Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
Refine search result
1234 1 - 50 of 165
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Abacan, MaryAnn
    et al.
    Univ Philippines Manila, Inst Human Genet, NIH, Manila, Philippines.
    Alsubaie, Lamia
    KASCH, King Abdulaziz Med City, Riyadh, Saudi Arabia.
    Barlow-Stewart, Kristine
    Univ Sydney, Fac Med & Hlth, Northern Clin Sch, Sydney, NSW, Australia.
    Caanen, Beppy
    Maastricht Univ, Dept Clin Genet, Med Ctr, Maastricht, Netherlands.
    Cordier, Christophe
    SYNLAB Genet, Dept Genet, Lausanne, Switzerland.
    Courtney, Eliza
    Natl Canc Ctr, Div Med Oncol, Canc Genet Serv, Singapore, Singapore.
    Davoine, Emeline
    Lausanne Univ Hosp CHUV, Lausanne, Switzerland.
    Edwards, Janice
    Univ South Carolina, Genet Counseling Program, Transnat Alliance Genet Counseling, Columbia, SC USA.
    Elackatt, Niby J.
    Cloudnine Hosp, Org Rare Dis India, Bangalore, Karnataka, India.
    Gardiner, Kate
    LifeLabs Genet, Toronto, ON, Canada.
    Guan, Yue
    Emory Univ, Rollins Sch Publ Hlth, Atlanta, GA USA.
    Huang, Lian-Hua
    China Med Univ, Sch Nursing, Taichung, Taiwan;Natl Taiwan Univ, Coll Med, Sch Nursing, Taipei, Taiwan.
    Ingvoldstad, Charlotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Univ Hosp, Ctr Fetal Med & Clin Genet, Stockholm, Sweden;Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Kejriwal, Sahil
    Univ Washington, Inst Publ Hlth Genet, Seattle, WA USA.
    Kim, Hyon J.
    Ajou Univ, Med Sch, Suwon, South Korea;Konyang Univ, Grad Sch, Suwon, South Korea.
    Lambert, Deborah
    Natl Rare Dis Off, Dublin, Ireland.
    Lantigua-Cruz, Paulina Araceli
    Univ Med Sci Havana, Havana, Cuba.
    Lee, Juliana M. H.
    Natl Univ Malaysia, Kuala Lumpur, Malaysia.
    Lodahl, Marianne
    Copenhagen Univ Hosp, Rigshosp, Dept Clin Genet, Copenhagen, Denmark.
    Lunde, Ashild
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Macaulay, Shelley
    Univ Witwatersrand, Fac Hlth Sci, Div Human Genet, Johannesburg, South Africa;Natl Hlth Lab Serv, Johannesburg, South Africa.
    Macciocca, Ivan
    Victorian Clin Genet Serv, Melbourne, Vic, Australia.
    Margarit, Sonia
    Clin Alemana Univ Desarrollo, Fac Med, Ctr Genet & Genom, Santiago, Chile.
    Middleton, Anna
    Soc & Eth Res Connecting Sci, Wellcome Genome Campus, Cambridge, England;Univ Cambridge, Fac Educ, Cambridge, England.
    Moldovan, Ramona
    Babes Bolyai Univ, Dept Psychol, Cluj Napoca, Romania.
    Ngeow, Joanne
    Natl Canc Ctr, Div Med Oncol, Canc Genet Serv, Singapore, Singapore.
    Obregon-Tito, Alexandra J.
    Univ Arkansas Med Sci, Little Rock, AR 72205 USA.
    Ormond, Kelly E.
    Stanford Univ, Sch Med, Dept Genet, Stanford, CA USA;Stanford Univ, Sch Med, Stanford Ctr Biomed Eth, Stanford, CA USA;Stanford Univ, Sch Med, 300 Pasteur Dr,MC 5208, Stanford, CA USA.
    Paneque, Milena
    Univ Porto, CGPP Ctr Predict & Prevent Genet, I3S, Porto, Portugal;Univ Porto, IBMC Inst Mol & Cell Biol, Porto, Portugal.
    Powell, Karen
    Cone Hlth Canc Ctr, Greensboro, NC USA.
    Sanghavi, Kunal
    Jackson Lab Genom Med, Farmington, CT USA.
    Scotcher, Diana
    Manchester Univ Hosp NHS Fdn Trust, St Marys Hosp, Manchester Ctr Genom Med, Manchester, Lancs, England.
    Scott, Jenna
    Univ British Columbia, Vancouver, BC, Canada.
    Juhe, Clara Serra
    Univ Pompeu Fabra, Dept Ciencies Expt & Salut, Inst Hosp Mar Invest Med, Ctr Invest Biomed Red Enfermedades Raras, Barcelona, Spain.
    Shkedi-Rafid, Shiri
    Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel.
    Wessels, Tina-Marie
    Univ Cape Town, Div Human Genet, Cape Town, South Africa.
    Yoon, Sook-Yee
    Natl Univ Malaysia, Kuala Lumpur, Malaysia;Canc Res, Subang Jaya, Malaysia;Univ Malaya, Med Ctr, Kuala Lumpur, Malaysia.
    Wicklund, Catherine
    Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA.
    The Global State of the Genetic Counseling Profession2019In: European Journal of Human Genetics, ISSN 1018-4813, E-ISSN 1476-5438, Vol. 27, no 2, p. 183-197Article, review/survey (Refereed)
    Abstract [en]

    The profession of genetic counseling (also called genetic counselling in many countries) began nearly 50 years ago in the United States, and has grown internationally in the past 30 years. While there have been many papers describing the profession of genetic counseling in individual countries or regions, data remains incomplete and has been published in diverse journals with limited access. As a result of the 2016 Transnational Alliance of Genetic Counseling (TAGC) conference in Barcelona, Spain, and the 2017 World Congress of Genetic Counselling in the UK, we endeavor to describe as fully as possible the global state of genetic counseling as a profession. We estimate that in 2018 there are nearly 7000 genetic counselors with the profession established or developing in no less than 28 countries.

    Download full text (pdf)
    fulltext
  • 2. Abrahams, Harriët J. G.
    et al.
    Knoop, Hans
    Schreurs, Maartje
    Aaronson, Neil K.
    Jacobsen, Paul B.
    Newton, Robert U.
    Courneya, Kerry S.
    Aitken, Joanne F.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Brandberg, Yvonne
    Chambers, Suzanne K.
    Gielissen, Marieke F. M.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Goedendorp, Martine M.
    Graves, Kristi D.
    Heiney, Sue P.
    Horne, Rob
    Hunter, Myra S.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Northouse, Laurel L.
    Oldenburg, Hester S. A.
    Prins, Judith B.
    Savard, Josée
    van Beurden, Marc
    van den Berg, Sanne W.
    Verdonck-de Leeuw, Irma M.
    Buffart, Laurien M.
    Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer: Individual patient data meta-analyses2020In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 29, no 11, p. 1772-1785Article, review/survey (Refereed)
    Abstract [en]

    Objective

    Psychosocial interventions can reduce cancer‐related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta‐analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention‐related characteristics on the effect of psychosocial interventions on cancer‐related fatigue in patients with non‐metastatic breast and prostate cancer.

    Methods

    Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta‐analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed‐effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008).

    Results

    Statistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: β = −0.19 [95% confidence interval (95%CI) = −0.30; −0.08]; prostate cancer: β = −0.11 [95%CI = −0.21; −0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention‐related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (β = −0.27 [95%CI = −0.40; −0.15]), fatigue‐specific interventions (β = −0.48 [95%CI = −0.79; −0.18]), and interventions that only targeted patients with clinically relevant fatigue (β = −0.85 [95%CI = −1.40; −0.30]).

    Conclusions

    Our findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue.

  • 3.
    Ahmad, Awais
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division Vi3.
    Premanandan, Shweta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Informatics and Media.
    Langegård, Ulrica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine.
    Cajander, Åsa
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division Vi3.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    Carlsson, Maria E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Positive Design Framework for Carer-eSupport: A Qualitative Study to Support Informal Caregivers of Patients with Head and Neck Cancer in Sweden2023In: JMIR Cancer, E-ISSN 2369-1999, Vol. 9, article id e45748Article in journal (Refereed)
    Abstract [en]

    Background: Informal caregivers of patients with head and neck cancer (HNC), such as the patient’s spouse, other close relatives, or friends, can play an important role in home-based treatment and health care. Research shows that informal caregivers are usually unprepared for this responsibility and need support with taking care of patients and other daily life activities. These circumstances place them in a vulnerable position, and their well-being may be compromised. This study is part of our ongoing project Carer eSupport, which aims to develop a web-based intervention to facilitate informal caregivers in the home environment.

    Objective: This study aimed to explore the situation and context of informal caregivers of patients with HNC and their needs for designing and developing a web-based intervention (Carer eSupport). In addition, we proposed a novel framework for the development of a web-based intervention aimed at promoting the well-being of informal caregivers. Methods: Focus groups were conducted with 15 informal caregivers and 13 healthcare professionals. Both informal caregivers and healthcare professionals were recruited from 3 university hospitals in Sweden. We adopted a thematic data analysis process to analyze the data.

    Results: We investigated informal caregivers’ needs, critical factors for adoption, and desired functionalities of Carer eSupport.A total of 4 major themes, including information, web-based forum, virtual meeting place, and chatbot, emerged and were discussed by informal caregivers and health care professionals for Carer eSupport. However, most study participants did not like the idea of a chatbot for asking questions and retrieving information and expressed their concerns such as a lack of trust in robotic technologies and missing human contact while communicating with chatbots. The results from the focus groups were discussed through the lens of positive design research approaches.

    Conclusions: This study provided an in-depth understanding of informal caregivers’ contexts and their preferred functions for a web-based intervention (Carer eSupport). Using the theoretical foundation of designing for well-being and positive design in the informal caregiving context, we proposed a positive design framework to support informal caregivers’ well-being. Our proposed framework might be helpful for human-computer interaction and user experience researchers to design meaningful health interventions with a clear focus on users’ well-being and positive emotions, especially for informal caregivers of patients with HNC.

    Download full text (pdf)
    fulltext
  • 4. Andersen, Janice
    et al.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Sandberg, Sverre
    Illness Perception and Psychological Distress in Persons with Porphyria Cutanea Tarda2016In: Acta Dermato-Venereologica, ISSN 0001-5555, E-ISSN 1651-2057, Vol. 96, no 5, p. 674-678Article in journal (Refereed)
    Abstract [en]

    Porphyria cutanea tarda (PCT) requires long-term treatment and follow-up, although many patients experience life-long remission. The aim of this cross-sectional postal survey was to describe and investigate the association between illness perception, health complaints, self-reported symptoms and distress in persons with PCT. The participants perceived PCT as a chronic condition with high levels of personal and treatment control. Persons who reported active symptoms scored higher on perceived illness threat, total health complaints and psychological distress compared with those in remission or latent phases. However, a higher perception of illness threat and the total burden of health complaints were more closely associated with psychological distress than were perceived PCT symptoms activity. This has implications for clinical consultation; dermatologists should be attentive to symptoms activity, but also recognize that patients in remission with a high perceived illness threat and multiple health complaints might be especially vulnerable to psychological distress with regards to PCT.

  • 5.
    Andersson, Camilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Röing, Marta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    It's a question of endurance: patients with head and neck cancer experiences of 18F-FDG PET/CT in a fixation mask2017In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 29, p. 85-90, article id S1462-3889(17)30082-0Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to explore how patients with head and neck cancer experienced undergoing an (18)F-fluoro-deoxy-glucose positrons emissions tomography/computed tomography ((18)F-FDG PET/CT) examination in a fixation mask.

    METHOD: Interviews were conducted with nine patients with known or suspected head and neck cancer who were scheduled for the examination for the first time. The phenomenological method according to van Manen and his four lifeworld existentials; lived space, lived body, lived time, and lived relation was used to analyse the interviews.

    RESULTS: The thoughts and feelings of the patients during the PET/CT examination varied, some found it very difficult, while others did not. However, for all the patients, it was an experience that required some form of coping to maintain composure for example distraction.

    CONCLUSIONS: PET/CT examnation in a fixation mask may be strenuous for some patients. Patients need more detailed information, including suggestions for coping behaviours, prior to the examination, as well as higher level of support during and after the examination. The results of this study may be used to improve patient care and optimize the procedure of PET/CT examination in a fixation mask.

  • 6.
    Andersén, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Berglund, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Rehabilitation coordinator intervention versus control in psychiatric specialist care for return to work and reduced sick leave: study protocol of a randomised controlled trial2020In: BMC Public Health, E-ISSN 1471-2458, Vol. 20, no 1, article id 250Article in journal (Refereed)
    Abstract [en]

    Background Mental disorders are the most common reason for sick leave in Sweden. Knowledge about effective methods to help these individuals to return to work (RTW)/entry into work or studies is limited. Rehabilitation coordinators (RC's) have been introduced within healthcare with the purpose to promote cooperation, streamline the sick leave and rehabilitation process, and facilitate RTW for sick-listed patients. The function of RC's has shown positive results by reducing sick leave within primary healthcare. However, the function has not been evaluated in terms of specialist psychiatry. This paper describes the design of a study to evaluate effects of a RC intervention on sick leave and RTW/entry in work or studies in patients with moderate to severe affective and/or moderate to severe anxiety disorders within specialist psychiatric care. Methods A randomised controlled trial (RCT) comparing an intervention group receiving support from a RC with a control group receiving treatment as usual (TAU). The target group is patients on sick leave, treated for affective and/or anxiety disorder, aged 25-64, with or without employment. Discussion This study gives the possibility to evaluate a RC intervention for individuals with mental disorders. If the study has promising vocational outcomes, it may be of importance for the participants in many ways, e.g. increase participation in society, provide economic benefits and improve health and wellbeing. This would be valuable for the individual as well as for the society.

    Download full text (pdf)
    FULLTEXT01
  • 7. Armuand, Gabriela
    et al.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Women’s and Children’s Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
    Elenis, Evangelia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Sydsjö, Gunilla
    Attitudes among paediatric healthcare professionals in Sweden towards sperm donation to single women: a survey study2020In: Fertility Research and Practice, ISSN 2054-7099, Vol. 6, article id 9Article in journal (Refereed)
    Abstract [en]

    Background: The number of families conceived through sperm donation to single women is increasing. However, there is limited knowledge about health care professionals' attitudes towards solo-mothers by choice, and there is some indication that professionals' personal opinions influence their care of individuals who use alternate ways to build a family. The primary aim of the study was to investigate attitudes towards, and experiences of, families following sperm donation to single women among healthcare professionals working in primary child healthcare.

    Methods: Between April and November 2016 a total of 712 physicians, registered nurses and psychologists working within primary healthcare in Sweden were invited to participate in a cross-sectional online survey study. The study-specific questionnaire contained the following four domains: Attitudes towards legalization and financing, Attitudes towards the family and the child's health, Clinical experience and Knowledge about sperm donation to single women.

    Results: The majority of the participants were positive or neutral towards sperm donation being allowed to single women in Sweden. However, one third believed that children risk worse mental health and social stigma. Half of healthcare professionals had own clinical experience of caring for solo-mothers by choice and their children, and of these one third perceived that these families had more need of support than other parents. One out of four indicated that they did not have sufficient knowledge to be able to provide adequate care to these families.

    Conclusions: The present results indicate that while there was a relatively large support for sperm donation being allowed to single women in Sweden among health care professionals, many expressed concerns about the child's health, as well as low confidence in their knowledge about the specific needs in this patient group. There is a need for educational interventions targeted to healthcare professionals in primary child healthcare in order to provide adequate care to solo-mothers by choice and their children.

    Download full text (pdf)
    fulltext
  • 8.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Assmus, Jörg
    Thormodsen, Inger
    Berntsen, Sveinung
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Early rehabilitation of cancer patients: An individual randomized stepped-care stress-management intervention.2019In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 28, no 2, p. 301-308Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of an individual stepped-care stress-management intervention for cancer patients on cancer-related stress reactions (intrusion/avoidance), and secondarily on psychological distress (anxiety/depression) and emotional reactivity (impatience/hostility).

    METHODS: Consecutively 291 cancer patients were included in a randomized controlled intervention study. Patients randomized to the intervention who did not report clinically significant stress levels (n = 72) after the first counseling session participated in only one counseling session and a follow-up (Step 1). The remaining patients (n = 66) received an additional three to eight sessions, depending on individual needs (Step 2). The intervention used techniques derived from cognitive behavioral therapy (CBT) such as daily registration of events and behaviors as well as scheduled behavioral and physical activity, along with short relaxation exercises. The intervention was completed within 26 weeks of inclusion. The Impact of Event Scale, Hospital Anxiety and Depression Scale, and Everyday Life Stress Scale were used to evaluate effects for 2 years.

    RESULTS: The linear mixed effects model analysis showed a difference between the randomization groups in favor of the intervention for avoidance and intrusion after the first 6 weeks (P = 0.001 and P = 0.003) and for emotional reactivity after 17 weeks (P = 0.007). There were no differences in psychological distress. Decreases in cancer-related stress reactions and depression were noted for the Step 2 intervention.

    CONCLUSIONS: An individual stepped-care stress-management intervention for cancer patients, performed by specially educated health professionals using techniques derived from CBT, seems beneficial for cancer patients and may therefore be a realistic complement to routine cancer care.

  • 9.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Rissanen, Ritva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Ahlgren, Johan
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Effects of a Stepped Care Stress Management Intervention on Cancer-Related Traumatic Stress Symptoms Among Breast Cancer Patients: A Randomized Study of Group Versus Individual Setting2014In: Psycho-Oncology, ISSN 1057-9249, E-ISSN 1099-1611, Vol. 23, no Suppl. 3, p. 171-171, article id P1-0300Article in journal (Other academic)
  • 10. Ax, Anna-Karin
    et al.
    Husberg, Magnus
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Cancer precision medicine.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
    Berntsen, Sveinung
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Sjövall, Katarina
    Börjeson, Sussanne
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Davidson, Thomas
    Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT2023In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 62, no 4, p. 414-421Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cost-effectiveness is important in the prioritisation between interventions in health care. Exercise is cost-effective compared to usual care during oncological treatment; however, the significance of exercise intensity to the cost-effectiveness is unclear. In the present study, we aimed to evaluate the long-term cost-effectiveness of the randomised controlled trial Phys-Can, a six-month exercise programme of high (HI) or low-to-moderate intensity (LMI) during (neo)adjuvant oncological treatment.

    METHODS: A cost-effectiveness analysis was performed, based on 189 participants with breast, colorectal, or prostate cancer (HI: n = 99 and LMI: n = 90) from the Phys-Can RCT in Sweden. Costs were estimated from a societal perspective, and included cost of the exercise intervention, health care utilisation and productivity loss. Health outcomes were assessed as quality-adjusted life-years (QALYs), using EQ-5D-5L at baseline, post intervention and 12 months after the completion of the intervention.

    RESULTS: At 12-month follow-up after the intervention, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensity groups. On average HI generated 1.190 QALYs and LMI 1.185 QALYs. The mean incremental cost-effectiveness ratio indicated that HI was cost effective compared with LMI, but the uncertainty was large.

    CONCLUSIONS: We conclude that HI and LMI exercise have similar costs and effects during oncological treatment. Hence, based on cost-effectiveness, we suggest that decision makers and clinicians can consider implementing both HI and LMI exercise programmes and recommend either intensity to the patients with cancer during oncological treatment to facilitate improvement of health.

    Download full text (pdf)
    fulltext
  • 11.
    Ax, Anna-Karin
    et al.
    Department of Oncology, Linköping University, Linköping, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Husberg, Magnus
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
    Berntsen, Sveinung
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Sjövall, Katarina
    Department of Oncology, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.
    Börjeson, Sussanne
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Davidson, Thomas
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Long-term resource utilisation and associated costs of exercise during (neo)adjuvant oncological treatment: the Phys-Can project2022In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 61, no 7, p. 888-896Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise during oncological treatment is beneficial to patient health and can counteract the side effects of treatment. Knowledge of the societal costs associated with an exercise intervention, however, is limited. The aims of the present study were to evaluate the long-term resource utilisation and societal costs of an exercise intervention conducted during (neo)adjuvant oncological treatment in a randomised control trial (RCT) versus usual care (UC), and to compare high-intensity (HI) versus low-to-moderate intensity (LMI) exercise in the RCT.

    METHODS: We used data from the Physical Training and Cancer (Phys-Can) project. In the RCT, 577 participants were randomised to HI or to LMI of combined endurance and resistance training for 6 months, during oncological treatment. The project also included 89 participants with UC in a longitudinal observational study. We measured at baseline and after 18 months. Resource utilisation and costs of the exercise intervention, health care, and productivity loss were compared using analyses of covariance (RCT vs. UC) and t test (HI vs. LMI).

    RESULTS: Complete data were available for 619 participants (RCT HI: n = 269, LMI: n = 265, and UC: n = 85). We found no difference in total societal costs between the exercise intervention groups in the RCT and UC. However, participants in the RCT had lower rates of disability pension days (p < .001), corresponding costs (p = .001), and pharmacy costs (p = .018) than the UC group. Nor did we find differences in resource utilisation or costs between HI and LMI exercise int the RCT.

    CONCLUSION: Our study showed no difference in total societal costs between the comprehensive exercise intervention and UC or between the exercise intensities. This suggests that exercise, with its well-documented health benefits during oncological treatment, produces neither additional costs nor savings.

    Download full text (pdf)
    fulltext
  • 12. Ax, Anna-Karin
    et al.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carlsson, Maria E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Public Health, Sport and Nutrition, University of Agder.
    Börjeson, Sussanne
    Exercise: A positive feature on functioning in daily life during cancer treatment — Experiences from the Phys-Can study2020In: European Journal of Oncology Nursing, ISSN 1462-3889, E-ISSN 1532-2122, Vol. 44, article id 101713Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life.

    METHODS: Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis.

    RESULTS: Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities.

    CONCLUSIONS: Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.

    Download full text (pdf)
    fulltext
  • 13. Ax, Anna-Karin
    et al.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Lyth, Johan
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Börjeson, Sussanne
    Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment-results from the Phys-Can project2022In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 30, no 7, p. 5949-5963Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study aimed to evaluate the effect of high intensity (HI) vs low-to-moderate intensity (LMI) exercise on health-related quality of life (HRQoL) up to 18 months after commencement of oncological treatment in patients with breast, colorectal or prostate cancer. In addition, we conducted a comparison with usual care (UC).

    METHODS: Patients scheduled for (neo)adjuvant oncological treatment (n = 577) were randomly assigned to 6 months of combined resistance and endurance training of HI or LMI. A longitudinal descriptive study (UC) included participants (n = 89) immediately before the RCT started. HRQoL was assessed by EORTC QLQ-C30 at baseline, 3, 6 and 18 months (1 year after completed exercise intervention) follow-up. Linear mixed models were used to study the groups over time.

    RESULTS: Directly after the intervention, HI scored significant (P = 0.02), but not clinically relevant, higher pain compared with LMI. No other significant difference in HRQoL was found between the exercise intensities over time. Clinically meaningful improvements in HRQoL over time were detected within both exercise intensities. We found favourable significant differences in HRQoL in both exercise intensities compared with UC over time.

    CONCLUSION: This study adds to the strong evidence of positive effect of exercise and shows that exercise, regardless of intensity, can have beneficial effects on HRQoL during oncological treatment and also for a substantial time after completion of an exercise intervention. In this study, for one year after.

    IMPLICATIONS FOR CANCER SURVIVORS: Patients can be advised to exercise at either intensity level according to their personal preferences, and still benefit from both short-term and long-term improvements in HRQoL.

    Download full text (pdf)
    fulltext
  • 14.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kosmadopoulos, Anastasi
    Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.
    Hutchinson, Amanda
    School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, SA, Australia.
    Matthews, Raymond
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    Sargent, Charli
    Appleton Institute for Behavioural Science, Central Queensland University, Adelaide, SA, Australia.
    Stengård, Johanna
    Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Winefield, Helen
    School of Psychology, University of Adelaide, Adelaide, SA, Australia.
    Adams, Robert
    The Health Observatory, Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia.
    Short sleep, psychosocial work stressors, and measures of obesity: results from an Australian cohort study2019Conference paper (Refereed)
    Abstract [en]

    Introduction: Short sleep and workplace stress are both established risk factors for overweight and obesity, yet few studies have considered how these two factors may intersect. The aim of this study was to establish the associations between these two exposures and their relative associations with body mass index (kg/m2 ) and waist circumference (cm).

    Methods: A cross-sectional design sampled current employees (N=423) from an Australian cohort using a computer-assisted telephone interview and clinic-measured height, weight, and waist circumference. Short sleep (≤6h/ night) was reported by 25.8% of the participants. Psychosocial work stressors were defined using the Job Demand-ControlSupport (JDCS) model and calculated at the subscale level (psychological demands; skill discretion; decision authority; coworker support; supervisor support). General linear models were used to assess associations between short sleep, the JDCS subscales (split at median), and BMI and waist circumference.

    Results: Separate analyses identified short sleep and a lack of skill discretion at work as predictors of both BMI and waist circumference. Furthermore, when both predictors were entered in the same model, each was associated with elevated BMI (b=1.79, p=.003; b=1.08, p=.045) and waist circumference (b=4.20, p=.005; b=2.97, p=.028). Short sleep was also associated with high perceived psychological demands at work (b=1.81, p=.003). All models were adjusted for gender, age, work hours, blue vs. white collar job, and household income.

    Discussion: These findings indicate the importance of considering the interplay between short sleep and psychosocial work stressors, and their respective associations with measures of overweight Sleep Sci. 2019;12(Supl.3):1-75 26 and obesity. Further research using longitudinal data is needed to model potential mechanisms (e.g., behavioral and physiological). A novel feature was the subscale consideration of the prominent JDCS model of work stress. Advocacy for both improved habitual sleep (e.g., ≥7h/night) and job redesign to increase skill discretion at work may promote lower levels of overweight and obesity for employees.

  • 15.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Youth participation in Active Labour Market Programs (ALMPs) during boom/recession and mental health: a 20-year follow-up2019Conference paper (Refereed)
  • 16.
    Berg, Noora J.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Kiviruusu, Olli H.
    Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Lintonen, Tomi P.
    Finnish Fdn Alcohol Studies, Helsinki, Finland;Univ Tampere, Tampere, Finland.
    Huurre, Taina M.
    Natl Inst Hlth & Welf, POB 30, Helsinki 00271, Finland.
    Longitudinal prospective associations between psychological symptoms and heavy episodic drinking from adolescence to midlife2019In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 47, no 4, p. 420-427Article in journal (Refereed)
    Abstract [en]

    Aim: This study examined whether development of psychological symptoms (PS) differed between persons with different longitudinal profiles of heavy episodic drinking (HED) from adolescence to midlife. In addition, the reciprocal associations between PS and HED were studied. Methods: Participants of a Finnish cohort study in 1983 at age 16 (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471), and 42 (N = 1334). HED was assessed with frequency of intoxication (16-22 years) and having six or more drinks in a session (32-42 years). Using latent class analysis, the participants were allocated to steady high, increased, moderate, and steady low groups according to their longitudinal profiles of HED. The PS scale (16-42 years) covered five mental complaints. The latent growth curve of PS was estimated in the HED groups for comparisons. In addition, the prospective associations between symptoms and HED were examined using cross-lagged autoregressive models. Results: PS grew from 16 to 32 years, but declined after that, with women having higher level of PS than men. PS trajectory followed a path at highest and lowest level in the steady high and steady low HED groups, respectively. Symptoms predicted later HED, but the association in the opposite direction was not found. Conclusions: The more the HED trajectory indicated frequent HED, the higher was the level of PS throughout the follow-up. Results support the self-medication hypothesis, suggesting that alcohol is used to ease the burden of PS. More attention should be paid to alcohol use of people with mental symptoms in health services.

  • 17.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, Helsinki, Finland.
    Kiviruusu, Olli
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, Helsinki, Finland..
    Grundström, Jenna
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, Helsinki, Finland.;Univ Helsinki, Fac Social Sci, Helsinki, Finland..
    Huurre, Taina
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, Helsinki, Finland.;City Vantaa, Dept Educ & Learning, Vantaa, Finland..
    Marttunen, Mauri
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, Helsinki, Finland.;Univ Helsinki, Adolescent Psychiat, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland..
    Stress, development and mental health study, the follow-up study of Finnish TAM cohort from adolescence to midlife: cohort profile2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 12, article id e046654Article in journal (Refereed)
    Abstract [en]

    Purpose This cohort profile describes the Stress, development and mental health study (TAM), which is a cohort study investigating risk and protective factors as well as longitudinal associations regarding mental health and well-being from adolescence to midlife. This interdisciplinary cohort study operates, for example, in the fields of public health, social medicine, psychiatry and the life course perspective.

    Participants In 1981 (n=2242, 98.0% of the target population), 1982 (n=2191, 95.6%) and 1983 (n=2194, 96.7%) during school classes, surveys were conducted to all Finnish-speaking pupils (mostly born 1967) in the Tampere region in Finland. Participants of the school study at age 16 in 1983 (n=2194) comprised the base population for the longitudinal data and were followed-up using postal questionnaires in the years 1989, 1999, 2009 and 2019 at ages 22 (n=1656, 75.5% of the age 16 participants), 32 (n=1471, 67.0%), 42 (n=1334, 60.8%) and 52 (n=1160, 52.9%).

    Findings to date The self-reported questionnaires include information on physical and mental health (eg, depression and mood disorders, anxiety disorders), health behaviour and substance misuse (eg, alcohol, tobacco and exercise), socioeconomic conditions, psychosocial resources (eg, self-esteem), social relationships and support, life events, etc. The numerous studies published to date have examined mental health and various factors from several perspectives such as risk and protective factors, individual developmental paths (eg, trajectories) and pathway models (mediation and moderation).

    Future plans Current and future research areas include, for example, longitudinal associations between mental health (eg, depressive symptoms, self-esteem) and (1) substance use (alcohol and tobacco), (2) family transitions (eg, parenthood, relationship status) and (3) retirement. Next follow-up is planned to be conducted at the latest at age 62 in 2029. Before that it is possible to link the data with cause-of-death register.

    Download full text (pdf)
    FULLTEXT01
  • 18.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. University of Eastern Finland.
    Lintonen, Tomi
    Tampere University.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stockholm University.
    The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife2020In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 30, no 2, p. 357-363Article in journal (Refereed)
    Abstract [en]

    Background

    The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals’ heavy episodic drinking (HED) from adolescence to midlife.

    Methods

    Participants in the ‘Northern Swedish Cohort’ study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16.

    Results

    After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03–2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness.

    Conclusions

    These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.

  • 19.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Bean, Christopher
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Lintonen, Tomi
    Nummi, Tapio
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    The relevance of macroeconomic conditions on concurrent and subsequent alcohol use –: results from two Northern Swedish cohorts2020In: Addiction Research and Theory, ISSN 1606-6359, E-ISSN 1476-7392, Vol. 28, no 6, p. 501-509Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study is to examine the relevance of macroeconomic conditions (boom vs. recession) and own labor market status on alcohol use in youth and midlife.

    Method: Two Northern Swedish cohorts, born in either 1965 (boom at age 21 years) or 1973 (recession at age 21 years), included all pupils attending the last grade of compulsory school in Luleå, in 1981 (n = 990) or 1989 (n = 686), respectively. Questionnaires were completed at ages 21 and 43/39 years. Alcohol use was measured as volume of consumption (cl/year) and heavy episodic drinking (HED).

    Results: Women aged 21 years during the boom (Cohort65) consumed less alcohol and were less likely to be heavy episodic drinkers at age 21 years compared to those who were exposed to recession at the same age (Cohort73). In men there were no such cohort differences. Women, and to some extent men, in Cohort65 increased their consumption at midlife, whereas this decreased for those in Cohort73. HED decreased in both cohorts, but the decrease was steeper in the recession cohort. Analyses stratified by labor market status revealed between-cohort differences in consumption among women who were either employed or students at baseline; but not for men. Alcohol use for those unemployed did not differ between the cohorts.

    Conclusions: In our study, comparing two cohorts that experienced either macroeconomic boom (1986) or recession (1994) at age 21 years in Sweden, the association between individual alcohol use and concurrent unemployment in youth was not affected by macroeconomic conditions.

  • 20.
    Bergstrom, Charlotta
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Danderyd Hosp, Dept Surg & Urol, Stockholm, Sweden..
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden.;Umea Univ, Dept Psychol, Umea, Sweden..
    Roy, Ricky
    Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Karolinska Univ Hosp, Dept Urol, Huddinge, Sweden..
    Hedman, Christel
    Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden.;Stockholms Sjukhem Fdn, R&D Dept, Stockholm, Sweden.;Lund Univ, Dept Clin Sci Lund, Lund, Sweden..
    Ahlgren, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Research and Development, Gävleborg. Orebro Univ, Fac Med & Hlth, Dept Oncol, Orebro, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Uppsala, Sweden..
    Stahl, Olof
    Skane Univ Hosp, Dept Oncol, Lund, Sweden..
    Smedby, Karin E.
    Karolinska Inst, Dept Med Solna, Clin Epidemiol Div, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Hematol, Stockholm, Sweden..
    Hellman, Kristina
    Karolinska Univ Hosp, Dept Gynecol Canc, Theme Canc, Stockholm, Sweden..
    Henriksson, Roger
    Univ Hosp, Dept Radiat Sci & Oncol, Umea, Sweden..
    Eriksson, Lars E.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.;City Univ London, Sch Hlth & Psychol Sci, London, England.;Karolinska Univ Hosp, Med Unit Infect Dis, Huddinge, Sweden..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, SE-17177 Stockholm, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Do young adults with cancer receive information about treatment- related impact on sex life?: Results from a population-based study2023In: Cancer Medicine, E-ISSN 2045-7634, Vol. 12, no 8, p. 9893-9901Article in journal (Refereed)
    Abstract [en]

    Background Sexual dysfunction is common following a cancer diagnosis in young adulthood (18-39 years) and problems related to sex life are ranked among the core concerns in this age group. Yet, few studies have investigated to what extent adults younger than 40, receive information from healthcare providers about the potential impact of cancer and its treatment on their sex life.Methods A population-based cross-sectional survey study was conducted with 1010 young adults 1.5 years after being diagnosed with cancer (response rate 67%). Patients with breast, cervical, ovarian and testicular cancer, lymphoma, and brain tumors were identified in national quality registries. Sociodemographic and clinical factors associated with receiving information were examined using multivariable binary logistic regression.Results Men to a higher extent than women reported having received information about potential cancer-related impact on their sex life (68% vs. 54%, p < 0.001). Receipt of information varied across diagnoses; in separate regression models, using lymphoma as reference, both women and men with brain tumors were less likely to receive information (women: OR 0.10, CI = 0.03-0.30; men: OR 0.37, CI = 0.16-0.85). More intensive treatment was associated with higher odds of receiving information in both women (OR 1.89; CI = 1.28-2.79) and men (OR 2.08; CI = 1.09-3.94). None of the sociodemographic factors were associated with receipt of information.Conclusions To improve sexual health communication to young adults with cancer, we recommend diagnosis-specific routines that clarify when in the disease trajectory to discuss these issues with patients and what to address in these conversations.

  • 21.
    Berntsen, Sveinung
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Aaronson, Neil K
    Buffart, Laurien
    Börjeson, Sussanne
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hellbom, Maria
    Hojman, Pernille
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Raastad, Truls
    Velikova, Galina
    Åsenlöf, P.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Design of a randomized controlled trial of physical training and cancer (Phys-Can) - the impact of exercise intensity on cancer related fatigue, quality of life and disease outcome2017In: BMC Cancer, E-ISSN 1471-2407, Vol. 17, no 1, article id 218Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cancer-related fatigue is a common problem in persons with cancer, influencing health-related quality of life and causing a considerable challenge to society. Current evidence supports the beneficial effects of physical exercise in reducing fatigue, but the results across studies are not consistent, especially in terms of exercise intensity. It is also unclear whether use of behaviour change techniques can further increase exercise adherence and maintain physical activity behaviour. This study will investigate whether exercise intensity affects fatigue and health related quality of life in persons undergoing adjuvant cancer treatment. In addition, to examine effects of exercise intensity on mood disturbance, adherence to oncological treatment, adverse effects from treatment, activities of daily living after treatment completion and return to work, and behaviour change techniques effect on exercise adherence. We will also investigate whether exercise intensity influences inflammatory markers and cytokines, and whether gene expressions following training serve as mediators for the effects of exercise on fatigue and health related quality of life.

    METHODS/DESIGN: Six hundred newly diagnosed persons with breast, colorectal or prostate cancer undergoing adjuvant therapy will be randomized in a 2 × 2 factorial design to following conditions; A) individually tailored low-to-moderate intensity exercise with or without behaviour change techniques or B) individually tailored high intensity exercise with or without behaviour change techniques. The training consists of both resistance and endurance exercise sessions under the guidance of trained coaches. The primary outcomes, fatigue and health related quality of life, are measured by self-reports. Secondary outcomes include fitness, mood disturbance, adherence to the cancer treatment, adverse effects, return to activities of daily living after completed treatment, return to work as well as inflammatory markers, cytokines and gene expression.

    DISCUSSION: The study will contribute to our understanding of the value of exercise and exercise intensity in reducing fatigue and improving health related quality of life and, potentially, clinical outcomes. The value of behaviour change techniques in terms of adherence to and maintenance of physical exercise behaviour in persons with cancer will be evaluated.

    TRIAL REGISTRATION: NCT02473003 , October, 2014.

    Download full text (pdf)
    fulltext
  • 22.
    Berntsen, Sveinung
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hetlelid, Ken J.
    Henriksson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Phys-Can Feasibility Study: Objectively Recorded Physical Activity in Cancer Patients2014Conference paper (Other academic)
  • 23.
    Bjorke, Ann Christin Helgesen
    et al.
    Univ Agder, Dept Publ Hlth Sport & Nutr, Kristiansand, Norway.
    Sweegers, Maike G.
    Vrije Univ, Amsterdam Univ, Amsterdam Publ Hlth Inst, Dept Epidemiol & Biostat,Med Ctr, Amsterdam, Netherlands;Vrije Univ, Amsterdam Univ, Canc Ctr Amsterdam, Med Ctr, Amsterdam, Netherlands.
    Buffart, Laurien M.
    Vrije Univ, Amsterdam Univ, Amsterdam Publ Hlth Inst, Dept Epidemiol & Biostat,Med Ctr, Amsterdam, Netherlands;Vrije Univ, Amsterdam Univ, Canc Ctr Amsterdam, Med Ctr, Amsterdam, Netherlands;Vrije Univ, Amsterdam Univ, Dept Med Oncol, Med Ctr, Amsterdam, Netherlands.
    Raastad, Truls
    Norwegian Sch Sport Sci, Oslo, Norway.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Berntsen, Sveinung
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Univ Agder, Dept Publ Hlth Sport & Nutr, Kristiansand, Norway.
    Which exercise prescriptions optimize V̇O2max during cancer treatment?: a systematic review and meta-analysis2019In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, no 9, p. 1274-1287Article, review/survey (Refereed)
    Abstract [en]

    The aims of the present systematic review and meta-analysis were to investigate the effect of exercise on maximal oxygen uptake ((V) over dot O(2)max) and to investigate whether exercise frequency, intensity, duration, and volume are associated with changes in (V) over dotO(2)max among adult patients with cancer undergoing treatment. Medline and Embase through OvidSP were searched to identify randomized controlled trials. Two reviewers extracted data and assessed the risk of bias. The overall effect size and differences in effects for different intensities and frequencies were calculated on change scores and post-intervention (V) over dot O(2)max data, and the meta-regression of exercise duration and volumes was analyzed using the Comprehensive Meta-Analysis software. Fourteen randomized controlled trials were included in the systematic review, comprising 1332 patients with various cancer types receiving (neo-) adjuvant chemo-, radio-, and/or hormone therapy. Exercise induced beneficial changes in (V) over dotO(2)max compared to usual care (effect size = 0.46, 95% Confidence Interval = 0.23-0.69). Longer session duration (P = 0.020), and weekly duration (P = 0.010), larger weekly volume (P < 0.001), and shorter intervention duration (P = 0.005) were significantly associated with more beneficial changes in (V) over dot O(2)max. No differences in effects between subgroups with respect to frequency and intensity were found. In conclusion, exercise has beneficial effects on (V) over dotO(2)max in patients with cancer undergoing (neo-) adjuvant treatment. As interventions with larger exercise volumes and longer session durations resulted in larger beneficial changes in (V) over dot O(2)max, exercise frequency, intensity, and duration should be considered carefully for sufficient exercise volume to induce changes in (V) over dot O(2)max for this patient group.

  • 24.
    Borjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrin Oncology.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Nurses’ experiences of taxane-induced pain in people treated for breast cancerIn: Article in journal (Other academic)
  • 25.
    Borjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrine Oncology.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Taxane-induced pain in breast cancer patients as perceived by nurses2021In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 60, no 4, p. 412-418Article in journal (Refereed)
    Abstract [en]

    Introduction Treatment with taxane-containing chemotherapy regimens is crucial for improving survival in patients with early-stage invasive breast cancer. Recent literature describes a high incidence of taxane-induced neuropathic pain or/and muscle and joint pain. For patients, oncology nurses can play an integral role as a resource for pain control. There is a knowledge gap regarding how nurses perceive patients' experienced taxane-induced pain and support from their organizations when caring for patients with such pain. Aim Investigate nurses' perceptions of occurrence of taxane-induced pain and identify organizational support for managing such pain. Material and methods A cross-sectional observation study, conducted in 2017-2018, with a web-based questionnaire to 240 nurses working at oncology outpatient units in Sweden. The areas of concern were start-decline, duration, prevalence, intensity, and bodily distribution of taxane-induced pain. Patient information, guidelines, prophylactic analgesia, and perceived support were used to counteract such pain. Data were analyzed using descriptive statistics and a logistic regression model to estimate associations. Results One hundred sixty-one nurses completed the questionnaire, describing their perceptions of taxane-induced pain in patients with breast cancer. The prevalence and intensity of taxane-induced pain were experienced as divergent. Some consensus was found among the nurses regarding the start of the pain, but not when declined. The body areas where pain was expected to occur were the muscles, joints, legs, feet, and mainly the back of the trunk. Low use of local/national guidelines for managing taxane-induced pain was described. No relationship was found between factors related to the nurses' characteristics (age, work experience in oncology care, or specialist education in oncology) that significantly affected their perceptions regarding the occurrence of taxane-induced pain or pain intensity. Conclusion: This study highlights a need for attention to education and guidelines for how to observe, treat, and evaluate this particular type of pain.

  • 26.
    Brooke, Hannah L.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Mazzoni, Anne-Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Buffart, Laurien M.
    Radboud Univ Nijmegen Med Ctr, Radboud Inst Hlth Sci, Dept Physiol, Nijmegen, Netherlands..
    Berntsen, Sveinung
    Univ Agder, Dept Sport Sci & Phys Educ, Kristiansand, Norway..
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT2022In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 14, no 1, article id 155Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge regarding adherence is necessary to improve the specificity of exercise interventions during cancer treatment. We aimed to determine adherence to resistance and endurance training interventions in parallel; identify subgroups with similar adherence characteristics; and examine determinants of these subgroups. Methods: In the Phys-Can randomised controlled trial, participants (n=577, 81% women, mean(SD) age 59(12) years, and 50% with BMI >= 25 kg/m(2)) starting (neo-) adjuvant treatment for breast, colorectal or prostate cancer were randomized to 6-month of high (HI) or low-to-moderate intensity (LMI) supervised, group-based resistance training and individual home-based endurance training, with or without behavior change support. Adherence was calculated as performed exercise volume as a proportion of prescribed exercise volume (0-100%), overall (HI and LMI groups) and for frequency, intensity, type and time (FITT principles) (HI group). Adherence to resistance training was plotted against adherence to endurance training overall and for each FITT principle. K-means cluster analysis was used to identify subgroups with similar adherence characteristics. Potential determinants of subgroup membership were examined using multinomial logistic regression. Results: We found a positive curvilinear correlation between adherence to resistance and endurance training overall. A similar correlation was seen for adherence to frequency of resistance vs. endurance training in the HI group. In the HI group, adherence to resistance training intensity and time was > 80% for almost all participants. For endurance training adherence ranged from 0 to 100% for each of the FITT principles. Three clusters were identified, representing low, mixed, and high adherence to resistance and endurance training overall. Participants with higher age (Relative risk ratio [95% Cl]; LMI: 0.86[0.77-0.96], HI: 0.83[0.74-0.93]), no behaviour change support (LMI: 0.11 [0.02-0.56], HI: 0.20[0.05-0.85]), higher cardiorespiratory fitness (LMI: 0.81 [0.69-0.94], HI: 0.80[0.69-0.92]), more fatigue (according to the reduced activity subscale of the MFI questionnaire) (LMI: 0.48[0.31-0.73], HI: 0.69[0.52-0.93]) or higher quality of life (LMI: 0.95[0.90-1.00], HI: 0.93[0.88-0.98]) were less likely to be in the low than the high adherence cluster whether randomised to LMI or HI training. Other determinants were specific to those randomised to LMI or HI training. Conclusions: In an exercise intervention during cancer treatment, adherence to resistance and endurance training were positively correlated. Personalisation of interventions and additional support for some subgroups of participants may improve adherence.

    Download full text (pdf)
    FULLTEXT01
  • 27.
    Brynjulfsen, Trine
    et al.
    Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Berntsen, Sveinung
    Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Foyn, Tonje Hellum
    Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Andersen, Oddbjorn Klomsten
    Norwegian Sch Sport Sci, Dept Sport Med, Oslo, Norway..
    Stang, Julie
    Norwegian Sch Sport Sci, Dept Sport Med, Oslo, Norway..
    Sigdestad, Joakim Brodvik
    Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Stensrud, Trine
    Norwegian Sch Sport Sci, Dept Sport Med, Oslo, Norway..
    Tufte, Kristine
    Norwegian Sch Sport Sci, Dept Sport Med, Oslo, Norway..
    Nielsen, Anette
    Univ Oslo, Fac Med, Oslo, Norway..
    Westergren, Thomas
    Univ Agder, Fac Hlth & Sport Sci, POB 422, N-4604 Kristiansand, Norway..
    Motivation for physical activity in adolescents with asthma2021In: Journal of Asthma, ISSN 0277-0903, E-ISSN 1532-4303, Vol. 58, no 9, p. 1247-1255Article in journal (Refereed)
    Abstract [en]

    Objective:We explored motivation for physical activity (PA) and exercise in adolescents with asthma who entered and continued a 10-week play-based exercise intervention. Methods:Eighteen adolescents with asthma, aged 13-17 years, participated in a 10-week play- and interval-based indoor exercise intervention during winter and autumn months. Semi-structured focus group interviews were conducted in weeks 2 and 8, focusing on motivation for PA and exercise, as well as field observations of exercise sessions in weeks 2, 6, and 8. The first interview was analyzed separately from the second one and descriptive observational data were obtained using thematic analysis and self-determination theory as a framework. Results:In the first round of focus group interviews, participants (n= 18) described amotivation and motivation for PA within the following five themes: "teachers' lack of asthma knowledge", "embarrassment over asthma symptoms", "not being able to keep pace with peers", "seasonal challenges", and "mastering fun physical activities". Based on the second interview (n= 14) and descriptive observational data (n= 18), participants reported and revealed amotivation and motivation for PA within the following four themes: "understanding and relatedness", "social support", "competition", and "mastering fun activities". Conclusion:We conclude that play-based exercises designed for groups of adolescents with asthma can support motivation for PA and exercise and reduce social and asthma-specific barriers.

    Download full text (pdf)
    FULLTEXT01
  • 28. Buffart, L. M.
    et al.
    Schreurs, M. A. C.
    Abrahams, H. J. G.
    Kalter, J.
    Aaronson, N. K.
    Jacobsen, P. B.
    Newton, R. U.
    Courneya, K. S.
    Armes, J.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Braamse, A. M.
    Brandberg, Y.
    Dekker, J.
    Ferguson, R. J.
    Gielissen, M. F.
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Goedendorp, M. M.
    Graves, K. D.
    Heiney, S. P.
    Horne, R.
    Hunter, M. S.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Northouse, L. L.
    Oldenburg, H. S.
    Prins, J. B.
    Savard, J.
    van Beurden, M.
    van den Berg, S. W.
    Brug, J.
    Knoop, H.
    Verdonck-de Leeuw, I. M.
    Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses2020In: Clinical Psychology Review, ISSN 0272-7358, E-ISSN 1873-7811, Vol. 80, article id 101882Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE: This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects.

    METHODS: Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs.

    RESULTS: CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05).

    CONCLUSIONS: CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

  • 29.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Fogelberg, Jonathan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Gabrielsson, G
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Lindberg, Mikaela
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) - A pilot testing of the tool.2020In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 41, no 6, p. 790-803Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the test-retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents.

    METHOD: Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated.

    RESULTS: The test--retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC2. = 0.78--0.91 and MAINtAIN(S)-barriers subscales from ICC2.1 = 0.60--0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults.

  • 30.
    Börjesson, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Fjällskog, Marie-Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrin Oncology.
    Rissanen, Ritva
    Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden.
    Peterson, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Arving, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Colored body images reveal the perceived intensity anddistribution of pain in women with breast cancer treated with adjuvant taxanes:: a prospective multi-method study of pain experience2018In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, p. 581-591Article, review/survey (Refereed)
    Abstract [en]

    Background and aims:

    Breast cancer is the most prevalent adult cancer worldwide. A broader use of screening for early detection and adjuvant systemic therapy with chemotherapy has resulted in improved survival rates. Taxane-containing chemotherapy is one of the cornerstones of the treatment. However, taxane-containing chemotherapy may result in acute chemotherapy-induced nociceptive and neuropathic pain. Since this pain may be an additional burden for the patient both during and after taxane chemotherapy, it is important to rapidly discover and treat it. There is yet no gold standard for assessing taxane-induced pain. In the clinic, applying multiple methods for collecting information on pain may better describe the patients’ pain experiences. The aim was to document the pain during and after taxane through the contribution of different methods for collecting information on taxane-induced pain. Fifty-three women scheduled for adjuvant sequential chemotherapy at doses of ≥75 mg/m2 of docetaxel and epirubicin were enrolled in the study.

    Methods:

    Prospective pain assessments were done on a visual analog scale (VAS) before and during each cycle of treatment for about 5 months, and using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire’s (EORTC-QLQ-C30) two pain questions at baseline, 3 months, and 12 months. Participants scoring pain on the VAS >30 and undergoing an interview also colored their pain on a body image during treatment and at 12 months.

    Results:

    Surprisingly widespread, intense pain was detected using a multi-method approach. The colored body image showed pain being perceived on 51% of the body surface area during treatment, and on 18% 12 months after inclusion. In general, the pain started and peaked in intensity after the first cycle of taxane. After Cycle 3, most women reported an increase in pain on the VAS. Some women continued to report some pain even during the epirubicin cycles. The VAS scores dropped after the last chemotherapy cycle, but not to the baseline level. At baseline, 3 months and 12 months after inclusion, the women who estimated VAS >30 reported higher levels of pain on the pain questions of the EORTC-QLQ-C30.

    Conclusions:

    This study contributes information on how different pain assessment tools offer different information in the assessment of pain. The colored body image brings another dimension to pain diagnostics, providing additional information on the involved body areas and the pain intensities as experienced by the women. A multi-method approach to assessing pain offers many advantages. The timing of the assessment is important to properly assess pain.

    Implications:

    Pain relief needs to be included in the chemotherapy treatment, with individual assessment and treatment of pain, in the same way as is done in chemotherapy-triggered nausea. There is a time window whereby the risk of pain development is at its highest within 24–48 h after receiving taxane chemotherapy. Proper attention to pain evaluation and treatment should be in focus during this time window.

  • 31.
    Carlsson, Maria E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Gunningberg, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Unavoidable pressure ulcers at the end of life and nurse understanding2017In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 26, no 20, p. s6-s17Article in journal (Refereed)
    Abstract [en]

    Objectives:

    prevention of pressure ulcers (PUs) in end-of-life care is often problematic because both PUs and interventions to prevent them can cause suffering. The primary aim of this study was to identify and describe the different ways in which nurses understood unavoidable PUs in late palliative care. A second aim was to explore the expediency of the different levels of understanding.

    Methods:

    a qualitative interview study with a phenomenographic approach was carried out. The study participants were nurses and healthcare assistants who worked in nursing homes or in specialist palliative inpatient care units run by private providers, non-profit foundations, municipalities and county councils. A phenomenographic analysis of the interview data was undertaken.

    Results:

    all participants shared a fundamental understanding that the prevention of PUs is highly worthwhile in end-of-life care. Within this common view, practitioners' understanding of whether PUs could be prevented differed in four main ways, and were divided into categories: A: unavoidable PUs do not exist. All can be prevented if all interventions are applied, and all patients are at the same risk for developing PUs in end-of-life care; B: unavoidable PUs do not exist, but some patients do not participate in prevention interventions, which makes prevention difficult. The risk of developing pressure ulcers in end-of-life care varies between patients; C: some PUs are unavoidable because some patients do not participate in prevention interventions; the risk of developing pressure ulcers in end-of-life care differs between patients. D: some PUs are unavoidable, depending on the pathophysiological processes in the dying body. The risk of developing pressure ulcers in end-of-life care differs between patients.

    Conclusion:

    it is paramount to communicate to nurses that not all PUs can be prevented in dying patients, to lessen the burden of ethical stress for the nurses.

  • 32.
    Carlsson, Maria E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hjelm, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Equal palliative care for foreign-born patients: A national quality register study2021In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 19, no 6, p. 656-663Article in journal (Refereed)
    Abstract [en]

    Objectives: To use data from a national quality register to investigate if there are differences relating to migrant background in the quality of end-of-life care of patients dying in Sweden.

    Methods: A retrospective, comparative register-based study. In total, 81,418 deceased patients, over 18 years of age, registered in the Swedish Register of Palliative Care during 2017 and 2018, of expected death were included in the study. Of these, 72,012 were Swedish-born and 9,395 were foreign-born. Descriptive and analytical statistical methods were used.

    Results: No general pattern of differences in quality regarding end-of-life care was found between Swedish- and foreign-born patients. There were several significant differences in various quality indicators but not in a specific direction. Sometimes, the quality indicators showed an advantage for Swedish-born patients but just as often, they were also favorable for foreign-born patients. Swedish-born patients had greater access to specialized palliative care than foreign-born patients. Foreign-born patients were more often cared for in general home care setting, despite a higher frequency of cancer diagnosis.

    Significance of results: Foreign-born patients were less likely to be cared for in specialized palliative care units and had poorer access to palliative care teams than Swedish-born patients, despite having a higher proportion of cancer diagnoses. However, no general pattern was found indicating that foreign-born patients were disadvantaged in the quality indicators measured in the present study. Perhaps, this is an indication that the palliative care in Sweden is individualized; nonetheless, the quality of end-of-life care would be higher if dying patients, regardless of country of birth, have better access to specialized palliative care.

    Download full text (pdf)
    fulltext
  • 33.
    Casado-Bedmar, Maite
    et al.
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    de-Faria, Felipe Meira
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Biskou, Olga
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Lindqvist, Carl Marten
    Örebro Univ, Dept Med Sci, Örebro, Sweden..
    Ranasinghe, Purnika Damindi
    Queens Univ Belfast, Sch Biol Sci, Inst Global Food Secur, Belfast, Antrim, North Ireland..
    Bednarska, Olga
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden.;Dept Gastroenterol, Linköping, Sweden..
    Peterson, Christer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Diagnost Dev, Uppsala, Sweden..
    Walter, Susanna A.
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden.;Dept Gastroenterol, Linköping, Sweden..
    Carlsson, Maria E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Keita, Asa, V
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Elevated F-EDN correlates with mucosal eosinophil degranulation in patients with IBS-A possible association with microbiota?2022In: Journal of Leukocyte Biology, ISSN 0741-5400, E-ISSN 1938-3673, Vol. 111, no 3, p. 655-665Article in journal (Refereed)
    Abstract [en]

    Eosinophils have been linked to functional dyspepsia; however, less is known about their role in irritable bowel syndrome (IBS). This study tested the hypothesis of alterations in levels of fecal eosinophil-derived neurotoxin (F-EDN) and eosinophil density and degranulation within the colonic mucosa of IBS patients compared with healthy controls (HC). Colonic biopsies were collected from 37 IBS patients and 20 HC and analyzed for eosinophil numbers and local degranulation of eosinophil cationic protein (ECP) by histologic procedures. Fecal samples were collected for F-EDN and microbiota analysis. Differentiated 15HL-60 cells were used in vitro to investigate the direct effect of live bacteria on eosinophil activation measured by a colorimetric assay with o-phenylenediamine (OPD) substrate. We observed a higher number of eosinophils and increased extracellular ECP in the mucosa of IBS patients compared with HC. Moreover, F-EDN levels in IBS samples were elevated compared with HC and positively correlated to extracellular ECP. Metagenomic analysis showed significant correlations between bacterial composition and eosinophil measurements in both HC and IBS patients. In vitro experiments revealed an increased degranulation of 15HL-60 after stimulation with Salmonella typhimurium, Salmonella enterica, and Yersinia enterocolitica. To conclude, we could demonstrate alterations related to eosinophils in IBS, and, for the first time, a positive correlation between F-EDN levels and degranulated eosinophils in the colonic mucosa of IBS patients. Together our results suggest that eosinophils play a role in the pathophysiology of IBS and the mechanisms might be linked to an altered microbiota.

    Download full text (pdf)
    fulltext
  • 34.
    Cedstrand, Emma
    et al.
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, S-17177 Stockholm, Sweden..
    Mølsted Alvesson, Helle
    Karolinska Inst, Dept Global Publ Hlth, S-17177 Stockholm, Sweden..
    Augustsson, Hanna
    Karolinska Inst, Dept Learning Informat Management & Eth, Procome Res Grp, Med Management Ctr, S-17177 Stockholm, Sweden..
    Bodin, Theo
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, S-17177 Stockholm, Sweden.;Ctr Occupat & Environm Med, S-11365 Stockholm, Sweden..
    Bodin, Erika
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, S-17177 Stockholm, Sweden..
    Nyberg, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health equity and working life. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Inst Environm Med, Unit Occupat Med, S-17177 Stockholm, Sweden.
    Johansson, Gun
    Karolinska Inst, Inst Environm Med, Unit Occupat Med, S-17177 Stockholm, Sweden.;Ctr Occupat & Environm Med, S-11365 Stockholm, Sweden..
    Co-Creating an Occupational Health Intervention within the Construction Industry in Sweden: Stakeholder Perceptions of the Process and Output2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 24, article id 12872Article in journal (Refereed)
    Abstract [en]

    One way to prevent work-related stress, is to implement primary occupational health interventions aimed at improving the psychosocial work environment. However, such interventions have shown a limited effect, often due to implementation failure and poor contextual fit. Co-creation, where researchers, together with end-users and other relevant stakeholders, develop the intervention is increasingly encouraged. However, few studies have evaluated the effects of co-created interventions, and participants' experience of the co-creation process. This is one of the first studies evaluating stakeholder perceptions of co-creating an occupational health intervention. We applied a thematic analysis, with data from 12 semi-structured interviews with stakeholders involved in the co-creation. Our results show that the respondents, in general, were satisfied with engaging in the co-creation, and they reported an increased awareness regarding risk factors of stress and how these should be handled. Additionally, the respondents described trust in the intervention activities and a good fit into the context. The study indicates that co-creating occupational health interventions can enhance the implementation and the contextual fit.

    Download full text (pdf)
    fulltext
  • 35.
    Demmelmaier, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Brooke, Hannah L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Henriksson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Mazzoni, Anne-Sophie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Helgesen Björke, Ann Christin
    University of Agder, Department of Sport Science and Physical Education, Kristiansand, Norway .
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Ax, Anna-Karin
    Linköping University Department of Oncology and Department of Medical and Health Sciences.
    Sjövall, Katarina
    Lund University, Department of Oncology and Skåne University Hospital, Department of Oncology.
    Hellbom, Maria
    Stockholm Health Care Services, Centre for Cancer Rehabilitation, Stockholm, Sweden.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Lindman, Henrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Johansson, Silvia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Galina, Velikova
    University of Leeds, Leeds Cancer Centre, Leeds Institute of Medical Research at St James's, Leeds, UK .
    Raastad, Truls
    Norwegian School of Sport Sciences, Department of Physical Performance, Oslo, Norway .
    M Buffart, Laurien
    Amsterdam Public Health Research Institute, Department of Epidemiology and Biostatistics, and Amsterdam UMC, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands .
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Aaronson, Neil K
    The Netherlands Cancer Institute, Division of Psychosocial Research & Epidemiology, Amsterdam, The Netherlands .
    Glimelius, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Börjesson, Sussanne
    , Linköping University Department of Oncology and Department of Medical and Health Sciences, Linköping, Sweden .
    Berntsen, Sveinung
    University of Agder, Department of Sport Science and Physical Education, Kristiansand, Norway .
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Does exercise intensity matter for fatigue during (neo)adjuvant cancer treatment?: The PhysCan randomized clinical trial2021In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 31, no 5, p. 1144-1159Article in journal (Refereed)
    Abstract [en]

    Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference -1.05 [95% CI: -1.85, -0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.

    Download full text (pdf)
    fulltext
  • 36.
    Demmelmaier, Ingrid
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Stockholm, Sweden..
    Iversen, Maura D.
    Karolinska Inst, Stockholm, Sweden.;Northeastern Univ, Boston, MA 02115, Sweden.;Harvard Med Sch, Boston, MA, Sweden..
    How Are Behavioral Theories Used in Interventions to Promote Physical Activity in Rheumatoid Arthritis?: A Systematic Review2018In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 70, no 2, p. 185-196Article, review/survey (Refereed)
    Abstract [en]

    ObjectiveTo identify the use of behavioral theories in physical activity interventions in populations with rheumatoid arthritis (RA). MethodsThis review includes articles published in English between January 1, 1980 and November 8, 2015 in MEDLINE, Cochrane, and CINAHL, identified by a strategic literature search. Included studies were published in international peer-reviewed journals, mentioned theory, evaluated a physical activity intervention for adults with RA, and had 1 physical activity variable as the outcome. References and reviews were also checked. Two investigators independently selected articles and extracted data using a validated scale, the theory coding scheme. Additional extracted data included author, sample characteristics, study design, physical activity outcomes, intervention type and duration, and control group. ResultsA total of 245 articles were identified, 211 articles and references were screened, and 29 articles were reviewed. Of these, 18 were excluded, leaving 11 articles with 1,472 participants (75% women). Ten studies (91%) were randomized controlled trials, 8 (73%) assessed physical activity plus self-management, and 3 (27%) physical activity only. Program durations ranged from 5 weeks to 1 year. Eight studies (73%) used a single theory, 7 studies (64%) linked at least 1 intervention technique to theory, 2 studies (18%) analyzed mediating effects of theoretical constructs, and 5 studies (45%) discussed results in relation to theory. ConclusionFindings indicate that physical activity intervention studies claiming the use of behavioral theories use theory to a small extent. We suggest expanding theory use in design, evaluation, and interpretation of physical activity intervention results. Further, we recommend that future studies evaluate the most salient behavioral theories, interventions components, and delivery modes in RA populations.

  • 37.
    Eklund, Caroline
    et al.
    Mälardalen Univ, Sch Hlth, Div Physiotherapy, Västerås, Sweden..
    Elfström, Magnus L.
    Mälardalen Univ, Sch Hlth, Div Psychol, Eskilstuna, Sweden..
    von Heideken Wågert, Petra
    Mälardalen Univ, Sch Hlth, Div Physiotherapy, Västerås, Sweden..
    Söderlund, Anne
    Mälardalen Univ, Sch Hlth, Div Physiotherapy, Västerås, Sweden..
    Gustavsson, Catharina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Cederbom, Sara
    Vastmanland Cty Council, Ctr Dev Social Welf & Care, Västerås, Sweden..
    Thunborg, Charlotta
    Karolinska Inst, Ctr Alzheimer Res, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, Stockholm, Sweden..
    Lööf, Helena
    Mälardalen Univ, Sch Hlth Care & Social Welf, Div Caring Sci, Västerås, Sweden.;Sophiahemmet Univ, Dept Hlth Promoting Sci, Stockholm, Sweden..
    The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement: An Empirical Phenomenological Study2021In: Physical Therapy, ISSN 0031-9023, E-ISSN 1538-6724, Vol. 101, no 8, article id pzab117Article in journal (Refereed)
    Abstract [en]

    Objective

    Sedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement.

    Methods

    The study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64 to 75 years. Data were analyzed using the empirical phenomenological psychological method.

    Results

    The participants described that voluntary sedentary time was positively related to general health and well-being, whereas involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants’ descriptions formed 3 typologies: in light of meaningful SB, in the shadow of involuntary SB, and a dual process—postponing SB with physical activity.

    Conclusion

    Increased SB was perceived as natural when aging but something that may be postponed by conscious choices. SB was perceived as associated with health, rest, and recovery but also with the risk of deteriorating health.

    Impact

    This knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement.

    Lay Summary

    This study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.

    Download full text (pdf)
    fulltext
  • 38.
    Emilson, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Bergman, Stefan
    Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, Göteborgs universitet.
    Pettersson, Susanne
    Department of Rheumatology, Karolinska university hospital.
    Åsenlöf, Pernilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Concurrent validity and stability of subgroup assignment based on three levels of pain condition severity in patients with musculoskeletal painIn: Article in journal (Refereed)
    Abstract [en]

    Pain screening instruments have been used to identify risk factors for poor prognosis and are recommended for the stratification of treatment for musculoskeletal pain. The aim of this study was to investigate the concurrent validity of subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire compared with reference instruments: The Pain Disability Index, the Tampa Scale for Kinesiophobia, and the Pain Catastrophizing Scale. A secondary aim was to investigate the stability of the subgroup assignment over a defined period of time. Participants (n=40) aged 18-65 years were recruited from five primary health care centers in Sweden. Data were collected using self-reported questionnaires. The subgroups based on the Örebro Musculoskeletal Pain Screening Questionnaire were predefined to low, moderate or high pain condition severity. The reference instrument data were dichotomized into low or high level based on previously used cut-off scores. Concurrent validity was analyzed with Fisher´s exact test. Stability was calculated using quadraticweighted kappa analysis. The results indicated acceptable psychometric properties of the subgroup assignment based on the Örebro Musculoskeletal Pain Screening Questionnaire regarding concurrent validity, and the stability over two to three weeks. To further increase validity, it is suggested that subgroup assignment is complemented with other measures assessing e.g. pain catastrophizing. In conclusion, assignment to subgroups with low, moderate and high pain condition severities based on the Örebro Musculoskeletal Pain Screening Questionnaire, could be used as a valid base for stratified treatment for patients with musculoskeletal pain.   

  • 39.
    Ferede, Abebaw Jember
    et al.
    Univ Gondar, Coll Med & Hlth Sci, Sch Nursing, Dept Med Nursing, Gondar 196, Ethiopia..
    Erlandsson, Kerstin
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, S-17177 Stockholm, Sweden..
    Gezie, Lemma Derseh
    Univ Gondar, Coll Med & Hlth Sci, Inst Publ Hlth, Dept Epidemiol & Biostat, Gondar 196, Ethiopia..
    Geda, Biftu
    Madda Walabu Univ, Coll Hlth Sci, Dept Nursing, Shashamene Campus, Robe 247, Ethiopia..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, S-17177 Stockholm, Sweden..
    Psychometric Properties of the Caring Behaviors Inventory-16 in Ethiopia2022In: Nursing Reports, ISSN 2039-439X, E-ISSN 2039-4403, Vol. 12, no 2, p. 387-396Article in journal (Refereed)
    Abstract [en]

    Background: The Caring Behaviors Inventory-16 (CBI-16) is a comprehensive instrument measuring caring behaviors as experienced by patients. The study aimed to translate, culturally adapt and evaluate the psychometric properties of the CBI-16 among adult patients who speak the Amharic language. Methods: The measure was completed by 304 hospitalized patients. Construct validity was evaluated via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and contrasted groups' validity. Total CBI-16 scores were compared between groups that differed in self-rated satisfaction with care (Patient Satisfaction Instrument) to examine the contrasted groups' validity. Reliability was assessed using internal consistency (Cronbach's alpha). Results: The EFA suggested a four-factor model accounting for 66.1% of the total variance. The items loaded onto the subscales were similar to the CBI-24. The CFA supported the four-factor model with acceptable fit indices: normed Chi-square value 2.65 (X-2 = 259.60, df = 98), SRMR = 0.06, and RMSEA = 0.07, CFI = 0.88 and TLI = 0.86. The contrasted groups' validity was supported by significantly higher CBI-16 scores reported by patients more satisfied with their care (t = 3.66, p < 0.001). The reliability of the instrument was satisfactory (Cronbach's alpha = 0.83). Conclusions: The Amharic version of the CBI-16 displayed a four-factor solution and was shown to be a valid and reliable instrument for the assessment of the perceptions of caring behaviors in Ethiopia.

    Download full text (pdf)
    FULLTEXT01
  • 40.
    Ferede, Abebaw Jember
    et al.
    Univ Gondar, Coll Med & Hlth Sci, Sch Nursing, Dept Med Nursing, Postal address 196, Gondar, Ethiopia..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Erlandsson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Dalarna Univ, Sch Educ Hlth & Welf, Falun, Sweden..
    Gezie, Lemma Derseh
    Univ Gondar, Inst Publ Hlth, Coll Med & Hlth Sci, Dept Epidemiol & Biostat, Gondar, Ethiopia..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Geda, Biftu
    Madda Walabu Univ, Coll Hlth Sci, Dept Nursing, Shashamene Campus, Shashemene, Ethiopia..
    Patients' perceptions of caring behaviors at referral hospitals in Ethiopia: A cross-sectional survey2023In: International Journal of Nursing Sciences, E-ISSN 2352-0132, Vol. 10, no 3, p. 391-397Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to determine patients' perceptions of nurse caring behaviors and to identify factors associated with these perceptions.

    Methods: A cross-sectional study was conducted at three referral hospitals in Ethiopia. A consecutive sample of male and female patients (n = 652, response rate 98.8%) was interviewed using the Amharic version of the Caring Behaviors Inventory-16 (CBI-16, including four subscales: Assurance, Knowledge and skill, Respectful, and Connectedness) and the Patient Satisfaction Instrument (PSI). Socio-demographic and clinical factors associated with perceptions of caring behaviors were identified using multiple linear regression analysis.

    Results: Patients' perceptions of nurse caring behaviors were high (total Mean = 4.86, SD = 0.72). Be-haviors related to the Assurance subscale were rated the highest. The multiple linear regression analysis result showed several socio-demographic and clinical factors statistically significantly associated with patients' perceptions of caring behaviors (total mean scores). Patients who were 40-49 years (B = -0.19, P = 0.012) and single (B = -0.13, P = 0.03) scored lower on total CBI-16 scores. Whereas, patients who had a higher educational level (B = 0.35, P = 0.001), cared for at surgery units (B = 0.11, P = 0.027), and reported having spent more time with a nurse in the past 8-h shift (B = 0.16, P < 0.001) were more likely to have higher perceptions of the care they received. The CBI-16 was positively correlated with satis-faction with received care, as measured with the Patient Satisfaction Instrument (r = 0.62, P < 0.001).

    Conclusion: Hospitalized patients in Ethiopia have overall high perceptions of nurse caring behaviors, especially with regard to physical-based caring, while their expectations of emotional-focused care are lower. We identified patients who were in need of care, patients aged 40-49 years and single. The time spent with nurses plays a pivotal role in patients' perceptions of nurse caring behaviors.

    Download full text (pdf)
    fulltext
  • 41.
    Finnes, Anna
    et al.
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, Nobels Väg 9, SE-17165 Solna, Sweden.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Dahl, JoAnne
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Molin, Linnea
    Uppsala Univ Hosp, SE-75185 Uppsala, Sweden.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Karolinska Inst, Dept Clin Neurosci, Div Insurance Med, Berzelius Väg 3, SE-17165 Solna, Sweden.
    Comparing the Efficacy of Multidisciplinary Assessment and Treatment, or Acceptance and Commitment Therapy, with Treatment as Usual on Health Outcomes in Women on Long-Term Sick Leave: A Randomised Controlled Trial2021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 4, article id 1754Article in journal (Refereed)
    Abstract [en]

    Background: Chronic pain and mental disorders are common reasons for long term sick leave. The study objective was to evaluate the efficacy of a multidisciplinary assessment and treatment program including acceptance and commitment therapy (TEAM) and stand-alone acceptance and commitment therapy (ACT), compared with treatment as usual (Control) on health outcomes in women on long-term sick leave.

    Method: Participants (n = 308), women of working age on long term sick leave due to musculoskeletal pain and/or common mental disorders, were randomized to TEAM (n = 102), ACT (n = 102) or Control (n = 104). Participants in the multidisciplinary assessment treatment program received ACT, but also medical assessment, occupational therapy and social counselling. The second intervention included ACT only. Health outcomes were assessed over 12 months using adjusted linear mixed models. The results showed significant interaction effects for both ACT and TEAM compared with Control in anxiety (ACT [p < 0.05]; TEAM [p < 0.001]), depression (ACT [p < 0.001]; TEAM [p < 0.001]) and general well-being (ACT [p < 0.05]; TEAM [p < 0.001]). For self-rated pain, there was a significant interaction effect in favour of ACT (p < 0.05), and for satisfaction with life in favour of TEAM (p < 0.001).

    Conclusion: Both ACT alone and multidisciplinary assessment and treatment including ACT were superior to treatment as usual in clinical outcomes.

    Download full text (pdf)
    FULLTEXT01
  • 42.
    Frygner-Holm, Sara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Igelström, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Demmelmaier, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Development, preliminary validation and reliability testing of SEDA - Self-Efficacy in Daily Activities for children with pain2022In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, no 4, p. 561-571Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-efficacy can affect a child's ability to perform important activities, infuse him/her with a sense of control and is likely an integral target for successful treatment in pediatric pain rehabilitation. Modern physical therapy treatment includes behavioral aspects and valid measures of self-efficacy are important for both research and clinical practice. In this study, the aim was to develop and perform preliminary testing of a self-efficacy scale for children and adolescents with pain.

    METHODS: Children and adolescents participated, along with researchers and healthcare staff, in developing the Self-Efficacy in Daily Activities (SEDA) measure. A total of 109 children and adolescents seeking physical therapy treatment for pain lasting longer than 3 months responded to the SEDA. Pain and pain-related disability were assessed using the Functional Disability Inventory (FDI). Exploratory analyzes for testing validity and reliability - principal component analyses (PCA), intraclass correlation coefficients (ICCs) and bivariate correlations - were performed.

    RESULTS: The PCA revealed a 16-item SEDA and a three-component scale. The components represented self-efficacy for physical activities, self-efficacy for personal care and self-efficacy for daily exertion. Validity correlation analyses showed moderate association between SEDA and FDI, -0.72 (p < .01), and low correlation with pain intensity, -0.29 (p = .03).

    CONCLUSIONS: The 16-item SEDA has satisfactory psychometric properties in children moderately affected by long-term pain. Further validation of the SEDA in other populations and confirmatory analyses are warranted.

    Download full text (pdf)
    fulltext
  • 43.
    Gebrie, Mignote Hailu
    et al.
    Univ Gondar, Coll Med & Hlth Sci, Sch Nursing, Gondar, Ethiopia..
    Asfaw, Hussen Mekonnen
    Addis Ababa Univ, Coll Hlth Sci, Sch Nursing & Midwifery, Dept Nursing, Addis Ababa, Ethiopia..
    Bilchut, Workagegnehu Hailu
    Univ Gondar, Coll Med & Hlth Sci, Sch Med, Dept Internal Med, Gondar, Ethiopia..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden.;Sophiahemmet Univ, Stockholm, Sweden..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden..
    Health-related quality of life among patients with end-stage renal disease undergoing hemodialysis in Ethiopia: a cross-sectional survey2023In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 21, no 1, article id 36Article in journal (Refereed)
    Abstract [en]

    BackgroundMeasurement of health-related quality of life (HRQOL) enables identification of treatment-related side effects of a disease. Such aspects may negatively impact on patients' lives and should be taken into consideration in medical decision-making. In sub-Saharan Africa, research from the perspective of patients with chronic kidney disease is scarce, and it is almost non-existent in patients undergoing hemodialysis. We aimed to determine HRQOL among end-stage renal disease patients undergoing maintenance hemodialysis in Ethiopia and to identify factors associated with HRQOL.MethodsA multi-center cross-sectional study was conducted in Addis Ababa, Ethiopia directed to all patients receiving hemodialysis due to kidney failure at 11 randomly-selected government and private hospitals/dialysis centers in the capital of Ethiopia. Data were collected by trained nurses using the KDQOL-36 instrument with five subscales measuring generic and disease-specific HRQOL. Study-specific items were used to collect socio-demographic and clinical data. Factors associated with HRQOL were examined using multivariable linear regression models.ResultsFour hundred eighty-one patients completed the survey through face-to-face interviews (response rate 96%; mean age 45.34 +/- 14.67). The mean scores of the subscales ranged from 25.6 to 66.68 (range 0-100), with higher scores reflecting better health. Factors associated with low HRQOL included older age, female sex, no formal education, poor medication adherence, > 2 hemodialysis sessions/week, lower body mass index (< 18.5), longer duration of hemodialysis treatment (>= 12 months), and poor social support.ConclusionPatients with kidney failure undergoing hemodialysis in Addis Ababa, Ethiopia, had low HRQOL across all subscales compared to previous studies. Therefore, the implementation of guidelines is crucial to improve patients' adherence to their prescribed medications. Furthermore, establishing patient support groups and encouraging patients to use the available support resources from family members, neighbors, and friends have the potential to improve patients' HRQOL.

    Download full text (pdf)
    FULLTEXT01
  • 44.
    Gebrie, Mignote Hailu
    et al.
    Univ Gondar, Coll Med & Hlth Sci, Sch Nursing, Gondar, Ethiopia.
    Asfaw, Hussen Mekonnen
    Addis Ababa Univ, Coll Hlth Sci, Sch Nursing & Midwifery, Dept Nursing, Addis Ababa, Ethiopia.
    Bilchut, Workagegnehu Hailu
    Univ Gondar, Coll Med & Hlth Sci, Sch Med, Dept Internal Med, Gondar, Ethiopia.
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden.;Sophiahemmet Univ, Stockholm, Sweden.
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden.
    Patients' experience of undergoing maintenance hemodialysis: An interview study from Ethiopia2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5Article in journal (Refereed)
    Abstract [en]

    Background People with kidney failure require renal replacement therapy in the form of dialysis or a kidney transplant for survival. Many facets of their life, both within and outside the dialysis unit, are impacted by the management of this disease. It is important to comprehend the experiences of people undergoing hemodialysis in order to improve the care provided to them. Therefore, this study aimed to explore the experiences of patients undergoing maintenance hemodialysis in Ethiopia.

    Methods A qualitative descriptive study was conducted at two healthcare facilities in Ethiopia. Individual interviews with 15 participants (men and women aged 19-63), undergoing hemodialysis in Ethiopia, were analyzed using reflexive thematic analysis.

    Results The analysis resulted in five themes: Feeling grateful, Facing a restricted life, a Supportive environment, Dreaming of a transplant, and Leading a hassled life. The subthemes include Trust in treatment, Faith in God, Challenging fluid and dietary restrictions, Being too fatigued to socialize, Being stigmatized, Family and social support, Supportive healthcare, Lacking a donor and sponsor, COVID-19 as a barrier, Financial constraints, Inaccessibility to care and transport and Access line implantation. Despite being dependent on a machine and having to deal with food and fluid restrictions as well as financial challenges, participants were hopeful and dreamed of a transplant.

    Conclusion From the study's participants, it was discovered that the experiences of people with kidney failure undergoing hemodialysis were generally, considerably negative narratives. Based on the results we recommend development of multidisciplinary teams to better meet patients' physical, emotional, and social needs while undergoing hemodialysis. Such a team should also involve the patient's family members when caring for patients on hemodialysis.

    Download full text (pdf)
    FULLTEXT01
  • 45.
    Gebrie, Mignote Hailu
    et al.
    Univ Gondar, Coll Med & Hlth Sci, Sch Nursing, Gondar, Ethiopia..
    Asfaw, Hussen Mekonnen
    Addis Ababa Univ, Coll Hlth Sci, Sch Nursing & Midwifery, Dept Nursing, Addis Ababa, Ethiopia..
    Bilchut, Workagegnehu Hailu
    Univ Gondar, Coll Med & Hlth Sci, Sch Med, Dept Internal Med, Gondar, Ethiopia..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Solna, Sweden..
    Psychometric properties of the kidney disease quality of life-36 (KDQOL-36) in Ethiopian patients undergoing hemodialysis2022In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 20, no 1, article id 24Article in journal (Refereed)
    Abstract [en]

    Background Health-related quality of life (HRQOL) has a direct association with increased morbidity and mortality among end stage renal disease patients. Valid and reliable instruments to measure the HRQOL of patients with end stage renal disease are therefore required. This study aimed to translate, culturally adapt and evaluate the psychometric properties of the Amharic version of the Kidney Disease Quality of Life-36 (KDQOL-36) instrument in Ethiopian patients with end stage renal disease undergoing hemodialysis. Methods The KDQOL-36 instrument was developed for individuals with kidney disease who are being treated with dialysis and includes both generic and disease-specific components. The KDQOL-36 was translated to Amharic language and distributed to a cross-sectional sample of 292 hemodialysis patients. The psychometric evaluation included construct validity through corrected item-total correlation, confirmatory factor analysis and known group analysis. Convergent validity was evaluated by correlations between each of the three kidney disease targeted scales (symptoms/problems list, burden of kidney disease and effects of kidney diseases) and the European Quality of Life 5D-5L and Visual Analog Scales. Regarding reliability, internal consistency and test-retest reliability were assessed. Results Two hundred ninety-two patients with a mean age of 48 (SD +/- 14.7) completed the questionnaire. Corrected item- total correlation scores were > 0.4 for all items. Confirmatory factor analysis revealed a two chi(2) /df was 4.4, Root Mean Square Error of Approximation (RMSEA) = 0.108 (90% CI 0.064-0.095), Comparative Fit Index (CFI) = 0.922, Tucker Lewis Index (TLI) = 0.948 and Standardized Root mean-squared residual (SRMR) = 0.058) and three chi(2) /df = 3.1, RMSEA = 0.085 (90% CI 0.064-0.095), CFI = 0.854, TLI = 0.838 and SRMR = 0.067) factor models for the generic and disease specific components respectively. The mean scores of the three kidney disease targeted domains were correlated to the EQ-5D-5L & VAS with correlation coefficients of large magnitude (0.55-0.81). The reliability of the instrument was satisfactory (Cronbach's alpha = 0.81-0.91) and Intra-class correlation (ICC) = 0.90-0.96). Conclusion The Amharic version of the KDQOL-36 is a reliable and valid instrument recommended for assessment of HRQOL of Ethiopian patients on hemodialysis.

    Download full text (pdf)
    FULLTEXT01
  • 46.
    Godskesen, Tove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Ersta Sköndal University College.
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Kihlbom, Ulrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Hope for a cure and altruism are the main motives behind participation in phase 3 clinical cancer trials2015In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 24, no 1, p. 133-141Article in journal (Refereed)
    Abstract [en]

    It is necessary to carry out randomised clinical cancer trials (RCTs) in order to evaluate new, potentially useful treatments for future cancer patients. Participation in clinical trials plays an important role in determining whether a new treatment is the best therapy or not. Therefore, it is important to understand on what basis patients decide to participate in clinical trials and to investigate the implications of this understanding for optimising the information process related to study participation. The aims of this study were to (1) describe motives associated with participation in RCTs, (2) assess if patients comprehend the information related to trial enrolment, and (3) describe patient experiences of trial participation. Questionnaires were sent to 96 cancer patients participating in one of nine ongoing clinical phase 3 trials at the Department of Oncology, Uppsala University Hospital in Sweden. Eighty-eight patients completed the questionnaire (response rate 92%); 95% of these were patients in adjuvant therapy and 5% participated in clinical trials on palliative care. Two main reasons for participation were identified: personal hope for a cure and altruism. Patients show adequate understanding of the information provided to them in the consent process and participation entails high patient satisfaction.

  • 47.
    Godskesen, Tove
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Ersta Sköndal University College.
    Kihlbom, Ulrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Nordin, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Silen, Marit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Nygren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
    Differences in trial knowledge and motives for participation among cancer patients in phase 3 clinical trials2016In: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 25, no 3, p. 516-523Article in journal (Refereed)
    Abstract [en]

    While participants in clinical oncology trials are essential for the advancement of cancer therapies, factors decisive for patient participation have been described but need further investigation, particularly in the case of phase 3 studies. The aim of this study was to investigate differences in trial knowledge and motives for participation in phase 3 clinical cancer trials in relation to gender, age, education levels and former trial experience. The results of a questionnaire returned from 88 of 96 patients (92%) were analysed using the Mann-Whitney U-test. There were small, barely relevant differences in trial knowledge among patients when stratified by gender, age or education. Participants with former trial experience were less aware about the right to withdraw. Male participants and those aged ≥65 years were significantly more motivated by a feeling of duty, or by the opinions of close ones. Men seem more motivated than women by external factors. With the awareness that elderly and single male participants might be a vulnerable group and participants with former trial experience are less likely to be sufficiently informed, the information consent process should focus more on these patients. We conclude that the informed consent process seems to work well, with good results within most subgroups.

  • 48.
    Gottvall, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Swedish Red Cross Univ Coll, Dept Hlth Sci, Box 1059, SE-14121 Huddinge, Sweden..
    Fagerkvist, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research Sörmland. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden.;Uppsala Univ, Ctr Clin Res Sormland, SE-63188 Eskilstuna, Sweden..
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden.;Umeå Univ, Dept Psychol, SE-90187 Umeå, Sweden..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A, SE-17177 Stockholm, Sweden..
    Including a discussion forum in a web-based intervention on fertility and sexuality following cancer - Usage and content2022In: Internet Interventions, ISSN 2214-7829, Vol. 29, article id 100559Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to investigate how young adult survivors of childhood cancer used an online discussion forum as part of a web-based psycho-educational intervention. Specifically, we aimed to characterize users of the discussion forum, investigate how they used the discussion forum (type of usage) and content of the posted messages. Methods: This study is a part of a randomized controlled trial, Fex-Can Childhood RCT. Participants with self-reported sexual dysfunction or fertility-related distress were drawn from a population-based national cohort. Sociodemographic and clinical characteristics of the intervention group (n = 322) and data on usage of the discussion forum were analysed with descriptive statistics and compared between subgroups. Messages posted in the online discussion forum were analysed with qualitative thematic analysis. Results: Approximately half (48 %) of participants in the intervention group accessed the discussion forum and most of them (76 %) without writing own posts. Users of the discussion forum did not statistically differ in sociodemographic or clinical characteristics from the rest of the intervention group. The 97 written posts, written by 38 individuals, were mainly descriptions of own experiences and thoughts and concerned three themes: A changed body, Concerns around family building and Longing for support. Peer-support and interaction between participants were seen in some forum threads and the 'like'-function was frequently used, demonstrating engagement and activity. Participants expressed that they felt affinity with and appreciated sharing own experiences and to recognize themselves in others' stories. Conclusions: A discussion forum as part of a web-based intervention appears to be a valuable component by giving participants an opportunity to share intimate experiences and concerns related to surviving cancer.

    Download full text (pdf)
    fulltext
  • 49.
    Grundström, Jenna
    et al.
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, POB 30, Helsinki 00271, Finland.;Univ Helsinki, Fac Social Sci, POB 18, Helsinki 00014, Finland..
    Konttinen, Hanna
    Univ Helsinki, Fac Social Sci, POB 18, Helsinki 00014, Finland..
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, POB 30, Helsinki 00271, Finland.;Univ Helsinki, Helsinki Inst Life Sci, POB 20, Helsinki 00014, Finland..
    Kiviruusu, Olli
    Finnish Inst Hlth & Welf, Dept Publ Hlth & Welf, POB 30, Helsinki 00271, Finland..
    Associations between relationship status and mental well-being in different life phases from young to middle adulthood2021In: SSM - Population Health, ISSN 2352-8273, Vol. 14, article id 100774Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to assess the associations between relationship status and mental well-being in four different phases during the life course, and to identify whether relationship quality moderated these associations. We used a broader concept of relationship status (instead of marital status) and also included the positive dimension of mental health. Participants in a Finnish cohort study were followed up at ages 22 (N = 1,656), 32 (N = 1,471), 42 (N = 1,334), and 52 (N = 1,159). Measures in all study panels covered relationship status (marriage, cohabitation, dating, single and divorced/widowed), Short Beck Depression Inventory (S-BDI), self-esteem (seven items) and relationship quality (six items). Analyses were carried out using linear regression. Compared to marriage, being single or being divorced/widowed were associated with depressive symptoms at every age in men. For women, in turn, being single - but not being divorced/widowed - was associated with depressive symptoms. Among men, being single or being divorced/widowed were also associated with lower self-esteem at age 32, 42 and 52, but in women, only one association between lower self-esteem and being single was found at age 32. Of the age stages, the age 32 is highlighted in men, at which point all relationship statuses were risk factors compared to marriage. There were only few indications of the moderating role of the relationship quality. Compared to marriage, being single or being divorced/widowed were quite consistently associated with poorer mental well-being during the life course, especially among men. For dating and cohabiting the associations were more fragmented depending on age and gender; particularly among women, these relationship statuses tended not to differ from marriage in terms of mental well-being. These observations on mental well-being across five relationship statuses are important in our contemporary society, where the number of marriages is decreasing, and other forms of relationships are becoming more common.

    Download full text (pdf)
    fulltext
  • 50.
    Haavisto, Anu
    et al.
    Univ Helsinki, Dept Psychol & Logoped, Helsinki, Finland.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Wettergren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Lampic, Claudia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Umeå Univ, Dept Psychol, Umeå, Sweden..
    Lahteenmaki, Päivi M.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Turku Univ Hosp, Dept Pediat & Adolescent Med, Turku, Finland.;Univ Turku, FICANWEST, Turku, Finland..
    Jahnukainen, Kirsi
    Univ Helsinki, Childrens Hosp, Helsinki, Finland.;Helsinki Univ Hosp, Helsinki, Finland.;Karolinska Inst, Dept Womens & Childrens Hlth, NORDFERTIL Res Lab Stockholm, Stockholm, Sweden..
    Premature ovarian insufficiency and chance of pregnancy after childhood cancer: A population-based study (the Fex-Can study)2023In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 153, no 3, p. 644-653Article in journal (Refereed)
    Abstract [en]

    Endocrine complications are a common late effect after childhood cancer. Our study assessed the prevalence and predictors of premature ovarian insufficiency (POI) and prospects of pregnancy in young female survivors. This nationwide study combined registry and survey data for female childhood cancer survivors aged 19 to 40 years, identified through the National Quality Registry for Childhood Cancer in Sweden. Of 1989 approached young women, 1333 (67%) participated by completing a survey. Median age at diagnosis 1981 to 2017 was 6 (range 0-17) and at study 28 (19-40) years. There were two indicators of POI, induced puberty reported in 5.3% and estrogen replacement therapy (ERT) in 9.3% at assessment. In separate logistic regression analyses (P < .001), induced puberty and ERT were significantly predicted by hematopoietic stem cell transplantation (HSCT), abdominal irradiation, central nervous system irradiation and chemotherapy. ERT was also associated with older age at diagnosis. Of the 626 women (48% of responders) who had tried to become pregnant, 25% had undergone fertility investigations and 72% reported having a biological child. Treatment with HSCT was associated with 5.4 times the odds of needing fertility investigations (P < .001). Having a biological child was associated with non-HSCT treatment, but also with ever having had a partner and older age at the time of study (all P < .001). In conclusion, the majority of those female childhood cancer survivors who had tried to conceive were able to successfully give birth. However, a small identifiable group of female survivors are at risk of subfertility and early menopause.

    Download full text (pdf)
    fulltext
1234 1 - 50 of 165
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf