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1.
  • Ax, Anna-Karin, 1980-, et al. (author)
  • Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT
  • 2023
  • In: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 62:4, s. 414-421
  • Journal article (peer-reviewed)abstract
    • BackgroundCost-effectiveness is important in the prioritisation between interventions in health care. Exercise is cost-effective compared to usual care during oncological treatment; however, the significance of exercise intensity to the cost-effectiveness is unclear. In the present study, we aimed to evaluate the long-term cost-effectiveness of the randomised controlled trial Phys-Can, a six-month exercise programme of high (HI) or low-to-moderate intensity (LMI) during (neo)adjuvant oncological treatment.MethodsA cost-effectiveness analysis was performed, based on 189 participants with breast, colorectal, or prostate cancer (HI: n = 99 and LMI: n = 90) from the Phys-Can RCT in Sweden. Costs were estimated from a societal perspective, and included cost of the exercise intervention, health care utilisation and productivity loss. Health outcomes were assessed as quality-adjusted life-years (QALYs), using EQ-5D-5L at baseline, post intervention and 12 months after the completion of the intervention.ResultsAt 12-month follow-up after the intervention, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensity groups. On average HI generated 1.190 QALYs and LMI 1.185 QALYs. The mean incremental cost-effectiveness ratio indicated that HI was cost effective compared with LMI, but the uncertainty was large.ConclusionsWe conclude that HI and LMI exercise have similar costs and effects during oncological treatment. Hence, based on cost-effectiveness, we suggest that decision makers and clinicians can consider implementing both HI and LMI exercise programmes and recommend either intensity to the patients with cancer during oncological treatment to facilitate improvement of health.
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2.
  • Ax, Anna-Karin, 1980-, et al. (author)
  • Exercise : A positive feature on functioning in daily life during cancer treatment — Experiences from the Phys-Can study
  • 2020
  • In: European Journal of Oncology Nursing. - : Elsevier. - 1462-3889 .- 1532-2122. ; 44
  • Journal article (peer-reviewed)abstract
    • PURPOSE: Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life.METHODS: Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis.RESULTS: Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities.CONCLUSIONS: Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.
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3.
  • Ax, Anna-Karin, 1980- (author)
  • Exercise in patients with cancer : Effects on health-related quality of life, costs, and cost-effectiveness during oncological treatment
  • 2023
  • Doctoral thesis (other academic/artistic)abstract
    • Background: Short and long-term side effects of oncological treatment negatively affect daily living and health-related quality of life (HRQoL) in patient with cancer. Exercise during treatment is beneficial for HRQoL, however evidence as to what exercise intensity is most optimal for improving HRQoL and cost-effectiveness is lacking. Cost-effectiveness is important information for decisionmakers when implementing healthcare interventions, such as exercise programmes. The overall aim of this thesis was to study functioning in daily life, HRQoL, costs, and cost-effectiveness of an exercise intervention of different exercise intensities in patients with cancer receiving oncological treatment. Method: Study I was qualitative and explored how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life. Semi-structured individual interviews (n =21) were performed and analysed with thematic analysis. Studies II–IV were quantitative and used data from a randomised controlled trial (RCT) of high-intensity (HI) and low-to-moderate-intensity (LMI) exercise of combined resistance and endurance training with or without self-regulatory behaviour change support. The RCT was preceded by a descriptive longitudinal study with usual care (UC). Participants were diagnosed with breast, prostate, or colon cancer and received (neo)adjuvant oncological treatment. Study II evaluated the effects on HRQoL of exercising at HI (n =288) and LMI (n =289) versus UC (n =89) up to 18 months after start of oncological treatment, using the EORTC QLQ-C30 questionnaire. Data were analysed using descriptive and multivariate statistics. Study III evaluated resource utilisation and societal costs of the exercise intervention in the RCT (n =534) versus UC (n =85), and of HI (n =269) versus LMI (n =265) exercise 18 months after start of oncological treatment. Societal costs included costs of healthcare resource utilisation (healthcare visits, hospitalisation, prescribed medication), productivity loss (disability pensions and sick leave), and the exercise intervention. Study IV evaluated the cost-effectiveness of the exercise intensities in the RCT (HI: n =99 and LMI: n =90) at 1-year follow-up post intervention. Cost data were retrieved from Study III and health outcome were collected using the EQ-5D-5L questionnaire and calculated for quality-adjusted life-years. Cost-effectiveness was evaluated as the incremental cost-effectiveness ratio (ICER). Results: Participants experienced impairments from oncological treatment but strove to maintain function in daily life. The exercise programme improved physical and psychological wellbeing during treatment (Study I). There were no significant differences in HRQoL between exercise intensities up to 1 year after the exercise intervention. The exercise groups scored significant better HRQoL compared to UC over time (Study II). There was no significant difference in mean societal costs between the exercise intervention and UC, nor between the exercise intensities (Study III). There was no significant difference in cost or in effect between the exercise intensities. Although the mean ICER indicated that HI was cost-effective compared to LMI, the uncertainty was large (Study IV). Conclusion: Participating in an exercise programme during oncological treatment was a positive and supportive experience that contributed to increase physical and psychological wellbeing. Exercise of HI and LMI during oncological treatment had similar effect on HRQoL and societal costs. In addition, the exercise group had beneficial effects on HRQoL and no significant difference in societal costs compared to UC, meaning the exercise programme did not save or add societal cost. Thus, based on cost-effectiveness we suggest decisionmakers and clinicians implement exercise programmes including both HI and LMI in cancer care and recommend exercise regardless of intensity according to the patient’s preferences to improve or to maintain aspects of HRQoL during oncological treatment. 
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4.
  • Ax, Anna-Karin, 1980-, et al. (author)
  • Long-term resource utilisation and associated costs of exercise during (neo)adjuvant oncological treatment : the Phys-Can project
  • 2022
  • In: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 61:7, s. 888-896
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Exercise during oncological treatment is beneficial to patient health and can counteract the side effects of treatment. Knowledge of the societal costs associated with an exercise intervention, however, is limited. The aims of the present study were to evaluate the long-term resource utilisation and societal costs of an exercise intervention conducted during (neo)adjuvant oncological treatment in a randomised control trial (RCT) versus usual care (UC), and to compare high-intensity (HI) versus low-to-moderate intensity (LMI) exercise in the RCT.METHODS: We used data from the Physical Training and Cancer (Phys-Can) project. In the RCT, 577 participants were randomised to HI or to LMI of combined endurance and resistance training for 6 months, during oncological treatment. The project also included 89 participants with UC in a longitudinal observational study. We measured at baseline and after 18 months. Resource utilisation and costs of the exercise intervention, health care, and productivity loss were compared using analyses of covariance (RCT vs. UC) and t test (HI vs. LMI).RESULTS: Complete data were available for 619 participants (RCT HI: n = 269, LMI: n = 265, and UC: n = 85). We found no difference in total societal costs between the exercise intervention groups in the RCT and UC. However, participants in the RCT had lower rates of disability pension days (p < .001), corresponding costs (p = .001), and pharmacy costs (p = .018) than the UC group. Nor did we find differences in resource utilisation or costs between HI and LMI exercise int the RCT.CONCLUSION: Our study showed no difference in total societal costs between the comprehensive exercise intervention and UC or between the exercise intensities. This suggests that exercise, with its well-documented health benefits during oncological treatment, produces neither additional costs nor savings.
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5.
  • Ax, Anna-Karin, et al. (author)
  • Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment-results from the Phys-Can project
  • 2022
  • In: Supportive Care in Cancer. - Heidelberg, Germany : Springer Nature. - 0941-4355 .- 1433-7339. ; 30:7, s. 5949-5963
  • Journal article (peer-reviewed)abstract
    • PURPOSE: This study aimed to evaluate the effect of high intensity (HI) vs low-to-moderate intensity (LMI) exercise on health-related quality of life (HRQoL) up to 18 months after commencement of oncological treatment in patients with breast, colorectal or prostate cancer. In addition, we conducted a comparison with usual care (UC).METHODS: Patients scheduled for (neo)adjuvant oncological treatment (n = 577) were randomly assigned to 6 months of combined resistance and endurance training of HI or LMI. A longitudinal descriptive study (UC) included participants (n = 89) immediately before the RCT started. HRQoL was assessed by EORTC QLQ-C30 at baseline, 3, 6 and 18 months (1 year after completed exercise intervention) follow-up. Linear mixed models were used to study the groups over time.RESULTS: Directly after the intervention, HI scored significant (P = 0.02), but not clinically relevant, higher pain compared with LMI. No other significant difference in HRQoL was found between the exercise intensities over time. Clinically meaningful improvements in HRQoL over time were detected within both exercise intensities. We found favourable significant differences in HRQoL in both exercise intensities compared with UC over time.CONCLUSION: This study adds to the strong evidence of positive effect of exercise and shows that exercise, regardless of intensity, can have beneficial effects on HRQoL during oncological treatment and also for a substantial time after completion of an exercise intervention. In this study, for one year after.IMPLICATIONS FOR CANCER SURVIVORS: Patients can be advised to exercise at either intensity level according to their personal preferences, and still benefit from both short-term and long-term improvements in HRQoL.
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6.
  • Berglund, Gunilla, et al. (author)
  • "Between Men" : A psychosocial rehabilitation programme for men with prostate cancer
  • 2007
  • In: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 46:1, s. 83-89
  • Journal article (peer-reviewed)abstract
    • The aim of this study was to evaluate the effect of psychosocial rehabilitation on newly diagnosed prostate cancer patients. The “Between Men” programme consisted of seven weekly sessions of physical training (Phys) alone, information (Info) alone or physical training plus information (PhysInfo). After diagnoses, patients (n =211) were consecutively included, stratified and randomised to one of four groups: Phys, Info, PhysInfo or standard care control (C). A nurse specialised in urology, an urologist and a physiotherapist performed the interventions. Patients were followed up during one year with mailed standardised questionnaires. It could not be assumed that the “Between Men” programme had any effect on patients’ anxiety and depression (HADS). Health-related quality of life (HRQOL) was associated with stage of disease but not with psychosocial intervention. Thus, Physical Function (PF), Role Function (RF) and Fatigue (FA) were inferior among patients with, than without, metastases of prostate cancer both at baseline and at the 12-month follow-up. This randomized study did not demonstrate any significant effect of psychosocial rehabilitation among prostate cancer patients. Considering the low rate (1/2), of included/eligible patients a less complicated design (intervention versus control) would have been preferred in order to increase power.
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7.
  • Demmelmaier, Ingrid, 1960-, et al. (author)
  • Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial
  • 2021
  • In: Scandinavian Journal of Medicine and Science in Sports. - : Wiley. - 0905-7188 .- 1600-0838. ; 31:5, s. 1144-1159
  • Journal article (peer-reviewed)abstract
    • Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference −1.05 [95% CI: −1.85, −0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.
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8.
  • Ek, Anna, et al. (author)
  • A long-term follow-up of treatment for young children with obesity : a randomized controlled trial
  • 2023
  • In: International Journal of Obesity. - : Springer Nature. - 0307-0565 .- 1476-5497. ; 47:11, s. 1152-1160
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Early childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.OBJECTIVE: To examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.METHODS: 177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012-2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.RESULTS: After 48 months (mean 50 months, range 38-67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB -0.45 (-0.18 to -0.73, p < 0.001), PGNB -0.34 (-0.13 to -0.55, p < 0.001), ST -0.25 (-0.10 to -0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (-1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.CONCLUSION: The intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT01792531 .
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9.
  • Ek, Anna, et al. (author)
  • Responding positively to "children who like to eat" : Parents' experiences of skills-based treatment for childhood obesity
  • 2020
  • In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 145
  • Journal article (peer-reviewed)abstract
    • This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
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11.
  • Lundblad, Anders Olof, et al. (author)
  • Vätgas som alternativ för skogsindustrins transporter– en jämförande studie (H2Timmer) : Exekutiv sammanfattning
  • 2022
  • Reports (other academic/artistic)abstract
    • Detta förstudieprojekt har undersökt vätgas som alternativ för skogsindustrins transporter. Hela värdekedjan, inklusive produktion, komprimering, lagring, och användning inkluderas i analysen som beaktar kostnader, energieffektivitet och växthusgasutsläpp ur ett ”well-to wheel”-perspektiv. Projektet har genomförts av RISE tillsammans med följande företag och organisationer: Sveaskog, SmurfitKappa, Metsä Group, Holmen, StoraEnso, BillerudKorsnäs, AB Volvo, Volvo Penta, Volvo CE, Nilsson Energy, Euromekanik, Energiforsk, Skogsindustrierna.
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12.
  • Lundblad, Anders Olof, et al. (author)
  • Vätgas som alternativ för skogsindustrins transporter– en jämförande studie (H2Timmer)
  • 2022
  • Reports (other academic/artistic)abstract
    • Detta förstudieprojekt har visat att vätgasdrift för timmerlastbilar ger något högre men ändå liknande kilometerkostnad som ren batteridrift, men snabbare tankning och längre körsträcka, vilket ger större flexibilitet för åkaren. Även biodrivmedel kan vara ett konkurrenskraftigt alternativ. Skogsindustrin är en av Sveriges största transportanvändare. För timmertransporter är lastbil det klart viktigaste transportslaget och skogsindustrins transporter motsvarar ca 17 % av Sveriges transporterade gods på väg. Ett alternativ för omställning av skogsindustrins transporter till fossilfrihet är förnybar vätgas, som kan produceras genom elektrolys med förnybar el. Precis som el ger vätgas inte upphov till några lokala emissioner vid användningen. Produktion av vätgas kan potentiellt ha synergier för skogsindustrins massabruk, som behov av syrgas och tillgång till överskottsel. Projektet har undersökt vätgas som alternativ för skogsindustrins transporter. Hela värdekedjan, inklusive produktion, komprimering, lagring, och användning inkluderas i analysen som beaktar kostnader, energieffektivitet och växthusgasutsläpp ur ett ”well-to wheel”-perspektiv. Studien inkluderar jämförelser med andra möjliga alternativ för att ställa om transporterna till fossilfrihet så som elektrifiering och biodrivmedel. Projektet har gett resultat som kommer att ligga till grund för en mer detaljerad projekteringsstudie inför ett framtida demonstrations- och pilotprojekt. Studien som finansierats av Trafikverket genom TripleF har genomförts av RISE tillsammans med 6 skogsindustribolag, tre företag från fordonsbranschen och två systemintegratörer med fokus på vätgas. Medverkande företag och organisationer: Sveaskog, SmurfitKappa, Metsä Group, Holmen, StoraEnso, BillerudKorsnäs, AB Volvo, Volvo Penta, Volvo CE, Nilsson Energy, Euromekanik, Energiforsk, Skogsindustrierna.
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13.
  • Müller, Kathrin, et al. (author)
  • De novo mutations in SOD1 are a cause of ALS
  • 2022
  • In: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ Publishing Group Ltd. - 0022-3050 .- 1468-330X. ; 93, s. 201-206
  • Journal article (peer-reviewed)abstract
    • Objective: The only identified cause of amyotrophic lateral sclerosis (ALS) are mutations in a number of genes found in familial cases but also in sporadic cases. De novo mutations occurring in a parental gonadal cell, in the zygote or postzygotic during embryonal development can result in an apparently sporadic/isolated case of ALS later in life. We searched for de novo mutations in SOD1 as a cause of ALS.Methods: We analysed peripheral-blood exome, genome and Sanger sequencing to identify deleterious mutations in SOD1 in 4000 ALS patients from Germany, South Korea and Sweden. Parental kinship was confirmed using highly polymorphic microsatellite markers across the genome. Medical genealogical and clinical data were reviewed and compared with the literature.Results: We identified four sporadic ALS cases with de novo mutations in SOD1. They aggregate in hot-spot codons earlier found mutated in familial cases. Their phenotypes match closely what has earlier been reported in familial cases with pathogenic mutations in SOD1. We also encountered familial cases where de novo mutational events in recent generations may have been involved.Conclusions:  De novo mutations are a cause of sporadic ALS and may also be underpinning smaller families with few affected ALS cases. It was not possible to ascertain if the origin of the de novo mutations was parental germline, zygotic or postzygotic during embryonal development. All ALS patients should be offered genetic counselling and genetic screening, the challenges of variant interpretation do not outweigh the potential benefits including earlier confirmed diagnosis and possible bespoken therapy.Data availability statement: Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.
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14.
  • Neuman, Nicklas, 1987-, et al. (author)
  • Children's experiences of meals after obesity treatment : a qualitative follow-up four years after a randomized controlled trial
  • 2022
  • In: BMC Pediatrics. - : BioMed Central (BMC). - 1471-2431. ; 22:1
  • Journal article (peer-reviewed)abstract
    • Background: The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.Method: The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.Results: We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.Conclusions: While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.
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15.
  • Nordin, Angelica, et al. (author)
  • Extensive size variability of the GGGGCC expansion in C9orf72 in both neuronal and non-neuronal tissues in 18 patients with ALS or FTD
  • 2015
  • In: Human Molecular Genetics. - : Oxford University Press (OUP). - 0964-6906 .- 1460-2083. ; 24:11, s. 3133-3142
  • Journal article (peer-reviewed)abstract
    • A GGGGCC-repeat expansion in C9orf72 is the most common genetic cause of amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) among Caucasians. However, little is known about the variability of the GGGGCC expansion in different tissues and whether this correlates with the observed phenotype. Here, we used Southern blotting to estimate the size of hexanucleotide expansions in C9orf72 in neural and non-neural tissues from 18 autopsied ALS and FTD patients with repeat expansion in blood. Digitalization of the Southern blot images allowed comparison of repeat number, smear distribution and expansion band intensity between tissues and between patients. We found marked intra-individual variation of repeat number between tissues, whereas there was less variation within each tissue group. In two patients, the size variation between tissues was extreme, with repeat numbers below 100 in all studied non-neural tissues, whereas expansions in neural tissues were 20-40 times greater and in the same size range observed in neural tissues of the other 16 patients. The expansion pattern in different tissues could not distinguish between diagnostic groups and no correlation was found between expansion size in frontal lobe and occurrence of cognitive impairment. In ALS patients, a less number of repeats in the cerebellum and parietal lobe correlated with earlier age of onset and a larger number of repeats in the parietal lobe correlated with a more rapid progression. In 43 other individuals without repeat expansion in blood, we find that repeat sizes up to 15 are stable, as no size variation between blood, brain and spinal cord was found.
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16.
  • Nordin, Angelica, et al. (author)
  • Sequence variations in C9orf72 downstream of the hexanucleotide repeat region and its effect on repeat-primed PCR interpretation : a large multinational screening study
  • 2017
  • In: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. - : Informa UK Limited. - 2167-8421 .- 2167-9223. ; 18:3-4, s. 256-264
  • Journal article (peer-reviewed)abstract
    • A large GGGGCC-repeat expansion mutation (HREM) in C9orf72 is the most common known cause of ALS and FTD in European populations. Sequence variations immediately downstream of the HREM region have previously been observed and have been suggested to be one reason for difficulties in interpreting RP-PCR data. Our objective was to determine the properties of these sequence variations with regard to prevalence, the range of variation, and effect on disease prognosis. We screened a multi-national cohort (n = 6981) for the HREM and samples with deviant RP-PCR curves were identified. The deviant samples were subsequently sequenced to determine sequence alteration. Our results show that in the USA and European cohorts (n = 6508) 10.7% carried the HREM and 3% had a sequence variant, while no HREM or sequence variants were observed in the Japanese cohort (n = 473). Sequence variations were more common on HREM alleles; however, certain population specific variants were associated with a non-expanded allele. In conclusion, we identified 38 different sequence variants, most located within the first 50 bp downstream of the HREM region. Furthermore, the presence of an HREM was found to be coupled to a lower age of onset and a shorter disease survival, while sequence variation did not have any correlation with these parameters.
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17.
  • Nowicka, Paulina, 1974-, et al. (author)
  • How Do Interpersonal Relationships Affect Children's Weight Management? : A Qualitative Analysis of Parents' Long-Term Perceptions after Obesity Treatment
  • 2022
  • In: Childhood Obesity. - : Mary Ann Liebert. - 2153-2168 .- 2153-2176. ; 18:4, s. 274-280
  • Journal article (peer-reviewed)abstract
    • Background: Childhood obesity interventions are particularly effective during the preschool age, but little is known about parents' long-term perceptions of weight management. This study explores how parents perceive the influence of interpersonal relationships on their children's eating and physical activity 4 years after participating in a randomized controlled trial. Bronfenbrenner's ecological systems theory frames this study, with the child's environment conceptualized as interlocking microsystems that affect weight management.Methods: Interviews were conducted with 33 parents (85% mothers, 48% with university degree) of 33 children [mean age 9.3 (standard deviation 0.7), 46% girls] from Stockholm, Sweden. Interviews were analyzed using thematic analysis, focusing on parents' perceptions of interpersonal relationships: family, relatives, other children, preschool/school staff, and health care practitioners.Results: Two main themes were developed: (1) Discouragement, with the subthemes Conflicting rules and Social comparison, and (2) Support and understanding, with the subthemes Teamwork and Shared responsibility and continuity of care. Parents perceived children's weight management as a continuous orchestration of different influences across social spheres. Years after obesity treatment, parents struggled to maintain the child's healthy routines outside the home. However, when siblings, grandparents, teachers, and friends' parents acted supportively, routines were easier to maintain.Conclusions: The findings suggest that each microsystem in a child's environment has important influence on weight management, such that, as children grow older, children's lifestyles cannot be managed by parents alone. To facilitate weight management, more people in the child's environment should be involved early in the treatment process, and continued professional support should be offered to parents.
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18.
  • Rissanen, Ritva, 1978- (author)
  • Distress, Emotional reactivity and Fatigue following Breast Cancer : A Theoretical Approach and a Randomised Intervention Study
  • 2014
  • Doctoral thesis (other academic/artistic)abstract
    • Aim: Overall aims were to evaluate a stress management intervention with a stepped care approach among women with breast cancer and to explore distress, emotional reactivity and fatigue, both using a theoretical approach and self-reported assessment.Methods: A total of 821 women were approached, 372 women rejected participation, 23 women failed to return the questionnaire and one died, hence, 425 patients (52%) accepted participation. Study I evaluated the cognitive processing model with the aid of an untreated patient group, including 189 women according to the main study protocol. Sixty-six of these women were ineligible for the intervention, as they did not report clinical levels of distress. The remaining 123 women were eligible but they declined participation. Study II explored the validation of the ELSS and emotional reactivity among women with breast cancer. The population comprised of all 425 women (breast cancer sample) and 176 women randomly selected from the PAR register (random women sample). Studies III and IV evaluated the intervention and included all 425 women.Main findings: Study I: avoidance does not mediate the relationship between intrusion and later psychological distress in an early stage breast cancer population. Study II: the ELSS has acceptable validity and reliability. The factor structure of the ELSS was similar in both samples and correlated well with the STAQ (gold standard). Younger age was the only variable associated with emotional reactivity at the start of curative treatment. Studies III and IV: a stepped care approach did not reduce the number of women who require a more extensive treatment at three-months post-diagnosis. Both intervention groups (group/individual) reduced their levels of distress, but there were no significant differences between them. Only about half of the women who were randomised in the second step of the intervention accepted participation.Conclusions: The present thesis provides information regarding distress, emotional reactivity and fatigue among women with breast cancer. A majority of women with early stage breast cancer seem to process the trauma of a cancer diagnosis in a satisfactory way but may experience some emotional reactivity, and younger women may experience more emotional distress. The results also highlight the need for validated measures and carefully planned psychosocial interventions.
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19.
  • Sandström, Camilla, et al. (author)
  • Understanding consistencies and gaps between desired forest futures : An analysis of visions from stakeholder groups in Sweden
  • 2016
  • In: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 45, s. S100-S108
  • Journal article (peer-reviewed)abstract
    • Conflicting perspectives on forests has for a long time challenged forest policy development in Sweden. Disagreements about forest futures create intractable deadlocks when stakeholders talk past each other. The purpose of this study is to move beyond this situation through the application of participatory backcasting. By comparing visions of the future forest among stakeholder groups, we highlight contemporary trajectories and identify changes that were conceived as desirable. We worked with four groups: the Biomass and Bioenergy group, the Conservation group, the Sami Livelihood group and the Recreation and Rural Development group; in total representatives from 40 organizations participated in workshops articulating the groups' visions. Our results show well-known tensions such as intrinsic versus instrumental values but also new ones concerning forests' social values. Identified synergies include prioritization of rural development, new valued-added forest products and diversified forest management. The results may feed directly into forest policy processes facilitating the process and break current deadlocks.
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20.
  • Sjunnestrand, My, et al. (author)
  • "A balancing act" : parents' longitudinal perspectives of weight-related discussions with their children following obesity treatment
  • 2024
  • In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 24:1
  • Journal article (peer-reviewed)abstract
    • Weight-related discussions during childhood may have long-lasting effects on children's body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children's self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children's obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.
  •  
21.
  • Sjunnestrand, My, et al. (author)
  • “A balancing act” : parents’ longitudinal perspectives of weight-related discussions with their children following obesity treatment
  • 2024
  • In: BMC Public Health. - 1471-2458. ; 24:1
  • Journal article (peer-reviewed)abstract
    • Weight-related discussions during childhood may have long-lasting effects on children’s body image and well-being. However, little is known about how parents frame these discussions with children who have undergone treatment for obesity. Our study aimed to explore how parents perceive weight-related discussions, several years after their children started obesity treatment. This qualitative study is part of the 4-year follow-up of the More and Less study, a randomized controlled trial examining the effectiveness of a parental support program as part of obesity treatment for preschool-aged children in Stockholm, Sweden. Semi-structured interviews were conducted with 33 parents (79% mothers, 48% with a university degree, 47% with foreign background) of 33 children (mean age 9.3 years (SD 0.7), 46% girls), transcribed and analyzed using realist informed thematic analysis. Three main themes, encompassing three subthemes were developed. Under the first theme, Parental attitudes and concerns, parents emphasized the importance of discussing weight and health behaviors with their children, yet found it challenging due to uncertainties about how to approach it safely and sensitively. A few parents found the conversation manageable, citing their own experiences of having overweight or their style of communication with the child as facilitating the conversation. Under the second theme, The significance of time and context, parents said they engaged in weight-related conversations with their children more frequently as the children matured, driven by their growing self-awareness. Parents also expressed how contextual factors, such as gender and the presence of others, shaped conversations. Parents perceived boys as more resilient, thus exposing them to more negative weight talk. The third theme, Navigating weight stigma, revealed how parents employed strategies such as nurturing their children’s self-confidence, downplaying the significance of appearance and emphasizing health when discussing weight to shield their children from weight stigma. Taken together, we found that many parents need support to navigate weight-related discussions. Addressing weight stigma is part of children’s obesity management process, as children may be bullied, teased, or experience discrimination in different social settings. More research is needed to explore how young children undergoing obesity treatment experience weight stigma and to understand gendered differences in these experiences.
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22.
  • Sjunnestrand, My, et al. (author)
  • Planting a seed - child health care nurses' perceptions of speaking to parents about overweight and obesity : a qualitative study within the STOP project
  • 2019
  • In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses' perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project "Science and Technology in childhood Obesity Policy" (STOP), this study examines CHC nurses' perceptions of speaking to parents about children's overweight/obesity and of their role in referring children to treatment for overweight/obesity.METHODS: All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis.RESULTS: Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children's weights if this could compromise parents' trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child's weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers.CONCLUSIONS: We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system.TRIAL REGISTRATION: ClinicalTrials.gov NCT03800823; 11 Jan 2019, prospectively registered.
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23.
  • Sorgenfrei, Simon, Docent, et al. (author)
  • Mångreligiositet och sekularitet i svenskt polisväsende, vård, skola och offentlig förvaltning : en forskningsöversikt
  • 2021
  • Reports (other academic/artistic)abstract
    • Under de senaste decennierna har Sverige genomgått stora demografiska och politiska förändringar. Tillsammans har dessa inneburit att Sverige idag samtidigt är ett av Europas mest sekulariserade och mest mångreligiösa länder. Den snabba demografiska förändring Sverige har genomgått har ställt många inför nya, stora och i vissa fall skyndsamma kunskapsbehov samtidigt är forskningen om situationen delvis eftersatt. I denna rapport identifieras hur den nya situationen relaterar till det lagstadgade uppdrag som svenskt polisväsende, vård, skola och offentlig förvaltning har. Den forskning som gjorts inom dessa områden sammanfattas och de viktigaste forskningsbehoven identifieras.
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24.
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25.
  • Ahlqvist, Margary, et al. (author)
  • Handling of peripheral intravenous cannulae : effects of evidence-based clinical guidelines.
  • 2006
  • In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 15:11, s. 1354-61
  • Journal article (peer-reviewed)abstract
    • AIM: This study aimed at evaluating the outcome of implemented evidence-based clinical guidelines by means of surveying the frequency of thrombophlebitis, nurses' care, handling and documentation of peripheral intravenous cannulae. BACKGROUND: Peripheral intravenous cannulae are frequently used for vascular access and, thereby, the patients will be exposed to local and systemic infectious complications. Evidence-based knowledge of how to prevent these complications and how to care for patients with peripheral intravenous cannula is therefore of great importance. Deficient care, handling and documentation of peripheral intravenous cannulae have previously been reported. DESIGN: A cross-sectional survey was conducted by a group of nurses at three wards at a university hospital before and after the implementation of the evidence-based guidelines. METHOD: A structured observation protocol was used to review the frequency of thrombophlebitis, the nurses' care, handling and the documentation of peripheral intravenous cannulae in the patient's record. RESULTS: A total of 107 and 99 cannulae respectively were observed before and after the implementation of the guidelines. The frequency of peripheral intravenous cannulae without signs of thrombophlebitis increased by 21% (P < 0.01) and the use of cannula size 0.8 mm increased by 22% (P < 0.001). Nurses' documentation of peripheral intravenous cannula improved significantly (P < 0.001). CONCLUSION: We conclude that implementation of the guidelines resulted in significant improvements by means of decreased frequency of signs of thrombophlebitis, increased application of smaller cannula size (0.8 mm), as well as of the nurses' documentation in the patient's record. RELEVANCE TO CLINICAL PRACTICE: Further efforts to ameliorate care and handling of peripheral intravenous cannulae are needed. This can be done by means of increasing nurses' knowledge and recurrent quality reviews. Well-informed patients can also be more involved in the care than is common today.
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26.
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27.
  • Andersen, Janice, et al. (author)
  • Illness Perception and Psychological Distress in Persons with Porphyria Cutanea Tarda
  • 2016
  • In: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 96:5, s. 674-678
  • Journal article (peer-reviewed)abstract
    • Porphyria cutanea tarda (PCT) requires long-term treatment and follow-up, although many patients experience life-long remission. The aim of this cross-sectional postal survey was to describe and investigate the association between illness perception, health complaints, self-reported symptoms and distress in persons with PCT. The participants perceived PCT as a chronic condition with high levels of personal and treatment control. Persons who reported active symptoms scored higher on perceived illness threat, total health complaints and psychological distress compared with those in remission or latent phases. However, a higher perception of illness threat and the total burden of health complaints were more closely associated with psychological distress than were perceived PCT symptoms activity. This has implications for clinical consultation; dermatologists should be attentive to symptoms activity, but also recognize that patients in remission with a high perceived illness threat and multiple health complaints might be especially vulnerable to psychological distress with regards to PCT.
  •  
28.
  • Arving, Cecilia, et al. (author)
  • Early rehabilitation of cancer patients : a randomized controlled intervention study
  • 2013
  • In: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 13, s. 9-
  • Journal article (peer-reviewed)abstract
    • Background: Faced with a life-threatening illness, such as cancer, many patients develop stress symptoms, i.e. avoidance behaviour, intrusive thoughts and worry. Stress management interventions have proven to be effective; however, they are mostly performed in group settings and it is commonly breast cancer patients who are studied. We hereby present the design of a randomized controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of an individual stress-management intervention with a stepped-care approach in several cancer diagnoses. Method: Patients (>= 18 years) with a recent diagnosis of breast cancer, colorectal cancer, lymphoma, prostate cancer or testicle cancer and scheduled for adjuvant/curative oncology treatment, will consecutively be included in the study. In this prospective longitudinal intervention study with a stepped-care approach, patients will be randomized to control, treatment as usual, or an individual stress-management intervention in two steps. The first step is a low-intensity stress-management intervention, given to all patients randomized to intervention. Patients who continue to report stress symptoms after the first step will thereafter be given more intensive treatment at the second step of the programme. In the intervention patients will also be motivated to be physically active. Avoidance and intrusion are the primary outcomes. According to the power analyses, 300 patients are planned to be included in the study and will be followed for two years. Other outcomes are physical activity level, sleep duration and quality recorded objectively, and anxiety, depression, quality of life, fatigue, stress in daily living, and patient satisfaction assessed using valid and standardized psychometric tested questionnaires. Utilization of hospital services will be derived from the computerized patient administration systems used by the hospital. The cost-effectiveness of the intervention will be evaluated through a cost-utility analysis. Discussion: This RCT will provide empirical evidence of whether an individually administered stress-management programme in two steps can decrease stress as well as maintain or enhance patients' physical activity level, quality of life and psychological well-being. Further, this RCT, with a stepped-care approach, will provide knowledge regarding the cost-effectiveness of an individually administered stress-management programme whose aim is to help and support individual patients at the right level of care.
  •  
29.
  • Arving, Cecilia, et al. (author)
  • Early rehabilitation of cancer patients : An individual randomized stepped-care stress-management intervention.
  • 2019
  • In: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 28:2, s. 301-308
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To evaluate the effects of an individual stepped-care stress-management intervention for cancer patients on cancer-related stress reactions (intrusion/avoidance), and secondarily on psychological distress (anxiety/depression) and emotional reactivity (impatience/hostility).METHODS: Consecutively 291 cancer patients were included in a randomized controlled intervention study. Patients randomized to the intervention who did not report clinically significant stress levels (n = 72) after the first counseling session participated in only one counseling session and a follow-up (Step 1). The remaining patients (n = 66) received an additional three to eight sessions, depending on individual needs (Step 2). The intervention used techniques derived from cognitive behavioral therapy (CBT) such as daily registration of events and behaviors as well as scheduled behavioral and physical activity, along with short relaxation exercises. The intervention was completed within 26 weeks of inclusion. The Impact of Event Scale, Hospital Anxiety and Depression Scale, and Everyday Life Stress Scale were used to evaluate effects for 2 years.RESULTS: The linear mixed effects model analysis showed a difference between the randomization groups in favor of the intervention for avoidance and intrusion after the first 6 weeks (P = 0.001 and P = 0.003) and for emotional reactivity after 17 weeks (P = 0.007). There were no differences in psychological distress. Decreases in cancer-related stress reactions and depression were noted for the Step 2 intervention.CONCLUSIONS: An individual stepped-care stress-management intervention for cancer patients, performed by specially educated health professionals using techniques derived from CBT, seems beneficial for cancer patients and may therefore be a realistic complement to routine cancer care.
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30.
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31.
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32.
  • Benoni, Henrik, et al. (author)
  • Relative and absolute cancer risks among Nordic kidney transplant recipients-a population-based study
  • 2020
  • In: Transplant International. - : WILEY. - 0934-0874 .- 1432-2277. ; 33:12, s. 1700-1710
  • Journal article (peer-reviewed)abstract
    • Kidney transplant recipients (KTRs) have an increased cancer risk compared to the general population, but absolute risks that better reflect the clinical impact of cancer are seldom estimated. All KTRs in Sweden, Norway, Denmark, and Finland, with a first transplantation between 1995 and 2011, were identified through national registries. Post-transplantation cancer occurrence was assessed through linkage with cancer registries. We estimated standardized incidence ratios (SIR), absolute excess risks (AER), and cumulative incidence of cancer in the presence of competing risks. Overall, 12 984 KTRs developed 2215 cancers. The incidence rate of cancer overall was threefold increased (SIR 3.3, 95% confidence interval [CI]: 3.2-3.4). The AER of any cancer was 1560 cases (95% CI: 1468-1656) per 100 000 person-years. The highest AERs were observed for nonmelanoma skin cancer (838, 95% CI: 778-901), non-Hodgkin lymphoma (145, 95% CI: 119-174), lung cancer (126, 95% CI: 98.2-149), and kidney cancer (122, 95% CI: 98.0-149). The five- and ten-year cumulative incidence of any cancer was 8.1% (95% CI: 7.6-8.6%) and 16.8% (95% CI: 16.0-17.6%), respectively. Excess cancer risks were observed among Nordic KTRs for a wide range of cancers. Overall, 1 in 6 patients developed cancer within ten years, supporting extensive post-transplantation cancer vigilance.
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33.
  • Berglund, Gunilla, et al. (author)
  • Intention to test for prostate cancer
  • 2005
  • In: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 0959-8049. ; 41:7, s. 990-997
  • Journal article (peer-reviewed)
  •  
34.
  • Berntsen, Sveinung, et al. (author)
  • Design of a randomized controlled trial of physical training and cancer (Phys-Can) - the impact of exercise intensity on cancer related fatigue, quality of life and disease outcome
  • 2017
  • In: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 17:1, s. 1-12
  • Journal article (peer-reviewed)abstract
    • Background: Cancer-related fatigue is a common problem in persons with cancer, influencing health-related quality of life and causing a considerable challenge to society. Current evidence supports the beneficial effects of physical exercise in reducing fatigue, but the results across studies are not consistent, especially in terms of exercise intensity. It is also unclear whether use of behaviour change techniques can further increase exercise adherence and maintain physical activity behaviour. This study will investigate whether exercise intensity affects fatigue and health related quality of life in persons undergoing adjuvant cancer treatment. In addition, to examine effects of exercise intensity on mood disturbance, adherence to oncological treatment, adverse effects from treatment, activities of daily living after treatment completion and return to work, and behaviour change techniques effect on exercise adherence. We will also investigate whether exercise intensity influences inflammatory markers and cytokines, and whether gene expressions following training serve as mediators for the effects of exercise on fatigue and health related quality of life. Methods/design: Six hundred newly diagnosed persons with breast, colorectal or prostate cancer undergoing adjuvant therapy will be randomized in a 2 × 2 factorial design to following conditions; A) individually tailored low-to-moderate intensity exercise with or without behaviour change techniques or B) individually tailored high intensity exercise with or without behaviour change techniques. The training consists of both resistance and endurance exercise sessions under the guidance of trained coaches. The primary outcomes, fatigue and health related quality of life, are measured by self-reports. Secondary outcomes include fitness, mood disturbance, adherence to the cancer treatment, adverse effects, return to activities of daily living after completed treatment, return to work as well as inflammatory markers, cytokines and gene expression. Discussion: The study will contribute to our understanding of the value of exercise and exercise intensity in reducing fatigue and improving health related quality of life and, potentially, clinical outcomes. The value of behaviour change techniques in terms of adherence to and maintenance of physical exercise behaviour in persons with cancer will be evaluated. Trial registration:NCT02473003 , October, 2014.
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35.
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36.
  • Bestas, Burcu, et al. (author)
  • Splice-correcting oligonucleotides restore BTK function in X-linked agammaglobulinemia model
  • 2014
  • In: Journal of Clinical Investigation. - 0021-9738 .- 1558-8238. ; 124:9, s. 4067-4081
  • Journal article (peer-reviewed)abstract
    • X-linked agammaglobulinemia (XLA) is an inherited immunodeficiency that results from mutations within the gene encoding Bruton's tyrosine kinase (BTK). Many XLA-associated mutations affect splicing of BTK pre-mRNA and severely impair B cell development. Here, we assessed the potential of antisense, splice-correcting oligonucleotides (SCOs) targeting mutated BTKtranscripts for treating XLA. Both the SCO structural design and chemical properties were optimized using 2'-O-methyl, locked nucleic acid, or phosphorodiamidate morpholino backbones. In order to have access to an animal model of XLA, we engineered a transgenic mouse that harbors a BAC with an authentic, mutated, splice-defective human BTK gene. BTK transgenic mice were bred onto a Btk knockout background to avoid interference of the orthologous mouse protein. Using this model, we determined that BTK-specific SCOs are able to correct aberrantly spliced BTK in B lymphocytes, including pro-B cells. Correction of BTK mRNA restored expression of functional protein, as shown both by enhanced lymphocyte survival and reestablished BTK activation upon B cell receptor stimulation. Furthermore, SCO treatment corrected splicing and restored BTK expression in primary cells from patients with XLA. Together, our data demonstrate that SCOs can restore BTK function and that BTK-targeting SCOs have potential as personalized medicine in patients with XLA.
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37.
  • Bjørke, Ann Christin Helgesen, et al. (author)
  • Exploring Moderators of the Effect of High vs. Low-to-Moderate Intensity Exercise on Cardiorespiratory Fitness During Breast Cancer Treatment - Analyses of a Subsample From the Phys-Can RCT
  • 2022
  • In: Frontiers in Sports and Active Living. - : Frontiers Media S.A.. - 2624-9367. ; 4
  • Journal article (peer-reviewed)abstract
    • Introduction: The results from the physical training and cancer randomized controlled trial (Phys-Can RCT) indicate that high intensity (HI) strength and endurance training during (neo-)adjuvant cancer treatment is more beneficial for cardiorespiratory fitness (CRF, measured as peak oxygen uptake [VO2peak]) than low-to-moderate intensity (LMI) exercise. Adherence to the exercise intervention and demographic or clinical characteristics of patients with breast cancer undergoing adjuvant treatment may moderate the exercise intervention effect on VO2peak. In this study, the objective was to investigate whether baseline values of VO2peak, body mass index (BMI), time spent in moderate- to vigorous-intensity physical activity (MVPA), physical fatigue, age, chemotherapy treatment, and the adherence to the endurance training moderated the effect of HI vs. LMI exercise on VO2peak.Materials and Methods: We used data collected from a subsample from the Phys-Can RCT; women who were diagnosed with breast cancer and had a valid baseline and post-intervention VO2peak test were included (n = 255). The exercise interventions from the RCT included strength and endurance training at either LMI, which was continuous endurance training at 40–50% of heart rate reserve (HRR), or at HI, which was interval training at 80–90% of HRR, with similar exercise volume in the two groups. Linear regression analyses were used to investigate moderating effects using a significance level of p < 0.10. Statistically significant interactions were examined further using the Johnson–Neyman (J-N) technique and regions of significance (for continuous variables) or box plots with adjusted means of post-intervention VO2peak (for binary variables).Results: Age, as a continuous variable, and adherence, dichotomized into < or > 58% based on median, moderated the effect of HI vs. LMI on CRF (B = −0.08, 95% CI [−0.16, 0.01], pinteraction = 0.06, and B = 1.63, 95% CI [−0.12, 3.38], pinteraction = 0.07, respectively). The J-N technique and regions of significance indicated that the intervention effect (HI vs. LMI) was positive and statistically significant in participants aged 61 years or older. Baseline measurement of CRF, MVPA, BMI, physical fatigue, and chemotherapy treatment did not significantly moderate the intervention effect on CRF.Conclusion: Women with breast cancer who are older and who have higher adherence to the exercise regimen may have larger effects of HI exercise during (neo-)adjuvant cancer treatment on CRF.
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38.
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39.
  • Borjesson, Susanne, 1956-, et al. (author)
  • Taxane-induced pain in breast cancer patients as perceived by nurses
  • 2021
  • In: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 60:4, s. 412-418
  • Journal article (peer-reviewed)abstract
    • Introduction Treatment with taxane-containing chemotherapy regimens is crucial for improving survival in patients with early-stage invasive breast cancer. Recent literature describes a high incidence of taxane-induced neuropathic pain or/and muscle and joint pain. For patients, oncology nurses can play an integral role as a resource for pain control. There is a knowledge gap regarding how nurses perceive patients' experienced taxane-induced pain and support from their organizations when caring for patients with such pain. Aim Investigate nurses' perceptions of occurrence of taxane-induced pain and identify organizational support for managing such pain. Material and methods A cross-sectional observation study, conducted in 2017-2018, with a web-based questionnaire to 240 nurses working at oncology outpatient units in Sweden. The areas of concern were start-decline, duration, prevalence, intensity, and bodily distribution of taxane-induced pain. Patient information, guidelines, prophylactic analgesia, and perceived support were used to counteract such pain. Data were analyzed using descriptive statistics and a logistic regression model to estimate associations. Results One hundred sixty-one nurses completed the questionnaire, describing their perceptions of taxane-induced pain in patients with breast cancer. The prevalence and intensity of taxane-induced pain were experienced as divergent. Some consensus was found among the nurses regarding the start of the pain, but not when declined. The body areas where pain was expected to occur were the muscles, joints, legs, feet, and mainly the back of the trunk. Low use of local/national guidelines for managing taxane-induced pain was described. No relationship was found between factors related to the nurses' characteristics (age, work experience in oncology care, or specialist education in oncology) that significantly affected their perceptions regarding the occurrence of taxane-induced pain or pain intensity. Conclusion: This study highlights a need for attention to education and guidelines for how to observe, treat, and evaluate this particular type of pain.
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40.
  • Brooke, Hannah L., et al. (author)
  • Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT
  • 2022
  • In: BMC Sports Science, Medicine and Rehabilitation. - : BioMed Central (BMC). - 2052-1847. ; 14:1
  • Journal article (peer-reviewed)abstract
    • Background: Knowledge regarding adherence is necessary to improve the specificity of exercise interventions during cancer treatment. We aimed to determine adherence to resistance and endurance training interventions in parallel; identify subgroups with similar adherence characteristics; and examine determinants of these subgroups. Methods: In the Phys-Can randomised controlled trial, participants (n=577, 81% women, mean(SD) age 59(12) years, and 50% with BMI >= 25 kg/m(2)) starting (neo-) adjuvant treatment for breast, colorectal or prostate cancer were randomized to 6-month of high (HI) or low-to-moderate intensity (LMI) supervised, group-based resistance training and individual home-based endurance training, with or without behavior change support. Adherence was calculated as performed exercise volume as a proportion of prescribed exercise volume (0-100%), overall (HI and LMI groups) and for frequency, intensity, type and time (FITT principles) (HI group). Adherence to resistance training was plotted against adherence to endurance training overall and for each FITT principle. K-means cluster analysis was used to identify subgroups with similar adherence characteristics. Potential determinants of subgroup membership were examined using multinomial logistic regression. Results: We found a positive curvilinear correlation between adherence to resistance and endurance training overall. A similar correlation was seen for adherence to frequency of resistance vs. endurance training in the HI group. In the HI group, adherence to resistance training intensity and time was > 80% for almost all participants. For endurance training adherence ranged from 0 to 100% for each of the FITT principles. Three clusters were identified, representing low, mixed, and high adherence to resistance and endurance training overall. Participants with higher age (Relative risk ratio [95% Cl]; LMI: 0.86[0.77-0.96], HI: 0.83[0.74-0.93]), no behaviour change support (LMI: 0.11 [0.02-0.56], HI: 0.20[0.05-0.85]), higher cardiorespiratory fitness (LMI: 0.81 [0.69-0.94], HI: 0.80[0.69-0.92]), more fatigue (according to the reduced activity subscale of the MFI questionnaire) (LMI: 0.48[0.31-0.73], HI: 0.69[0.52-0.93]) or higher quality of life (LMI: 0.95[0.90-1.00], HI: 0.93[0.88-0.98]) were less likely to be in the low than the high adherence cluster whether randomised to LMI or HI training. Other determinants were specific to those randomised to LMI or HI training. Conclusions: In an exercise intervention during cancer treatment, adherence to resistance and endurance training were positively correlated. Personalisation of interventions and additional support for some subgroups of participants may improve adherence.
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41.
  • Börjesson, Susanne, 1956-, et al. (author)
  • Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes: : a prospective multi-method study of pain experience
  • 2018
  • In: Scandinavian Journal of Pain. - Berlin/Boston : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; , s. 581-591
  • Research review (peer-reviewed)abstract
    • Background and aims:Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients’ pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study.Methods:Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire’s (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months.Results:Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30.Conclusions:This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain.Implications:Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24–48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.
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42.
  • Downing, Charlotte, et al. (author)
  • A systematic review of quantitative studies concerning psychological aspects of early specialisation
  • 2023
  • In: International Journal of Sport and Exercise Psychology. - : Routledge. - 1612-197X .- 1557-251X.
  • Journal article (peer-reviewed)abstract
    • Despite the intense and long-standing interest surrounding early sport specialisation, scholars still debate its nature and implications. Previous researchers have also identified the need for further research relating to the psychological aspects of early specialisation such as lower quality motivation, dropout and burnout. To help guide future research it is important to build upon the quantitative literature concerning such psychological aspects of early specialisation. The specific aims of this paper are to provide an overview of research results of quantitative studies that set out to explore relationships between early specialisation and psychological aspects, and to critically examine the designs of such studies. As such, study design characteristics including participant demographics, the psychological aspects represented, and the research questions and results are explored. Data searches were conducted in PubMed, SportDiscus, and PsychINFO using search terms such as "early sport speciali*". Twenty-one relevant papers met the inclusion criteria. The results highlight that the published papers in this area are broad in some respects (variety of sports, performance levels, and gender), but narrow in others (North American dominance, few psychological aspects explored, and few papers per psychological aspect). Many of the studies are based on cross-sectional and retrospective self-reports. Overall, this paper serves as a foundation on which to design future research studies in this area.
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43.
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44.
  • Downing, Charlotte, et al. (author)
  • An Index Approach to Early Specialization Measurement : An Exploratory Study.
  • 2020
  • In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 11
  • Journal article (peer-reviewed)abstract
    • The methodological underpinnings of studies into early specialization have recently been critiqued. Previous researchers have commented on the variety of, and over-simplified, methods used to capture early specialization. This exploratory study, therefore, suggests a new direction for how early specialization can be conceptualized and measured. We aim to create an index approach whereby early specialization is measured as a continuous variable, in line with commonly used definitions. The continuous variable for degrees of early specialization is calculated from a questionnaire which captures the four key components of early specialization; (1) intensity, (2) year-round training, (3) single sport, and (4) commencing age 12 or younger. The proposed index approach is illustrated in a sample of 290 Swedish aesthetic performers aged 12-20 years (M = 15.88), whose descriptive statistics are used to discuss the suitability and usability of the measure. The proposed index approach functions as a guideline to future researchers. We hope that introducing a new index approach we will encourage further discussion around the measurement of early specialization. Additionally, we hope to pave the way for future research to explore more complex research questions.
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45.
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46.
  • Downing, Charlotte, et al. (author)
  • Early specialisation among Swedish aesthetic performers : exploring motivation and perceptions of parental influence
  • 2022
  • In: International Journal of Sport and Exercise Psychology. - : Routledge. - 1612-197X .- 1557-251X. ; 20:4, s. 1013-1032
  • Journal article (peer-reviewed)abstract
    • Early specialisation is largely advised against, partly due to the postulated negative motivational implications. However, early specialisation is commonly considered necessary for high-level performance in aesthetic activities, such as gymnastics and dance. The present study, therefore, explores the relationship between motivation and early specialisation in a sample of Swedish aesthetic performers, from a self-determination theory perspective. The aims of this study were twofold: (1) to identify whether early specialisation is associated with motivation (autonomous motivation, controlled motivation, and dropout intentions) within a sample of aesthetic performers, and (2) to investigate if such relationships are moderated by perceptions of parental influence. Two hundred and ninety high-level aesthetic performers (M=15.88 years old, SD=2.34; 83% female) were recruited from Swedish clubs and schools to complete a questionnaire pack. The questionnaire pack included questions concerning demographic information, specialisation history, motivation, dropout intentions, and perceptions of parental influence. The results of our analyses do not support the claims that early specialisation is associated with negative motivational implications. In fact, the results show that those who reported a higher degree of specialisation ≤ 12 years old reported less controlled motivation than those who reported a lesser degree of early specialisation. Additionally, perceptions of parental influence were not found to moderate the relationship between early specialisation and motivation. These results are discussed in relation to the growing critique regarding the conceptualisation and measurement of early specialisation in sport literature.
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47.
  • Downing, Charlotte (author)
  • Early specialising aesthetic performers : An investigation of conceptualisation, motivation, and context
  • 2023
  • Doctoral thesis (other academic/artistic)abstract
    • This doctoral research project is situated within the wider debate of talent development in so-called early sports, where early specialisation is often normalised. The overarching aim is to investigate early specialisation within the context of Swedish aesthetic activities. Two research questions guided this research: 1) what characterises early specialisation, and 2) in what ways are aspects of early specialisation related to motivation?This doctoral research project includes four individual papers. The first paper is a systematic review that investigated the contextual underpinnings of recommendations regarding early specialisation and psychological aspects (e.g., motivation, burnout). The second paper outlines the development of a measurement tool for capturing degrees of early specialisation within the context of Swedish aesthetic activities. The third paper is a cross-sectional questionnaire-based study which used this measurement tool to explore the relationship between degrees of early specialisation and motivation (autonomous motivation, controlled motivation, and dropout intentions), and explored perceptions of parental influence as a moderator. The fourth paper is a qualitative interview-based study that investigated reflections on motivation throughout the training history of high-level gymnasts and figure skaters who specialised early. Additional data regarding perfectionism and parental participation in sport, collected in relation to this research but not included within the four papers, is also outlined and discussed in this thesis. Results highlight the complexity of early specialisation in terms of how it is defined, measured, and conceptualised, as well as the possible relationship to psychological aspects (e.g., motivation, perfectionism). Overall, the results do not align with the notion that early specialisation leads to lower quality motivation and an increased risk of dropout. While this research has made methodological, theoretical and empirical contributions to this research area, it is also clear that more research is needed to better understand and explain the possible outcomes often associated with early specialisation.
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48.
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49.
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50.
  • Downing, Charlotte, et al. (author)
  • Why did they continue? Female gymnasts’ reflections on early specialisation
  • 2022
  • In: 16th European Congress of Sport &amp; Exercise Psychology.
  • Conference paper (peer-reviewed)abstract
    • Previous research largely advises against early specialisation, due to possible physical and psychological risks (Côté, Lidor, & Hackfort,2009). For this study, we are interested in exploring gymnasts’ reflections of early specialisation in relation to motivation and autonomy.Despite limited empirical evidence, early specialisation is commonly considered necessary for high-level performance in aestheticactivities, such as gymnastics (Kliethermes et al., 2021). This study is one of the first to present qualitative data concerning experiencesof early specialisation, and the first known study to collect such data within female gymnasts.The research questions for this study are, 1) What motivated female gymnasts to remain in early specialised training? 2) How do theyreflect upon key specialisation milestones in relation to motivation and autonomy? and 3) How do they reflect upon the necessity of earlyspecialisation? The study is underway, with semi-structured interviews being conducted with female gymnasts aged 15-24 who selfreported a high degree of early specialisation. Specifically, those who reported reaching specialisation milestones at the youngest ageswere recruited from a database of 115 high-level gymnasts. The data will be analysed using abductive thematic analysis, where selfdetermination theory provides a framework to explore the interplay between early specialisation and motivation towards continuedparticipation in gymnastics.It is anticipated that the results will contribute valuable data regarding experiences of early specialisation, and how these experiencesmight influence motivation towards continued training. Such data also has the potential to shed light on the often-inconsistent quantitativeresults exploring motivational correlates of early specialisation.
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