. RESULTS: Isometric plantar- and dorsiflexion torques were significantly lower (48% and 38% respectively; P<.05) for the children with JIA than for the controls. The JIA group also produced lower shortening plantarflexion torques (52%, P<.05). Lengthening plantarflexor torques did not differ significantly between the 2 groups (P<.05). Controls were stronger than the JIA group for both shortening and lengthening maximal dorsiflexor actions (P<.05). All children were 4 to 5 times stronger in plantarflexion than in dorsiflexion. CONCLUSIONS: Girls with JIA had significantly less plantar- and dorsiflexor strength than age-matched, healthy peers. The reduced strength of children with JIA is likely to affect function in daily activities and probably contributes to reduced levels of physical activity.
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| 30. |
- Broström, Eva, et al.
(author)
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Trunk and center of mass movements during gait in children with juvenile idiopathic arthritis
- 2007
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In: Human Movement Science. - : Elsevier BV. - 0167-9457 .- 1872-7646. ; 26:2, s. 296-305
-
Journal article (peer-reviewed)abstract
- Motion of the body center of mass (CoM) can often indicate the overall effect of the strategy of forward progression used. In the present study, focus is placed on trunk movements in the sagittal, coronal, and transverse/rotation plane, as well as placement of the CoM, during gait in children with juvenile idiopathic arthritis (JIA). Seventeen children with JIA, all with polyarticular lower extremity involvement were examined before and approximately two weeks after treatment with intra-articular cortico-steroid injections. Movement was recorded with a 6-camera 3D motion analysis system in both the children with JIA and in 21 healthy controls. Trunk and center of mass movements were compared between JIA and controls, and effects of intra-articular cortico-steroid treatment were evaluated. Children with JIA were more posteriorly tilted in the trunk, contrary to the common clinical impression, and had their CoM placed more posterior and off-centred, which may have been a result of pain. With such knowledge, it might be possible to better understand the effects of their pain and involvement, and ultimately to plan a treatment strategy for improving their gait patterns.
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| 31. |
- Broström, Eva W., et al.
(author)
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Gait in children with achondroplasia – a cross-sectional study on joint kinematics and kinetics
- 2022
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In: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
-
Journal article (peer-reviewed)abstract
- Background: Children with achondroplasia have extreme short stature due to short limbs, as well as several other clinical features that may affect their gait. The purpose of this cross-sectional study was to provide a detailed description of gait in children with achondroplasia compared to age-matched controls. Methods: Between the years 2007 and 2010, 16 children with achondroplasia [mean age 9.6 years (range 5–16; six female)] with no previous history of orthopaedic lower limb surgery and 19 age-matched controls conducted three-dimensional (3D) gait analysis at one occasion. The gait analysis rendered pelvis and lower limb joint kinematics and kinetics, and time and distance data. Descriptive statistics, independent samples t-tests, and Fisher’s exact test were used to describe the cohort including gait data and participant characteristics. Results: Children with achondroplasia had kinematic gait pattern deviations in all three planes, especially in the sagittal plane, when compared to the control group. Peak anterior pelvic tilt and peak ankle dorsiflexion were found to be increased. Increased knee flexion was noted at initial contact and again at terminal stance. During stance, children with achondroplasia had a higher peak hip abduction angle and a higher peak knee varus angle in the frontal plane. In the sagittal plane, kinetic gait pattern deviations were found at the hip, knee, and ankle, consistent with a flexion pattern. Compared to the control group, children with achondroplasia walked with reduced walking speed and step length, and increased cadence. There was no difference in walking speed when leg length was taken into account. Normalised step length and normalised cadence, on the other hand, were found to be increased in children with achondroplasia. Conclusions: The observed gait characteristics in children with achondroplasia are related to anatomical attributes and strategies to increase step length, and hence walking speed.
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| 32. |
- Broström, Linus, et al.
(author)
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Known unknowns and proto-second-personal address in photographic art
- 2015
-
In: Against Boredom : 17 essays : on ignorance, values, creativity, metaphysics, decision-making, truth, preference, art, processes, Ramsey, ethics, rationality, validity, human ills, science and eternal life : to Nils-Eric Sahlin on the occasion of his 60th birthday - 17 essays : on ignorance, values, creativity, metaphysics, decision-making, truth, preference, art, processes, Ramsey, ethics, rationality, validity, human ills, science and eternal life : to Nils-Eric Sahlin on the occasion of his 60th birthday. - 9789187935374
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Book chapter (pop. science, debate, etc.)
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| 33. |
- Broström, Magnus, 1969-
(author)
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Äldre människors föreställningar om den egna framtiden, döendet och döden
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Syftet med avhandlingen är att utforska äldre människors föreställningar om och förhållningssätt till den egna framtiden, döendet och döden. Det är ämnen som hittills har fått begränsad uppmärksamhet. En bakomliggande orsak till detta är att äldreforskning och dödsforskning sällan har förenats. Dessutom synliggörs äldres döende och död nästan inte alls i offentlig debatt, trots att ålderdomen är den fas i livet då döden normalt inträffar. Studien bygger på kvalitativa intervjuer med 27 äldre kvinnor och män i åldrarna 70–91 år, vilka alla bodde i ordinärt boende och betraktade sig själva som relativt friska. Genomförande, analys och tolkning av intervjuerna har utgått från ett livsloppsperspektiv, där både en abduktiv och en hermeneutisk ansats tillämpades. I analys och tolkning framkom kontrasterande mönster i de intervjuades funderingar på den egna framtiden och döden, i deras samtal med någon om döden, i deras erfarenheter av döende och död, och i vad de trodde hände efter döden. Resultaten visar också att funderingar och agerande inför en krympande framtid utgjorde centrala inslag i de äldres vardag och att de intervjuade laborerade med olika tidshorisonter. Ett annat resultat handlar vad som är rätt tidpunkt i livet för att fundera på döden, samtala med andra om döden, för att planera inför döden och för ett ”efter döden”. Det är en komplex bild av äldres föreställningar om den egna framtiden, döendet och döden som framkommit, där teman som åldersmönster, ett förlängt livslopp, ansvar, kontroll och värdighet är centrala inslag. Avhandlingens resultat kan bidra till en bättre förståelse för äldre människors situation i ljuset av en krympande framtid, döende och död.
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| 34. |
- Einarsdottir, Johanna, et al.
(author)
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Democracy, caring and competence : values perspectives in ECEC curricula in the Nordic countries
- 2015
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In: International Journal of Early Years Education. - : Routledge. - 0966-9760 .- 1469-8463. ; 23:1, s. 97-114
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Journal article (peer-reviewed)abstract
- The aim of the study is to explore how Nordic Early Childhood Education and Carepolicies frame values education in preschools with a special focus on the values ofdemocracy, caring and competence. The study is part of a larger Nordic project, Valueseducation in Nordic preschools: Basis of education for tomorrow, the aim of which isto explore values education from various perspectives, policy levels, institutional levelsand personal levels. The study applies Habermas’s theoretical ideas of communicativeactions, lifeworld, and the system. Here the focus is on the system level, namely, valuesin national curriculum guidelines that serve as the basis of pedagogical practices inpreschools in the Nordic countries. Thematic research analysis described by Braun andClarke inspired the qualitative analysis of the documents. In addition, a quantitativelanguage-based approach was applied to the study. Keywords related with democratic,caring and competence values were selected. The findings reveal different dimensionsand meanings of the three value fields, such as democracy as being and/or becoming;care as fulfilment of basic needs and an ethical relationship; and competence values aslearning for sociality and academic skills.
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| 35. |
- Elfström, Maria, et al.
(author)
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Decisive Situations Affecting Partners Support to Continuous Positive Airway Pressure-Treated Patients With Obstructive Sleep Apnea Syndrome A Critical Incident Technique Analysis of the Initial Treatment Phase
- 2012
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In: Journal of Cardiovascular Nursing. - : Lippincott, Williams and Wilkins. - 0889-4655 .- 1550-5049 .- 1474-5151 .- 1873-1953. ; 27:3, s. 228-239
-
Journal article (peer-reviewed)abstract
- Background and Research Objective: Effective treatment of obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) can reduce morbidity and mortality, but adherence rates are low. The partner has an important role in supporting the patient, but this role may be adversely affected by difficulties during the early phase of the CPAP initiation. The aim of this study was to explore and describe decisive situations affecting partners support to patients with OSAS and how the partners manage these situations during the initial phase of CPAP treatment. Subjects and Methods: A qualitative descriptive design using critical incident technique was used. A total of 542 decisive situations affecting partners support and 222 situations describing managing were collected by means of interviews with 25 strategically selected partners of patients with CPAP treated OSAS. Results: Adverse effects, limited effect, practical and psychosocial problems, limited presence, and inappropriate initiation emerged as negative influences on the partners support. A well-functioning treatment, improvements, high motivation, and receiving support from others were identified as positive influences on the partners support. The partner managed the situations by letting the patient handle the CPAP treatment by himself/herself, by handling the treatment together with the patient, or taking over the handling of CPAP treatment. Conclusion: Increased knowledge about the different situations that affect the partners support negatively or positively and how these situations are managed by partners can be used in educational situations involving both patients and partners during CPAP initiation.
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| 36. |
- Eriksson, Kerstin
(author)
-
Postoperative pain assessment and impact of pain on early physical recovery, from the patients' perspective
- 2017
-
Doctoral thesis (other academic/artistic)abstract
- Background: Pain is a common postoperative experience. Guidelines recommend performing regular pain assessments, which include self-rated pain and additional communication to capture patients' experiences. During hospitalisation, pain intensity is found to be a vital factor influencing other aspects of an early physical recovery, and is consequently an important item in questionnaires for recovery. These tools consist of extensive questionnaires which are difficult to use in everyday clinical work. A simplified method of monitoring postoperative recovery would benefit both patients and healthcare professionals.Aim: The overall aim of this thesis was twofold: (A) to determine the ability of extending the use of pain ratings to reflect and predict early physical postoperative recovery and (B) to describe patients’ perspectives on pain assessments.Methods: The studies were carried out at one (I), three (IV) and four hospitals (II, III) involving general surgical and orthopaedic inpatients. Two quantitative methods were used based on data from questionnaires and medical records. They consisted of one cross-sectional study (I) and one study with repeated measures (IV). An association was sought between pain intensity and postoperative recovery on days 1 and 2 (I, IV), and prehospital data (IV). Two qualitative methods were used involving a phenomenographic (III) approach and Critical Incident Technique (IV), where semi-structured interviews were performed postoperatively and analysed inductively in accordance with the approach.Results: An association was found between moderate/severe average pain intensity compiled from monitoring records and impact on early physical postoperative recovery on day 1 (I). Retrospective average pain intensity at rest and during activity reflected impact on recovery on postoperative day 1 (IV). Severe pain intensity at rest and during activity on postoperative day 1 predicted impact on physical recovery items on day 2 (IV). The use of the Numeric Rating Scale (NRS 0-10) was considered to facilitate communication about pain, but to involve difficulties of interpretation and place demand on healthcare professionals and care routines (II). Patients’ descriptions of their experiences when in need of describing pain indicated two main areas: patients’ resources when needing to describe pain and ward resources for performing pain assessments (III). Descriptions of their actions when they were in pain indicated two main areas: patients used active strategies when needing to describe pain or patients used passive strategies when needing to describe pain (III).Conclusions: This thesis contributes to knowledge about the possibility of using patients' self-rated average pain intensity to reflect early physical postoperative recovery on day 1 and to predict recovery on the following day. The pain scale gave patients and healthcare professionals a shared vocabulary, which facilitated communication. Furthermore, dialogue during pain assessments was described as critical in ascertaining whether pain intensity had an impact on different aspects of physical recovery. Environmental factors such as the attitude of healthcare professionals, workload and staffing influenced how pain assessments were performed.
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| 37. |
- Eriksson, Marie, et al.
(author)
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Gait pattern in children with arthrogryposis multiplex congenita
- 2010
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In: Journal of Children's Orthopaedics. - : SAGE Publications. - 1863-2521 .- 1863-2548. ; 4:1, s. 21-31
-
Journal article (peer-reviewed)abstract
- Purpose: Lower limb contractures and muscle weakness are common in children with arthrogryposis multiplex congenita (AMC). To enhance or facilitate ambulation, orthoses may be used. The aim of this study was to describe gait pattern among individuals wearing their habitual orthotic devices. Methods: Fifteen children with AMC, mean age 12. 4 (4. 3) years, with some lower limb involvement underwent 3-D gait analysis. Three groups were defined based on orthosis use; Group 1 used knee-ankle-foot orthoses with locked knee joints, Group 2 used ankle-foot orthoses or knee-ankle-foot orthoses with open knee joints and Group 3 used no orthoses. Results: The greatest trunk and pelvis movements in all planes and the greatest hip abduction were observed in Group 1, compared to Groups 2 and 3, as well as to the gait laboratory control group. Maximum hip extension was similar in Groups 1 and 2, but in Group 3, there was less hip extension and large deviations from the control data. Lower cadence and walking speed were observed in Group 1 than in Groups 2 and 3. The step length was similar in all groups and also with respect to the gait laboratory reference values. Conclusions: Children with AMC were subdivided according to orthoses use. Kinematic data as recorded with 3-D gait analysis showed differences among the groups in trunk, pelvis and knee kinematics, and in cadence and walking speed. The step length was similar in all groups and to the gait laboratory reference values, which may be attributable to good hip extension strength in all participants.
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| 38. |
- Gralén, Katarina, et al.
(author)
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Clinical practice of BOTOX® treatment for overactive bladder syndrome in Sweden : an assessment of resource use and external validity
- 2017
-
In: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813.
-
Journal article (peer-reviewed)abstract
- Objective: The objective of this study was to assess the resource use of treating overactive bladder (OAB) patients in real-world clinical practice and to evaluate whether there is external validity in the treatment of OAB in clinical practice. Materials and methods: The study included 55 patients suffering from OAB and treated with BOTOX® at two Swedish clinics. The study was conducted as an anonymized retrospective chart review study. Results: The estimated yearly direct cost of BOTOX treatment was €902. The mean age of patients in the study was 60 years, and 85% were women. The severity of OAB before BOTOX treatment, given by the mean number of daily leakages, equalled 4.8. The median interval between treatments was 210 days. Conclusions: Patient characteristics in the real world were similar to those in the clinical trials, showing a high degree of external validity. Treatment intervals were longer in the real world than in clinical trials, indicating that treatment cost could be lower when patients are treated as observed in real-world clinical practice.
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| 39. |
- Gustafsson, Greta, et al.
(author)
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Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation
- 2015
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In: Clinical Neurophysiology. - : Elsevier BV. - 1388-2457 .- 1872-8952. ; 126:8, s. 1493-1497
-
Journal article (peer-reviewed)abstract
- OBJECTIVE:To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.METHODS:We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.RESULTS:No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12 years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.CONCLUSION:Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.SIGNIFICANCE:Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.
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| 40. |
- Henckel, Ewa, et al.
(author)
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A novel association between ykl-40, a marker of structural lung disease, and short telomere length in 10-year-old children with bronchopulmonary dysplasia
- 2021
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In: Children. - : MDPI. - 2227-9067. ; 8:2
-
Journal article (peer-reviewed)abstract
- Extremely preterm infants are born with immature lungs and are exposed to an inflammatory environment as a result of oxidative stress. This may lead to airway remodeling, cellular aging and the development of bronchopulmonary dysplasia (BPD). Reliable markers that predict the long-term consequences of BPD in infancy are still lacking. We analyzed two biomarkers of cellular aging and lung function, telomere length and YKL-40, respectively, at 10 years of age in children born preterm with a history of BPD (n = 29). For comparison, these markers were also evaluated in sex-and-age-matched children born at term with childhood asthma (n = 28). Relative telomere length (RTL) was measured in whole blood with qPCR and serum YKL-40 with ELISA, and both were studied in relation to gas exchange and the regional ventilation/perfusion ratio using three-dimensional V/Q-scintigraphy (single photon emission computer tomography, SPECT) in children with BPD. Higher levels of YKL-40 were associated with shorter leukocyte RTL (Pearson’s correlation: −0.55, p = 0.002), but were not associated with a lower degree of matching between ventilation and perfusion within the lung. Serum YKL-40 levels were significantly higher in children with BPD compared to children with asthma (17.7 vs. 13.2 ng/mL, p < 0.01). High levels of YKL-40 and short RTLs were associated to the need for ventilatory support more than 1 month in the neonatal period (p < 0.01). The link between enhanced telomere shortening in childhood and structural remodeling of the lung, as observed in children with former BPD but not in children with asthma at the age of 10 years, suggests altered lung development related to prematurity and early life inflammatory exposure. In conclusion, relative telomere length and YKL-40 may serve as biomarkers of altered lung development as a result of early-life inflammation in children with a history of prematurity.
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| 41. |
- Igelström, Helena, 1976-
(author)
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Physical Activity and Eating Behaviour Changes in Patients with Obstructive Sleep Apnea Syndrome
- 2013
-
Doctoral thesis (other academic/artistic)abstract
- This thesis aimed at developing and evaluating a tailored behavioural sleep medicine intervention for enhanced physical activity and healthy eating in patients with obstructive sleep apnea syndrome (OSAS) and overweight.Participants with moderate or severe OSAS (apnea-hypopnea index ≥15) and obesity (Studies I-II) or overweight (Studies III-IV), treated with continuous positive airway pressure (CPAP) (Studies I-II) or admitted to CPAP treatment (Studies III-IV), were recruited from the sleep clinic at Uppsala University Hospital, Sweden. Semi-structured individual interviews were analysed using qualitative content analysis (Study I). Data on moderate-to-vigorous physical activity (MVPA) and sedentary time were collected with three measurement methods and analysed regarding the level of measurement agreement (Study II). Potential disease-related and psychological correlates for the amount of MVPA, daily steps and sedentary time were explored using multiple linear regression (Study III). Physical activity and eating behaviour changes were examined after a six month behaviour change trial (Study IV). A tailored behavioural sleep medicine intervention targeting physical activity and healthy eating in combination with first- time CPAP treatment was compared with CPAP treatment and advice on the association between weight and OSAS.According to participants’ conceptions, a strong incentive is needed for a change in physical activity and bodily symptoms, external circumstances and thoughts and feelings influence physical activity engagement (Study I). Compared with accelerometry, the participants overestimated the level of MVPA and underestimated sedentary time when using self-reports (Study II). The participants spent 11 hours 45 minutes (71.6% of waking hours) while sedentary. Fear of movement contributed to the variation in steps and sedentary time. Body mass index was positively correlated to MVPA (Study III). The experimental group increased intake of fruit and fish and reduced more weight and waist circumference compared with controls. There were no changes in physical activity (Study IV).The novel tailored behavioural sleep medicine intervention combined with first-time CPAP facilitated eating behaviour change, with subsequent effects on anthropometrics, but it had no effects on physical activity and sedentary time. Fear of movement may be a salient determinant of sedentary time, which has to be further explored in this population. The results confirm sedentary being a construct necessary to separate from the lower end of a physical activity continuum and highlight the need of developing interventions targeting sedentary behaviours specifically.
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| 42. |
- Johansson, Eva, et al.
(author)
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Individual and Collective Rights Expressed in Educator and Child Interactions in Nordic Preschools
- 2016
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In: International Journal of Early Childhood. - : Springer Science and Business Media LLC. - 0020-7187 .- 1878-4658. ; 48:2, s. 209-224
-
Journal article (peer-reviewed)abstract
- This study focuses on rights and gender in educator and child interactions in Nordic preschools. The research questions are as follows: What kinds of rights are communicated in the interactions and how? What kind of gender patterns can be identified? Rights refer to entitlements related to the early childhood education context, given or claimed by educators or children. The research material consists of 25 video observations of conflicts in educator and child interactions in Nordic preschools. Jürgen Habermas’ concepts of strategic and communicative actions informed the interpretation of the communication of rights, and Bronwyn Davies’s idea of duality between femininity and masculinity informed the analyses of gender. The analyses revealed two kinds of rights: individual and collective rights. The individual rights were connected to the integrity of the person and, alternatively, to the institution. Collective rights were related to shared institutional rights. The governing of the children appeared as benevolent. The study displayed how masculinity was given hegemony in interactions on rights and how adaptation was directed toward girls, which required them to compromise and sometimes waive rights.
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| 43. |
- Johansson, Gudrun M., et al.
(author)
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Assessment of arm movements during gait in stroke : the Arm Posture Score
- 2014
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In: Gait & Posture. - : Elsevier BV. - 0966-6362 .- 1879-2219. ; 40:4, s. 549-555
-
Journal article (peer-reviewed)abstract
- The purpose of the study was to apply the Arm Posture Score (APS) to a stroke population, since comprehensive measures to quantify arm swing in the affected and non-affected arms during gait are lacking. A further aim was to investigate how gait speed and upper limb function estimated by clinical measures are related to the APS in the stroke group. The APS is the summarized root mean square deviation (RMSD) from normal, based on kinematics. Four arm movements (sagittal and frontal planes) as well as six arm movements (incorporating transversal plane) were included in the calculation of APS, referred to as APS4 and APS6, respectively. The study population consisted of 25 persons with stroke and 25 age- and gender-matched controls. The APS measures were significantly different between the affected and non-affected arms, as well as between the affected arm and the non-dominant arm of the controls (p≤0.001). Spasticity significantly influenced both APS measures, while speed only had a significant effect on the APS4. The APS measures correlated significantly to clinical measures of upper limb function. Both APS measures seem to be useful indices to quantify and discriminate between impaired and normal arm swing during gait after stroke. The variability of rotational arm movements needs to be studied further before considering the additional value of the APS6 over the APS4. When interpreting the APS, complementary kinematics should be taken into account, as the single value of the APS gives no information about the direction of the deviation.
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| 44. |
- Johansson, Peter, et al.
(author)
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Clinical characteristics and mortality risk in relation to obstructive and central sleep apnoea in community-dwelling elderly individuals: a 7-year follow-up
- 2012
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In: Age and Ageing. - : Oxford University Press (OUP): Policy A. - 0002-0729 .- 1468-2834. ; 41:4, s. 468-474
-
Journal article (peer-reviewed)abstract
- Methods: a total of 331 community-dwelling elderly aged 71-87 years underwent a clinical examination and one-night polygraphic recordings in their homes. Mortality data were collected after seven years. Results: a total of 55% had SDB, 38% had OSA and 17% had CSA. Compared with those with no SDB and OSA, more participants with CSA had a left ventricular ejection fraction less than 50% (LVEF less than 50%) ischaemic heart disease (IHD) and transient ischaemic attack (TIA)/stroke. There was no difference in the rate of IHD and TIA/stroke between OSA and no SDB, but more LVEF less than 50% was found in those with OSA. CSA significantly increased the risk for all-cause (P = 0.002) and CV mortality (P = 0.018) by more than two times. After adjustments for CV disease, diabetes and the biomarker NT-pro-brain natriuretic peptide CSA associations to all-cause mortality and CV mortality lost significance. Conclusion: OSA, in persons greater than 75 years does not appear to be associated with cardiovascular disease (CVD) disease or mortality, whereas CSA might be a pathological marker of CVD and impaired systolic function associated with higher mortality.
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| 45. |
- Johansson, Peter, et al.
(author)
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Determinants of global preceived health in community-dwelling elderly screened for heart failure and sleep-disordered breathing.
- 2010
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In: European Journal of Cardiovascular Nursing. - : Wolters Kluwer. - 1474-5151 .- 1873-1953 .- 0889-4655 .- 1550-5049. ; 25:5, s. 16-26
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Journal article (peer-reviewed)abstract
- The relationships between heart failure (HF), sleep-disordered breathing (SDB), insomnia, depressive symptoms, and excessive daytime sleepiness (EDS), as well as their relationship to Global Perceived Health (GPH) in an elderly community-dwelling population, have not been explored. Data from 331 community-dwelling elderly (71-87 years old) were collected by echocardiography, polygraphy, and specific questionnaires. Factor analyses and structural equation modeling were used to explore the relationships between HF, SDB, sleep, psychosocial factors, and GPH. Exploratory and confirmatory factor analyses derived a 5-factor model representing SDB, insomnia, systolic function, breathlessness/physical function, and psychosocial function. Structural equation modeling analyses were used to explore the relationships between the 5 factors and to GPH. Sleep-disordered breathing had a weak effect on systolic function, but no effects on any of the other factors or GPH were found. Psychosocial function and breathlessness/physical function directly affected GPH. Indirect effects on GPH, mediated by psychosocial function, were found for breathlessness/physical function and insomnia. Systolic function also had an indirect effect on GPH. The fact that SDB in the elderly has no obvious negative associations to sleep complaints or GPH does not exclude them from being adequately treated for SDB. However, the present study has shown that SDB, by means of self-rated sleep complaints and health-related quality of life, can be problematic to detect. Psychosocial function was the most important factor for perceived GPH as it had a direct effect, as well as mediated the factors breathlessness/physical function and insomnia effects, on GPH. This study indicates that interventions in clinical practice targeting psychosocial dysfunction, such as depressive symptoms, could help to improve GPH in the elderly with or without HF.
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| 46. |
- Johansson, Peter, et al.
(author)
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Difficulties in identification of sleep disordered breathing in an outpatient clinic for heart failure– A case study
- 2014
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In: Annals of Nursing and Practice. - : JSciMedCentral. ; 1:3
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Journal article (peer-reviewed)abstract
- Sleep disordered breathing (SDB) is prevalent in patients with heart failure (HF). The clinical signs of newly diagnosed HF and untreated SDB may overlap and patients in need of SDB treatment can therefore be difficult to identify in patients participating in disease management programmes (DMP). The aim was to describe the care process of two patients with HF involved in a DMP, focusing on the difficulties to identify and initiate treatment of SDB.A prospective case study design was used to follow one male (70 yrs) and one female (74 yrs) patient during 18 months at a Swedish University hospital. It took 5 to 10 months from diagnosis of HF until optimal treatment was reached for their heart conditions and 12 to 17 months until SDB was treated. None of the patients complained of poor sleep, but suffered from fatigue. In the male SDB was detected by the wife’s complaints of her husband’s snoring, apnoeas and restless sleep. In the female, SDB was detected after a detailed assessment of fatigue which was shown to be sleepiness. After optimal treatment of HF but before imitation of SDB treatment both cases cardiac function improved. For the female case improvements also were found in the blood pressure. SDB treatment improved fatigue in both patients. Initiation of HF treatment and self-care routines, as well as identification of SDB is complex and time consuming. Treatment of HF and SDB can improve sleep, cardiac function as well as disturbing associated symptoms.
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| 47. |
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| 48. |
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| 49. |
- Johansson, Peter, 1962-, et al.
(author)
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Sleep disordered breathing in an elderly community-living population : Relationship to cardiac function, insomnia symptoms and daytime sleepiness
- 2009
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In: Sleep Medicine. - : Elsevier BV. - 1389-9457 .- 1878-5506. ; 10:9, s. 1005-1011
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Journal article (peer-reviewed)abstract
- Introduction: The relationship between sleep disordered breathing (SDB), systolic function/heart failure in elderly people living in community has not been investigated, nor has insomnia and excessive daytime sleepiness (EDS). Aim: To describe the prevalence of SDB and its relationship to systolic function, the different insomnia symptoms as well as EDS. Method: 331 subjects (71-87 years) underwent echocardiographic examinations and sleep respiratory recordings. Questionnaires were used to evaluate insomnia symptoms and EDS. Results: Mild SDB (AHI 5-15), was found in 32%. Moderate SDB (AHI 15-30) occurred in 16%, and 7% had severe SDB (AHI >30). Median AHI was significantly higher (p<0.001) in those with mild impaired systolic function (AHI 11.7) and moderate impaired systolic function (AHI 10.9) compared to those with normal systolic function (AHI 5.0). Mild and moderate impaired systolic function was also independently associated to SDB as indicated by an AHI≥10. Concerning insomnia symptoms and EDS, only difficulties in initiating sleep correlated significantly (p<0.05) with AHI. Conclusion: SDB is common among the elderly and may be related to impaired systolic function/heart failure. However, detection of SDB in such population may be problematic since insomnia symptoms and EDS correlated poorly with SDB.
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