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| 2. |
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| 3. |
- Nilsson, Petra, 1980-, et al.
(author)
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How to make a workplace health promotion questionnaire process applicable, meaningful, and sustainable
- 2011
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In: Journal of Nursing Management. - : Wiley-Blackwell. - 0966-0429 .- 1365-2834. ; 19:7, s. 906-914
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Journal article (peer-reviewed)abstract
- Background In workplace health promotion, a questionnaire could be of great use. Unfortunately, fatigue regarding answering questionnaires has recently become greater than before. An action research approach could be a possible way of increasing employee participation.Aim This study reports an attempt to explore key aspects for participation in, and commitment to, a workplace health promotion questionnaire process.Method The study was conducted at two wards in a Swedish hospital. Data was collected during an action research process. Data were analysed with regard to a framework of questions.Findings The three key aspects for participation in, and commitment to, a workplace health promotion questionnaire process were: an applicable questionnaire, a meaningful questionnaire process and a continuous and sustainable questionnaire process. A structure is presented as practical advice to managers, describing how such a process could be established to be applicable, meaningful and sustainable.Conclusion This study has identified key aspects and prerequisites for questionnaire processes. The prerequisites – share decision-making, involve a core group and follow a structure – are discussed and proposed for managers and workgroups to consider in further workplace health promotion questionnaire processes.Implications for nursing management The key aspects and prerequisites presented could provide a stimulating standpoint or advice, useful for planning and accomplishing workplace questionnaire processes.
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| 4. |
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| 5. |
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| 6. |
- Allbrand, Marianne, 1958-, et al.
(author)
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Expression of genes involved in inflammation and growth : does sampling site in human full-term placenta matter?
- 2019
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In: Journal of Perinatal Medicine. - : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 47:5, s. 539-546
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Journal article (peer-reviewed)abstract
- Objective: To investigate the placental gene expression of substances in the inflammatory cascade and growth factors at nine different well-defined sampling sites in full-term placentas from 12 normal weight healthy non-smoking women with an uncomplicated singleton pregnancy.Methods: All placentas (six girls and six boys) were delivered vaginally. Quantitative real-time polymerase chain reaction was used to analyze toll receptor-2 and -4, interleukin-6 and -8, tumor necrosis factor-α, leptin, ghrelin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor (IR).Results: The leptin gene and the IR gene showed higher expression in lateral regions near the chorionic plate compared to central regions near the basal plate (P = 0.028 and P = 0.041, respectively).Conclusion: Our results suggest that the sampling site may influence the gene expression for leptin and IR in placental tissue obtained from full-term normal pregnancies. We speculate that this may be due to differences in placental structure and perfusion and may be important when future studies are designed.
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| 7. |
- Allbrand, Marianne, 1958-
(author)
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Gene expression of inflammatory markers and growth factors in placenta in relation to maternal obesity and foetal and postnatal growth
- 2020
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Doctoral thesis (other academic/artistic)abstract
- Maternal obesity is a growing health problem, that contributes to obstetrical complications in pregnancy, as well as neonatal morbidity and mortality. The placenta serves for gas and nutrient exchange between the mother and the foetus, and obesity may influence and modify placental growth and function. The aims of this thesis were to investigate associations between maternal obesity without associated morbidity and gene expression of inflammatory markers and growth factors in the placenta, as well as offspring birth weight and postnatal growth. Study I and III were designed as matched case-control studies including 32 obese women with an early pregnancy body mass index (BMI) ≥ 35.0 kg/m2, study II was an experimental study examining twelve placentas of normal weight women, and study IV was a cohort study including 109 obese women with a BMI ≥ 34.5 kg/m2. In studies I-IV analyses of gene expression were performed and in study III additionally cord blood concentrations were determined. No difference was found in the occurrence of placental gene expression of inflammatory markers or growth factors between obese and normal weight women, nor did the sampling site in placentas of normal weight women influence gene expression of these markers, except for leptin gene (LEP) and insulin receptor gene (INSR) expression. Ghrelin gene (GHRL) and LEP expression, as well as cord blood ghrelin and adiponectin levels, was not altered in maternal obesity, and a negatively U-shaped relationship between LEP expression and infant birth weight (BW) z-scores was observed in the placentas of obese women.In conclusion, no statistically significant difference in gene expressions of inflammatory markers and growth factors in the placenta between severely obese and normal weight women was found. These results are in contrast with earlier studies and could be due to the fact that we examined mainly healthy obese women. The correlations we found between gene expression of leptin in the placenta and the birth weight of the infants warrants further studies.
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| 8. |
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| 9. |
- Allbrand, Marianne, 1958-, et al.
(author)
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Gene expression of leptin, leptin receptor isoforms and inflammatory cytokines in placentas of obese women : Associations to birth weight and fetal sex
- 2022
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In: Placenta. - : Elsevier. - 0143-4004 .- 1532-3102. ; 117, s. 64-71
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Leptin signaling in placentas of obese women may influence fetal growth and may be dependent on fetal sex. The aim of this study was to investigate placental gene expression of leptin, its receptor and inflammatory cytokines in obese mothers in relation to offspring birth weight and sex.METHODS: In total, 109 placental tissue samples from severely obese women (body mass index in first trimester ≥35 kg/m2) giving birth vaginally at term to a healthy child were included. Quantitative real-time PCR was used for the analysis of leptin (LEP), its receptor LEPR with two splice variants, interleukin (IL)1B, chemokine (C-X-C motif) ligand 8 (CXCL8), tumour necrosis factor (TNF), IL6, IL10, hypoxia-inducible factor 1-alpha (HIF1A) and insulin receptor (INSR). The subjects were divided into three groups based on LEP expression percentiles (<25th percentile; 25-75th percentile and >75th percentile).RESULTS: A reverse U-shaped association between LEP expression and birth weight z-scores was found (R2 = 0.075, p = 0.005). Placental LEPRb expression was downregulated (p = 0.034) in those with highest LEP expression. Female infants had higher birth weight z-scores than males (0.58 (-1.49-2.88) vs 0.21 (-1.50-2.93), p = 0.020) and their placental LEPRb expression was upregulated (p = 0.047). The associations between expression of different genes differed by sex.DISCUSSION: A reverse U-shaped relationship between placental LEP expression and offspring birth weight z-scores was found together with sexual dimorphism in LEPRb expression indicating a complex regulation of fetal growth by placental leptin signaling in maternal obesity.
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| 10. |
- Allbrand, Marianne, 1958-, et al.
(author)
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Placental gene expression of inflammatory markers and growth factors : a case control study of obese and normal weight women
- 2015
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In: Journal of Perinatal Medicine. - : Walter de Gruyter. - 0300-5577 .- 1619-3997. ; 43:2, s. 159-164
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Journal article (peer-reviewed)abstract
- Objective: To survey the placental gene expression of inflammatory markers and growth factors in non-smoking obese women with an uncomplicated pregnancy without associated morbidity and delivery at term compared with normal weight women.Methods: Placental tissue samples from 32 obese women (body mass index, BMI >= 35.0 kg/m(2)) were compared with samples from 94 normal weight women (BMI 18.5-25.0 kg/m(2)) matched for age (+/- 1 year), gestational age (+/- 3 days), parity and mode of delivery. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to analyse toll receptor-2 and -4, interleukin-6 and -8, tumour necrosis factor-alpha, leptin, adiponectin, insulin-like growth factor-1 and -2, hepatocyte growth factor, hepatocyte growth factor receptor and insulin receptor.Results: There was no significant difference in gene expression in placental tissue samples from obese and normal weight women.Conclusion: We found no difference in the occurrence of inflammatory marker and growth factor mRNA levels in placental tissue samples from a large group of obese women without associated morbidity and with healthy infants compared to a closely matched control group of healthy normal weight women. Compared with the previous studies, this anomalous finding may be explained by the absence of associated morbidity in the obese women in our study.
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| 11. |
- Andersson, Gunnel, 1958-, et al.
(author)
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Perceptions of urinary incontinence among syrian Christian women living in Sweden
- 2009
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In: Journal of Transcultural Nursing. - : SAGE Publications. - 1043-6596 .- 1552-7832. ; 20:3, s. 296-303
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Journal article (peer-reviewed)abstract
- The purpose of this study was to describe the perception of urinary incontinence (UI) among Syrian women living in Sweden. DESIGN: A qualitative, descriptive design with focus group discussions (FGDs) was used and analyzed with content analysis. Fourteen Syrian women were interviewed in three FGDs. FINDINGS: Three categories emerged, "Thoughts on UI," "Managing UI," and "Communication With the Health Care System." Among the interviewees, UI was a common, and expected, problem, which could be managed. However, some expressed shame and embarrassment. Some talked about communication problems with health care. DISCUSSION: and Implications for Practice: The health care system should be adjusted to the women's needs, with awareness of the communication difficulties, which could result in misunderstanding and neglected treatments.
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| 12. |
- Andersson, Gunnel, 1958-, et al.
(author)
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Urinary incontinence prevalence, impact on daily living and desire for treatmentt : a population-based study
- 2004
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In: Scandinavian journal of urology and nephrology. - : Taylor & Francis. - 0036-5599 .- 1651-2065. ; 38:2, s. 125-130
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Journal article (peer-reviewed)abstract
- OBJECTIVE:To investigate the prevalence of urinary incontinence in a representative population in Sweden, and to assess to what extent the condition affects daily life and to what degree those afflicted desire treatment.MATERIAL AND METHODS:In a population-based study, a postal questionnaire comprising 12 questions on urinary incontinence was sent to a representative sample of 15 360 randomly selected residents (aged 18-79 years) of Orebro County, Sweden. This was a supplement to a comprehensive survey of public health and general living conditions.RESULTS:The response rate was 64.5%. The prevalence of urinary incontinence was 19% when defined as "any leakage" and 7% when defined as "at least once a week". Women were more afflicted than men, and the proportion of people with urinary incontinence increased markedly with increasing age. Most considered their problems to be minor, having little impact on daily life, which was reflected by the fact that only 18% of those with urinary incontinence desired treatment. About 17% of those with urinary incontinence reported severe problems that interfered with daily life. Of respondents with severe problems, 42% did not want treatment.CONCLUSION:According to this population-based study, urinary incontinence is not a major problem for most people in the community. Although a considerable proportion of the population report urinary incontinence, the majority experience minor problems and only 18% desire treatment. For a limited group of people, urinary incontinence is a severe problem. It is important that healthcare resources are optimized to identify and meet the needs of those who are most afflicted.
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| 13. |
- Baumgart, Juliane, 1978-, et al.
(author)
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Androgen levels during adjuvant endocrine therapy in postmenopausal breast cancer patients
- 2014
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In: Climacteric. - London, United Kingdom : Informa Healthcare. - 1369-7137 .- 1473-0804. ; 17:1, s. 48-54
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Journal article (peer-reviewed)abstract
- Objective: To investigate plasma steroid hormone levels in postmenopausal breast cancer patients with and without adjuvant endocrine therapy and in healthy postmenopausal women.Methods: Steroid hormone levels in postmenopausal breast cancer patients treated with aromatase inhibitors (n = 32) were compared with breast cancer patients treated with tamoxifen (n = 34), breast cancer patients without adjuvant endocrine therapy (n = 15), and healthy postmenopausal women (n = 56). Pregnenolone, 17-hydroxypregnenolone, 17-hydroxyprogesterone, 11-deoxycortisol, cortisol, cortisone, dehydroepiandrosterone (DHEA), androstenedione, total testosterone, dihydrotestosterone, estrone and estradiol were measured using liquid chromatography-tandem mass spectrometry. Sex hormone binding globulin was measured by solid-phase chemiluminescent immunometric assays, and the free androgen index was calculated.Results: Aromatase inhibitor users did not differ in dihydrotestosterone, total testosterone, androstenedione, DHEA, or free androgen index levels from healthy controls or untreated breast cancer patients. The highest total testosterone levels were found in tamoxifen-treated women, who had significantly higher plasma concentrations than both women treated with aromatase inhibitors and breast cancer patients without adjuvant treatment. Concentrations of cortisol and cortisone were significantly greater in aromatase inhibitor users as well as tamoxifen users, in comparison with healthy controls and untreated breast cancer patients. Aromatase inhibitor users had lower estrone and estradiol plasma concentrations than all other groups.Conclusion: Adjuvant treatment with aromatase inhibitors or tamoxifen was associated with increased cortisol and cortisone plasma concentrations as well as decreased estradiol concentrations. Androgen levels were elevated in tamoxifen-treated women but not in aromatase inhibitor users.
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| 14. |
- Baumgart, Juliane, 1978-, et al.
(author)
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Sexual dysfunction in women on adjuvant endocrine therapy after breast cancer
- 2013
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In: Menopause. - : Lippincott Williams & Wilkins. - 1072-3714 .- 1530-0374. ; 20:2, s. 162-168
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Journal article (peer-reviewed)abstract
- Objective: The goal of this study was to investigate sexual function in postmenopausal breast cancer patients treated with aromatase inhibitors.Methods: A population-based, cross-sectional study was conducted among postmenopausal breast cancer patients on adjuvant endocrine treatment and age-matched controls with and without estrogen treatment. Sexual function was assessed with a standardized questionnaire.Results: In all, 42.4% of aromatase inhibitor-treated breast cancer patients were dissatisfied with their sex life in general, and 50.0% reported low sexual interest; this was significantly more common than in tamoxifen-treated patients and controls (P < 0.05). Aromatase inhibitorYtreated patients reported insufficient lubrication in 73.9% and dyspareunia in 56.5% of cases, which were significantly more common than in controls, irrespective of hormonal use (P < 0.05). Tamoxifen-treated patients reported significantly more dyspareunia (31.3%; P < 0.05) but resembled controls in all other concerns.Conclusions: Our findings suggest that sexual dysfunction in aromatase inhibitorYtreated women is a greatly underestimated problem.
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| 15. |
- Dahlgren, Hedda, et al.
(author)
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Sexual function in primiparous women : a prospective study
- 2022
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In: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 33:6, s. 1567-1582
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Journal article (peer-reviewed)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth.METHODS: Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations.RESULTS: We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum.CONCLUSIONS: A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.
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| 16. |
- Engström, Gunnar, et al.
(author)
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Pulmonary function and atherosclerosis in the general population : causal associations and clinical implications
- 2024
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In: European Journal of Epidemiology. - : Springer Nature. - 0393-2990 .- 1573-7284. ; 39:1, s. 35-49
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Journal article (peer-reviewed)abstract
- Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50–64 years. The results were confirmed using 2-sample Mendelian randomization. Lower lung function and emphysema were associated with more atherosclerosis, but these relationships were attenuated after adjustment for cardiovascular risk factors. Lung function was not associated with coronary atherosclerosis in 14,524 never-smokers. No potentially causal effect of lung function on atherosclerosis, or vice versa, was found in the 2-sample Mendelian randomization analysis. Here we show that reduced lung function and atherosclerosis are correlated in the population, but probably not causally related. Assessing lung function in addition to conventional cardiovascular risk factors to gauge risk of subclinical atherosclerosis is probably not meaningful, but low lung function found by chance should alert for atherosclerosis.
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| 17. |
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| 18. |
- Erichsen Andersson, Annette, 1966, et al.
(author)
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Patients' experiences of acquiring a deep surgical site infection : An interview study
- 2010
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In: American Journal of Infection Control. - : Mosby, Inc.. - 0196-6553 .- 1527-3296. ; 38:9, s. 711-717
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Journal article (peer-reviewed)abstract
- Background: The negative impact of surgical site infection (SSI) in terms of morbidity, mortality, additional costs, and length of stay (LOS) in the hospital is well described in the literature, as are risk factors and preventive measures. Given the lack of knowledge regarding patients’ experiences of SSI, the aim of the present study was to describe patients’ experiences of acquiring a deep SSI. Methods: Content analysis was used to analyze data obtained from 14 open interviews with participants diagnosed with a deep SSI. Results: Patients acquiring a deep SSI suffer significantly from pain, isolation, and insecurity. The SSI changes physical, emotional, social, and economic aspects of life in extremely negative ways, and these changes are often persistent. Conclusion: Health care professionals should focus on strategies to enable early diagnosis and treatment of SSIs. The unacceptable suffering related to the infection, medical treatment, and an insufficient patient-professional relationship should be addressed when planning individual care, because every effort is needed to support this group of patients and minimize their distress. All possible measures should be taken to avoid bacterial contamination of the surgical wound during and after surgery to prevent the development of SSI.
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| 19. |
- Erichsen Andersson, Annette, 1966, et al.
(author)
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The application of evidence-based measures to reduce surgical site infections during orthopedic surgery - report of a single-center experience in Sweden.
- 2012
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In: Patient safety in surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 6:11
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Journal article (peer-reviewed)abstract
- ABSTRACT: BACKGROUND: Current knowledge suggests that, by applying evidence-based measures relating to the correct use of prophylactic antibiotics, perioperative normothermia, urinary tract catheterization and hand hygiene, important contributions can be made to reducing the risk of postoperative infections and device-related infections. The aim of this study was to explore and describe the application of intraoperative evidence-based measures, designed to reduce the risk of infection. In addition, we aimed to investigate whether the type of surgery, i.e. total joint arthroplasty compared with tibia and femur/hip fracture surgery, affected the use of protective measures. METHOD: Data on the clinical application of evidence-based measures were collected structurally on site during 69 consecutively included operations involving fracture surgery (n = 35) and total joint arthroplasties (n = 34) using a pre-tested observation form. For observations in relation to hand disinfection, a modified version of the World Health Organization hand hygiene observation method was used. RESULTS: In all, only 29 patients (49%) of 59 received prophylaxis within the recommended time span. The differences in the timing of prophylactic antibiotics between total joint arthroplasty and fracture surgery were significant, i.e. a more accurate timing was implemented in patients undergoing total joint arthroplasty (p = 0.02). Eighteen (53%) of the patients undergoing total joint arthroplasty were actively treated with a forced-air warming system. The corresponding number for fracture surgery was 12 (34%) (p = 0.04).Observations of 254 opportunities for hand hygiene revealed an overall adherence rate of 10.3% to hand disinfection guidelines. CONCLUSIONS: The results showed that the utilization of evidence-based measures to reduce infections in clinical practice is not sufficient and there are unjustifiable differences in care depending on the type of surgery. The poor adherence to hand hygiene precautions in the operating room is a serious problem for patient safety and further studies should focus on resolving this problem. The WHO Safe Surgery checklist "time out" worked as an important reminder, but is not per se a guarantee of safety; it is the way we act in response to mistakes or lapses that finally matters.
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| 20. |
- Erichsen Andersson, Annette, 1966, et al.
(author)
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Traffic flow in the operating room : An explorative and descriptive study on air quality during orthopedic trauma implant surgery
- 2012
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In: American Journal of Infection Control. - : Elsevier. - 0196-6553 .- 1527-3296. ; 40:8, s. 750-755
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Journal article (peer-reviewed)abstract
- Background:Understanding the protective potential of operating room (OR) ventilation under different conditions is crucial to optimizing the surgical environment. This study investigated the air quality, expressed as colony-forming units (CFU)/m³, during orthopedic trauma surgery in a displacementventilated OR; explored how traffic flow and the number of persons present in the OR affects the air contamination rate in the vicinity of surgical wounds; and identified reasons for door openings in the OR.Methods:Data collection, consisting of active air sampling and observations, was performed during 30 orthopedic procedures.Results:In 52 of the 91 air samples collected (57%), the CFU/m³ values exceeded the recommended level of <10 CFU/m³. In addition, the data showed a strongly positive correlation between the total CFU/m³ per operation and total traffic flow per operation (r=0.74;P=.001; n=24), after controlling for duration of surgery. A weaker, yet still positive correlation between CFU/m³ and the number of persons present in the OR (r=0.22;P=.04; n=82) was also found. Traffic flow, number of persons present, and duration of surgery explained 68% of the variance in total CFU/m³ (P=.001).Conclusions:Traffic flow has a strong negative impact on the OR environment. The results of this study support interventions aimed at preventing surgical site infections by reducing traffic flow in the OR.
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| 21. |
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| 22. |
- Fadl, Helena, 1965-, et al.
(author)
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Fasting capillary glucose as a screening test for gestational diabetes mellitus
- 2006
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In: BJOG: an International Journal of Obstetrics and Gynaecology. - Oxford : Blackwell Publishing. - 1470-0328 .- 1471-0528. ; 113:9, s. 1067-71
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Journal article (peer-reviewed)abstract
- Objective: To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.Design: Cross-sectional, population-based study.Setting: Maternal Health Care Clinics in Orebro County, Sweden.Population: An unselected population of women without diabetes.Methods: Fasting capillary glucose levels were measured at gestational weeks 28-32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.Main outcome measures: Sensitivity, specificity, likelihood ratios.Results: In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.Conclusion: In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.
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| 23. |
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| 24. |
- Franzén, Karin, 1958-, et al.
(author)
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Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women : a randomized controlled trial
- 2010
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In: International Urogynecology Journal. - Berlin, Germany : Springer. - 0937-3462 .- 1433-3023. ; 21:12, s. 1517-1524
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Journal article (peer-reviewed)abstract
- Introduction and hypothesis: Few randomized controlled trials have compared electrical stimulation treatment with drug therapy. Our hypothesis was that electrical stimulation treatment in women with urgency/urge incontinence would be more efficient compared to drug treatment.Methods: Women ≥18 years of age with urgency/urge incontinence were randomized to receive either ten electrical stimulation treatments vaginally and transanally over a period of 5-7 weeks or tolterodine 4 mg orally once daily.Results: Sixty-one women completed the study. There was no significant difference between the two treatment groups in micturition rate from baseline to 6 months, mean difference, -0.40 (95% confidence interval (CI), -1.61 to 0.82), but a clearly significant difference within each group for electrical stimulation, -2.8 (95% CI, -3.7 to -1.9), and for tolterodine, -3.2 (95% CI, -4.1 to -2.4).Conclusions: Both treatments reduced the number of micturitions, but electrical stimulation was not found to be superior to tolterodine.
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| 25. |
- Franzén, Karin, 1958-, et al.
(author)
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Urinary incontinence : evaluation of an information campaign directed towards the general public
- 2008
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In: Scandinavian Journal of Urology and Nephrology. - : Informa UK Limited. - 0036-5599 .- 1651-2065. ; 42:6, s. 534-538
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Journal article (peer-reviewed)abstract
- Objective. To study and evaluate the effect of an information campaign in the form of a brochure on urinary incontinence (UI) directed towards the general public, concerning knowledge, individual health behaviour, self-reported healthcare utilization and how the information was perceived.Material and methods. Within a community in central Sweden a random sample of the population, in age groups from 18 years upwards, was selected from the population registry, resulting in a total sample of 3658 people. The study group was sent the brochure "Treatment of urinary incontinence", produced by SBU (Swedish Council on Technology Assessment in Health Care) in March 2003 and a questionnaire 1–2 months after the brochure was received.Results. The overall response rate was 47.5%. Eighty per cent of the responders stated UI as an important health problem in society and 66% that they had gained new knowledge on UI. Twenty-eight per cent of the responders reported a current or previous history of UI, of whom 49% felt that they had received useful information for self-treatment and 21% had begun self-treatment.Conclusion. This population-based study found that the distribution of a brochure on UI to the general public was well received and can be an efficient method to spread knowledge and encourage self-management.
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| 26. |
- Franzén, Karin, 1958-, et al.
(author)
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Urinary incontinence in women is not exclusively a medical problem : a population-based study on urinary incontinence and general living conditions
- 2009
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In: Scandinavian Journal of Urology and Nephrology. - London : Taylor & Francis. - 0036-5599 .- 1651-2065. ; 43:3, s. 226-232
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The aim of the study was to analyse differences in general health and general living conditions between women with and without urinary incontinence (UI).MATERIAL AND METHODS: This cross-sectional population-based study was conducted in Orebro County, Sweden. A public health questionnaire, "Life and Health", was sent to a randomly selected sample of the population. The questionnaire consisted of 87 questions on broad aspects of general and psychiatric health. An additional questionnaire was enclosed for those respondents who reported experiencing UI. The data were analysed using binary logistic regression. The final study population constituted 4609 women, 1332 of whom had completed both questionnaires. The remaining 3277 had completed only the Life and Health questionnaire. Effect measures were odds ratios (ORs) with corresponding 95% confidence intervals (CIs).RESULTS: Statistically significant associations were found between UI and the occurrence of musculoskeletal pain (OR 1.45, 95% CI 1.20-1.76), fatigue and sleeping disorders (OR 1.59, 95% CI 1.30-1.95), feelings of humiliation (OR 1.29, 95% CI 1.12-1.50), financial problems (OR 1.36, 95% CI 1.11-1.66), and reluctance to seek medical care (OR 1.43, 95% CI 1.21-1.68).CONCLUSION: UI among women is commonly associated with a number of different psychosocial problems as well as an expressed feeling of vulnerability.
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| 27. |
- Franzén, Karin, 1958-, et al.
(author)
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Validation of the Swedish version of the Incontinence Impact Questionnaire, IIQ-7 and the Urogenital Distress Inventory, UDI-6.
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Other publication (other academic/artistic)abstract
- Introduction and hypothesis:The purpose was to validate the Swedish versions of the Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6). Methods: We analyzed reliability, validity, and responsiveness in a clinical sample of 96 women with UI. Result:Test-retest reliability ranged from moderate to almost perfect. Cronbach’s alpha was 0.39 (UDI-6) and 0.83 (IIQ-7). Effect size calculation of change after treatment demonstrated good responsiveness. The effect size at 6 months was moderate in the SUI group and small in the UUI+MUI group. There was a moderate to strong correlation between UDI-6 and IIQ-7 and treatment satisfaction at 6, 12, and 24 months for both groups. ConclusionThe Swedish UDI-6 and IIQ-7 show good responsiveness and are easy to administer and fill out. UDI-6 did not produce the same solid psychometrical results as IIQ-7, but both scales can be of clinical importance and are recommended for clinical use.
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| 28. |
- Helmerson, Birgitta, et al.
(author)
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A pilot study of the feasibility of a Swedish multimodal group intervention for severe migraine - The migraine patient school
- 2021
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In: Cephalalgia Reports. - : SAGE. - 2515-8163. ; 4, s. 1-9
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Journal article (peer-reviewed)abstract
- Objectives: To evaluate a multidisciplinary group intervention, the migraine patient school (MPS), for patients with severe, mostly chronic migraine. Method: A 13-week group intervention program including seven sessions of patient education, practical body awareness and relaxation exercises, and home assignments was performed in small groups with 5–11 participants. Four groups were consecutively included from spring 2014 to fall 2015. Headache diaries and standardized and study-specific questionnaires were used for evaluation at baseline before MPS (pre-interventional phase), and at follow-up. Results: Twenty-four of 30 included patients completed the study, i.e. attended ≥ four sessions. Most participants found it rewarding to participate in the MPS and easy to take part in, understand and complete home assignments. Validated standardized questionnaires delivered before, and after (follow-up) MPS showed that the impact on life (HIT-6) and avoidance behavior (PIPS-A) were significantly improved whereas quality of life (MSQL), anxiety and depression (HAD) and perceived stress (PSS-14) did not show a statistically significant change. Conclusion: The Migraine patient school with a multimodal educational and behavioral group intervention program was feasible to perform and seem to benefit patients with severe (high-frequency or chronic) migraine. © The Author(s) 2021.
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| 29. |
- Holmdahl, C., et al.
(author)
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CPAP treatment in obstructive sleep apnoea : a randomised, controlled trial of follow-up with a focus on patient satisfaction
- 2009
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In: Sleep Medicine. - : Elsevier. - 1389-9457 .- 1878-5506. ; 10:8, s. 869-874
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Journal article (peer-reviewed)abstract
- AIM OF THE STUDY: To assess a simplified model for follow-up in patients undergoing CPAP-treatment for obstructive sleep apnoea syndrome.PATIENTS AND METHODS: A total of 200 patients in stable condition were randomised to annual follow-up visits either by a specialist nurse (intervention) or physician-led visits including oximetry (control). Patients were followed for two years and assessed for the following outcomes: global satisfaction, quality of life, medical events, and resource utilisation.RESULTS: The overall experience of CPAP treatment was rated as excellent or good by 99% in each group. Global satisfaction was high in both groups, and there were no clinically significant differences between the groups. Quality of life did not differ between the groups. No serious medical events related to OSAS occurred during the study period. Extra physician consultations occurred rarely, and were managed within the limits of the follow-up visits.CONCLUSION: For stable patients undergoing CPAP treatment for obstructive sleep apnoea, regular follow-up visits by a specialist nurse can optimise the use of health care resources while retaining high patient satisfaction, without increasing medical risks.
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| 30. |
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| 31. |
- Jansson, Markus, 1982-, et al.
(author)
-
Cost-effectiveness of antibiotic prophylaxis in elective cesarean section
- 2018
-
In: Cost Effectiveness and Resource Allocation. - : BMC. - 1478-7547. ; 16
-
Journal article (peer-reviewed)abstract
- Background: The proportion of pregnant women delivered by cesarean section has increased steadily during the past three decades. The risk of infection is 10-fold augmented after elective cesarean section compared to vaginal delivery. Antibiotic prophylaxis may reduce endometritis by 62% and superficial wound infection by 38% after elective cesarean section. International guidelines recommend antibiotic prophylaxis in elective cesarean section, but this procedure is not routinely followed in Sweden. Studies of costs of antibiotic prophylaxis in cesarean section show conflicting results and are based on substantially different incidence of postoperative infections. No study of costs of antibiotic prophylaxis in elective cesarean section in a Swedish or Nordic context has been pursued. The aim of this study was to investigate if antibiotic prophylaxis is cost-reducing in elective cesarean section in orebro County, Sweden.Methods: All women undergoing elective cesarean in the Region orebro County health care system during 2011-2012 were eligible for inclusion. Postoperative infections and risk factors for infections were registered. A hypothetical situation in which all participants had received antibiotic prophylaxis was compared to the actual situation, in which none of them had received antibiotic prophylaxis. The reduction in the risk of postoperative infections resulting from antibiotic prophylaxis was based on a meta-analysis. Costs for in-patient care of postoperative infections were extracted from the accounting system, and costs for out-patient care were calculated according to standard costs. Costs for antibiotic prophylaxis were calculated and compared with the cost reduction that would be implied by the introduction of such prophylaxis.Results: The incidences of deep and superficial surgical site infection were 3.5% and 1.3% respectively. Introduction of antibiotic prophylaxis would reduce health care costs by 31 Euro per cesarean section performed (95% credible interval 4-58 Euro). The probability of cost-saving was 99%.Conclusions: Antibiotic prophylaxis in elective cesarean section is cost-reducing in this health care setting. Our results indicate that the introduction of antibiotic prophylaxis in elective cesarean section can also be cost-saving in low infection rate settings.Trial registration Ethical approval was given by the Regional Ethical Review Board in Uppsala (registration number 2013/484).
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| 32. |
- Jansson, Markus, 1982-, et al.
(author)
-
Development and validation of a protocol for documentation of obstetric perineal lacerations
- 2019
-
In: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 30:12, s. 2069-2076
-
Journal article (peer-reviewed)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method.METHODS: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods.RESULTS: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX.CONCLUSIONS: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.
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| 33. |
- Jansson, Markus, 1982-, et al.
(author)
-
Development and Validation of a Protocol for Documentation of Obstetric Perineal Lacerations
- 2018
-
Conference paper (peer-reviewed)abstract
- Introduction and hypothesis: The aim of this study was to develop a new protocol for documentation of perineal lacerations and to validate the latter against the most common obstetric record system in Sweden. The hypothesis was that the new protocol would render more complete data on perineal lacerations than the current documentation method. Methods: A protocol for documentation of perineal lacerations was developed to be sufficiently comprehensive to serve research purposes. All women delivering their first child vaginally from 13 October 2015 to 1 February 2016 at Örebro University Hospital were eligible for the validation study. Perineal lacerations were documented using the protocol in parallel with the regular obstetric record system (ObstetriX). Cross tabulations were used to compare the coverage regarding perineal lacerations between the two documentation methods. McNemar's test was used to evaluate systematic differences between the methods. Results: A total of 187 women were included. The coverage of documentation regarding perineal laceration was significantly higher (p < 0.001) in the new protocol (89%) compared with ObstetriX (18%). Incidence of second-degree perineal tears was 26% according to the new protocol and 11% according to ObstetriX. The incidence of third-degree perineal tears A, B, and C was 2.7%, 2.1%, and 2.1%, respectively, according to the new protocol, and 3.2%, 2.7%, and 1.1% according to ObstetriX. Conclusions: This validation study of a new documentation protocol showed that it delivered significantly more comprehensive information regarding perineal lacerations than the most common obstetric record system in Sweden.
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| 34. |
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| 35. |
- Jansson, Markus, 1982-, et al.
(author)
-
Fecal incontinence and associated pelvic floor dysfunction during and one year after the first pregnancy
- 2023
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 102:8, s. 1034-1044
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum.MATERIAL AND METHODS: This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs).RESULTS: At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5).CONCLUSIONS: This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.
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| 36. |
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| 37. |
- Jansson, Markus, 1982-
(author)
-
Pelvic Floor Dysfunction and Perineal and Vaginal Tears in Primiparous Women
- 2022
-
Doctoral thesis (other academic/artistic)abstract
- Pelvic floor dysfunction (PFD), including urinary incontinence, faecal incontinence (FI), and pelvic organ prolapse, is highly prevalent among parous women. There is evidence that pregnancy, vaginal delivery, and obstetric perineal tears increase the risk of pelvic floor dysfunction, but many of the studies in this field are retrospective. The overall aim of this thesis was to prospectively examine risk factors for perineal and vaginal tears and postpartum PFD in primiparous women.Study I was a validation study of a protocol for documentation of perineal tears, including 187 primiparous women in 2015–2016. The coverage of documentation was higher in the protocol compared to the obstetric record system (ObstetriX). Incidence of second degree perineal tears was 26% according to the protocol and 11% according to ObstetriX.Studies II–IV utilized a cohort of initially nulliparous women (n=1049) prospectively included in early pregnancy in 2014–2017. Women completed questionnaires on PFD in early and late pregnancy and at 8 weeks and 1 year postpartum.Study II (n=644) showed that high foetal weight and vacuum extraction were risk factors for both second degree tears and OASI, suggesting that these tears should be viewed as a continuum rather than different entities. Risk factors for high vaginal tears were large foetal head circumference, vacuum extraction, and heredity of PFD/connective tissue deficiency. Study III (n=670) found that vaginal delivery increased the risk of stress urinary incontinence (SUI) but not urgency urinary incontinence (UUI) 1 year postpartum. No single characteristic of the vaginal delivery was associated with SUI. SUI during pregnancy increased the risk of SUI postpartum, and UUI during pregnancy increased the risk of UUI postpartum.Study IV (n=898) showed that FI increased by late pregnancy, and that this increase persisted 1 year postpartum. Obstructed defecation was associated with increased FI postpartum, suggesting that post-defecatory faecal loss may be an underlying mechanism of FI. Overall conclusion: The extent to which pregnancy, vaginal delivery, and their respective characteristics contributed to the development of PFD differed between the pelvic floor disorders studied. For SUI, both the pregnancy and the vaginal delivery increased the risk, whereas for FI it was the pregnancy itself rather than the vaginal delivery that was demonstrated to increase the risk.
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| 38. |
- Jansson, Markus, 1982-, et al.
(author)
-
Risk factors for perineal and vaginal tears in primiparous women : the prospective POPRACT-cohort study
- 2020
-
In: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 20:1
-
Journal article (peer-reviewed)abstract
- Background: The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.Methods: All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.Results: A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).Conclusion: The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.
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| 39. |
- Jansson, Markus, 1982-, et al.
(author)
-
Stress and urgency urinary incontinence one year after a first birth-prevalence and risk factors : A prospective cohort study
- 2021
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 100:12, s. 2193-2201
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Few prospective studies have examined the effect of pregnancy and childbirth on stress and urgency urinary incontinence separately. The aim of the present study was to assess the extent to which pregnancy, vaginal delivery, and vaginal delivery characteristics affect the risk of significant stress and urgency incontinence 1 year after delivery.MATERIAL AND METHODS: We conducted a prospective cohort study of 670 nulliparous women from early pregnancy to 1 year partum. The women were recruited at maternity health care service in Region Örebro County, Sweden, between October 1, 2014 and October 1, 2017 and completed questionnaires in early and late pregnancy and at 8 weeks and 1 year postpartum. Primary outcome measures were significant stress and urgency incontinence at 1 year postpartum in women who reported being continent before pregnancy. Generalized linear models were used.RESULTS: Stress and urgency incontinence commencing before pregnancy were reported by 4% and 3% of women, respectively, in the first questionnaire in early pregnancy, and these women were excluded from subsequent analysis. Stress and urgency incontinence were reported by 21% and 8%, respectively, at 1 year postpartum, in women not reporting incontinence before pregnancy. Stress incontinence during pregnancy increased the risk of stress incontinence postpartum (risk ratio [RR] 2.48, 95% CI 1.86-3.3). Urgency incontinence during pregnancy increased the risk of urgency incontinence postpartum (RR 4.07, 95% CI 2.1-7.89). Vaginal delivery increased the risk of stress incontinence postpartum (adjusted RR 2.63, 95% CI 1.39-5.01) but not of urgency incontinence. This effect of vaginal delivery on stress incontinence was similar irrespective of incontinence status during pregnancy. The population-attributable fraction of stress incontinence associated with vaginal delivery was 0.58 (95% CI 0.23-0.77).CONCLUSIONS: This study shows essentially different risk factors for stress and urgency incontinence, supporting stress incontinence as being the subtype mostly associated with pregnancy and childbirth, and urgency incontinence as being more stable over time. At a population level, vaginal delivery was the major risk factor for stress incontinence, followed by reporting stress incontinence during pregnancy.
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| 40. |
- Kahnberg, Karl-Erik, 1941, et al.
(author)
-
Sinus lifting procedure. I. One-stage surgery with bone transplant and implants.
- 2001
-
In: Clinical oral implants research. - 0905-7161. ; 12:5, s. 479-87
-
Journal article (peer-reviewed)abstract
- A prospective study of one-stage surgery with intrasinus bone transplant and implants has been performed in 26 patients (13 males and 13 females). The aim of the study was to evaluate the success rate with the one-stage sinus lifting procedure in patients with a need for bony augmentation of the alveolar process. Fifteen patients were partially dentate and 11 edentulous. The mean height of the alveolar ridge was 2.5 mm preoperatively (range 1-5.5 mm). 126 fixtures were inserted, 93 in grafted bone and 33 in alveolar bone. Twenty-two patients have been followed for three years, 21 for four years and 11 for five years. The clinical overall survival rate was 69.6% although only 61.2% in grafted bone. Ten of the patients had varying degree of sinusitis post-fixture installation. At the end of the study, 23 patients had permanent bridges. The survival rate was low for inlay supported implants when the one-stage surgical technique was applied. Two-stage surgery may be a safer method.
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| 41. |
- Kallak, Theodora Kunovac, 1985-, et al.
(author)
-
Aromatase inhibitors affect vaginal proliferation and steroid hormone receptors
- 2014
-
In: Menopause. - : Lippincott Williams & Wilkins. - 1072-3714 .- 1530-0374. ; 21:4, s. 383-390
-
Journal article (peer-reviewed)abstract
- Objective: Women with breast cancer who are treated with aromatase inhibitors often experience vaginal atrophy symptoms and sexual dysfunction. This work aims to study proliferation and the presence and distribution of steroid hormone receptors in vaginal biopsies in relation to vaginal atrophy and vaginal pH in women with breast cancer who are on adjuvant endocrine treatment and in healthy postmenopausal women.Methods: This is a cross-sectional study that compares postmenopausal aromatase inhibitor-treated women with breast cancer (n = 15) with tamoxifen-treated women with breast cancer (n = 16) and age-matched postmenopausal women without treatment (n = 19) or with vaginal estrogen therapy (n = 16). Immunohistochemistry was used to study proliferation and steroid hormone receptor staining intensity. Data was correlated with estrogen and androgen levels, vaginal atrophy scores, and vaginal pH.Results: Aromatase inhibitor-treated women had a lower grade of proliferation, weaker progesterone receptor staining, and stronger androgen receptor staining, which correlated with plasma estrone levels, vaginal atrophy scores, and vaginal pH.Conclusions: Women with aromatase inhibitor-treated breast cancer exhibit reduced proliferation and altered steroid hormone receptor staining intensity in the vagina, which are related to clinical signs of vaginal atrophy. Although these effects are most probably attributable to estrogen suppression, a possible local inhibition of aromatase cannot be ruled out.
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| 42. |
- Kallak, Theodora Kunovac, 1985-, et al.
(author)
-
Higher than expected estradiol levels in aromatase inhibitor-treated, postmenopausal breast cancer patients
- 2012
-
In: Climacteric. - London, United Kingdom : Informa Healthcare. - 1369-7137 .- 1473-0804. ; 15:5, s. 473-480
-
Journal article (peer-reviewed)abstract
- Objective: Vaginal estradiol is considered contraindicated in aromatase inhibitor (AI)-treated patients because of the risk of elevated estrogen levels. This leaves limited treatment options for patients experiencing gynecological symptoms. However, in clinical practice, no precise estimation has been performed of circulating estrogens and aromatase index in postmenopausal breast cancer patients on long-lasting AI or tamoxifen treatment.Methods: Steroid hormones were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) and extraction radioimmunoassay (RIA). Postmenopausal AI-treated patients (n =33) were compared with tamoxifen-treated patients (n =34) and controls without vaginal treatment (n =56), with vaginal estradiol (n =25), or with estriol (n =11) treatment.Results: By use of LC-MS/MS, median (range) estradiol plasma concentrations were 16.7 (2.4-162.6), 31.0 (13.4-77.1), 27.2 (7.8-115.8) and 33.3 (20.3-340.1) pmol/l in AI-treated breast cancer patients, tamoxifen-treated breast cancer patients, postmenopausal controls and postmenopausal controls on vaginal estradiol, respectively. The AI-treated group and subgroups had significantly lower estradiol and estrone concentrations than all other groups (p <0.05). There was extensive interindividual variation in estradiol concentration within the AI-treated group, measured using both LC-MS/MS (2.3-182.0 pmol/l) and extraction RIA (2.4-162.6 pmol/l). The AI-treated group had lower aromatase index compared to all other groups (p <0.05-0.001).Conclusion: Circulating estrogen levels may have been underestimated in previous longitudinal studies of AI-treated breast cancer patients. Additional studies are required to further evaluate the role of circulating estrogens in breast cancer patients suffering from gynecological symptoms.
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| 43. |
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| 44. |
- Kunovac Kallak, Theodora, et al.
(author)
-
Vaginal Gene Expression During Treatment With Aromatase Inhibitors
- 2015
-
In: Clinical Breast Cancer. - : CIG MEDIA GROUP. - 1526-8209 .- 1938-0666. ; 15:6, s. 527-535.e2
-
Journal article (peer-reviewed)abstract
- Vaginal gene expression in aromatase inhibitor-treated women was compared with postmenopausal control women treated with vaginal estrogen therapy. Vaginal tissue from aromatase inhibitor-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion, and associated with vaginal discomfort. The presence of vaginal aromatase suggests that this is the result of local and systemic aromatase inhibition.Background: Aromatase inhibitor (AI) treatment suppresses estrogen biosynthesis and causes genitourinary symptoms of menopause such as vaginal symptoms, ultimately affecting the quality of life for many postmenopausal women with breast cancer. Thus, the aim of this study was to examine vaginal gene expression in women during treatment with AIs compared with estrogen-treated women. The secondary aim was to study the presence and localization of vaginal aromatase.Patients and Methods: Vaginal biopsies were collected from postmenopausal women treated with AIs and from age-matched control women treated with vaginal estrogen therapy. Differential gene expression was studied with the Affymetrix Gene Chip Gene 1.0 ST Array (Affymetrix Inc, Santa Clara, CA) system, Ingenuity pathway analysis, quantitative real-time polymerase chain reaction, and immunohistochemistry.Results: The expression of 279 genes differed between the 2 groups; AI-treated women had low expression of genes involved in cell differentiation, proliferation, and cell adhesion. Some differentially expressed genes were found to interact indirectly with the estrogen receptor alpha. In addition, aromatase protein staining was evident in the basal and the intermediate vaginal epithelium layers, and also in stromal cells with a slightly stronger staining intensity found in AI-treated women.Conclusion: In this study, we demonstrated that genes involved in cell differentiation, proliferation, and cell adhesion are differentially expressed in AI-treated women. The expression of vaginal aromatase suggests that this could be the result of local and systemic inhibition of aromatase. Our results emphasize the role of estrogen for vaginal cell differentiation and proliferation and future drug candidates should be aimed at improving cell differentiation and proliferation.
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| 45. |
- Lindberg, Erik, 1953-
(author)
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Effects of management by objectives : studies of Swedish upper secondary schools and the Influence of role stress and self-efficacy on school leaders
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- The purpose of this dissertation is to explore the impacts of Management by Objectives (MBO) on upper secondary school education in Sweden. In particular the goal is to increase our understanding of how the implementation of MBO affects the schools and the role of head teachers. In addition this work seeks to generate new knowledge about the factors that influence the performance of head teachers. This dissertation includes four separate, but interconnected articles, each addressing a different aspect of the impact of MBO on schools and head teachers, it begins with an overview of all material. A multi-theoretical approach is taken here, using insights from diffusion theory, goal setting theory and role stress theory to guide the research. Even though qualitative methods are used the quantitative methods dominate the dissertation and most of the data is collected from a mail survey of head teachers. The results confirm the findings of other research that the diffusion of new ideas (in this the context MBO) stalls when it is introduced into local environments within which day to day work takes place. Goal setting and role stress theory are integrated, which makes it possible to show that role commitment had both functional and dysfunctional effects. It shows that efficacy plays a mediating role between stressors and performance and that the relationship between stressors and self-efficacy is not linear. Finally, the nature of the different stressors are described and role design has an impact on the level of them. All of these findings have practical implications for those responsible for education and school policy. The first article in the dissertation looks at how well MBO has been implemented in the upper secondary scools and its impact on student performance and school effectiveness. The results of the stydy are that head teachers report that the effects of MBO have declined over time. Its implementation appears not to have influenced student performance. On the other hand, it seems to have rediced teacher stress, but increased head teachers´ sense of frustration. The second article argues in contrast to previous research that goal commitment can have both a positive and negative effect on rple performance and conceptualizes self-efficacy as a mediator between commitment and performance. The findings of the study show that self-efficacy does act as a mediator and that high commitment can have both positive and negative consequences. In particular, high commitment can improve performance by reducing role ambiguity, but it also drives role overload, which can reduce performance. The third article builds on the findings of article two in order to deepen our understanding of the impact of self-efficacy on head teacher performance. In contrast to most of the literature it shows that stressors might have positive effects and that self-efficacy is involved in these relationships. The research presented in the article confirms that both role conflict and role ambiguity influence self-efficacy in a non-linear way. The focus of the final article focuses on the design of the role of the head teacher and how this impacts stress levels. The results show that when the head teacher´s role includes significant economic responsibility and more space to maneuver, or less, they experience role ambiguity, role conflict and role overload differently. Overall, the results suggest that it would be beneficial to take the factors that this study has shown to be important for head teacher´s performance into consideration when the role is designed.
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| 46. |
- Megeus, Veronika, 1983, et al.
(author)
-
Hand Contamination, Cross-Transmission, and Risk-Associated Behaviors: An Observational Study of Team Members in ORs
- 2015
-
In: AORN Journal. - : Wiley. - 0001-2092. ; 102:6
-
Journal article (peer-reviewed)abstract
- Team members in ORs have frequent hand contact with many surfaces and sites during high workload, thus increasing the risk for microorganism cross-transmission. This study aimed at identifying risks for hand contamination and microorganism cross-transmission during invasive procedures in ORs. We carried out observations during 22 daytime sessions and analyzed data using qualitative content analysis. The results revealed that clinicians’ hands may be contaminated by self-contamination, via objects, or by touching the patient. Contamination may occur before, during, or directly after performing an invasive procedure requiring the use of aseptic technique, which risks cross-transmitting microorganisms. The results of the study contribute detailed knowledge about risk-associated activities and behaviors in relation to performing invasive procedures in the OR. This knowledge provides clinicians, managers, and educators with specific information that can be used in nursing and medical education and in quality improvement projects aimed at improving hand hygiene routines and enhancing aseptic technique.
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| 47. |
- Megeus, Veronika, 1983, et al.
(author)
-
Hand hygiene and aseptic techniques during routine anesthetic care - observations in the operating room.
- 2015
-
In: Antimicrobial resistance and infection control. - : Springer Science and Business Media LLC. - 2047-2994. ; 5:4
-
Journal article (peer-reviewed)abstract
- More knowledge is needed about task intensity in relation to hand hygiene in the operating room during anesthetic care in order to choose effective improvement strategies. The aim of this study was to explore the indications and occurrence of hand hygiene opportunities and the adherence to hand hygiene guidelines during routine anesthetic care in the operating room.
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| 48. |
- Mol, Femke, et al.
(author)
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The ESEP study: salpingostomy versus salpingectomy for tubal ectopic pregnancy; the impact on future fertility: a randomised controlled trial.
- 2008
-
In: BMC women's health. - London : Springer Science and Business Media LLC. - 1472-6874. ; 8
-
Journal article (peer-reviewed)abstract
- For most tubal ectopic pregnancies (EP) surgery is the treatment of first choice. Whether surgical treatment should be performed conservatively (salpingostomy) or radically (salpingectomy) in women wishing to preserve their reproductive capacity, is subject to debate. Salpingostomy preserves the tube, but bears the risks of both persistent trophoblast and repeat ipsilateral tubal EP. Salpingectomy, avoids these risks, but leaves only one tube for reproductive capacity. This study aims to reveal the trade-off between both surgical options: whether the potential advantage of salpingostomy, i.e. a better fertility prognosis as compared to salpingectomy, outweighs the potential disadvantages, i.e. persistent trophoblast and an increased risk for a repeat EP.
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| 49. |
- Nilsson, Jonna, et al.
(author)
-
Smärta och dokumentation i sjukhusmiljö
- 2010
-
Reports (other academic/artistic)abstract
- Bakgrund: Smärta är vanligt hos Sveriges befolkning. I en undersökning av levnadsförhållanden i Sverige från 2008 framgår att 19 % i åldrarna 16-84 lever med svår värk. Forskning visar att sjukvården brister i smärtdokumentation vilket kan innebära att vårdens smärtlindring blir lidande. Syfte: Syftet var att, hos en grupp sjukhusvårdade patienter med smärta, beskriva smärta och i vilken utsträckning smärtan dokumenterats samt belysa hinder för smärtdokumentation. Metod: Empirisk studie med kvantitativ, beskrivande statistik samt ett avsnitt med kvalitativ innehållsanalys. Resultat: Smärta hos en grupp patienter visar att en stor andel alltid har ont vid aktivitet men även vid vila. Dokumentationen brister främst gällande duration och är mest tillfredsställande angående lokalisation. Ett hinder för god dokumentation är patienter som väljer att inte visa eller berätta om sin smärta. Diskussion: En god relation mellan sjuksköterska och patient underlättar smärthantering. Sjukvårdens smärtlindring är otillräcklig och alltför många lider av att ha ont. Nuvarande smärtbehandlingsmetoder har god möjlighet att, om inte eliminera, så ge en betydande smärtlindring. Dokumentation är viktig för att kunna lindra smärta och därmed minska patienters lidande. Förslag till vidare forskning inriktar sig på hur tillfredställande dokumentation ser ut. Även forskning kring alternativa behandlingsmetoder behövs för att kunna sänka andelen som lever med smärta och värk. Detta skulle öka livskvaliteten hos Sveriges befolkning.
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| 50. |
- Nilsson, Kerstin, 1953-, et al.
(author)
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"It depends on us" : Employee perspective of healthy working conditions during continual reorganisations in a radiology department
- 2009
-
In: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 33:2, s. 191-200
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Journal article (peer-reviewed)abstract
- Background: This study focuses on employees' experience of occupational health in a radiology department within a Swedish university hospital during years of continual reorganisations. This department's stable personal health trends in terms of self-rated mental health and sick-leave rates diverged from the general trends of deteriorating working conditions in the hospital. Aim: The aim was to identify dimensions of working conditions as positive determinants contributing to occupational health in a department of radiology undergoing continual reorganisations. Method: Open-ended interviews with twelve employees were transcribed and analyzed using content-analysis. Result: The employees experienced their new stimulating working tasks and a supporting organizational climate as important contributors to the healthy work condition. Conclusion: The positive effects of handling new technical challenges and the positive organisational climate, which were characterized by mutual trust, as well as work-confidence and respect for each others' competence, seem to function as buffering factors, balancing the negative effects of parallel downsizing and restructuring processes.
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