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1.	Bark, Lovisa, et al. (författare) Central nervous system biomarkers GFAp and NfL associate with post-acute cognitive impairment and fatigue following critical COVID-19. 2023 Ingår i: Scientific reports. - : Springer Nature. - 2045-2322. ; 13:1 Tidskriftsartikel (refereegranskat)abstract A high proportion of patients with coronavirus disease 2019 (COVID-19) experience post-acute COVID-19, including neuropsychiatric symptoms. Objective signs of central nervous system (CNS) damage can be investigated using CNS biomarkers such as glial fibrillary acidic protein (GFAp), neurofilament light chain (NfL) and total tau (t-tau). We have examined whether CNS biomarkers can predict fatigue and cognitive impairment 3-6months after discharge from the intensive care unit (ICU) in critically ill COVID-19 patients. Fifty-seven COVID-19 patients admitted to the ICU were included with analysis of CNS biomarkers in blood at the ICU and at follow up. Cognitive dysfunction and fatigue were assessed with the Montreal Cognitive Assessment (MoCA) and the Multidimensional Fatigue inventory (MFI-20). Elevated GFAp at follow-up 3-6months after ICU discharge was associated to the development of mild cognitive dysfunction (p=0.01), especially in women (p=0.005). Patients who experienced different dimensions of fatigue at follow-up had significantly lower GFAp in both the ICU and at follow-up, specifically in general fatigue (p=0.009), physical fatigue (p=0.004), mental fatigue (p=0.001), and reduced motivation (p=0.001). Women showed a more pronounced decrease in GFAp compared to men, except for in mental fatigue where men showed a more pronounced GFAp decrease compared to women. NfL concentration at follow-up was lower in patients who experienced reduced motivation (p=0.004). Our findings suggest that GFAp and NfL are associated with neuropsychiatric outcome after critical COVID-19.Trial registration The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
2.	Bjarnadóttir, Kristín J., et al. (författare) Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure. A physiological study 2024 Ingår i: Frontiers in Physiology. - 1664-042X. ; 15 Tidskriftsartikel (refereegranskat)
3.	Duffy, Stephen W., et al. (författare) Mammography screening reduces rates of advanced and fatal breast cancers : Results in 549,091 women 2020 Ingår i: Cancer. - : John Wiley & Sons. - 0008-543X .- 1097-0142. ; 126:13, s. 2971-2979 Tidskriftsartikel (refereegranskat)abstract Background: It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death.Methods: Among 549,091 women, covering approximately 30% of the Swedish screening‐eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression.Results: Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51‐0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66‐0.84 [P < .001]).Conclusions: Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
4.	Ekbom, Emil, et al. (författare) Impaired diffusing capacity for carbon monoxide is common in critically ill Covid-19 patients at four months post-discharge 2021 Ingår i: Respiratory Medicine. - : Elsevier. - 0954-6111 .- 1532-3064. ; 182 Tidskriftsartikel (refereegranskat)abstract There is limited knowledge about the long-term effects on pulmonary function of COVID-19 in patients that required intensive care treatment. Spirometry and diffusing capacity for carbon monoxide (DLCO) were measured in 60 subjects at 3-6 months post discharge. Impaired lung function was found in 52% of the subjects, with reduced DLCO as the main finding. The risk increased with age above 60 years, need for mechanical ventilation and longer ICU stay as well as lower levels of C-reactive protein at admission. This suggests the need of follow-up with pulmonary function testing in intensive-care treated patients.
5.	Eklund, Rakel, 1986-, et al. (författare) Surviving COVID-19 : patients' experiences of care and path to recovery 2024 Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 19:1 Tidskriftsartikel (refereegranskat)abstract Purpose: To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process.Methods: An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis.Results: The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process.Conclusions: This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies.
6.	Elfwen, Ludvig, et al. (författare) Direct or subacute coronary angiography in out-of-hospital cardiac arrest (DISCO)-An initial pilot-study of a randomized clinical trial 2019 Ingår i: Resuscitation. - : ELSEVIER IRELAND LTD. - 0300-9572 .- 1873-1570. ; 139, s. 253-261 Tidskriftsartikel (refereegranskat)abstract Background: The clinical importance of immediate coronary angiography, with potentially subsequent percutaneous coronary intervention (PCI), in out-of-hospital cardiac arrest (OHCA) patients without ST-elevation on the ECG is unclear. In this study, we assessed feasibility and safety aspects of performing immediate coronary angiography in a pre-specified pilot phase of the 'DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest' (DISCO) randomized controlled trial (ClinicalTrials.gov ID: NCT02309151). Methods: Resuscitated bystander witnessed OHCA patients > 18 years without ST-elevation on the ECG were randomized to immediate coronary angiography versus standard of care. Event times, procedure related adverse events and safety variables within 7 days were recorded. Results: In total, 79 patients were randomized to immediate angiography (n = 39) or standard of care (n = 40). No major differences in baseline characteristics between the groups were found. There were no differences in the proportion of bleedings and renal failure. Three patients randomized to immediate angiography and six patients randomized to standard care died within 24 h. The median time from EMS arrival to coronary angiography was 135 min in the immediate angiography group. In patients randomized to immediate angiography a culprit lesion was found in 14/38 (36.8%) and PCI was performed in all these patients. In 6/40 (15%) patients randomized to standard of care, coronary angiography was performed before the stipulated 3 days. Conclusion: In this out-of-hospital cardiac arrest population without ST-elevation, randomization to a strategy to perform immediate coronary angiography was feasible although the time window of 120 min from EMS arrival at the scene of the arrest to start of coronary angiography was not achieved. No significant safety issues were reported.
7.	Erichsen Andersson, Annette, 1966, et al. (författare) Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room : experiences from the safe hands study 2018 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. This study aimed to evaluate the process of implementing a theory-driven knowledge translation program for improved use of hand hygiene and aseptic techniques in the operating room.METHODS: The study was set in an operating department of a university hospital. The intervention was underpinned by theories on organizational learning, culture and person centeredness. Qualitative process data were collected via participant observations and analyzed using a thematic approach.RESULTS: Doubts that hand-hygiene practices are effective in preventing hospital acquired infections, strong boundaries and distrust between professional groups and a lack of psychological safety were identified as barriers towards change. Facilitated interprofessional dialogue and learning in "safe spaces" worked as mechanisms for motivation and engagement. Allowing for the free expression of different opinions, doubts and viewing resistance as a natural part of any change was effective in engaging all professional categories in co-creation of clinical relevant solutions to improve hand hygiene.CONCLUSION: Enabling nurses and physicians to think and talk differently about hospital acquired infections and hand hygiene requires a shift from the concept of one-way directed compliance towards change and learning as the result of a participatory and meaning-making process. The present study is a part of the Safe Hands project, and is registered with ClinicalTrials.gov (ID: NCT02983136 ). Date of registration 2016/11/28, retrospectively registered.
8.	Hagmar, L., et al. (författare) Intra-individual variations and time trends 1991-2001 in human serum levels of PCB, DDE and hexachlorobenzene 2006 Ingår i: Chemosphere. - : Elsevier BV. - 0045-6535 .- 1879-1298. ; 64:9, s. 1507-1513 Tidskriftsartikel (refereegranskat)abstract Background: An important question is whether human serum levels of persistent organic pollutants has continued to decrease during the last decades. The aim of this study was to assess intra-individual variations over time of serum levels of 2,2',4,4',5,5'-hexachlorobiphenyl (CB-153), 1,1-dichloro-2,2-bis(4-chlorophenyl)-ethene (p,p'-DDE) and hexachlorobenzene (HCB), considering the impact of a number of possible determinants. Methods: Blood samples were drawn for the same 39 subjects in 1991 and 2001. Interviews were made at both occasions. Lipid adjusted serum concentrations of CB-153, p,p'-DDE and HCB were determined in both sets of blood samples using gas chromatography-mass spectrometry. The fatty acid composition of the serum lipids was analyzed by means of gas-liquid chromatography. Result: The CB-153 concentrations in serum had averagely decreased with 34% in between 1991 and 2001 (p < 0.001). Of individual determinants only increasing BMI was associated with decreasing CB-153 levels (beta = -1.0, 95% CI -1.8, -0.2, p = 0.01), explaining 13% of the variation. The average decrease of p,p'-DDE was 55%, and could only weakly be associated with a relative increase of BMI (beta = - 1.0, 95% CI-2.3, 0.2, p=0.09), explaining only 5% of the variation. The average decrease of HCB was 53%, and was associated only with high fish consumption in 1991, explaining 12% of the variation. Conclusions: The results support a continuing decrease in human body burdens of PCBs, DDE and HCB during the 1990s. The explanatory factors relative change of BMI and fish consumption explained only a minor part of the time-related variations in serum levels.
9.	Hagmar, Lars, et al. (författare) Tidstrender för halter av persistenta klororganiska miljögifter i blod hos vuxna svenska män i relation till konsumtion av fet östersjöfisk 2004 Rapport (övrigt vetenskapligt/konstnärligt)abstract Det har skett en signifikant genomsnittlig minskning med 34 till 55 % av serumhalterna av CB-153, p,p´-DDE och HCB under perioden 1991 till 2001 bland 39 medelålders svenska män, varav en del med hög konsumtion av fet östersjöfisk. Detta kunde inte förklaras med förändrad fiskkonsumtion över tiden. Däremot förklarade en ökad kroppsvikt en del av minskningen, genom en ”utspädningseffekt” (större distributionsvolym). Det är sannolikt att en minskad förorening av animaliska livsmedel med dessa POPs under senare år bidragit till de sjunkande halterna i serum. I motsats till resultaten för CB-153, p,p´-DDE och HCB förelåg det inte någon signifikant tidstrend för TEQ för PCDD eller PCDF I serum bland 26 medelålders svenska män, trots en längre uppföljningsperiod (1987 till 2002). För enskilda PCDD/F kongeners noterades såväl minskningar som ökningar över tiden. Resultaten ger vid handen att dioxinbelastningen varit oförändrad under den senaste 15 års perioden.
10.	Halvorsen, Peter, et al. (författare) Health-related quality of life after surviving intensive care for COVID-19 : a prospective multicenter cohort study 2023 Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1 Tidskriftsartikel (refereegranskat)abstract In survivors of severe coronavirus disease 2019 (COVID-19) incomplete mental and physical recovery may considerably impact daily activities and health-related quality of life (HRQoL). HRQoL can be evaluated with the RAND-36 questionnaire, a multidimensional instrument that assesses physical and mental aspects of health in eight dimensions. The objective was to investigate HRQoL in intensive care patients previously treated for COVID-19 at three Nordic university hospitals, in a prospective multi-center cohort study. HRQoL was measured using RAND-36, 3-9 months after discharge from intensive care units (ICU). One hospital performed a second follow-up 12 months after discharge. A score under the lower limit of the 95% confidence interval in the reference cohorts was considered as significantly reduced HRQoL. We screened 542 and included 252 patients. There was more than twice as many male (174) as female (78) patients and the median age was 61 (interquartile range, IQR 52-69) years. Hypertension was the most common comorbidity observed in 132 (52%) patients and 121 (48%) patients were mechanically ventilated for a median of 8 (IQR 4-14) days. In RAND-36 physical functioning, physical role functioning, general health (p < 0.001 for all) and social functioning (p < 0.05) were below reference, whereas bodily pain, emotional role functioning and mental health were not. In a time-to-event analysis female sex was associated with a decreased chance of reaching the reference HRQoL in the physical function, bodily pain and mental health dimensions. Higher body mass index was found in the physical functioning dimension and hypertension in the physical functioning, vitality and social functioning dimensions. Similar results were seen for diabetes mellitus in general health, vitality and mental health dimensions, as well as pulmonary illness in the physical role functioning dimension and psychiatric diagnosis in the social functioning dimension. Mechanical ventilation was associated with a decreased likelihood of achieving reference HRQoL in the bodily pain and physical functioning dimensions. Patients treated in an ICU because of COVID-19 had lower HRQoL 3-9 months after ICU discharge than 95% of the general population. Physical dimensions were more severely affected than mental dimensions. Female sex and several comorbidities were associated with a slower rate of recovery.
11.	Hamnerius, Nils, et al. (författare) Fast and Standardized Skin Grafting of Leg Wounds With a New Technique : Report of 2 Cases and Review of Previous Methods 2016 Ingår i: Eplasty: Open Access Journal of Plastic and Reconstructive Surgery. - 1937-5719. ; 16 Forskningsöversikt (refereegranskat)abstract BACKGROUND: Chronic leg ulcers remain a challenge to the treating physician. Such wounds often need skin grafts to heal. This necessitates a readily available, fast, simple, and standardized procedure for grafting.OBJECTIVES: The aim of this work was to test a novel method developed for outpatient transplant procedures.METHODS: The procedure employs a handheld disposable dermatome and a roller mincer that cut the skin into standardized micrografts that can be spread out onto a suitable graft bed. Wounds were followed until healed and photographed.RESULTS: The device was successfully used to treat and close a traumatic lower limb wound and a persistent chronic venous leg ulcer. The donor site itself healed by secondary intent with minimal cosmetic impairment.CONCLUSION: The method was successfully used to graft 2 lower extremity wounds.
12.	Hultström, Michael, 1978-, et al. (författare) Dehydration is associated with production of organic osmolytes and predicts physical long-term symptoms after COVID-19 : a multicenter cohort study 2022 Ingår i: Critical Care. - : Springer Nature. - 1364-8535 .- 1466-609X. ; 26 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: We have previously shown that iatrogenic dehydration is associated with a shift to organic osmolyte production in the general ICU population. The aim of the present investigation was to determine the validity of the physiological response to dehydration known as aestivation and its relevance for long-term disease outcome in COVID-19.METHODS: The study includes 374 COVID-19 patients from the Pronmed cohort admitted to the ICU at Uppsala University Hospital. Dehydration data was available for 165 of these patients and used for the primary analysis. Validation was performed in Biobanque Québécoise de la COVID-19 (BQC19) using 1052 patients with dehydration data. Dehydration was assessed through estimated osmolality (eOSM = 2Na + 2 K + glucose + urea), and correlated to important endpoints including death, invasive mechanical ventilation, acute kidney injury, and long COVID-19 symptom score grouped by physical or mental.RESULTS: Increasing eOSM was correlated with increasing role of organic osmolytes for eOSM, while the proportion of sodium and potassium of eOSM were inversely correlated to eOSM. Acute outcomes were associated with pronounced dehydration, and physical long-COVID was more strongly associated with dehydration than mental long-COVID after adjustment for age, sex, and disease severity. Metabolomic analysis showed enrichment of amino acids among metabolites that showed an aestivating pattern.CONCLUSIONS: Dehydration during acute COVID-19 infection causes an aestivation response that is associated with protein degradation and physical long-COVID.TRIAL REGISTRATION: The study was registered à priori (clinicaltrials.gov: NCT04316884 registered on 2020-03-13 and NCT04474249 registered on 2020-06-29).
13.	Hultström, Michael, 1978-, et al. (författare) Severe acute kidney injury associated with progression of chronic kidney disease after critical COVID-19 2021 Ingår i: Critical Care. - : BioMed Central (BMC). - 1364-8535 .- 1466-609X. ; 25:1 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
14.	Israelsson, Johan, et al. (författare) Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender 2017 Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 114, s. 27-33 Tidskriftsartikel (refereegranskat)abstract AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p<0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p<0.001) and symptoms of depression (p<0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.
15.	Israelsson, Johan, et al. (författare) Neurologic outcome, health-related quality of life, anxiety and symptoms of depression among in-hospital cardiac arrest survivors 2015 Ingår i: Resuscitation. - : Elsevier. - 0300-9572 .- 1873-1570. ; 96:Supplement 1 Konferensbidrag (refereegranskat)
16.	Lagedal, Rickard, et al. (författare) Design of DISCO—Direct or Subacute Coronary Angiography in Out-of-Hospital Cardiac Arrest study 2018 Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 197, s. 53-61 Tidskriftsartikel (refereegranskat)abstract Background Acute coronary syndrome is a common cause of out-of-hospital cardiac arrest (OHCA). In patients with OHCA presenting with ST elevation, immediate coronary angiography and potential percutaneous coronary intervention (PCI) after return of spontaneous circulation are recommended. However, the evidence for this invasive strategy in patients without ST elevation is limited. Observational studies have shown a culprit coronary artery occlusion in about 30% of these patients, indicating the electrocardiogram's (ECG's) limited sensitivity. The aim of this study is to determine whether immediate coronary angiography and subsequent PCI will provide outcome benefits in OHCA patients without ST elevation. Methods/design We describe the design of the DIrect or Subacute Coronary angiography in Out-of-hospital cardiac arrest study (DISCO)—a pragmatic national, multicenter, randomized, clinical study. OHCA patients presenting with no ST elevation on their first recorded ECG will be randomized to a strategy of immediate coronary angiography or to standard of care with admission to intensive care and angiography after 3 days at the earliest unless the patient shows signs of acute ischemia or hemodynamic instability. Primary end point is 30-day survival. An estimated 1,006 patients give 80% power (α =.05) to detect a 20% improved 30-day survival rate from 45% to 54%. Secondary outcomes include good neurologic recovery at 30 days and 6 months, and cognitive function and cardiac function at 6 months. Conclusion This randomized clinical study will evaluate the effect of immediate coronary angiography after OHCA on 30-day survival in patients without ST elevation on their first recorded ECG.
17.	Larsson, Ing-Marie, et al. (författare) Cold saline infusion and ice packs alone are effective in inducing and maintaining therapeutic hypothermia after cardiac arrest 2010 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 81:1, s. 15-19 Tidskriftsartikel (refereegranskat)abstract AIM OF THE STUDY: Hypothermia treatment with cold intravenous infusion and ice packs after cardiac arrest has been described and used in clinical practice. We hypothesised that with this method a target temperature of 32-34 degrees C could be achieved and maintained during treatment and that rewarming could be controlled. MATERIALS AND METHODS: Thirty-eight patients treated with hypothermia after cardiac arrest were included in this prospective observational study. The patients were cooled with 4 degrees C intravenous saline infusion combined with ice packs applied in the groins, axillae, and along the neck. Hypothermia treatment was maintained for 26h after cardiac arrest. It was estimated that passive rewarming would occur over a period of 8h. Body temperature was monitored continuously and recorded every 15min up to 44h after cardiac arrest. RESULTS: All patients reached the target temperature interval of 32-34 degrees C within 279+/-185min from cardiac arrest and 216+/-177min from induction of cooling. In nine patients the temperature dropped to below 32 degrees C during a period of 15min up to 2.5h, with the lowest (nadir) temperature of 31.3 degrees C in one of the patients. The target temperature was maintained by periodically applying ice packs on the patients. Passive rewarming started 26h after cardiac arrest and continued for 8+/-3h. Rebound hyperthermia (>38 degrees C) occurred in eight patients 44h after cardiac arrest. CONCLUSIONS: Intravenous cold saline infusion combined with ice packs is effective in inducing and maintaining therapeutic hypothermia, with good temperature control even during rewarming.
18.	Larsson, Ing-Marie, et al. (författare) Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment 2014 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:2, s. 215-220 Tidskriftsartikel (refereegranskat)abstract Aim of the study:To investigate whether there were any changes in and correlations between anxiety, depression and health-related quality of life (HRQoL) over time, between hospital discharge and one and six months after cardiac arrest (CA), in patients treated with therapeutic hypothermia (TH). Method: During a 4-year period at three hospitals in Sweden, 26 patients were prospectively included after CA treated with TH. All patients completed the questionnaires Hospital Anxiety and Depression Scale (HADS), Euroqol (EQ5D), Euroqol visual analogue scale (EQ-VAS) and Short Form 12 (SF12) at three occasions, at hospital discharge, and at one and 6 months after CA. Result: There was improvement over time in HRQoL, the EQ5D index (p = 0.002) and the SF12 physical component score (PCS) (p = 0.005). Changes over time in anxiety and depression were not found. Seventy-three percent of patients had an EQ-VAS score below 70 (scale 0–100) on overall health status at discharge from hospital; at 6 months the corresponding figure was 41%. Physical problems were the most com-mon complaint affecting HRQoL. A correlation was found between depression and HRQoL, and this was strongest at six months (rs = −0.44 to −0.71, p ≤ 0.001). Conclusion: HRQoL improves over the first 6 months after a CA. Patients reported lower levels of HRQoL on the physical as compared to mental component. The results indicate that the less anxiety and depression patients perceive, the better HRQoL they have and that time can be an important factor in recovery after CA.
19.	Larsson, Ing-Marie, 1963-, et al. (författare) Healthcare workers' structured daily reflection on patient safety, workload and work environment in intensive care. A descriptive retrospective study 2022 Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 68 Tidskriftsartikel (refereegranskat)abstract Objectives: To describe the results of use of structured daily reflection assessments among healthcare workers at an intensive care unit over the course of one year. Methods: In this descriptive retrospective study, data were analysed both quantitatively and qualitatively. The data encompassed 1095 work shifts, evaluated by healthcare workers at an intensive care unit using a structured daily reflection instrument. The areas evaluated were patient safety, workload and work environment, and free-text comments were possible.Findings: The results showed that 36% (n = 395) of work shifts, most of them daytime shifts (44%; n = 161), were affected. Workload was the area that affected most work shifts (29%; n = 309). Missed nursing care, complex care and inaccurate communication impacted patient safety, while patient care, multitasking and working conditions affected workload. Work environment was impacted by organisational factors, environment, lack of control and moral stress.Conclusion: Using daily reflection among healthcare workers in the intensive care unit illuminated areas that affect patient safety, workload, and work environment. The importance of communication and collaboration and how they can impact patient safety, workload, and the work environment were highlighted by the team.
20.	Larsson, Ing-Marie, 1963-, et al. (författare) Poor long-term recovery after critical COVID-19 during 12 months longitudinal follow-up 2023 Ingår i: Intensive & Critical Care Nursing. - : Elsevier. - 0964-3397 .- 1532-4036. ; 74 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: This study aimed to describe the burden of illness and impact on health and working situation among former intensive care patients treated for COVID-19.METHODS: A prospective cohort study was performed at one intensive care unit of a university hospital in Sweden during the first wave of COVID-19 in spring 2020. The burden of illness in health status, cognitive, physical, and psychological outcomes, and working situation were assessed at four and 12 months after discharge from intensive care, using nine validated instruments.RESULTS: Forty-six participants treated for COVID-19 participated in both follow-ups and were included in this study. General fatigue was reported by 37 of 46 participants (82%) at both follow-ups (p = 1.000). For overall health status 28 (61%) participants at the first follow-up and 26 (57%) (p = 0.414) at the second reported lower values than the general population. Cognitive impairment was seen in 22 (52%) participants at four months and in 13 (31%) at 12 months (p = 0.029). The proportion of participants on sick-leave decreased between the first and second follow-up (24% vs 13%, p = 0.025), but the proportion of participants working full-time was almost the same at both follow-ups (35% vs 37%, p = 0.317).CONCLUSIONS: The burden of illness of patients treated in intensive care due to COVID-19 included cognitive, physical, and psychological impacts. Cognitive functions were improved after 12 months, but no clear improvements could be distinguished in the physical or psychological outcome. Higher burden of illness was associated with inability to return to work.
21.	Larsson, Ing-Marie, et al. (författare) Post-cardiac arrest serum levels of glial fibrillary acidic protein for predicting neurological outcome 2014 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:12, s. 1654-1661 Tidskriftsartikel (refereegranskat)abstract Aim of the study: To investigate serum levels of glial fibrillary acidic protein (GFAP) for evaluation of neurological outcome in cardiac arrest (CA) patients and compare GFAP sensitivity and specificity to that of more studied biomarkers neuron-specific enolas (NSE) and S100B. Method: A prospective observational study was performed in three hospitals in Sweden during 2008-2012. The participants were 125 CA patients treated with therapeutic hypothermia (TH) to 32-34. °C for 24. hours. Samples were collected from peripheral blood (n. =. 125) and the jugular bulb (n. =. 47) up to 108. hours post-CA. GFAP serum levels were quantified using a novel, fully automated immunochemical method. Other biomarkers investigated were NSE and S100B. Neurological outcome was assessed using the Cerebral Performance Categories scale (CPC) and dichotomized into good and poor outcome. Results: GFAP predicted poor neurological outcome with 100% specificity and 14-23% sensitivity at 24, 48 and 72. hours post-CA. The corresponding values for NSE were 27-50% sensitivity and for S100B 21-30% sensitivity when specificity was set to 100%. A logistic regression with stepwise combination of the investigated biomarkers, GFAP, did not increase the ability to predict neurological outcome. No differences were found in GFAP, NSE and S100B levels when peripheral and jugular bulb blood samples were compared. Conclusion: Serum GFAP increase in patients with poor outcome but did not show sufficient sensitivity to predict neurological outcome after CA. Both NSE and S100B were shown to be better predictors. The ability to predict neurological outcome did not increased when combining the three biomarkers.
22.	Larsson, Ing-Marie, et al. (författare) Relatives' experiences during the next of kin's hospital stay after surviving cardiac arrest and therapeutic hypothermia 2013 Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 12:4, s. 353-359 Tidskriftsartikel (refereegranskat)abstract Aim: To describe relatives’ experiences during the next of kin’s hospital stay after surviving a cardiac arrest (CA) treated with hypothermia at an intensive care unit (ICU).Methods: Twenty relatives were interviewed when the person having suffered the CA was discharged from hospital, 1.5 to 6 weeks post-CA. Data were analysed using qualitative content analysis.Results: Three themes are described: The first period of chaos, Feeling secure in a difficult situation, and Living in a changed existence. Relatives found it difficult to assimilate the medical information and wanted it in written form. They wanted honest and clear information about their next of kin’s condition and prognosis. They lacked rehabilitation plans after discharge from the medical ward. Relatives felt a need to maintain telephone contact with family members and friends, which was time-consuming. They felt guilty and had a conscience about these feelings. Relatives felt uncertain about the future, but still hopeful.Conclusion: Relatives asked for more information and individual rehabilitation plans. Booklets describing CA, the ICU stay and continuing care and rehabilitation directed at both the patients and their relatives are needed. Follow-up visits to the ICU staff, for both patients and relatives, need to be arranged. Hospitals should consider having a rehabilitation plan for this group of patients, which is presented by a team of healthcare professionals and that focuses on the individual’s situation, including the consequences of their heart disease and brain damage.
23.	Lena, Stefenson (creator_code:cre_t, regissör) Transit 2019 Konstnärligt arbete (film/video) (refereegranskat)abstract Transit är en kort akt om människor på en flygplats. Den är kollektivt framarbetad av förstaårsstudenterna vid mimskådespelarprogrammet på SKH under deras lektioner i rörelseskapande/koreografi hösten 2019. Guide och regissör var lektor Lena Stefenson varit. Transit framfördes på Stora teatern i Göteborg i november 2019 för GBG Mime Fest.
24.	Lilja, Gisela, et al. (författare) Uppföljning av patient och närstående efter hjärtstopp varierar stort 2015 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 112 Tidskriftsartikel (refereegranskat)abstract The return to a good life after successfully resuscitated cardiac arrest may be hindered by cardiovascular morbidity, psychological distress and the consequences of anoxic brain injury. To support the return to everyday life, patients and their relatives are in need of health care follow-up with multiple focuses. Usually, this follow-up consists of at least one of three parallel tracks; cardiology for interventions and secondary prevention, post intensive care follow-up to capture and prevent consequences of the traumatic event and the ICU stay, or neurological follow-up for patients with neurological sequels. None of these tracks include all patients. In addition, survivors are usually included and followed with patient related outcome measures (PROM) through the multiple Swedish national quality registers. The different clinical follow-up systems and the registers are not coordinated and assessments and questions may be repeated multiple times. A more integrated follow-up model has the potential to benefit the patient and their relatives and to reduce costs.
25.	Milton, Anna, et al. (författare) Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study 2022 Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 66:1, s. 94-102 Tidskriftsartikel (refereegranskat)abstract Background: Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes.Methods: A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL.Results: Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (+/- standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (r(s) -0.74, p < 0.001).Conclusion: Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.
26.	Milton, Anna, et al. (författare) ICU discharge screening for prediction of new-onset physical disability - a multinational cohort study 2020 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley-Blackwell Publishing Inc.. - 0001-5172 .- 1399-6576. ; 64:6, s. 789-797 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge.METHODS: Multinational prospective cohort study in ten general ICUs in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability three months post-ICU, defined as a ≥10 score reduction in the Barthel Index compared to baseline.RESULTS: Of 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea Critical Care Physical Assessment Tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81 to 0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61 to 0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, positive predictive value for a high-risk group (CPAx score ≤18) was 0.32.CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.
27.	Olsson, Viktoria, et al. (författare) Sensory acceptance of a diet designed to counteract obesity, diabetes and periodontaldisease 2017 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract A modified Nordic diet, developed by Igelösa Life Science AB, was tested in a clinical pilot study including ten individuals with type 2 diabetes during two weeks. The diet was based on locally produced, traditional ingredients such as intact grains, vegetables, legumes, root vegetables, fish, poultry, fruit and nuts. The intake of sugar, red meat and dairy products was restricted. One of the aims of the study was to study the sensory acceptance of the diet.The study was designed as a case-series. The diet was provided, ready-made and free of charge, to both the experimental subjects (N=10) and their partners (N=5). Two subjects were excluded due to heath implications, not related to the diet. The sensory acceptance was measured through questionnaire data and two focus groups (before and after the 2-week test period, 20 minutes each). Partners were invited to participate in the focus group interviews.Data from the questionnaire showed a high degree of liking for most meals. The result of the focus groups indicated the importance of the every-day meal as a social activity. They further expressed satisfaction with sensory properties and the perceived health benefits of the Igelösa diet but also some frustration regarding small portions, too little salt and somewhat unfamiliar ingredients.Sensory acceptance for diets nutritionally designed for weight reduction and/or maintenance is a key factor. Despite the low number of participants, the pilot study indicate that the Igelösa diet is well accepted. An innovation of the study was that both the experimental subjects and their partners received the diet. The participants stated that this was supportive, facilitating adherence and promoting long-term impact on health. Habits, such as poor diet, can only be defeated by a concerted team effort and our work provide a glimpse of the potential benefits of this shared approach.
28.	Olsson, Viktoria, et al. (författare) Sensory acceptance of a diet designed to counteract obesity, diabetes and periodontaldisease 2017 Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract A modified Nordic diet, developed by Igelösa Life Science AB, was tested in a clinical pilot study including ten individuals with type 2 diabetes during two weeks. The diet was based on locally produced, traditional ingredients such as intact grains, vegetables, legumes, root vegetables, fish, poultry, fruit and nuts. The intake of sugar, red meat and dairy products was restricted. One of the aims of the study was to study the sensory acceptance of the diet. The study was designed as a case-series. The diet was provided, ready-made and free of charge, to both the experimental subjects (N=10) and their partners (N=5). Two subjects were excluded due to heath implications, not related to the diet. The sensory acceptance was measured through questionnaire data and two focus groups (before and after the 2-week test period, 20 minutes each). Partners were invited to participate in the focus group interviews. Data from the questionnaire showed a high degree of liking for most meals. The result of the focus groups indicated the importance of the every-day meal as a social activity. They further expressed satisfaction with sensory properties and the perceived health benefits of the Igelösa diet but also some frustration regarding small portions, too little salt and somewhat unfamiliar ingredients. Sensory acceptance for diets nutritionally designed for weight reduction and/or maintenance is a key factor. Despite the low number of participants, the pilot study indicate that the Igelösa diet is well accepted. An innovation of the study was that both the experimental subjects and their partners received the diet. The participants stated that this was supportive, facilitating adherence and promoting long-term impact on health. Habits, such as poor diet, can only be defeated by a concerted team effort and our work provide a glimpse of the potential benefits of this shared approach.
29.	Rylander, Lars, et al. (författare) Associations between CB-153 and p,p'-DDE and hormone levels in serum in middle-aged and elderly men. 2006 Ingår i: Chemosphere. - : Elsevier BV. - 1879-1298 .- 0045-6535. ; 65:3, s. 375-381 Tidskriftsartikel (refereegranskat)abstract Background: Animal and epidemiologic data indicate that exposure to persistent organochlorine pollutants (POPs) may disrupt the hypothalamus-pituitary-thyroid (HPT) and the hypothalamus-pituitary-gonadal (HPG) axes. We have assessed whether the POP-biomarkers 2,2'4,4',5,5'-hexachlorobiphenyl (CB-153) and 1,1-dichloro-2,2-bis(4-chlorophenyl)-ethene (p,p'-DDE) affect thyrotropin (TSH), thyroid hormones, gonadotropins or sex hormone concentrations in men. Methods: Lipid adjusted serum concentrations of CB-153, and p,p'-DDE, were determined in 196 men (median age 59 years, range 48-82). Hormone analyses in serum were performed with immunoassays. The effect of CB-153 and p,p'-DDE (as continuous or categorized variables) were evaluated by linear regression models, adjusting for potential confounders. Results: There was a significant positive association between p,p'-DDE and TSH. An increase of 100 ng/g lipid of p,p'-DDE corresponded to an increase of 0.03 mU/l (95% Confidence Interval (CI) 0.01, 0.05) in TSH level. The explanatory value (R 2) of the multi-variate model was only 7%. Moreover, there was a significant negative association between p,p'-DDE and estradiol. An increase of 100 ng/g lipid of p,p'-DDE corresponded to a decrease of 0.57 pmol/l (95% CI -1.0, -0.12) in estradiol level. The R-2-value was only 4%. No associations were observed between any of the POP biomarkers and the other hormones. Conclusions: The positive association between p,p'-DDE and TSH and the negative association between p,p'-DDE and estradiol, among middle-aged and elderly men, were not accompanied by associations between the POP-markers and thyroxin, testosterone, and gonadotropins, respectively. The results gives some additional support for that POP exposure may affect HPT- and HPG-axes also in humans, but the overall epidemiological data are still not coherent enough to allow any firm conclusions. (c) 2006 Elsevier Ltd. All rights reserved.
30.	Rylander, Lars, et al. (författare) Intra-individual variations and temporal trends in dioxin levels in human blood 1987-2002 2009 Ingår i: Chemosphere. - Oxford : Pergamon Press. - 0045-6535 .- 1879-1298. ; 76:11, s. 1557-1562 Tidskriftsartikel (refereegranskat)abstract Objectives: In Sweden, an important source for exposure to persistent organochlorine pollutants, such as PCDD and PCDF, is through intake of fatty fish from the Baltic Sea off the Eastern coast of Sweden. The present study assesses temporal trends for human levels of PCDD/F between 1987 and 2002 among 26 men from Sweden. In addition, we investigate the impact of potential determinants (age, relative change in BMI and fish consumption) on the relatively change in individual PCDD/F congener levels between 1987 and 2002. Methods: In 1987, nine of the men did not eat fatty fish from the Baltic Sea, eight had a moderate intake, and nine were high consumers. For the same individuals,blood samples were collected in 1987 as well as in 2002, and the concentrations of seven PCDD and 10 PCDF congeners were analyzed at the same laboratory. Results: The WHO-TEQ levels for PCDD/F did not significantly change over the 15-year period. There were, however, some specific congeners that significantly had changed over time. None of the investigated determinants were associated with the change over time for the specific PCDD/F congeners. Conclusion: The present study may be of importance for risk assessment and setting standards for food contamination with PCDD/F, especially regarding intake of fatty fish from the Baltic Sea.
31.	Rylander, Lars, et al. (författare) Intra-Individual Variations and Temporal Trends in Dioxin Levels in Human Blood 1987 to 2002 2008 Ingår i: Organohalogen Compounds. ; 70, s. 001240-2 Tidskriftsartikel (refereegranskat)abstract In Sweden, an important source for exposure to persistent organohalogen pollutants (POP), such as PCDD and PCDF, is through intake of fatty fish from the Baltic Sea, off the Eastern coast of Sweden.1-3 The present study aimed to assess temporal trends for human levels of PCDD/F between 1987 and 2002 among 26 men from Sweden whom in 1987 had various intakes of fish from the Baltic Sea. In addition, we investigated the impact ofpotential determinants on the relatively change in individual PCDD/F congener levels between 1987 and 2002.
32.	Saarijärvi, Markus, et al. (författare) Factors affecting adolescents' participation in randomized controlled trials evaluating the effectiveness of healthcare interventions : the case of the STEPSTONES project 2020 Ingår i: BMC Medical Research Methodology. - : Springer Science and Business Media LLC. - 1471-2288. ; 20:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Recruitment of adolescents to intervention studies is a known challenge. For randomized controlled trials (RCT) to be generalizable, reach must be assessed, which means ascertaining how many of the intended population actually participated in the trial. The aim of this study was to evaluate the reach and representativeness of an RCT evaluating the effectiveness of a complex intervention for adolescents with chronic conditions.METHODS: A mixed methods sequential explanatory design was employed. Firstly, quantitative cross-sectional data from the RCT, patient registries and medical records were collected and analysed regarding baseline differences between participants and non-participants in the trial. Secondly, qualitative data on their reasons for participating or not were collected and analysed with content analysis to explain the quantitative findings.RESULTS: Participants showed larger differences in effect sizes and a significantly more complex chronic condition than non-participants. No other statistically significant differences were reported, and effect sizes were negligible. Reasons for declining or accepting participation were categorized into three main categories: altruistic reasons, personal reasons and external reasons and factors.CONCLUSIONS: Integration of quantitative and qualitative findings showed that participation in the RCT was affected by disease complexity, the perceived need to give back to healthcare and research and the adolescents' willingness to engage in their illness. To empower adolescents with chronic conditions and motivate them to participate in research, future intervention studies should consider developing tailored recruitment strategies and communications with sub-groups that are harder to reach.
33.	Saarijärvi, Markus, 1988, et al. (författare) Implementation fidelity of a transition program for adolescents with congenital heart disease: the STEPSTONES project 2022 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22 Tidskriftsartikel (refereegranskat)abstract Background: Although transition programs have been evaluated for adolescents with chronic conditions, these have rarely involved process evaluations. Indeed, outcomes of complex interventions are dependent on how the intervention is implemented in practice and evaluations of implementation process are therefore pivotal. The aim of this study was to evaluate the extent to which a transition program for adolescents with congenital heart disease was delivered as intended. Research questions were 1) to what level of fidelity was the program delivered? and 2) what potential moderating factors affected the delivery of the program and overall fidelity? Methods: A mixed methods design was used, where a process evaluation was embedded in the STEPSTONES randomized controlled trial in Sweden. The implementation fidelity framework by Carrol (2007) and Hasson (2010) was used to design, collect and analyze data. Quantitative data consisted of intervention records on adherence and were analyzed with descriptive statistics. Qualitative data on moderators affecting fidelity were collected through interviews, log-books and focus group interviews with healthcare professionals implementing the intervention and participatory observations of the implementation process. Data were analyzed with deductive content analysis. Triangulation was used to integrate quantitative and qualitative data within the fidelity framework. Results: Six out of eight components of the transition program were delivered to an extent that adhered to the program theory or achieved a high level of fidelity. However, components involving peer support had a low attendance by the participating sample (32.2%), and the joint transfer meeting was challenging to implement, despite achieving high adherence. Moderators affecting the implementation process were the adolescent’s and healthcare professional’s engagement in the intervention, contextual factors and a lack of standard operating procedures for all components in the program. Conclusion: Barriers and facilitators for a future implementation of transition programs have been illuminated in this study. The use of an implementation fidelity framework in the process evaluation proved successful in providing a comprehensive evaluation of factors affecting the implementation process. However, implementation fidelity must be considered in relation to adaptations to the local and personal prerequisites in order to create interventions that can achieve fit.
34.	Saarijärvi, Markus, et al. (författare) Mechanisms of impact and experiences of a person-centred transition programme for adolescents with CHD : the Stepstones project. 2021 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: During the past decade there has been some evaluation of transition programmes for adolescents with chronic conditions. However, this has rarely involved process evaluations focusing on mechanisms leading to outcomes, thus hampering implementation of these complex interventions. Our aim was to (I) describe adolescents' and parents' experiences of participating in a person-centred transition programme aiming to empower them in transition to adulthood and (II) explore the mechanisms of impact.METHODS: A qualitative process evaluation was performed, embedded in a randomized controlled trial evaluating the effectiveness of a transition programme for adolescents with congenital heart disease in Sweden. A purposive sample of 14 adolescents and 12 parents randomized to the intervention group were interviewed after participation in the programme. Data were analysed deductively and inductively in NVivo v12.RESULTS: Experiences of participation in the transition programme were generally positive. Meeting a transition coordinator trained in person-centred care and adolescent health and embarking on an educational process based on the adolescents' prerequisites in combination with peer support were considered key change mechanisms. However, support to parents were not sufficient for some participants, resulting in ambivalence about changing roles and the unmet needs of parents who required additional support.CONCLUSIONS: Participants experienced increased empowerment in several dimensions of this construct, thus demonstrating that the transition programme was largely implemented as intended and the evidence-based behaviour-change techniques used proved effective in reaching the outcome. These findings can inform future implementation of transition programmes and illuminate challenges associated with delivering a complex intervention for adolescents with chronic conditions.
35.	Saarijärvi, Markus, 1988, et al. (författare) Participants and non-participants – factors affecting representativeness and reach in randomized controlled trials evaluating the effectiveness of complex interventions 2021 Ingår i: Nordic Conference in Nursing Research, Copenhagen 4-6th October 2021. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
36.	Saarijärvi, Markus, et al. (författare) Process evaluation of complex cardiovascular interventions : How to interpret the results of my trial? 2020 Ingår i: European Journal of Cardiovascular Nursing. - : SAGE PUBLICATIONS LTD. - 1474-5151 .- 1873-1953. ; 19:3 Tidskriftsartikel (refereegranskat)abstract Complex interventions of varying degrees of complexity are commonly used and evaluated in cardiovascular nursing and allied professions. Such interventions are increasingly tested using randomized trial designs. However, process evaluations are seldom used to better understand the results of these trials. Process evaluation aims to understand how complex interventions create change by evaluating implementation, mechanisms of impact, and the surrounding context when delivering an intervention. As such, this method can illuminate important mechanisms and clarify variation in results. In this article, process evaluation is described according to the Medical Research Council guidance and its use exemplified through a randomized controlled trial evaluating the effectiveness of a transition program for adolescents with chronic conditions.
37.	Saarijärvi, Markus, 1988, et al. (författare) Processutvärdering av ett personcentrerat övergångsprogram för ungdomar med medfödda hjärtfel i övergång till vuxenlivet – STEPSTONES-projektet 2020 Ingår i: Centrum för personcentrerad vård (GPCC) 10-årsjubileumskonferens 6-7 feb 2020, Konferenscentrum Wallenberg vid Sahlgrenska akademin i Göteborg. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
38.	Saarijärvi, Markus, et al. (författare) Transition program for adolescents with congenital heart disease in transition to adulthood : protocol for a mixed-method process evaluation study (the STEPSTONES project) 2019 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:8 Tidskriftsartikel (refereegranskat)abstract INTRODUCTION: Today, the majority of young persons living with chronic conditions in high-income countries survive into adulthood and will need life-long medical follow-up. Therefore, transition programmes have been developed to facilitate transfer to adult care, and to support self-management and independence during adulthood. The Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS (STEPSTONES) project aims to evaluate the effectiveness of a person-centred transition programme for empowering adolescents with congenital heart disease in transition to adulthood. To understand how the transition programme causes change and how outcomes are created, process evaluation is imperative to assess implementation, context and mechanisms of impact. This protocol aims to describe the process evaluation of the STEPSTONES transition programme.METHODS AND DESIGN: Medical Research Council guidance for process evaluation of complex interventions will be the guiding framework for this mixed-method study. The combination of qualitative and quantitative data will capture different aspects of programme delivery. The sample will consist of participants in the STEPSTONES randomised controlled trial (RCT), persons implementing the programme and healthcare professionals. Quantitative data will consist of protocols and routine monitoring documents from the RCT, data collected from patient registries and sociodemographic data to assess the implementation of the intervention. This data will be analysed with quantitative content analysis, along with descriptive and inferential statistics. Qualitative data will consist of participatory observations, logbooks and interviews with persons implementing the programme, participants and healthcare professionals. Analyses will be performed using qualitative content analysis to investigate mechanism of impact, context and delivery. Quantitative and qualitative data will be integrated in the final stage by using a triangulation protocol according to mixed-method guidelines.ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board in Gothenburg, Sweden. Results will be presented in open access, peer-reviewed journals and at international scientific conferences.
39.	Saarijärvi, Markus, 1988, et al. (författare) Transition program for adolescents with congenital heart disease in transition to adulthood: protocol and rationale for a mixed-methods process evaluation study (the STEPSTONES project) 2019 Ingår i: Knowledge Utilization (KU) Colloquium 2019, 25-28 juni, Montebello, Quebec, Canada. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
40.	Saarijärvi, Markus, 1988, et al. (författare) Transition program to empower adolescents with chronic conditions in their transition to adulthood: methods and rationale for the STEPSTONES project 2019 Ingår i: Forte Talks, 26-27 mars 2019, Stockholm. Konferensbidrag (övrigt vetenskapligt/konstnärligt)
41.	Tabar, Laszlo, et al. (författare) Early detection of breast cancer rectifies inequality of breast cancer outcomes 2021 Ingår i: Journal of Medical Screening. - : Sage Publications. - 0969-1413 .- 1475-5793. ; 28:1, s. 34-38 Tidskriftsartikel (refereegranskat)abstract Objectives: To explain apparent differences among mammography screening services in Sweden using individual data on participation in screening and with breast cancer-specific survival as an outcome.Methods: We analysed breast cancer survival data from the Swedish Cancer Register on breast cancer cases from nine Swedish counties diagnosed in women eligible for screening. Data were available on 38,278 breast cancers diagnosed and 4312 breast cancer deaths. Survival to death from breast cancer was estimated using the Kaplan-Meier estimate, for all cases in each county, and separately for cases of women participating and not participating in their last invitation to screening. Formal statistical comparisons of survival were made using proportional hazards regression.Results: All counties showed a reduction in the hazard of breast cancer death with participation in screening, but the reductions for individual counties varied substantially, ranging from 51% (95% confidence interval 46-55%) to 81% (95% confidence interval 74-85%). Survival rates in nonparticipating women ranged from 53% (95% confidence interval 40-65%) to 74% (95% confidence interval 72-77%), while the corresponding survival in women participating in screening varied from 80% (95% confidence interval 77-84%) to 86% (95% confidence interval 83-88%), a considerably narrower range.Conclusions: Differences among counties in the effect of screening on breast cancer outcomes were mainly due to variation in survival in women not participating in screening. Screening conferred similarly high survival rates in all counties. This indicates that the performance of screening services was similar across counties and that detection and treatment of breast cancer in early-stage reduces inequalities in breast cancer outcome.
42.	Wallin, Ewa, et al. (författare) Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest 2018 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 62:5, s. 625-647 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.METHODS:A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.RESULTS:Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.CONCLUSIONS:Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.
43.	Wallin, Ewa, et al. (författare) Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia. 2015 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 96:Suppl1, s. 147- Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.Results: MRI of the brain was obtained at a median of 4 days (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.
44.	Wallin, Ewa, et al. (författare) Cardiac arrest and hypothermia treatment : function and life satisfaction among survivors in the first 6 months 2014 Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:4, s. 538-543 Tidskriftsartikel (refereegranskat)abstract Aim of the study:To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors’ life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with "life as a whole" was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients’ functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients’ function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan.
45.	Wallin, Ewa, et al. (författare) Characteristics of jugular bulb oxygen saturation in patients after cardiac arrest: A prospective study 2018 Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 62:9, s. 1237-1245 Tidskriftsartikel (refereegranskat)abstract BACKGROUND:Using cerebral oxygen venous saturation post-cardiac arrest (CA) is limited because of a small sample size and prior to establishment of target temperature management (TTM). We aimed to describe variations in jugular bulb oxygen saturation during intensive care in relation to neurological outcome at 6 months post- CA in cases where TTM 33°C was applied.METHOD:Prospective observational study in patients over 18 years, comatose immediately after resuscitation from CA. Patients were treated with TTM 33°C M and received a jugular bulb catheter within the first 26 hours post-CA. Neurological outcome was assessed at 6 months using the Cerebral Performance Categories (CPC) and dichotomized into good (CPC 1-2) and poor outcome (CPC 3-5).RESULTS:Seventy-five patients were included and 37 (49%) patients survived with a good outcome at 6 months post-CA. No differences were found between patients with good outcome and poor outcome in jugular bulb oxygen saturation. Higher values were seen in differences in oxygen content between central venous oxygen saturation and jugular bulb oxygen saturation in patients with good outcome compared to patients with poor outcome at 6 hours (12 [8-21] vs 5 [-0.3 to 11]% P = .001) post-CA. Oxygen extraction fraction from the brain illustrated lower values in patients with poor outcome compared to patients with good outcome at 96 hours (14 [9-23] vs 31 [25-34]% P = .008).CONCLUSIONS:Oxygen delivery and extraction differed in patients with a good outcome compared to those with a poor outcome at single time points. Based on the present findings, the usefulness of jugular bulb oxygen saturation for prognostic purposes is uncertain in patients treated with TTM 33°C post-CA.
46.	Wallin, Ewa, et al. (författare) Exposure to CB-153 and p,p'-DDE and bone mineral density and bone metabolism markers in middle-aged and elderly men and women. 2005 Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 1433-2965 .- 0937-941X. ; 16:12, s. 2085-2094 Tidskriftsartikel (refereegranskat)
47.	Wallin, Ewa, et al. (författare) Exposure to persistent organochlorine compounds through fish consumption and the incidence of osteoporotic fractures. 2004 Ingår i: Scandinavian Journal of Work, Environment and Health. - 0355-3140. ; 30:1, s. 30-35 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: Animal studies have shown that persistent organochlorine compounds (POC) impair normal bone metabolism and result in increased bone fragility. These findings may have health implications for POC-exposed human populations. The aim of the present study was to assess the impact of POC-contaminated fish on the self-reported fracture incidence of Swedish fishermen and their wives. METHODS: A postal questionnaire was sent to 2096 fishermen and 1602 fishermen's wives from the Swedish east (exposed) coast and 4584 fishermen and 4217 fishermen's wives from the west (unexposed) coast. Self-reported fractures, together with specified current fish consumption and information about potential confounders, were registered. The response rates varied between 50% and 59%. The age distributions of the nonrespondents and respondents were almost identical. Hip, vertebral, and wrist fractures were classified as osteoporotic. The fracture incidence rates for specific skeletal locations were based on allocated fractures and person-years under risk from the age of 25 years until the time of fracture or the end of follow-up. RESULTS: No differences in fracture incidence were observed between the east and west-coast cohorts. East-coast wives with more than one meal of fatty fish from the Baltic Sea per month had, however, an increased fracture incidence as compared with that of the east-coast wives who ate, at most, one such meal per month (age-adjusted incidence rate ratio 1.68, 95% confidence interval 1.00-2.84). No such exposure-response association was found for the fishermen. CONCLUSIONS: The present study only minimally supports an association between POC exposure through contaminated fish and an increased risk of osteoporotic fractures.
48.	Wallin, Ewa, et al. (författare) Intensive care-treated COVID-19 patients' perception of their illness and remaining symptoms. 2022 Ingår i: Acta Anaesthesiologica Scandinavica. - : John Wiley & Sons. - 0001-5172 .- 1399-6576. ; 66:2, s. 240-247 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: The remaining symptoms in patients with coronavirus disease 2019 (COVID-19) treated in intensive care unit are limited described. Therefore, we assessed patient's perception of their COVID-19 disease, stay in intensive care, and remaining symptoms three to six months after intensive care.METHODS: Prospective cohort study was performed in one intensive care unit of a university hospital in Sweden during the first wave. A questionnaire with open-ended questions and closed-ended questions was used. Data were analyzed using qualitative and quantitative content analysis and descriptive statistics.RESULTS: Out of 123 patients treated for COVID-19, 64 answered the questionnaire 3-6 months after discharge from intensive care. Memories from illness and hospital stay revealed in three categories; awareness of the illness, losing anchor to reality and being cared for in a dynamic environment. Information was perceived as spare by 48% and they wanted the information to be more personal. The diary was perceived as personal and was received by 33% patients. The relationship with family was affected among 39% and 13% of the patients indicated that they had not resumed their daily life. A large amount, 84%, indicated that they had remaining symptoms from COVID-19. The dominated symptoms were impaired strength and energy both physically and mentally.CONCLUSION: Patients reported a variety of physical and mental symptoms, and revealed memories from the ICU, and specific awareness of other patients' health. It illustrates the need for screening patients for remaining symptoms after COVID-19 disease and ICU care and may affect resuming patients' daily life.
49.	Wallin, Ewa (författare) Post Cardiac Arrest Care : Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event 2015 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.
50.	Wallin, Ewa, et al. (författare) Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later 2016 Ingår i: Insights into Imaging 7:Suppl 1, 2016. - : Springer. Konferensbidrag (refereegranskat)abstract Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later,Purpose: To document the acute MRI findings in the brain of post-cardiac arrest (CA) patients treated with therapeutic hypothermia and their relationship to patient outcome after 6 months.Methods and Materials: MRI was performed prospectively 3-13 days (median 4) after CA in 56 patients regardless of the level of consciousness in three hospitals. The images were interpreted visually by two neuroradiologists. Apparent diffusion coefficient (ADC) was measured in predetermined areas in cerebral white matter, deep grey matter, cerebellar grey and white matter and the brainstem. Outcome was assessed using the Cerebral Performance Categories Scale (CPC ) and dichotomized into good and poor outcome.Results: Acute hypoxic lesions on diffusion-weighted MRI (DWI) were more common in patients with poor outcome (p=0.006) and affected mostly grey matter, deep or cortical, with or without involvement of underlying white matter. Pure white matter lesions were very few. Lesions in the occipital and temporal lobes, deep white matter and cerebellum were most associated with poor outcome. Reductions in the ADC, particularly in the occipital lobes, were more common in patients with poor outcome. None of the patients with an ADC below 604-678 x10-6 mm2/s (variation depending on the equipment and technique) in any region survived to 6 months.Conclusion: Extensive acute lesions in cortical regions and deep grey matter in visual analysis and regions with an ADC under the level 600-680 x10-6 mm2/s are associated with poor outcome. Lesions are fewer and mainly situated in the frontal and parietal lobes in patients with good outcome.

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