| 1. |
- Andersson, Johanna, 1972-, et al.
(författare)
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What’s in the body? Children’s annotated drawings
- 2020
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Ingår i: Journal of Biological Education. - : Routledge. - 0021-9266 .- 2157-6009. ; :2, s. 176-190
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents a study of children’s ideas of the body’s internal structure. Children between four and 13 years (N = 170) individually produced drawings. During each drawing session the children explained their drawings to a facilitator and added written labels either by them- selves or, if they were too young to write, with the facilitator’s help. The results provide an updated comprehensive picture of children in differ- ent age groups and their views on the internal structure of the body. The type and numbers of organs drawn are similar to those documented in previous studies. However, in comparison to recent studies, the children drew more organs, the brain was indicated almost as often as the heart, and the Valentine heart was frequently used as a symbol. In contrast with previous research, children drew connections between organs. This result calls for caution regarding conclusions made from decontextua- lized questions. The importance of providing children with the opportu- nity to clarify their drawings is emphasised since it otherwise becomes a question of the researcher’s interpretation. The connections they draw, and explanations they give to their drawings, have interesting implica- tions for understanding children’s ideas, and hence both for teaching and learning and for science education research.
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| 2. |
- Annerbäck, Johanna, et al.
(författare)
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Toddlers’ engagements with preschool playgrounds: ethnographic insights from Sweden
- 2024
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Ingår i: Children's Geographies. - 1473-3285 .- 1473-3277. ; , s. 1-16
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Tidskriftsartikel (refereegranskat)abstract
- This article explores toddler – place relationships outdoors during early childhood education in Sweden. Informed by Tim Ingold’s theorization of movement, we explore toddlers’ embodied engagements with the preschool playground and how the human–non-human environments become entangled. The results show that, just as in the wider world, the processes enabling and limiting toddlers’ engagements in the playground are continuously in motion. Toddler–place relationships are continuously created through a mutual dependence between human and non-human entities. In this sense, toddlers’ engagements with playgrounds are not separate from the place through which they engage, but change place.
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| 3. |
- Baumann, Henrikke, 1964, et al.
(författare)
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The Usefulness of an Actor’s Perspective in LCA
- 2011
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Ingår i: Towards Life Cycle Sustainability Management. - Dordrecht : Springer Netherlands. - 9789400718982 ; , s. 73-83
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Konferensbidrag (refereegranskat)abstract
- This paper is an argumentation for adding an actor’s perspective to lifecycleassessment (LCA). The need for this perspective stems from a criticismabout the usefulness of LCA interpretation methods comparing the relativecontribution of life-cycle phases of a product. Our argumentation is based on fourpreviously published studies providing practical examples of how value chainactors’ influence may be considered in an LCA and the benefit of doing so.Manufacturing sector examples show how one company's influence can beillustrated in results and how it may relate all relevant emissions to its ownprocesses. The food sector study shows how to assess several value chain actors’individual improvement potential. The final example, taken from building sector,explore how to consider the fact that actors in one part of the value chain caninfluence other actors to improve.
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| 4. |
- Berglund, Karin, 1967-, et al.
(författare)
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Engaged Sisters : studying the entrepreneurship and innovation support system from ‘within’
- 2013
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Konferensbidrag (refereegranskat)abstract
- Entrepreneurship and innovation support has grown into large institutions in a society that cherishes an enterprising culture. Individuals are encouraged to be entrepreneurial and innovative in general, and to start up their own companies in particular. To support individuals in their business creation processes, policy stresses the need of providing with measures. Together these measures comprise a support system, directed towards supporting new and established entrepreneurs. It has however been recognized that the entrepreneurship and innovation public support system is highly gendered, favoring men and male businesses, whilst programs targeting women put the onus on individual women to start and grow businesses. As well it has been recognized that the policy support system tends to exclude ‘othered’ groups rather than including them in enterprising activities. The subtext of entrepreneurship support points to how some people “are” entrepreneurs, whilst others need support in order to become more entrepreneurial. Hence, there is a need to change the support system of entrepreneurship and innovation since it tends to disempower rather than to empower ‘othered’ groups in society.“Sisters in Business” make up an organization of wo/men entrepreneurs who have joined forces to address this need. Their vision is that entrepreneurship should reflect the society at large. During the last year they have therefore taken several initiatives to make this happen and is today one of the support organizations in a medium sized Swedish town. In this paper three Sisters are working together with a researcher within this area. Together we have formed a group of “engaged sisters´”. In our dialogue the dichotomy between ‘practice’ and ‘theory’ have temporarily dissolved in favor of creating narratives, from episodes, experiences and the everyday life of sister´s, to illustrate how the support system works from ‘within’. This led us to questioning whether the ‘support system’ really is a support system, or something else? Furthermore, this insight made it apparent that there exists ‘other’ support system, tough concealed and silenced. Finally, suggestions are proposed for how ‘practitioners’ can work together with ‘academics’ to change the rules of the game.
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| 5. |
- Ejhed, Helene, et al.
(författare)
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Belastning och påverkan från dagvatten : Källor till föroreningar i dagvatten, potentiell effekt, och jämförelser med belastning från andra källor
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SMED har på uppdrag av Naturvårdsverket tagit fram denna rapport om föroreningar och belastning från dagvatten. Studien är en del av ett Regeringsuppdrag ”Föreslå etappmål om dagvatten”. Syftet med projektet har varit att ta fram en sammanställning om belastning av föroreningar från dagvatten till vattenrecipienter. Primära källor, potentiella toxiska och hormonstörande effekter samt belastning på ytvatten har sammanställts och beräknats av ett urval av prioriterade ämnen och Särskilda Förorenande Ämnen (SFÄ) och omfattande sammanlagt 22 st näringsämnen, metaller och organiska miljöföroreningar. Dessa ämnen valdes ut eftersom de är kända ämnen i dagvatten, prioriterade ämnen av Vattenmyndigheterna på grund av att de orsakar att god kemisk eller ekologisk status inte uppnås i många vattenförekomster samt att det var möjligt att göra beräkningar av belastning av dessa tack vare att det fanns data tillgängligt. Dessa 22 ämnen har sådana ekologiska, toxiska och/eller hormonstörande effekter i akvatisk miljö att belastningen av samtliga av dessa ämnen bör begränsas eller helt förhindras. Dagvattnets påverkan och effekter på miljön har sammanställts utifrån tillgänglig litteratur. Studierna är dock få och av varierande karaktär, vilket gör det svårt att dra några generella slutsatser gällande dagvattnet påverkan.Antalet föroreningar i dagvatten kan dock vara många fler än de 22 utvalda ämnena. Uppmätta halter i dagvatten har sammanställts från Naturvårdsverkets Screeningdatabas i denna rapport och visar att 74 st ämnen förekommer i samtliga prover av dagvatten där de har analyserats, och ytterligare 117 st ämnen förekommer i en del av dagvattenproverna. Många är ämnen som ännu inte är prioriterade av vattenförvaltningen. Bland annat förekommer ofta metaller och grundämnen, vissa dioxiner och furaner, alkylfenoler, antioxidanter, bekämpningsmedel, kolväten, LAS (Linear alkyl benzene sulfonate) och olika flamskyddsmedel. Resultat av belastningsberäkningarna visar att dagvatten är en betydande spridningsväg till belastningen i recipienter för vissa ämnen trots att arealen tätort är mindre än 1% av Sveriges totala yta. För metallerna kadmium, zink, bly och koppar så har bidragen från dagvatten beräknats till mellan 15% och 17% av den totala belastningen till recipienter i Sverige och kan anses vara betydande belastning. I mellan 451 och 1090 st enskilda vattenförekomstområden är belastningen från dagvatten den dominerande spridningsvägen (>50% av total belastning) till de olika metallerna. Dagvatten utgör 100% av belastningen i 17 st vattenförekomster för koppar, zink och bly, i 12 st vattenförekomster för kadmium och nickel och i enbart 3 st vattenförekomster för kvicksilver. För de organiska ämnena är uppgifterna om utsläpp väldigt osäkra eller saknas helt för många källor till total belastning i Sverige, så som läckage från olika marktyper, jordbruksmark och skog, men de tillgängliga data och beräkningarna som gjorts indikerar att dagvatten utgör en viktig spridningsväg för PAH16, DEHP, Nonylfenol, HCH, TBT, PBDE, PFOS och PCB7 till vattenrecipienter.Betydande bidrag (>25%) till belastningen i dagvatten kommer ifrån mark inom tätorter som används till ”industri, handelsplats, grus- och sandtag, hamn och deponiverksamhet” för samtliga metaller, för nonylfenol (58%), PFOS (54%), PAH16 (40%), HCH (23%), PCB7 (23%), PBDE (22%) och oktylfenol (18%). Industri och handelsplats utgör den största arealen inom den markanvändningsklassen och bör prioriteras i det fortsatta arbetet. Industri och handelsplatser har höga typhalter och höga avrinningskoefficienter som orsakar den höga belastningen. Belastningen i dagvatten av ftalaten DEHP kommer däremot till största del ifrån ytor av ”enstaka hus, mycket grönyta” (35%), ”bostadsområde, mindre grönyta” (29%) samt ”urbant grönområde, idrottsanläggning, flygfält gräs” (25%). Markanvändningsklassen ”enstaka hus, mycket grönyta” utgör den största arealen totalt inom tätorter i Sverige (35% av arean), vilket innebär att den ytan bidrar med generellt stor belastning.Det finns stora osäkerheter i resultaten beroende bland annat på brist på mätningar av ämnen i dagvatten. Beräkningarna i denna rapport baseras på markanvändning som sammanställts av SMED till HELCOM Pollution Load Compilation (PLC7) rapporteringen, typhalter och avrinningskoefficienter inom tätorter från Stormtac databasen samt rapporterade utsläpp i miljörapporter från avloppsreningsverk och industrier i Svenska Miljörapporteringsportalen. Framförallt för organiska ämnen är dataunderlaget litet, vilket gör dessa uppskattningar mer osäkra. Utökad miljöövervakning av metaller och organiska ämnen behövs för att kunna följa trender och sätta in rätt åtgärder uppströms vid källorna och nedströms genom rening av dagvatten.Det stora antalet ämnen som har uppmätts i dagvatten och den betydande belastningen som dagvatten har beräknats bidra med, indikerar trots osäkerheterna på att miljöproblemen med dagvatten kan vara omfattande. Påverkan i form av eventuella överskridanden av miljökvalitetsnormer i recipienterna har inte kunnat beräknas inom ramen för detta projekt.
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| 6. |
- Ekbäck, Erik, et al.
(författare)
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Training for Awareness, Resilience and Action (TARA) for medical students : a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms
- 2022
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Ingår i: BMC Medical Education. - : BioMed Central (BMC). - 1472-6920. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students.Methods: We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants’ experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed.Results: The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: “An uncommon meeting-ground for personal empowerment”, with 4 themes; “Acknowledging unmet needs”, “Entering a free zone”, “Feeling connected to oneself and others” and “Expanding self-efficacy”.Conclusion: TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students’ reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.
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| 7. |
- Eriksson, Pontus, et al.
(författare)
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Urodrill - a novel MRI-guided endoscopic biopsy technique to sample and molecularly classify muscle-invasive bladder cancer without fractionating the specimen during transurethral resection
- 2023
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Ingår i: European Urology Open Science. - 2666-1691. ; 53, s. 78-82
-
Tidskriftsartikel (refereegranskat)abstract
- The current diagnostic pathway for patients with muscle-invasive bladder cancer (MIBC), which involves with computed tomography urography, cystoscopy, and transurethral resection of the bladder (TURB) to histologically confirm MIBC, delays definitive treatment. The Vesical Imaging-Reporting and Data System (VI-RADS) has been suggested for MIBC identification using magnetic resonance imaging (MRI), but a recent randomized trial reported misclassification in one-third of patients. We investigated a new endoscopic biopsy device (Urodrill) for histological confirmation of MIBC and assessment of molecular subtype by gene expression in patients with VI-RADS 4 and 5 lesions on MRI. In ten patients, Urodrill biopsies were guided by MR images to the muscle-invasive portion of the tumor via a flexible cystoscope under general anesthesia. During the same session, conventional TURB was subsequently performed. A Urodrill sample was successfully obtained in nine of ten patients. MIBC was verified in six of nine patients, and seven of nine samples contained detrusor muscle. In seven of eight patients for whom a Urodrill biopsy sample was subjected to RNA sequencing, single-sample molecular classification according to the Lund taxonomy was feasible. No complications related to the biopsy device occurred. A randomized trial comparing this new diagnostic pathway for patients with VI-RADS 4 and 5 lesions and the current standard (TURB) is warranted. Patient summary: We report on a novel biopsy device for patients with muscle-invasive bladder cancer that facilitates histology analysis and molecular characterization of tumor samples.
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| 8. |
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| 9. |
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| 10. |
- Hermansen, Anna, et al.
(författare)
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Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery : analyses of a multicenter randomized controlled trial
- 2023
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Ingår i: Physiotherapy Theory and Practice. - Philadelphia, PA, United States : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 39:4, s. 750-760
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Tidskriftsartikel (refereegranskat)abstract
- Background Dizziness and balance problems are common symptoms in patients with cervical radiculopathy. Objective To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up.Methods Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance.Results Self-reported measures improved at three months (p < 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876).Conclusion Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.
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| 11. |
- Kritzberg, Emma S., et al.
(författare)
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Browning of freshwaters : Consequences to ecosystem services, underlying drivers, and potential mitigation measures
- 2020
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Ingår i: Ambio: a Journal of the Human Environment. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 49:2, s. 375-390
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Forskningsöversikt (refereegranskat)abstract
- Browning of surface waters, as a result of increasing dissolved organic carbon and iron concentrations, is a widespread phenomenon with implications to the structure and function of aquatic ecosystems. In this article, we provide an overview of the consequences of browning in relation to ecosystem services, outline what the underlying drivers and mechanisms of browning are, and specifically focus on exploring potential mitigation measures to locally counteract browning. These topical concepts are discussed with a focus on Scandinavia, but are of relevance also to other regions. Browning is of environmental concern as it leads to, e.g., increasing costs and risks for drinking water production, and reduced fish production in lakes by limiting light penetration. While climate change, recovery from acidification, and land-use change are all likely factors contributing to the observed browning, managing the land use in the hydrologically connected parts of the landscape may be the most feasible way to counteract browning of natural waters.
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| 12. |
- Lam, Kwun, et al.
(författare)
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Larger pain extent is associated with greater pain intensity and disability but not with general health status or psychosocial features in patients with cervical radiculopathy
- 2021
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Ingår i: Medicine. - : Lippincott, Williams & Wilkins. - 0025-7974 .- 1536-5964. ; 100:8
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Tidskriftsartikel (refereegranskat)abstract
- Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy. An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy. Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01). Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.
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| 13. |
- Liew, Bernard X. W., et al.
(författare)
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Clinical predictive modelling of post-surgical recovery in individuals with cervical radiculopathy : a machine learning approach
- 2020
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- Prognostic models play an important role in the clinical management of cervical radiculopathy (CR). No study has compared the performance of modern machine learning techniques, against more traditional stepwise regression techniques, when developing prognostic models in individuals with CR. We analysed a prospective cohort dataset of 201 individuals with CR. Four modelling techniques (stepwise regression, least absolute shrinkage and selection operator [LASSO], boosting, and multivariate adaptive regression splines [MuARS]) were each used to form a prognostic model for each of four outcomes obtained at a 12 month follow-up (disability-neck disability index [NDI]), quality of life (EQ5D), present neck pain intensity, and present arm pain intensity). For all four outcomes, the differences in mean performance between all four models were small (difference of NDI<1 point; EQ5D<0.1 point; neck and arm pain<2 points). Given that the predictive accuracy of all four modelling methods were clinically similar, the optimal modelling method may be selected based on the parsimony of predictors. Some of the most parsimonious models were achieved using MuARS, a non-linear technique. Modern machine learning methods may be used to probe relationships along different regions of the predictor space.
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| 14. |
- Liew, Bernard X W, et al.
(författare)
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Probing the mechanisms underpinning recovery in post-surgical patients with cervical radiculopathy using Bayesian networks
- 2020
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Ingår i: European Journal of Pain. - : John Wiley & Sons. - 1090-3801 .- 1532-2149. ; 24:5, s. 909-920
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Rehabilitation approaches should be based on an understanding of the mechanisms underpinning functional recovery. Yet, the mediators that drive an improvement in post-surgical pain-related disability in individuals with cervical radiculopathy (CR) are unknown. The aim of the present study is to use Bayesian networks (BN) to learn the probabilistic relationships between physical and psychological factors, and pain-related disability in CR.METHODS: We analysed a prospective cohort dataset of 201 post-surgical individuals with CR. In all, 15 variables were used to build a BN model: age, sex, neck muscle endurance, neck range of motion, neck proprioception, hand grip strength, self-efficacy, catastrophizing, depression, somatic perception, arm pain intensity, neck pain intensity and disability.RESULTS: A one point increase in a change of self-efficacy at 6 months was associated with a 0.09 point decrease in a change in disability at 12 months (t = -64.09, p < .001). Two pathways led to a change in disability: a direct path leading from a change in self-efficacy at 6 months to disability, and an indirect path which was mediated by neck and arm pain intensity changes at 6 and 12 months.CONCLUSIONS: This is the first study to apply BN modelling to understand the mechanisms of recovery in post-surgical individuals with CR. Improvements in pain-related disability was directly and indirectly driven by changes in self-efficacy levels. The present study provides potentially modifiable mediators that could be the target of future intervention trials. BN models could increase the precision of treatment and outcome assessment of individuals with CR.SIGNIFICANCE: Using Bayesian Network modelling, we found that changes in self-efficacy levels at 6-month post-surgery directly and indirectly influenced the change in disability in individuals with CR. A mechanistic understanding of recovery provides potentially modifiable mediators that could be the target of future intervention trials.
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| 15. |
- Löfgren, Charlotta, 1961-, et al.
(författare)
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Changes in Intimacy and Sexuality During the COVID-19 Pandemic : A Qualitative Analysis of Data from a Survey on Partnered Individuals in Eight European Countries
- 2023
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Ingår i: Sexuality & Culture. - : Springer. - 1095-5143 .- 1936-4822. ; 27:2, s. 693-714
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Tidskriftsartikel (refereegranskat)abstract
- This qualitative study explores experiences of intimacy and sexuality during the first phase of the COVID-19 pandemic of 3357 participants from Croatia, the Czech Republic, the Netherlands, France, Germany, Portugal, Sweden, and Turkey. Data were collected through open-ended questions within a survey on sexuality during the pandemic. Based on a reflexive thematic analysis three themes occurred. The first theme No change was described by 41% when summarizing their sex life during the pandemic. The second theme Positive change was experienced by 25%, and the third theme Negative change by 21%. An overarching theme then emerged as: "Still the same trajectories, but the pandemic could be a catalyst for improved or worsened sex- life." For those intimate partnered individuals who already had problems with intimacy and sexuality before the COVID-19 pandemic it seemed to remain the same or deteriorated throughout the pandemic. For those with positive experiences of intimacy and sexuality before the COVID-19 pandemic it remained the same or improved throughout the pandemic. These findings are relevant for researchers and clinicians in developing preventive and supportive interventions in the context of crisis and social isolation.
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| 16. |
- Löfgren, Johanna
(författare)
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Engineering of Candida antarctica Lipase A and B
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In organic chemistry, it is often desirable to have an efficient process yieldingpure product and not too much waste. When applicable, it is also desirable tohave a high enantioselective outcome. Enzymes are often displaying high regio-,chemo- and stereoselectivity. Furthermore, they are biodegradable, and theywork under mild conditions regarding temperature and solvent. Using enzymesas catalysts in organic synthesis is therefore an attractive approach.Enzymes have evolved over thousands of years to catalyze specific reactionsand they therefore often have a quite specific substrate scope. It is not alwayspossible to find the exact match between the desired reaction and an enzyme.Furthermore, reaction conditions such as high temperatures, the need of organicsolvents, or the substrate might be non-compatible with the enzyme. Directedevolution and protein engineering have been developed as methods forintroducing changes in already existing enzymes. By changing the genotype ofan enzyme, new enzyme variants can be obtained that are able to perform newreactions, tolerate new reaction conditions, and accepting a broader scope ofsubstrates. Immobilization of enzymes is also a strategy that has proven toincrease the stability and performance of an enzyme, allowing the use of highertemperatures and organic solvents.In this thesis, two lipases from Candida antarctica, denoted Lipase A (Cal A)and Lipase B (Cal B), have been studied. For both lipases, protein engineeringhas been used in order to improve the enzymes regarding activity andenantioselectivity for applications in organic synthesis.In the first part, a semi-rational protein engineering approach was used to createa highly condensed combinatorial library of Cal A variants for resolution ofchiral tertiary alcohols. Tertiary alcohols are sterically demanding substrates,and only a few reports of enzymes being active towards them are known.Exploring new enzyme variants that show activity towards tertiary alcohols istherefore of importance. To improve wild-type Cal A, seven positions in theactive site of Cal A were chosen and simultaneously altered. In the library, avariant with one single mutation was found to have promising activity. Thisvariant showed retained enantioselectivity and a 10-fold increase in activity(rate) towards the target tertiary alcohol.The second part consists of a study aiming at reversing the enantioselectivity ofCal B towards secondary alcohols with long alkyl chains. Also here, acondensed and highly combinatorial library was created where a cavity was constructed in the enzyme active site. This project is still ongoing, with the aimof finding a high performing Cal B variant.
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| 19. |
- Löfgren, Orvar, et al.
(författare)
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Pendler und Vaganten
- 2012
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Ingår i: Das Figurativ der Vagabondage. - 9783837620573 ; , s. 99-110
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Bokkapitel (refereegranskat)
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| 20. |
- Manni, Annika, 1971-, et al.
(författare)
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Discourses of outdoor play at new modern preschools
- 2022
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Ingår i: Conference proceedings. ; , s. 50-50
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Konferensbidrag (refereegranskat)abstract
- This study is part of a larger research project with the aim with to study how the outdoor environment and playgrounds affects children's physical activities and relational encounters with nature and peers. Previous research has shown the benefits of children's outdoor play in domains like; health, environmental engagement and care, as well as learning and meaning making. Preschool policy and practice is constantly balancing and combining school-like concepts and play (Pramling Samuelsson & Johansson, 2007). This study uses John Dewey's holistic and pragmatic perspective to study and analyse different notions of relational and experiential learning activities outdoors. In this particular study we have analyzed the interviews with teachers from 21 new and old preschools. A discourse analysis was carried out to uncover the different notions within different domains of outdoor play. The study is ethically motivated since it contributes knowledge about childrens' conditions in preschool in a time of change. The project has ethical approval for all steps of research. The findings show how the new preschool playgrounds has changed the use of the outdoor environments, the view on the preschool practice, and children in itself. There are more regulations on what children can or cannot do, as well as a strengthened focus on targeted learning in programmed areas. Potential risky-play are eliminated, and natural green areas are replaced either with artificial material or garden-like plants. The analyses open up for a critical discussion on what these changes in the modern preschools might mean for children of today.
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| 21. |
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| 22. |
- Manni, Annika, 1971-, et al.
(författare)
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Places, spaces and encounters with nature–socio-material discourses in Swedish preschools
- 2024
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Ingår i: International Journal of Early Years Education. - : Routledge. - 0966-9760 .- 1469-8463.
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Tidskriftsartikel (refereegranskat)abstract
- This article investigates views and discourses on outdoor play in preschool teachers talks about their playgrounds and outdoor practices in Swedish preschools. Included were a strategic sample of teachers from newer, larger preschool facilities with more programmed outdoor space, and teachers from older, more traditional facilities containing more nature. Through interviews with 38 teachers at 21 preschools and a thematic analysis inspired by socio-material theory, we identified three main themes: The meanings and limits of free outdoor play, the view on nature and children’s encounters with nature,and dangers and risks in the playground. Within these themes, we show how the teachers’ views construct discourses related to the outdoor educational places and spaces that are available. Furthermore, changes in preschool curricula as well as in the playground material and design are active agents in constructing discourses on outdoor play, including risks and limitations, beyond teachers’ own beliefs on children’s needs.
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| 23. |
- Peolsson, Anneli, 1967-, et al.
(författare)
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Neurological outcomes after surgery and postoperative rehabilitation for cervical radiculopathy due to disc disease: a 2-year-follow-up of a randomized clinical trial
- 2023
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Ingår i: Scientific Reports. - : NATURE PORTFOLIO. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Reports on neurological outcomes in patients with cervical radiculopathy (CR) undergoing surgery and postoperative rehabilitation are important to inform prognosis. This 2-year-follow-up of a randomized clinical trial aimed to compare secondary neurological outcomes between structured postoperative rehabilitation and a standard approach after surgery for CR. A secondary aim was to increase knowledge about recovery of neurological impairments in relation to patient-reported neck disability. Neurological outcomes included assessment of sensibility, motor function, arm reflexes and the Spurling test. A total of 153 and 135 participants (>70% response rate) completed the clinical examination. Between-group differences, changes over time, and associations between persistent neurological impairments and the Neck Disability Index were investigated. No between-group differences were reported (p>0.07), and neurological impairments in sensibility, motor function, and a positive Spurling test decreased over time in both groups (p<0.04). Persistent impairments in sensibility and reflex arm were most frequent at follow-up, whereas, a persistent positive Spurling test, and impairments in motor function were associated with higher NDI score. Neurological outcomes improved over time in patients undergoing surgery for CR with no between-group differences., However, persistent neurological impairments were common, and associated with poorer outcome for patient-reported neck disability.Clinical registration: clinicaltrial.gov NCT01547611, 08/03/2012, Title: Outcome of physiotherapy after surgery for cervical disc disease: a prospective multi-centre trial.
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| 24. |
- Peolsson, Anneli, et al.
(författare)
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Postoperative structured rehabilitation in patients undergoing surgery for cervical radiculopathy: a 2-year follow-up of a randomized controlled trial
- 2019
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Ingår i: Journal of Neurosurgery. - : AMER ASSOC NEUROLOGICAL SURGEONS. - 1547-5654 .- 1547-5646. ; 31:1, s. 60-69
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Information about postoperative rehabilitation for cervical radiculopathy (CR) is scarce. The aim of this study was to investigate the additional benefits of structured postoperative rehabilitation (SPT), which was performed in all patients, compared with a pragmatic standard postoperative approach (SA), in which rehabilitation was used as needed and patients sought physiotherapy on their own without a referral, in patients with MRI evidence of disc herniation and concomitant clinical signs who underwent surgery for CR. METHODS Patients (n = 202) were randomized to receive SPT or SA. Included key variables in the present study were primary and selected secondary outcomes of a prospective randomized controlled multicenter study. The main outcome was the Neck Disability Index (NDI) score. The NDI score, pain variables, self-efficacy, and health-related quality of life were investigated at baseline and 3, 6, 12, and 24 months postoperatively. RESULTS SPT provided no additional benefits over SA (p = 0.08 to p = 0.99) at the postoperative 2-year follow-up. Both groups improved over time (p amp;lt; 0.0001), with no reported adverse effects. CONCLUSIONS One can conclude that SPT offered no additional benefits over SA; however, patients tolerated postoperative neck exercises without any negative side effects. These findings are important for the development of future active and neck-specific post-operative rehabilitation interventions for patients with CR.
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| 25. |
- Peolsson, Anneli, et al.
(författare)
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Work Ability After Anterior Cervical Decompression and Fusion Followed by a Structured Postoperative Rehabilitation : Secondary Outcomes of a Prospective Randomized Controlled Multi-Centre Trial with a 2-year Follow-up
- 2022
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Ingår i: Journal of occupational rehabilitation. - : Springer / Plenum. - 1053-0487 .- 1573-3688. ; 32:3, s. 473-482
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Information on work ability after ACDF and postoperative rehabilitation is lacking. The aim of the present study is therefore to investigate the work ability benefits of a structured postoperative treatment (SPT) over a standard care approach (SA) in patients who underwent anterior cervical decompression and fusion (ACDF) for cervical radiculopathy and factors important to the 2-year outcome. Methods Secondary outcome and prediction model of a prospective randomized controlled multi-centre study with a 2-year follow-up (clinicaltrials.gov NCT01547611). The Work Ability Index (WAI) and Work Ability Score (WAS) were measured at baseline and up to 2 years after ACDF in 154 patients of working age who underwent SPT or SA after surgery. Predictive factors for the WAI at 2 years were analysed. Results Both WAI and WAS significantly improved with SPT and SA (p < 0.001), without any between-group differences. Thoughts of being able to work within the next 6 months, Neck Disability Index (NDI), and work-related neck load explained 59% of the variance in WAI at the 2-year follow-up after ACDF. Conclusions Patients improved over time without group differences, suggesting the improvement to be surgery related. Expectation to work within the next 6 months, self-reported neck functioning and work-related neck load were important to work ability and are central factors to ask early after ACDF, to identifying further interventions promoting return to work.
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| 26. |
- Stark, Lisa
(författare)
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Staphylococcus aureus : aspects of pathogenesis and molecular epidemiology
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Staphylococcus aureus is a human commensal colonizing about 30 per cent of the population. Besides, it is a frequent cause of infections such as skin, wound and deep tissue infections and also more life-threatening conditions such as pneumonia, endocarditis and septicaemia. S. aureus may also cause different toxicoses. Moreover, this bacterium is one of the most common causes of nosocomial infections worldwide and an increase in antibiotic resistance, especially against methicillin, is seen. This underlines the importance to prevent and control outbreaks of S. aureus. The aims of this thesis were to increase the knowledge of S. aureus virulence and pathogenesis as well as to understand pattern of colonization and transmission.Various virulence factors operate together in the pathogenic process of S. aureus. The virulence of S. aureus was studied by the interaction with human umbilical vein endothelial cells (HUVEC) as a model. In paper I, we found that one bacterial isolate survived intracellularly and that 156 genes were differentially regulated in microarray analysis of HUVEC. The major part of these genes coded for proteins involved in innate immunity. In paper II, we wanted to explore possible differences in global gene expression patterns in HUVEC induced by invasive compared to colonizing isolates of S. aureus. We also used microarray to investigate possible differences in the presence of virulence genes between the two groups. The main finding was that virulent and commensal S. aureus did not differ in interaction with HUVEC and in the presence of virulence genes. All isolates survived intracellularly for days.Since no obvious differences in virulence between the two groups of isolates were found, we focused on epidemiology and transmission patterns. Colonization with S. aureus is an important risk factor for subsequent S. aureus infection. In paper III, we investigated S. aureus colonization and transmission among nursing home residents in three regions in the south of Sweden and used staphylococcal protein A (spa) typing as an epidemiological tool. A diverse distribution of different spa types was found and a majority of types were unique to one individual. Interestingly, we found a local accumulation of one spa type in one nursing home. Also common spa types were equally distributed in the different regions. We also noted that some individuals were colonized with two different spa types of S. aureus and in five of these cases there was one resistant and one non-resistant strain.The issue of multiclonal colonization and infection is highly important and clinical diagnostic laboratories do not routinely address this problem. Therefore, in paper IV a novel method to assess multiclonality of S. aureus was developed. It was based on denaturing gradient gel electrophoresis with the amplification of the spa gene. The method simultaneously separated eight different spa types. It also detected two spa types in an outbreak.In conclusion, we found no differences in virulence genes and in the interaction with HUVEC between commensal and invasive isolates. This indicates that any isolate of S. aureus might have a pathogenic potential. We also confirmed that some spa types are more successful colonizers with a potential to nosocomial spread. The method for detection of multiclonality of S. aureus is of importance in future epidemiological and clinical studies.
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| 27. |
- Stulhofer, Aleksandar, et al.
(författare)
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Perceived Changes in Sexual Interest and Distress About Discrepant Sexual Interest During the First Phase of COVID-19 Pandemic : A Multi-Country Assessment in Cohabiting Partnered Individuals
- 2022
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Ingår i: Archives of Sexual Behavior. - : Springer. - 0004-0002 .- 1573-2800. ; 51, s. 231-246
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Tidskriftsartikel (refereegranskat)abstract
- Due to COVID-19 pandemic, different restrictive measures in terms of physical distancing and lockdowns have been introduced in most European countries, affecting all facets of social life. Currently, little is known about how partnered individuals perceive changes in their sexual life during this complex emergency. This study explored retrospectively assessed changes in sexual interest for one's partner and levels of distress related to perceived sexual interest discrepancy during the first phase of the pandemic in a large-scale online sample of partnered individuals (n = 4813; M-age = 38.5 years, SD = 10.74) recruited between May and July 2020 in seven European Union countries and Turkey. We also examined the possible role of approach/avoidance motives for sex in reported changes in sexual interest and associated distress. Most participants (53%) reported no change in their sexual interest during the pandemic, followed by those who reported an increase (28.5%). The pattern was similar across the eight countries. Distress about discrepant sexual interest, which was only weakly related to changes in sexual interest, was significantly associated with relationship quality and emotional closeness with a partner, coping with and worrying about the pandemic, and specific motivation for sex. In contrast to avoidant and relationship-focused approach motivation, ego-focused approach motivation was related to stable sexual interest during the pandemic. The current study contributes to the understanding of the link between sexual interest and complex emergencies. Considering that the COVID-19 pandemic continues, the reported experiences and perceptions are prone to change.
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| 28. |
- Svensson, Jard, et al.
(författare)
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Neck-Related Headache in Patients With Cervical Disc Disease After Surgery and Physiotherapy A 1-Year Follow-up of a Prospective Randomized Study
- 2020
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Ingår i: Spine. - : Lippincott Williams & Wilkins. - 0362-2436 .- 1528-1159. ; 45:14, s. 952-959
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Tidskriftsartikel (refereegranskat)abstract
- Study Design. A prospective randomized multicenter trial. Objective. To investigate the effects of surgery with either structured postoperative physiotherapy or standard postoperative approach on neck-related headache in patients with cervical radiculopathy. Secondary, to investigate associations between change in neck-related headache and change in neck muscle endurance, neck mobility, or neck pain. Summary of Background Data. The effect of physiotherapy on individuals with neck-related headache after surgery for cervical radiculopathy due to magnetic resonance imaging-verified disc disease is unknown. Methods. One hundred six patients with neck-related headache and participating in a randomized controlled trial evaluating the additional effects of physiotherapy after surgery for cervical radiculopathy were included. Patients were randomized preoperatively to structured postoperative physiotherapy (n = 51) or the standard postoperative approach (n = 55). Outcome measures were headache intensity and neck pain intensity, neck muscle endurance, and neck mobility. Measures were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results. Headache intensity significantly changed from baseline to 1 year postoperatively (P < 0.001) in both groups.Post-hoctests showed a significant difference between baseline and 6 weeks (P <= 0.05). No significant differences were found between groups (P > 0.05) or between-group differences in changes over time (P > 0.05). The change in current headache intensity over time was associated with a change in current neck pain intensity over time (P = 0.003, beta = 0.40). Conclusion. There was a significant improvement in headache intensity 1 year postoperatively in patients with cervical radiculopathy and neck-related headache, but there were no differences between groups over time. Change in current headache intensity was only associated with a change in current neck pain intensity.
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| 29. |
- Thorsheim, Karin, et al.
(författare)
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Synthesis and biology of oligoethylene glycol linked naphthoxylosides.
- 2013
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Ingår i: Bioorganic & Medicinal Chemistry. - : Elsevier BV. - 0968-0896. ; 21:11, s. 3310-3317
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Tidskriftsartikel (refereegranskat)abstract
- Proteoglycans (PGs) are important macromolecules in mammalian cells, consisting of a core protein substituted with carbohydrate chains, known as glycosaminoglycans (GAGs). Simple xylosides carrying hydrophobic aglycons can enter cells and act as primers for GAG chain synthesis, independent of the core protein. Previously it has been shown that aromatic aglycons can be separated from the sugar residue by short linkers without affecting the GAG priming ability. To further investigate the effects of the xylose-aglycon distance on the GAG priming ability, we have synthesized xyloside derivatives with 2-naphthyl and 2-(6-hydroxynaphthyl) moieties connected to xylose, directly, via a methylene bridge, or with oligoethylene glycol linkers of three different lengths. The GAG priming ability and the antiproliferative activity of the xylosides, as well as the composition of the xyloside-primed GAG chains were investigated in a matched pair of human breast fibroblasts and human breast carcinoma cells. An increase of the xylose-aglycon distance from 0.24 to 0.37nm resulted in an increased GAG priming ability in both cell lines. Further increase of the xylose-aglycon distance did not result in any pronounced effects. We speculate that by increasing the xylose-aglycon distance, and thereby the surface area of the xyloside, to a certain level would make it more accessible for enzymes involved in the GAG synthesis. The compositions of the primed GAG chains varied with different xylosides, independent of the xylose-aglycon distance, probably due to various affinities for enzymes and/or different cellular uptake. Furthermore, no correlations between the antiproliferative activities, the xylose-aglycon distances, and the amounts or compositions of the GAG chains were detected suggesting involvement of other factors such as fine structure of the GAG chains, effects on endogenous PG synthesis, or other unknown factors for the antiproliferative activity.
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| 30. |
- Wibault, Johanna, et al.
(författare)
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Individual factors associated with neck disability in patients with cervical radiculopathy scheduled for surgery : A study on physical impairments, psychosocial factors, and life style habits
- 2014
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 23:3, s. 599-605
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The influence of individual factors on patient-reported outcomes is important in the interpretation of disability and treatment effectiveness. The purpose of this study was to assess how physical impairments, psychosocial factors, and life style habits were associated with neck disability based on the Neck Disability Index (NDI), in patients with cervical radiculopathy scheduled for surgery. Methods: This cross-sectional study included 201 patients (105 men, 96 women; mean age 50 years). Data included self-reported measures and a clinical examination. Multiple linear regressions were performed to identify significant influencing factors. Results: Pain, physical impairments in the cervical active range of motion, low self-efficacy, depression, and sickness-related absences explained 73 % of the variance in NDI scores (p < 0.001). Conclusion: Assessments of physical impairments and psychosocial factors in patients with cervical radiculopathy could improve the description of neck disability and the interpretation of treatment outcomes in longitudinal studies.
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| 31. |
- Wibault, Johanna, 1978-
(författare)
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Neck disability in patients with cervical radiculopathy and evaluation of structured postoperative physiotherapy
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Non-surgical and surgical approaches to treatment are used in patients with cervical radiculopathy (CR) due to disc disease. Overall, good effects of surgery have been reported on arm pain and neurological symptoms. However, the effects on neck functioning are more uncertain. Studies have shown persistent activity limitations; participation restrictions; and impairments in neck-related body functions after surgery. Structured physiotherapy combining neck-specific exercises with a behavioural approach has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with CR. Randomized clinical trials of postoperative physiotherapy to inform evidence-based clinical guidelines for the treatment of patients with CR are lacking.The overall aim of the thesis was to investigate the additional benefit of structured postoperative physiotherapy combining neck-specific exercises with a behavioural approach compared to standard postoperative approach in patients with CR. A further aim was to evaluate the contribution of different aspects of neck-related body functions and mental functions on preoperative neck disability in these patients.A total of 202 patients with CR who were scheduled for surgery were recruited, and randomized preoperatively to either structured postoperative physiotherapy, or standard postoperative approach. Standard postoperative approach was in accordance with Swedish postoperative care, and may have included pragmatic physiotherapy after surgery when needed. Patients were evaluated with a set of questionnaires and clinical examinations before surgery and at 3 and 6 months after surgery. Outcomes included patient-reported measures of pain, neck functioning, global outcome, clinical evaluation of neckrelated body functions, self-efficacy and coping strategies, as well as expectation fulfilment and enablement. Differences between treatment groups were investigated in complete case and per-protocol approaches (Paper III & IV). A sub-sample of patients with CR who were scheduled for surgery were also compared with neck-healthy individuals for assessment of head repositioning accuracy with a cervical range of motion device (Paper I). In patients with CR who were scheduled for surgery, associations between preoperative measures of neck-related body functions, mental functions, and other contextual factors with patientreported neck disability were studied (Paper II).With the exception of greater expectation fulfilment in patients who received structured postoperative physiotherapy (p = 0.01), there were no differences between the treatment groups in outcomes at 6 months after surgery. There were no differences reported for changes in outcomes from before surgery to 6 months after surgery between the groups, but all outcomes significantly improved from baseline in both groups (p<0.001) (Paper III & IV). However, global outcome and frequency of neck pain improved during the postoperative period only in patients who received structured postoperative physiotherapy (p< 0.01) (Paper III). Six months after surgery, patients with at least 50% attendance to treatment sessions in the structured postoperative physiotherapy group reported less neck pain frequency (p = 0.05), and greater expectation fulfilment (p = 0.001), and enablement (p = 0.04) than those who received standard postoperative approach. These patients also had larger improvements in neck functioning, arm pain and catastrophizing during the rehabilitation period from 3 to 6 months after surgery (p< 0.03). Sixty-one percent of the patients who received standard postoperative approach reported additional use ofpostoperative physiotherapy. These patients had a worse surgical outcome compared with patients who reported no additional use of postoperative physiotherapy. In patients with CR who were scheduled for surgery, larger errors in head repositioning accuracy were found compared to neck-healthy individuals (Paper I). Preoperative measures of neck-related body functions, mental functions and other contextual factors explained 73% of the variance in Neck Disability Index scores in patients with CR who were scheduled for surgery (Paper II).The results may suggest a benefit from combining surgery with structured postoperative physiotherapy in patients with CR. Moreover, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery. However, CR is a heterogeneous condition and specific subgroups of patients are likely to benefit from different interventions. More studies are needed to inform evidence-based clinical guidelines for the treatment of patients with CR. A broader preoperative assessment in patients with CR improved the description of patient-reported neck disability.
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| 32. |
- Wibault, Johanna, et al.
(författare)
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Neck-related physical function, self-efficacy and coping strategies in patients with cervical radiculopathy : a randomized clinical trial of postoperative physiotherapy
- 2017
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Ingår i: Journal of Manipulative and Physiological Therapeutics. - : Elsevier BV. - 0161-4754 .- 1532-6586. ; 40:5, s. 330-339
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare postoperative rehabilitation with structured physiotherapy to standard approach in patients with cervical radiculopathy (CR) based on measures of neck-related physical function, self-efficacy and coping strategies at 6 months follow-up.Design: A randomized clinical trial of postoperative physiotherapy in patients with CR.Subjects: Patients (n= 202) with persistent CR who were scheduled for surgery.Methods: Patients were preoperatively randomized to receive structured postoperative physiotherapy (SPT, n=101) or standard postoperative approach (SA, n=101). SPT combined neck-specific exercises with a behavioral approach. Baseline, 3-month, and 6-month evaluations included questionnaires and clinical examinations. Neck muscle endurance, active cervical range of motion, self-efficacy, pain catastrophizing (CSQ_CAT), perceived control over pain, and ability to decrease pain were analyzed for between-group differences using complete case and per-protocol approaches.Results: No between-group difference was reported at the 6-month follow-up (p = 0.05 to 0.99), but all outcomes had improved from baseline (p<0.001). Patients in the SPT group with ≥50% attendance to treatment sessions showed larger improvements in CSQ_CAT (p= 0.04) during the rehabilitation period from 3 to 6 months after surgery compared to the patients who received SA.Conclusion: No between-group difference in outcomes was found at 6 months after surgery based on measures of neck-related physical function, self-efficacy and coping strategies. However, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery, and that there may be a benefit from combining surgery with structured postoperative physiotherapy in patients with CR.
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| 33. |
- Wibault, Johanna, et al.
(författare)
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Structured postoperative physiotherapy in patients with cervical radiculopathy : 6-month outcomes of a randomized clinical trial
- 2018
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Ingår i: Journal of Neurosurgery: Spine. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 28:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the additional benefit of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to standard postoperative approach in patients with cervical radiculopathy (CR) at 6 months after surgery.Design: A prospective multi-center randomized clinical trial.Subjects: Patients with CR (n=202, mean age 50.0, SD 8.4) who were scheduled for surgery.Methods: Patients were randomized pre-operatively to structured postoperative physiotherapy (n=101) or standard approach (n=101) which in accordance with Swedish usual care may have included pragmatic physiotherapy after surgery when needed. Outcome measures at baseline and at 3 and 6 months follow-up included the Neck Disability Index (NDI), pain intensity in the neck and arm measured with a visual analogue scale (VAS) and global outcome of treatment. Between-group differences were investigated using complete case and per-protocol approaches.Results: No between-group difference was found in NDI, VAS, or global outcome at 6 months after surgery (p> 0.18). The NDI and VAS neck and arm pain were improved in both groups from before surgery to 6 months after surgery (p< 0.001). Sixty-one percent of the patients who received SA reported additional use of postoperative physiotherapy. Global outcome improved during the postoperative period in patients who received structured postoperative physiotherapy only (p< 0.01).Conclusions: No additional benefit of structured postoperative physiotherapy compared to standard postoperative approach was found at 6 months of follow-up based on patientreported measures of pain, neck disability and global outcome. However, many patients with CR perceived a need for additional treatments after surgery; and the results may suggest a benefit from combining surgery with structured postoperative physiotherapy in patients with CR. Moreover, the results confirm that neck-specific exercises are tolerated by patients with CR after surgery.
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